Private Hospital and Specialist Cover
Comprehensive care when you need it
Private Hospital and Specialist Cover
Private Hospital and Specialist Cover is our most comprehensive cover, taking care of specialist consultations, diagnostics, surgery, and treatments in private hospitals. Even if you're fit and healthy, it's important to have a plan in place for unexpected medical expenses to help you get access to the right support when you need it most.
- Specialist Consultations**
- $300,000 Surgical cover per person each year**
- $200,000 non-surgical and cancer cover per person each year**
- Cover for many pre-existing conditions after three years
- Your choice of nil, $500, or $1,000 excess options
- 5% AA Member discount available if you provide a valid AA Membership number for you or someone named on your policy*
Apply for yourself and your family through our quick online application, at an AA Centre or over the phone with our New Zealand based team.
non-PHARMAC Plus
non-PHARMAC funded drugs can be lifesaving but could possibly cost up to hundreds of thousands of dollars. The non-PHARMAC Plus option can be added to Private Hospital or Private Hospital and Specialist Cover, and helps you cover the cost of some drugs that are Medsafe approved and prescribed under the Medsafe guidelines but aren’t funded by PHARMAC at the time of your treatment#.
With non-PHARMAC Plus, you may have access to wider treatment options and cover for approved drugs used to treat cancer and other types of health conditions.
Be confident knowing what your policy covers
We want to make sure you're confident knowing what you are and aren't covered for. That means reading your Policy Wording to understand the benefits as well as your responsibilities, and the cover limits and exclusions of your policy.
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Surgical Benefit
We will pay up to a total maximum of $300,000 for each insured person every policy year, less any excess for any of the surgery related benefits under this cover.
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Non-Surgical Benefit
We will pay up to a total maximum of $200,000 for each insured person every policy year, less any excess for the non-surgical and cancer related benefits under this cover. Individual limits may apply to each of the benefits.
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Specialist Consultation Benefit
We will cover all eligible claims for specialist consultations up to your Surgical or non-Surgical Benefit limit every policy year.
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Private Hospital and Specialist Cover |
Annual Benefit limits^ |
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Standalone benefits |
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Surgical Benefit |
$300,000 Includes oral surgery, mohs surgery and varicose vein treatment Includes extraction of unerupted or impacted teeth after a 12-month waiting period |
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Non-surgical Benefit |
$200,000 |
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Included under standalone benefits |
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Cancer Treatment |
In Hospital: up to Non-Surgical Benefit At Home: $10,000 |
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Non-PHARMAC Cancer Treatment |
$10,000 |
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Follow-up Investigations for Cancer Benefit |
$3,000 |
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Specialist Consultations |
Up to Surgical/Non-Surgical Benefit Doesn’t need to relate to hospital admission |
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Diagnostics Tests |
If related to hospital admission, up to the Surgical/Non-Surgical benefit limit If not related to hospital admission, up to $15,000 |
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CT, MRI and PET Scan Benefit |
If related to hospital admission, up to the Surgical/Non-Surgical benefit limit If not related to hospital admission, up to $5,000 |
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Physiotherapy Benefit |
$750 Must relate to and be within 6 months after hospital discharge Must have a referral from the specialist who treated you while you were in the hospital |
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Therapeutic Care Benefit |
$250 Must relate to and be within 6 months after hospital discharge |
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Home Care Benefit |
$150 per day, $6,000 per year Must relate to and be within 6 months after hospital discharge |
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Ambulance Transfer Benefit |
Up to Surgical/ Non-Surgical limit From public/private to closest private hospital |
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Travel and Accommodation Benefit |
Accommodation Up to $300 per night Travel Surgery/medical treatment: Up to $3,000 Cancer treatment: Up to the Surgical/Non-Surgical Benefit |
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Parent Accommodation Benefit |
$200 per night, up to $3,000 |
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High-Risk Pregnancy Benefit |
$2,000 per pregnancy For monitoring recognised risk factors only |
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Pre-existing cover for newborns |
Pre-existing conditions (except congenital conditions) are covered when a child is added within 4 months of birth General exclusions apply |
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GP Surgery Benefit |
$750 Includes 1 pre and 1 post consultation and related biopsies |
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Skin lesion Surgery |
$6,000 Surgery by a specialist, as well as related biopsies |
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Eye injections Benefit |
$3,000 |
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ACC Top Up Benefit |
Up to Surgical/Non-Surgical Benefit |
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ACC Treatment Injury Benefit |
Up to Surgical/Non-Surgical Benefit |
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Waiver of Premium Benefit |
Premiums waived for 2 years or until surviving insured person turns 70 |
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Loyalty – Suspending your cover Benefit |
Unemployment, redundancy, parental leave, or overseas travel or residence After 1-year continuous cover |
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Loyalty – Sterilisation Benefit |
$1,000 per lifetime After 2 years continuous cover |
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Pre-existing Conditions |
Pre-existing conditions are covered after 3 years of continuous cover Cardiovascular, cancer, hip or knee, back, transplant surgery and reconstructive or reparative surgery will never be covered Permanent exclusion doesn’t apply to cancer if it is pre-malignant and has been appropriately treated by a GP or specialist who is suitably qualified to carry out that treatment |
Things you should know
- Benefit limits and excesses apply per person and refresh each policy year.
- 100% of your eligible cover amount can be claimed if you select a provider from the nib First Choice Network. You can still choose a provider outside of the network; you will just need to make a 'gap-payment', as these provider rates aren't standardised and regulated through the group.
- There's a 14-day cooling off period that gives you peace of mind in knowing that if you change your mind in this time, we'll refund 100% of premiums paid.
- Waiting periods apply before you can access some benefits under your policy. See the above table and Policy Wording for more information.
- Many pre-existing conditions are covered after a 3 year waiting period. Some pre-existing conditions are never covered including cancer and cardio conditions. Please check the Policy Wording for full details.
- Premiums are based on the age, gender, and for some, smoking status of customers on the policy.
- It's possible for all premiums to increase in the future. We will always give you 30 days' written notice if that happens.
- For more information on non-PHARMAC Plus, see the non-PHARMAC Plus Policy Wording.
Making claims easy
We make the claims process simple so you can focus on recovering while we look after your claim. To make your claim hassle-free, some First Choice network healthcare providers can submit pre-approvals and claims on your behalf. Plus, by choosing a First Choice network healthcare provider, you'll have 100% of your eligible costs covered (up to your benefit limit, subject to any excess payable and in line with your policy terms).
For more information on making a claim, visit our Make a claim page.