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Pre-existing conditions and much more

February 28, 2017

Pre-existing conditions

When applying for good quality insurance cover, you should be asked about any pre-existing medical conditions, if not then you are probably getting second class cover and will have built-in terms that limit the payout. These are ailments, illnesses, conditions, or symptoms where the signs or symptoms are present before you take out insurance or upgrade to a higher level of cover. A pre-existing condition may not prevent you from obtaining health insurance cover, but you should be honest and disclose them, even if you may be charged an increased premium called a 'loading' to cover it, otherwise your insurance may not cover you at all for non-disclosure.  A good insurance adviser can negotiate with the insurance company, putting pressure on them to limit any increases or exclusions.  


This refers to a health condition or certain procedures or circumstances that your insurance provider does not provide cover for. Excluded health conditions tend to be pre-existing conditions or those connected to the misuse of drugs, prescription and non-prescription, or head, back, neck, spinal injuries. Then cancers or mental illness conditions like stress, depression, anxiety which can be more common.  If you have a standard policy with with no exclusions or loadings, you should be very cautious about moving off that and seek free insurance advice.

Benefit limits and maximums

Some policies may limit benefit amounts to a set maximum, for some operations and procedures, while some policies have clauses that restrict benefits for all conditions. This means you need to read policy documents carefully, in order to compare and contrast exactly how much you can claim.  If you have an adviser, they should be recommending the perfect amount of cover, after they find out your needs in a client profile or face find.

Stand-down periods

An insurance company may impose a waiting period before you can make a claim on types of benefits, like cancer or major events. The length of a claim stand-down period will vary from policy to policy.  When you replace insurance you should get in writing that any stand-down periods will be removed.

Change of circumstances

Most policies will allow you to add or remove family members or increase extra cover at the time of specific life events.  These could include, birth of a child, marriage, first home,  graduation and more.  Make your adviser aware of these events, so that revaluation of needs can be discussed and the options taken or rejected in your favour.

Free look period

Your insurer will send you policy documents when your policy has been set up. You will have 14 days or up to 30 days from the day you receive the policy, to decide whether the product is suitable for you. If you want to cancel your cover, you must do so within the stated period and tell the insurer that you want to cancel your cover. If you have made any payments, you will usually receive a full refund unless you have made a claim.


Going overseas

Most NZ life and income based policies cover you 24 hours a day worldwide, as they are limited by ACC payments.  Few policies have accident cover for overseas travel, so travellers are advised to take out separate travel insurance to cover foreign hospitals or medical care, costs of returning to NZ and many other unforeseen costs. Many insurers allow you to suspend your policy and cover if you are travelling overseas for an extended period.

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