The complete guide to primary care (day-to-day) health cover

If you’re thinking about getting health insurance, you might be trying to decide between a day-to-day health expenses type of cover or a policy that just takes care of the big, unexpected things. Both have their merits, but the benefits they offer are quite different.

In this guide, we take a closer look at primary care health cover, also called ‘day-to-day’ health insurance or ‘health essentials’ insurance. When you reach the end, you might want to move onto our guide to major medical cover.

What is primary care health cover?

Every year you probably spend money on doctors, dentists, opticians, prescriptions and a raft of health-related services, such as physiotherapy and chiropractic. You do this to stay in good health and solve problems that can make life miserable. Have you ever added up what it all costs? It’s likely to be a decent chunk of money, and that’s why some New Zealanders choose to get primary care health cover.

Primary care health cover is designed to cover a percentage of your regular health expenses (such as 50% or 75%), up to defined maximum limits for each expense category. There might also be an annual maximum for all benefits.

Every provider offering this type of insurance has their own variation of primary care health cover, but generally they provide a level of reimbursement for these costs:

  • General practitioner fees
  • Dental exams and treatment
  • Prescription medicines
  • Specialist consultations
  • Optometrist eye examinations, spectacles or contact lenses
  • Audiology consultations and tests
  • Complementary medical (physiotherapy, chiropractic, osteopathy, podiatry, acupuncture, naturopathy, homeopathy, psychotherapy, counselling, drug and alcohol therapy, dietitian and nutritionist consultations, lymphoedema therapy, allergy testing and chelation therapy, audiology, occupational therapy, speech-language therapy, infertility/sterilisation)

Some policies also include these extras:

  • Diagnostic tests and health screening (including mammography, prostate checks and skin checks)
  • Laboratory tests
  • A contribution towards the cost of CT/CAT, MRI and angiograms
  • A contribution towards the cost of private medical treatment
  • A contribution towards the cost of orthodontic treatment for insured children

Why get primary care health cover?

There are some powerful reasons to consider primary health cover. We’ve summarised the main motivations below:

  • Reduced health costs: Primary care health insurance has the potential to reduce your annual spend on essential health treatment and maintenance. For example, your policy might cost you around $450 a year, but its maximum total annual reimbursement limit could be something like $2200. Depending on how your health year shapes up, you could get much more than your money’s worth from a primary care policy.
  • Timely and convenient care: Having primary care health insurance means you’re more likely to seek prompt medical attention as soon as you have symptoms. This encourages early diagnosis and appropriate treatment, which can prevent little problems from turning into more serious health issues.
  • Preventative services: Primary care health insurance often includes cover for preventative and early-detection services, such as doctor and dental check-ups, diagnostic tests and regular complementary health services.

What does primary care cover cost?

Using a major NZ health insurer’s cost estimator, this is what basic primary care cover could cost:
Individual - non smokerApproximate monthly cost
30-year old$30
42-year old$40
55-year old$40
63-year old$40

The costs shown here are ballpark estimates only. To get an accurate price for primary health care cover, talk directly with a health insurer or insurance broker.

What will the health insurer want to know?

When you apply for any type of health cover, your insurer will want to know about your health history and any lifestyle factors that could affect your premiums, such as smoking. In particular, they usually want to know if you have any ‘pre-existing conditions’.

The term pre-existing conditions generally refers to any known conditions, signs and symptoms. This means you also have to disclose minor ailments (like aching knees or lower back) that may have been discussed with a doctor, but not diagnosed as medical conditions. Health insurance companies typically don’t offer coverage for pre-existing conditions unless they have explicitly agreed to include them in their coverage.

It’s very important to provide accurate and complete health information when you’re applying for cover. Non-disclosure is a common reason for declined health insurance claims. To be sure you don’t accidentally forget to reveal something, you can access your medical records. If you make a request to your doctor or other health agency, they must respond within 20 days. There could be a charge involved, so ask what it will cost.

Can you get primary care health cover for your family?

It’s easy to arrange primary care health cover for the whole family. You can include your partner and children (usually kids need to be under 21). Having family cover is a way to stay on top of basic health needs, particularly GP, dentist and optician visits.

Do you have access to primary care health cover through a group scheme?

If you’re lucky, you might have the opportunity to get primary care cover through your employer or union. If this is the case, your premiums could be subsidised or discounted.

Next steps for getting primary care health cover.

There are a number of private health insurance providers in New Zealand. They include Accuro, Southern Cross, UniMed, AIA, HealthCarePlus, Partners Life and NIB. When you’re comparing health insurance plans, always read the fine print and ask questions. It could be a good idea to enlist the help of an insurance broker or financial adviser, especially if they work with a range of insurance providers.

DISCLAIMER: The information contained in this article is general in nature. While facts have been checked, the article does not constitute an insurance advice service. It is only intended to provide education about the New Zealand insurances sector. Nothing in this article constitutes a recommendation that any type of insurance cover is suitable for any specific person. We cannot assess anything about your personal circumstances, all of which are unique to you. Before making insurance decisions, we recommend you seek assistance from an insurance adviser or expert.

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