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Health Insurance FAQs

This page answers a range of questions about Private Health insurance.

Eligibility

Am I eligible to apply for health insurance?

You are eligible to apply for Sovereign Private Health insurance if:

  • You are 16 to 70 years of age; and
  • You are a New Zealand citizen or a permanent resident or you hold a current New Zealand work permit or a long term New Zealand business visa. If you are not a New Zealand citizen or a permanent resident, minimum residency periods and/or intentions may apply.
Are all occupations eligible?

Yes. Regardless of your occupation (or even if you have no job at all right now), you are eligible to apply for Private Health.

Can I include my partner and/or my children in my policy?

Yes, you can. Just like you, your partner and children could at any time develop a medical condition which does not qualify them for immediate treatment in the public system, and the cost of that treatment could be prohibitively expensive for you or your partner to meet from your own resources.

What if I have a pre-existing medical condition?

If, prior to applying for cover or prior to the issue of your policy, you have or develop a medical condition or you suffer an injury, then that medical condition or injury must be disclosed to, and accepted by, Sovereign in order for it to be covered under your policy. A pre-existing medical condition can be accepted with or without an extra premium, or may only covered from a specified point in time after the commencement date of your policy. In some cases, a pre-existing condition may be excluded from cover.

What if I already have health insurance?

If you already have health insurance with another insurer and you intend to keep that policy, then you should think very carefully before applying for Sovereign Private Health as well. The reason for this is that, before any claim can be accepted under our health insurance policy, you must firstly make a claim with the other insurer if the condition or event is covered under that policy. In that instance any benefit which you receive under the other policy is deducted from any benefit which you are entitled to receive under your policy. You could therefore be effectively paying twice for the same cover.

Excess

Can I lower my premiums by choosing an excess?

Yes, you can. You can choose to have no excess at all, or select from six excess levels. Those excess levels are $250, $500, $750, $1,000, $2,000 and $4,000 per life insured, per annum. These excess levels produce corresponding reductions in your base premium rate of 19%, 28%, 34%, 40%, 55% and 70%.

Does the excess apply to every benefit received under the policy?

No it does not. While the excess applies generally, there are several benefits that always have no excess, regardless of the excess level you choose.

Can I change my excess after my policy has been issued?

You can apply to increase or reduce your excess, and if approved the change would take effect from the next anniversary date of your policy. Some health information may be requested if you apply to reduce your excess.

Cover

Am I still covered if I travel or work overseas?

No, you are not covered under your health insurance policy while you are outside New Zealand. Cover in that event is customarily provided by travel insurance policies. However, if you develop a medical condition or suffer an injury while you are overseas, and you then return to New Zealand, you are covered for that medical condition or injury.

If you plan to be overseas for two months or more, then you can apply to Sovereign to have your cover suspended during that period. In that event no premiums are payable, and on your return you can resume premium payments and cover under your policy will then be reinstated. The maximum period of suspension for overseas travel is 12 months.

Will my cover expire at any particular age or date?

No it will not. Your Private Health will not expire at any age or date. This means that provided you continue to meet the policy terms and pay your premiums, you will continue to be covered, irrespective of your age. There is no upper age limit.

Quotes

For questions about our Private Health quotes, please see our Quote FAQs.

Application Process

When should I apply?

You should apply today. If you don’t, you might find that you don’t apply at all, and then when you need the cover it would be too late. What’s more, you should apply while you can still be readily accepted, and not run the risk of developing a medical condition which could result in an exclusion being added to your policy or cause your application to be declined.

Is it easy to apply for Private Health?

Yes, it’s very easy. Simply get a quote and apply online. It takes most people less than 20 minutes.

Is there a lot of paperwork?

There is usually no paperwork at all. You apply for cover entirely online, and your application can be processed and your policy issued without you having to complete any paper forms.

What sort of questions do I need to answer?

In addition to your name and contact details, the application form has questions about your residency, your occupation and activities, your health, any other life or health insurance you might have, and payment details.

Will I need to undergo a medical examination or tests?

No medical examinations or tests are required.

What happens after I submit my application?

As soon as you submit your application a confirmation email will be sent to you. The email will outline what happens next, and it will have contact details in the event that you wish to contact us while your application is being processed. We will keep you updated at each step, right through to the acceptance and issue of your policy.

How long will it take to process my application?

All applications undergo initial processing right away, and the majority are fully processed within a matter of days. If there are any details missing from your application, or if further information is needed, then that may extend the time required to process your application.

Payment

What are my payment options?

All premiums are paid directly to Sovereign. You can pay your premiums by any of the methods below:

  • Direct Debit from a New Zealand bank account;
  • Credit Card (Visa or MasterCard); or
  • Debit Card.

You can change your payment method at any time.

You can pay your premiums weekly, fortnightly, monthly or annually. If you pay your premiums weekly or fortnightly, you can choose which day of the week your premiums are deducted. If you pay monthly, you can choose which date your premiums are deducted each month. You change your payment frequency at any time.

You will be notified before your first premium will be deducted. In any event, your first premium will not be deducted until at least 10 days after your policy is issued.

Do I get a discount if I pay my premiums annually?

Yes, you do. If you pay your premiums annually you will receive a discount of approximately 4.8% on the total benefit cost (everything except the policy fee). This discount is automatically calculated when you get a quote and select an annual payment frequency.

What happens if I miss a premium payment?

Don’t panic. Your cover will not immediately stop if you happen to miss a premium payment. Your policy provides 31 days’ grace for any premium due. If you miss a premium payment you should contact Sovereign as soon as possible and make arrangements to pay the missed premium. If you do nothing, and the premium remains outstanding beyond the 31-day grace period, then Sovereign is entitled to cancel your policy by providing notice to you in writing.

Cancellation

Can I change my mind after I receive my policy?

Yes, you can. You may cancel your policy at any time.

All of our policies come with a 15-day free-look period. If, at any time within the first 15 days of receiving your policy, you do not wish to continue your cover (for whatever reason), you may cancel your policy and get a full refund of any premiums paid.

You may still cancel your policy at any time after this free-look period, but you will not receive a refund of any premiums paid.

Can Sovereign cancel my policy for any reason?

Sovereign may cancel your policy in any of the following situations:

  • If a premium remains unpaid for more than 31 days after the premium due date.
  • If you did not disclose all material information at the time at which you applied for cover, or if you made a statement in your application which was material and substantially incorrect and was made either fraudulently or within the previous three years.
  • If you, a life assured or anyone acting on your behalf, makes a claim under the policy that is false or fraudulent in any respect. Sovereign can also decline liability in respect of any claim made under the policy.

Policy Owner

Can I change the owner of my policy?

Yes, you can. You may change the owner of your policy at any time. All existing and any new policy owners must agree to the change. For example, you could change the policy owner from just yourself to joint ownership between yourself and your partner. In order to change the policy owner, simply complete a Change of Ownership Form.

Claims

How do I make a claim?

If you need to make a Private Health claim, please read our guide to making a claim.

Can I choose to be treated by any doctor, specialist or private facility?

Yes, you can, provided the treatment occurs in New Zealand. Unlike some other insurers, Sovereign does not require you to receive treatment from a ‘preferred provider’. You can even be treated at an overseas hospital in certain circumstances, but that treatment must be approved by Sovereign beforehand.

Do I have to pay for medical treatment first, and then seek reimbursement?

No you do not. You can obtain pre-approval for upcoming medical treatment, and when your claim is approved Sovereign will pay your health care provider directly. This means you don’t have to be out of pocket for any period of time at all.

Is there a minimum claim amount to qualify for pre-approval?

No there is not. While some other insurers have a minimum claim amount of $1,000 before pre-approval can be obtained, there is no minimum amount for pre-approval with Sovereign. This provides you with financial certainty before you obtain treatment.

Policy

Can I see the policy wording before I apply?

Of course you can. You can view or download a copy of the Private Health Policy wording at any time. If you have any questions at all about the policy wording, please contact us.

Important Information

  • The above provides a summary only of the benefits, terms and conditions of the policy. Please refer to the policy wording, including the policy appendix and schedule, for full details of the policy benefits and the terms and conditions under which they are provided.