So you have existing medical insurance coverage, but you are concerned about unfunded and non-Pharmac subsidised medicines, especially for cancer.

You are concerned because your present cover is either limited or non-existent for this area of your medical treatment. 

If you are fit and healthy, then this is not quite the issue it could be, and moving to a plan that does cover this is relatively straightforward. 

But that’s not the reason you are reading this either.

You have medical insurance cover, and it covers your pre-existing conditions but it does not cover the unfunded medicines issue for you. 

You’ve acquired your cover through a work scheme, took it early enough, or had it as a kid, and your pre-existing conditions are all nicely covered. 

You don't want to move and not be covered for these conditions, but you don’t want to take a whole new plan and double the costs either. That's good!

We are both on the right track here. 

You don’t have to lose your pre-existing condition cover, switch providers, or take a whole new plan, either.

Well yes, there is a new plan, but it’s not quite a whole new plan. What we are doing in utilising the product options in the market to your advantage.

In reality, our approach to this works best with Southern Cross policies because Southern Cross does have some contribution to unfunded medicines, which we can utilise at claim time to minimise any out-of-pocket expenses.

If you have an older style 80% plan and you don’t want to face underwriting with your present provider and lose the 80% cover you do have, we can help with that too.

So who do we want to talk to?

If you hold a medical insurance policy with:

• Southern Cross (majority of the health insurance market)
• AA Health
• Accuro excluding the + (plus) plans
• BNZ
• nib Excluding Ultimate Health Max
• State
• Unimed
• Tower/nib Easy Health and Premier Health
• ING/OnePath/nib Major Medical excluding Major Medical Deluxe

The last two are now managed by nib; you may have acquired them with their original company and haven’t had an update other than increases in premiums due to moving house, etc. 

If so, get in touch and we can assist with updating your details to your insurer can keep you informed.

I have excluded Partners Life and Sovereign from this list as their products cover unfunded medicines.

Sovereign was an interesting example of a typical insurer.

They have had a number of different plans over the years and some have and some have not had unfunded medicines included.

To give you the rundown:

• MajorCare cover taken before November 2003 has cover for unfunded medicines. 
• MajorCare cover taken before October 2001 also has cover for preventative screening. It is not well known or utilised. But you can ask for a colonoscopy, and they will pay. I'm not sure why you would do that if you didn’t have symptoms, but you can.
• MajorCare taken after November 2003 has cover for unfunded cancer medicines, this was applied in October 2016 and is relatively recent.
• Absolute Health, launched in October 2003, has had the same treatment, with unfunded cancer treatment now included.
• Private Health & Private Health Plus, launched in 2015 has unfunded cancer treatments included.

The one risk is that the majority of insurers can make changes to policy wording within 30 days and remove benefits. 

This is of concern to us for you as a policyholder, as you are relying on your medical cover to front with $1-200,000 for treatment at a critical time. You don’t want to be in a position where your unfunded treatment could be removed and leave you without options.

We recommend, where possible, medical insurance policies that have wording guarantees. Guarantees that the insurer cannot take away from the cover you initially purchased. 

The better ones have upgrade provisions, where enhancements are applied to older policies.

• Since the AIA / Sovereign merger, AIA has applied cancer-related unfunded medicines to all of their historical policies; this now includes AIA Real Health, Superior Health and Superior Health 3.
• And since March 2024, prophylactic preventative cancer surgery following a cancer diagnosis has been added to almost all policies. An old EBS policy appears to be the only one this change has not applied to.

Where does this risk lie for you?

Provider and Policies with 30-day right to change policy wordings

• AA Health
• AIA MajorCare after November 2003
• AIA Absolute Health
• AIA Private Health & Private Health Plus
• AIA Real
• AIA Superior Health and Superior Health 3
• Accuro
• BNZ
• nib policies that are not Ultimate Health Max and Major Medical Deluxe (Old ING/OnePath Product)
• Southern Cross
• State
• Unimed
• Tower/nib Easy Health & Premier Health
• OnePath/nib Major Medical excluding Major Medical Deluxe

Hopefully, I’ve made sense and allayed some fears with those that actually have cover. 

If you don’t have unfunded provisions for your policy, get in touch or give us a call to discuss adding an unfunded medicines module to your existing medical cover.

The information is only intended to be of a general nature and should not be relied upon in any part without obtaining full details of the products and services by contacting Willowgrove Consulting Limited. 

All product and service details, terms, conditions and other information are subject to change at any time without notice. 

sources: Strategy Life Risk Insurance Analysis, Hospital & Hospital, Specialist & Diagnostics Tests cover February 2024, AIA Policy wordings and adviser updates, various dates.