Why We Do Not Rank Wordings
Policy wording is the legal document that decides what your insurer will and will not pay for. Two insurers can both say they cover specialist consultations and mean materially different things.
We are often asked which of Partners Life and AIA has the better wording. We do not answer that, for a reason worth stating plainly: a wording is only better or worse relative to a specific person's health, and the documents are revised. Any ranking we published would be out of date, would not fit your circumstances, and would be our opinion dressed up as a finding. What we can do is show you how to read the documents yourself, and tell you which clauses actually decide claims.
Both insurers publish their wordings. Partners Life documents its Private Medical Cover at partnerslife.co.nz; AIA publishes its policy documents at aia.co.nz. Ask your adviser for the current wording for the specific plan you are being quoted — not a summary, and not a brochure.
Read These Six Things First
Most of the money in a health insurance claim turns on a handful of clauses. In any wording, from any insurer, find these before you read anything else.
1. The definition of pre-existing condition. This single definition causes more declined claims than anything else. Look at how far back it reaches, whether it captures symptoms you never had diagnosed, and whether there is any path to having an exclusion reviewed and removed after a period.
2. What triggers cover. Does the policy pay for the specialist consultation that leads to a diagnosis, or only for treatment once a diagnosis exists? This is the difference between being covered for the six months of investigation and paying for it yourself.
3. The annual limits, and what resets. Look for the per-benefit maximums, the overall annual maximum, and whether limits reset on the policy anniversary or run per condition.
4. Non-Pharmac drug cover. If it matters to you, this is the most important number in the document. Check whether it is included or an optional add-on, what the limit is, and whether the limit is annual or lifetime.
5. Any test of necessity or approval. Look for words like "medically necessary", "reasonable", "usual and customary", or a requirement for prior approval. These clauses are normal and appear in most wordings, but they are where the insurer's judgement enters, so you want to know they are there and how they are defined.
6. The exclusions list. Read it in full. It is usually short and it is always the clearest statement of what you are not buying.
Questions to Put to the Insurer or Adviser
Take your own situation to the document rather than reading it in the abstract:
- If I developed the condition I am most worried about, which clause pays, and which clause could be used to decline?
- Are the consultations leading up to a diagnosis covered, or only treatment after it?
- What is my non-Pharmac drug limit, and is it per year or per lifetime?
- What exclusions would be placed on my policy given my medical history? Ask for these in writing before you accept the policy, not after.
- If a claim were declined, what is the internal review process and the disputes scheme?
That last question matters. Every licensed insurer in New Zealand belongs to an approved dispute resolution scheme, and asking which one, and how it works, is a fair question to put before you buy.
On Premiums
We do not publish premium comparisons between insurers. No New Zealand health insurer publishes a full premium schedule, so no site can build a like-for-like table. Two of the five — nib and UniMed — publish a starting price for one particular plan, each on its own stated basis, and those two figures are not comparable with each other. Any broader per-insurer price table has to come from somewhere else, and it is almost never comparing the same plan, the same excess and the same person. Get quoted on your own details, for the same level of cover, from each insurer you are considering — that is the only comparison that means anything.
The Practical Approach
Get quotes from both, ask for the full wording for each quoted plan, and compare the six clauses above side by side against your own health history. If you would rather not do that alone, that is precisely what a licensed adviser is for — and they are paid by the insurer, not by you.