Major Medical Cover
Comprehensive cover for hospital stays, surgery, and specialist consultations.
What Is Major Medical Cover?
Major medical cover is the cornerstone of private health insurance in New Zealand. When you're facing a serious diagnosis or need surgery, public waiting lists can stretch for months or even years. Major medical cover bypasses those queues entirely, getting you access to private hospitals, your choice of surgeon, and specialist consultations on your schedule.
Unlike surgical-only plans, major medical cover is comprehensive — it pays for pre-admission tests, specialist consultations leading up to a procedure, the procedure itself, post-surgical care, and follow-up appointments. It's the closest equivalent to having a private health system membership.
Premiums vary between providers and depend on your age, health history, the excess you choose and the level of cover selected. No insurer publishes a full premium schedule for major medical cover, so the only way to know what you would pay is to be quoted on your own details. A licensed adviser can request those quotes across the major insurers and take you through what differs between them.
What's Covered
Private hospital admission — skip public waiting lists
Surgeon and anaesthetist fees fully covered
Specialist consultation costs
Diagnostic imaging (MRI, CT, PET scans, X-ray)
Pre- and post-surgical care
Ambulance transport where required
Second medical opinion support
Choice of hospital and specialist
Who Needs Major Medical Cover?
Anyone on a public waiting list right now
Families wanting certainty about hospital access
People with a family history of serious conditions
Self-employed workers who can't afford recovery delays
Employers offering health benefits to key staff
Worked Examples
These are illustrations of how this type of cover is designed to work. They are not accounts of real people, and they are not records of any insurer’s claim decision. What is actually payable depends on the plan you hold, its benefit maximums and any waiting periods or exclusions that apply to you.
Hip replacement surgery
A 58-year-old Auckland teacher was told the public wait for hip replacement surgery was 14 months. She had major medical cover.
Within 3 weeks of her referral she had her surgery at a private hospital, was back on her feet in 6 weeks, and returned to work before Christmas.
Cancer diagnosis
A Wellington business owner received a cancer diagnosis. The public oncology system had a 6-week wait for his first specialist appointment.
His major medical policy covered specialist consultations, imaging, and surgery within 10 days of diagnosis. Early treatment significantly improved his prognosis.
NZ Providers Offering This Cover
Which of these can actually be quoted for you depends on the agencies your broker holds. Some New Zealand insurers deal direct only. We do not rate or score insurers.
nib
Splits cover into Everyday and Hospital plans; publishes indicative treatment costs on its own site
AIA
Health cover can be held alongside life and income products; runs the AIA Vitality programme
UniMed
A not-for-profit mutual society operating since 1979; plans include Hospital Select, UniCare Advantage and SmartCare+
Partners Life
Private Medical Cover sits within its wider Journey Plan range; sold through advisers
Southern Cross
Publishes that more than 951,000 New Zealanders were with it as at 30 June 2025
What Affects the Cost?
Premiums for Major Medical Cover vary between individuals. These are the key factors that determine your rate:
Your age — premiums increase as you get older
Chosen excess — higher excess means lower premium
Health history — pre-existing conditions may be excluded or loaded
Hospital tier — public, private, or premium private hospitals
Add-on cover (everyday health, income protection)
Frequently Asked Questions
What does Major Medical Cover actually cover?
Major medical cover is the most comprehensive type of health insurance available in New Zealand. It covers hospital admissions, surgical procedures, specialist consultations, diagnostic tests, and more — giving you full private healthcare access without the public waiting lists.
How much does Major Medical Cover cost per month?
We cannot give you a price for this cover, because no New Zealand health insurer publishes a full premium schedule. What we can tell you is what moves the number: your age, your medical history, the excess you choose, the level of cover, and who else is on the policy. An adviser can quote your actual situation at no charge.
Are pre-existing conditions covered?
Pre-existing conditions are typically excluded from cover, or may be subject to a premium loading. The definitions vary by insurer, and some conditions may be covered after a stand-down period. An adviser will help you understand each provider's approach before you commit.
How do I claim?
Claims processes differ by insurer. Most offer online or app-based claiming, and for surgical or hospital treatment the provider will often bill the insurer directly where the treatment has been approved in advance. For everyday cover you generally submit receipts and are reimbursed. Ask your insurer what their current process and turnaround are.
General information, not financial advice
Information on this page is general in nature and does not take into account your personal circumstances, goals or financial situation. BestHealthInsurance.co.nz is not a Financial Advice Provider. We do not compare policies for you, we do not recommend an insurer, and we do not give financial advice.
When you request a quote, we pass your details to one of the specialist brokers or underwriters we work with. Where that is a broker, they are an independent, licensed New Zealand Financial Advice Provider: they compare the insurers they hold an agency with, give you any advice, and are responsible for that advice. Where an insurer takes the enquiry directly, you are dealing with that insurer’s own team about their own products. Either way, ask them for their disclosure information — what they can advise on, the providers behind it, how they are paid and how to complain — before you act on anything they tell you.
Ready to Compare Major Medical Cover?
Tell us what you need and we will pass your details to one of the specialist brokers or underwriters we work with, each vetted before we refer them anything. They quote you across the insurers they can place. No obligation, no cost to you.
Get a Quote →Related Guides
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External resources: PHARMAC (funded medicines) · Health New Zealand (Te Whatu Ora) · FMA — Insurance guidance
BestHealthInsurance.co.nz is an independent referral service. We connect you with licensed insurance advisers regulated under the Financial Markets Conduct Act 2013. We do not provide financial advice. See full disclaimer.