Does health insurance in NZ cover pre-existing conditions?

Got an illness or injury? Find out if health insurance in NZ will cover your pre-existing conditions with our guide.

You might think that if you have a pre-existing condition in NZ, health insurance won’t cover it. This isn’t necessarily true. Some insurers provide cover for certain illnesses that you had before you purchased your policy, with a few terms, conditions, and exceptions.

What is a pre-existing condition?

A pre-existing condition is any condition (illness, injury, disease etc.) that you had or knew about before you purchased your insurance policy. Signs or symptoms of a condition also count as pre-existing conditions, even if you haven’t been diagnosed yet. Most insurers will count any conditions that you have received treatment for or experienced symptoms in the last five years as a pre-existing condition.

Note: While this is a good summary, different insurers have their own definitions of pre-existing conditions, so make sure you clarify with them before signing up for a policy.

Some common examples of pre-existing conditions include (but are not limited to):

• Eczema 
• Allergies
• Asthma
• Cancer
• Diabetes
• Heart disease
• Epilepsy
• Mental health conditions, such as depression
• Sleep apnea
• Past injuries or surgeries

How does getting cover for a pre-existing condition work?

• Every health insurer and policy is different. Some won’t cover pre-existing conditions at all, while others cover pre-existing conditions with a few exceptions.
  
  
• If you do manage to get cover for a pre-existing condition, most insurers have a ‘stand down’ or ‘waiting’ period of between one and four years after your join date. During this time, you won’t be able to make any claims related to your pre-existing condition. 
  
  
• Health insurance policies often don’t provide cover for cardiovascular, cancer, hip or knee, back, or transplant surgery if they’re required because of a pre-existing condition. 
  
  
• Despite this, you should always declare pre-existing conditions when you apply for health insurance. Non-declaration can void your health insurance policy. 
  
  
• The best way to get cover for a pre-existing condition is to speak to an insurance broker. They can provide expert advice on which policies and insurers will cover you and find you a policy that suits your needs. 

Do I have to pay more to get cover for pre-existing conditions?

That depends! Some insurers will charge those with such conditions a higher premium, while others won’t - likewise some policies will charge extra for pre-existing conditions and others won’t. 

To find out if you’ll be charged, speak to your insurer and make sure you fully understand the policy wording.

How to get advice around insurance

It’s always best to get advice around insurance before buying a policy, regardless of whether you have a pre-existing condition. You can get advice around insurance products from:

• Your bank
• Insurance brokers or advisers
• Most financial advisers 

With the right advice you may be able to find a policy that covers your pre-existing condition at a fair price. Read more about getting financial advice.

Disclaimer:

This ‘Does health insurance in NZ cover pre-existing conditions?’ blog is general information only. The views and opinions expressed do not necessarily reflect those of the FSC. It is not intended to constitute legal or financial advice and does not take your individual circumstances and financial situation into account. We encourage you to seek assistance from a trusted financial adviser, legal or other professional advice.

The names of any third parties are additional resources that you access at your own risk and the FSC takes no responsibility for any third-party content. 

The FSC and its employees make no express or implied representations or give any warranties regarding this blog, and we accept no responsibility for any loss, damage, cost or expense (whether direct or indirect) incurred by you as a result of any error, omission or misrepresentation in this blog.  

February 2025.