Christchurch, NZ -- (ReleaseWire) -- 04/07/2015 --In a recent survey of New Zealand consumers, Canstar discovered that over 40% of New Zealanders consider health insurance more important than contents or home insurance. With so many health insurers, brokers and plans on the market – some of which don't cover surgery - it's important to understand how to differentiate between providers and work out which is the right plan.
One of the most controversial negotiation points is pre-existing conditions, as many health insurance plans do not cover pre-existing medical conditions. Six in 10 New Zealanders with health insurance won't switch insurer because they fear losing cover for pre-existing conditions, the Canstar survey found. "It's a bit like you can't insure your house after it's burnt down. You can't insure your health if you know there is something serious wrong," says Roger Styles, chief executive of the Health Funds Association.
The main way people get cover for pre-existing conditions is via a group insurance scheme arranged by their employer, or on a case-by-case basis if it can be proven that the condition has been treated effectively. Health insurers often offer cover for pre-existing conditions as an incentive if the size of the company meets minimum criteria and the premiums are being paid by the employer, and cover can vary from fully covered to covered with some form of limitation.
There are two types of employer schemes: voluntary vs subsidised schemes. Voluntary schemes are where health cover is offered to staff at a discounted rate, with premiums paid individually by employees. Subsidised health cover is where the premiums for employees (and sometimes family members) are paid by the employer.
Ali Wilkinson, Manager Risk Acceptance and Claims at UniMed who specialise in employer provided health insurance, says that "subsidised schemes don't cost the earth. We tailor company health insurance plans so that different levels of staff can have different benefits for different premiums". For the second year in a row, UniMed were rated Number 1 for Most Satisfied Customers in the health insurance industry in the Canstar survey, getting 5 stars for speed of response, ease of claim, quality of service, communication and overall satisfaction.
Another factor to consider when weighing up health insurers is the financial rating which gives an indication as to vulnerability. A++ and A+ are Superior, A and A- are "Excellent"; B++ or B+ mean Good and anything less shows "vulnerability" according to AM Best global credit rating agency.
Compare too the percentage of premiums paid out as claims – too low and they are milking you for profit, but some not-for-profits like UniMed have a policy of being prudent in all operational spending to keep the claims ratio payout high at over 85% of premiums to benefit members.
How long a company has been around is an indication of whether they've been able to weather storms and got the payout ratios right to keep members well but also remain financially solid.
Another pitfall is to check that the treatment costs allowed for various conditions cover current actual costs, rather than just historic procedure costs, because health procedures get more and more sophisticated each year, and costs go up, so you don't want to discover you've got a large gap to pay for. One way of finding this out is to ask what date the procedure prices are benchmarked on and how often the benefit limits are reviewed and increased.
Some companies also place restrictions on where the patient can go to get treatment so either the surgeon will have to register to become accredited with the insurer, or in some cases, if the surgeon's costs are out of whack with what the insurance company deems to be fair, the insurer may fund only what they believe is a fair rate for that procedure leaving the patient with a hefty gap to cover.
There's certainly a wide array of options on offer. If you do switch, you can't be too careful", says Insurance Ombudsman, Karen Stevens. "The best way to cover yourself is to attach your full medical records to the application."
UniMed is one of New Zealand's Top 4 Health Insurers, and specialises in workplace health insurance. They have been operating since 1979.