That means breaking down some common terms often seen in policy documents and health insurance websites. Find out what we’re talking about when we use words like premium, excess, pre-existing condition, underwriting, or exclusion.
This is the amount you pay for a policy. Your premium is based on a range of factors.
The amount of money you need to pay towards the total cost of any claims you submit. We offer you different excess options that help make your premiums cheaper. The higher the excess, the larger discount on your premium.
We only apply an excess once per individual that is insured, per policy year. For example, if the excess on your plan is $250 and we accept a claim for a CT scan costing $2,000, we’ll pay $1,750 and you would pay the excess balance of $250. If you then require an MRI within the same policy year costing $1,200, we'll pay the full amount because you’ve already paid the excess.
Increasing your excess is a good way to save on your premium. Below are the approximate discounts for each excess level.
Any sign, symptom, health condition or health event that happened before you started your policy is a pre-existing condition. Health insurance is set up to cover the unexpected, so we ask that you tell us about all of your pre-existing conditions, current or previous. Not all pre-existing conditions will be excluded from cover, however to be able to tell you what isn't covered you will need to be honest about your medical history in your application form to us.
Unfortunately, we can’t cover every kind of medical condition or treatment so there are some things that we have to exclude from cover. As such there are two types of exclusions that apply to everyone.
General exclusions - these are general things such as a medical condition or service that we have decided that we will not cover for anyone who has the same type of policy. These are listed out in the what's not covered section of your policy document and apply to every person who has that policy.
Personal exclusions - these are specific to an individual and are based on their medical history (pre-existing conditions). Not all pre-existing conditions will require an exclusion, however our team do need to know about all previous and current signs, symptoms and conditions. Personal exclusions are excluded for different lengths of time (from 1 year to life) depending on the medical condition, and will be listed on your membership certificate under each individual.
Accuro is the only health insurer in New Zealand that offers exclusions that automatically drop off after a set period of time.
Find out what a claim and pre-approval is, why you might need to get pre-approval for an upcoming procedure or treatment and what documents are required to claim for your medical costs.