Health Insurance
Can You Get Health Insurance with a Pre-Existing Condition in NZ?
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Many Kiwis choose to get health insurance to avoid the stress and wait times often associated with the public healthcare system, as well as to gain access to top-tier treatments and providers.
But one of the most common questions we hear from our customers is, “Can I get health insurance if I have a pre-existing condition?”
In this blog, we’ll dive into this question and provide clear answers on how health insurance works and exactly what you need to know if you have a pre-existing condition.
First, let’s get clear on the definition: a pre-existing condition is a medical condition or injury you had prior to, or at the time of, applying for health insurance.
Common pre-existing conditions are asthma, diabetes, and high blood pressure. Insurers take into account pre-existing conditions when insuring people in order to keep costs affordable for everyone.
Health insurance in New Zealand offers access to private healthcare, which allows you to bypass the potential wait times associated with the public system. Public hospitals are government-funded, but they can be stretched for resources, leading to longer wait times for non-urgent treatments.
Take, for example, a situation where you’re experiencing stomach pain and visit your GP for an assessment. Your GP refers you to a specialist, who tells you that surgery is required but there’s a six-month wait. However, if you have health insurance, you could be covered for the $500 specialist consultation. Plus, through your insurer’s online portal, you could apply for pre-approval for the surgery you need. If approved, your insurer will arrange the fastest possible treatment, cutting down your wait time and getting you out of pain quicker.
This is just one of the many benefits of health insurance—especially when you consider that health conditions often worsen while waiting for treatment.
At Buffer, we specialise in helping our clients understand their health insurance options. Our expertise includes offering advisor-only options that are not available to the general public—plans that often provide more comprehensive coverage than you’d find directly on an insurer’s website.
Having an expert on your side to help you navigate complex terminology and compare options can save you money and prevent you from overpaying for coverage that doesn’t suit your needs. At Buffer, we make sure you get the best value for your health insurance.
Generally, pre-existing conditions are not covered by health insurance in NZ. However, there are exceptions.
If you're covered by a health insurance policy through your workplace, this is known as a "group scheme." Some group schemes can offer cover for pre-existing conditions.
At Buffer, we offer group schemes for health insurance that may include coverage for certain pre-existing conditions. Contact us to learn more about how we may be able to help you set up a group scheme at your workplace.
When you apply for health insurance, insurers will assess your application, which includes questions about your medical history and any pre-existing conditions. Based on this information, they’ll determine what’s covered and what’s not.
In many cases, pre-existing conditions will be what they call “excluded” from your coverage. An exclusion is essentially a condition that won’t be covered under your policy, meaning any health care costs that arise from this condition won’t be reimbursed by your health care provider. If you have a pre-existing condition, your insurer will let you know of any exclusions in your policy document.
From time to time, health insurers run special promotions that may include coverage for pre-existing conditions after a waiting period (usually three years, with some general exclusions). This can be a great option for those who have a pre-existing condition but want health insurance. If you're interested in learning more about these types of offers, contact us at Buffer to see if any are available to you.
To improve your chances of being approved for health insurance, it's important to be upfront and honest about your medical history.
We recommend to all our customers that before applying for any type of insurance, that they request a printout of their health records from your GP or visit managemyhealth.co.nz to print off their medical records. This way, they have a clear understanding of what’s on their medical file prior to going through the application process.
Being aware of your health history is crucial because when insurers assess your application, they look at your medical records. There could be notes or conditions that you’re unaware of noted on your record, which has the possibility of delaying your application or affecting your ability to make a claim in the future.
Working with an experienced insurance broker like Buffer can also improve your chances of securing the right coverage. We’ll work with you to find the best health insurance options for your needs and advocate on your behalf to ensure you get the coverage you deserve.
To sum up, yes, it is possible to get health insurance with a pre-existing condition in New Zealand, but it may not always be straightforward. Group schemes are the most common ways we help customers get health insurance coverage for pre-existing conditions. Insurers have varying policies on exclusions, waiting periods, and premiums, so it’s important to ensure you understand policy wording. Working with an insurance broker like Buffer ensures you have someone on your side who understands policy wording and can help you get the best advice that’s tailored to your unique situation.
At Buffer Insurance, we specialise in finding the best health insurance options for our clients, including those with pre-existing conditions. We can help you understand the full range of options available, including group schemes, special offers, and policies with waiting periods for pre-existing conditions.
If you want to make sure you’re getting the best possible coverage and avoiding overpaying, get in touch with us today. We offer free consultations to discuss your specific health insurance needs and help you navigate the often-complex world of health insurance.
Having health insurance is important for protecting your health and giving you access to the best medical care when you need it most. Even with a pre-existing condition, you still have options—whether through group schemes or policies with waiting periods.
If you're unsure about your options or how to get started, don’t hesitate to reach out. At Buffer Insurance, we’re here to help you find the coverage that suits your needs and your budget.
Take the next step today — contact us for a free consultation and start securing your peace of mind with the right health insurance coverage.
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