What is the primary difference between a public and private hospital?
In New Zealand we have two health systems: A Public Health System (public funded) and a Private Health System (funded by ‘user pays’).
The public health system focuses primarily on acute (emergency) services while the private health system deals with elective (planned) services. While we are fortunate in New Zealand to have a good public health system that deals well with emergency situations it is often very limited in its ability to deal with elective or non life threatening procedures.
What is the difference between acute and elective procedures?
Acute procedures are emergency and life threatening situations such as a car crash, heart attack, flu epidemic or broken leg. Elective procedures, while often critical, are procedures the patient chooses to have such as prostate/bowel/breast cancer surgery & treatment, hip replacement, heart bypass or varicose vein surgery.
A private hospital doesn’t have an emergency or intensive ward so is not equipped to deal with acute procedures while a public hospital may become so overloaded with acute situations they are unable to cope with elective procedures.
Are Serious Illness, Critical Illness and Tauma insurance the same thing?
Yes. Different insurance companies use these terms to refer to the same type of cover that we call "Serious Illness Cover".
What is meant by "Business Risk" and "Commercial Insurance"?
The term Business Risk refers to the life insurance and income protection required by a business entity for it's key people and the amount can be determined in consultation with an experienced adviser.
The term Commercial Insurance refers to the cover of physical assets such as buildings, plant, machinery, vehicles, as well as the range of Liability insurances.
What is the difference between elective and cosmetic surgery?
An elective procedure is generally designed to correct a situation that is diminishing a person’s quality of life such as replacing a hip or removing a cataract while cosmetic surgery generally enhances a person’s look such as a breast implant or face lift.
Cosmetic surgery is not covered by health insurance.
Is elective surgery covered by health insurance?
Yes. All surgery performed in a private hospital is termed elective surgery. It is called elective because it must be planned in advance. The patient visits the specialist/surgeon who then books the anaesthetist, theatre, hospital bed etc.
What's a Buy/Sell Agreement
A Buy/Sell agreement is a contract in which the owners of a business agree that if one of them dies, or leaves the business for any reason, the other(s) will purchase his or her interest in the business.
What's a Shareholders' Agreement
A shareholders' agreement will provide clarity on how a private company is run, from raising finance to business succession. An essential part will refer to how any share purchase will be funded and this is where a well-structured life insurance package will be of great benefit.
Why do I need Health Insurance?
Health insurance allows us to avoid waiting lists that can stretch for months or even years and regain that all important quality of life. Health insurance gives us the peace of mind of knowing we can gain immediate access to hospitalisation when and where we need it while having the often significant costs involved covered.
Simply put – health insurance books us a hospital bed or treatment spot when and where we need it and we know the sooner a condition is treated the better the chance of cure and the quicker the recovery time.
Surely if I am serious enough I would be covered by the public system?
If your condition is deemed to be acute you would gain immediate access to a hospital bed, if not you will be put on a waiting list. For example if someone had a heart attack they would be immediately admitted to a public hospital until they stabilised but could then be put on a waiting list for a heart bypass. Another example is someone being diagnosed with cancer and being put on a waiting list for treatment. The problem in both of these examples is that the longer it takes to have treatment or surgery the higher the chances of complications and/or death.
Will any of my previous or current medical conditions be covered?
In insurance terms a previous and/or current medical condition is known as a pre-existing medical condition. Not all pre-existing conditions are excluded and some may be covered after an initial stand down period although pre-existing heart, cancer (specific), back, knee and hip condition are generally permanently excluded by most insurers.
Pre-existing conditions are a very complex area and it is well worth your time to sit down with a trained adviser to discuss your personal circumstances and needs. Absolute insurance as a brokerage has been very successful in finding cover for many of its clients with pre-existing medical conditions.
What is the definition of a pre-existing condition?
Any illness, sickness, disease, injury or medical condition or symptom or sign, on or before the cover commencement date or the join date where an insured person is added to this policy:
Which you or any insured person was aware of, or
Of which you or any insured person had the first indication that something was wrong, or
For which you or the insured person sought investigation or medical advice, or
Where a symptom existed that would cause a reasonable person in the circumstances to seek diagnosis, care or treatment.
Do I have to disclose all my previous medical conditions?
It is critical that you disclose any previous and current (pre-existing) medical conditions. It doesn’t mean they will be automatically excluded but it does give the insurer an opportunity to cover, offer terms for or exclude the condition. If the insurer decides to not exclude a declared pre-existing condition and it does reoccur they are bound to cover that condition. If you fail to disclose a pre-existing condition and it reoccurs the insurer will generally refuse to pay for any treatment and are entitled to cancel (avoid) your policy.
What if I forget to disclose a previous condition?
When you realise that you have forgotten to declare a pre-existing medical condition it is important that you inform your adviser or the insurance company. Generally they will assess the condition and depending on the likelihood of the condition reoccurring will amend your policy to cover, offer terms for or exclude that condition.
Why won’t a health insurer cover all my previous medical conditions?
It is important that an insurance company remains profitable so that it can continue to service its client’s claims. If an insurance company agreed to cover all pre-existing conditions eventually the premiums would become so expensive very few people would be able to afford them. For example a person develops a heart condition that requires bypass surgery that could cost up to $65,000 so they decide to take insurance to pay for it. Very quickly anybody who developed a medical condition would follow suit. This would severely disadvantage the average policy holder that would have no, or very few, pre-existing conditions.
If however the insurer agrees to insure this person but excludes their pre-existing heart condition it would mean everybody comes in on an equal footing.
Through prudent underwriting, insurers aim to make an underwriting profit by getting more premium in than they pay out in claims and administration costs. A critical element in this equation is to set an appropriate premium at the outset – low enough to be competitive and high enough to make a profit.
Do I need to have a medical before I take out health insurance?
No. You will generally complete a written health declaration in which declare any pre-existing medical conditions. On top of this you may choose to get some Doctor’s notes to clarify a pre-existing condition with the view all not having this condition excluded.