Non-Pharmac drug cover

Pharmac is New Zealand’s pharmaceutical management agency, and it decides which medicines are funded from a fixed budget. That model keeps public drug spending predictable, and it means some medicines that are approved for use in New Zealand are not paid for by the health system. If a specialist recommends one of them, the cost falls on the patient.

For most conditions that is a manageable amount. For some — particularly certain cancer treatments and specialist biologic therapies — it is not. The sums involved can run well beyond what a household can fund, and the decision arrives at the worst possible moment.

Non-Pharmac drug cover on a health insurance policy is designed for exactly that. It pays for approved but unfunded medicines up to a limit set by the policy. Nearly every insurer offers something under this heading, which is why the existence of the benefit tells you almost nothing. The limit and the conditions tell you everything.

1. 1Ask what the limit is in dollars, and confirm the figure in the policy document rather than the brochure.
2. 2Ask whether the limit applies per year, per condition, or over the lifetime of the policy.
3. 3Ask whether the limit resets, and on what basis.
4. 4Ask what approval conditions apply — Medsafe approval for the specific indication is the usual requirement.
5. 5Ask whether the medicine must be administered in a private hospital or can be received in a public setting.
6. 6Ask whether the benefit is core cover or an optional add-on, and what removing it saves.

One further point: the benefit generally applies to medicines approved by Medsafe for the condition being treated. Medicines used outside their approved indication, or not approved in New Zealand at all, are usually outside the cover. That is a reasonable limit for an insurer to impose, but it is worth understanding before you rely on the benefit.

These are the details that decide whether the cover does what you expected. Read them before you compare on price.

• The dollar limit and the period it applies to.
• Whether the benefit is included as standard or must be added.
• Whether Medsafe approval for the specific indication is required.
• Where the medicine must be administered for the benefit to apply.
• Whether the benefit is available for pre-existing conditions, which it usually is not.
• Whether the limit is indexed over time, since treatment costs do not stand still.

Every New Zealand insurer writes health insurance in new zealand to its own wording, and the words are where the money is. Two policies that look identical on price can pay very differently when it matters. Closing that gap is the entire job of an adviser.

• Non-Pharmac limits are the single largest point of difference between New Zealand health policies and the hardest to compare from marketing material.
• An adviser can obtain the actual policy documents and put the limits and conditions side by side.
• Where an existing policy has a low limit, an adviser can assess whether increasing it is possible without losing cover for conditions already accepted.
• Because switching insurers restarts pre-existing condition exclusions, upgrading within your current insurer is often better than moving.

There are three ways to buy life cover in New Zealand, and they are not equivalent. You can buy direct from one insurer, which means you see one product range and one underwriting appetite. You can buy through your bank, which usually means a single insurer’s product sold under the bank’s brand, often with narrower definitions. Or you can go through an adviser, who quotes several insurers at once and is required to put your interests first.

The premium you pay is the same either way. Insurers build adviser commission into their pricing whether or not an adviser is involved, so going direct does not get you a discount — it just removes the person whose job is to argue your corner at application and at claim time.

• An adviser can see which insurer is currently taking your health history on standard terms, and which one will load or exclude it.
• An adviser can structure cover across two insurers if that produces a better outcome than putting everything with one.
• An adviser handles the underwriting back-and-forth, and is the person who chases the claim when a family is least able to.
• An adviser has to document why the recommendation suits you, which is a written record you can hold them to.

We are a referral service, not an insurer. We do not quote premiums and we do not sell policies. What we do is put you in front of one licensed New Zealand adviser who can compare the market properly.

1. 1

   You tell us what you are looking at

   The form takes about a minute. Nobody asks for your medical history on a web form — that conversation happens with the adviser, properly, and only once you have decided to proceed.

2. 2

   An adviser calls you

   A licensed New Zealand adviser talks through your situation: who depends on you, what you owe, what you already have in place, and what you are actually worried about.

3. 3

   They compare the market

   The adviser quotes across the major insurers, checks which of them will take your health history on the best terms, and puts the options side by side in writing.

4. 4

   You decide, in your own time

   There is no obligation and no cost to you. If the answer is that you already have enough cover, a good adviser will tell you that.