Health Insurance and Healthcare in New Zealand Explained

How Healthcare Works in New Zealand

The healthcare system in New Zealandhas a few peculiarities you may not be accustomed to. Here, the line between public and private healthcare may sometimes be blurred which could cause misunderstandings—to be safe, when reaching out for medical assistance, make sure to ask in advance which type of service you are being referred to.

Healthcare Facts About New Zealand

New Zealand’s healthcare system is generally high-performing. It is affordable, and access to doctors and medical care is typically easy.

However, medical assistance may not cover more remote or rural areas. Since most doctors and specialists are located in bigger cities, you may need to drive a considerable distance to access basic medical assistance.

Overall, New Zealand’s population has a good health status, with the country facing only the common issues of other high-income countries­—aging population, chronic diseases, heart disease, and obesity.

Does New Zealand Have Free or Public Healthcare?

Although New Zealand once had a fully public healthcare system, it has had a mixed private and public scheme since the 1980s. In practice, that means public healthcare is subsidized by the government, but some services may be partially charged when private providers are involved.

The vast network of hospitals treats citizens, permanent residents, and some holders of work visas free of charge. You are eligible for public healthcare if your work visa entitles you to remain in New Zealand for at least two years. You may also apply if your work visa together with the amount of time you have legally spent in New Zealand allows you to be in the country for two years.

Non-residents can also benefit from healthcare services but at a cost. That is why it is advised to have medical insurance from your home country if you are not eligible for public healthcare in New Zealand.

What Does Healthcare Cover in New Zealand?

The healthcare system in New Zealand provides some free services for prescriptions, treatments, x-rays, and some laboratory tests carried out at public hospitals or clinics. It also includes service charges for pregnant women, dental care until the age of 18, and breast exams for women of fifty years of age or older. General practitioner (GP) referral visits are also covered, the same with treatment for chronic conditions, and subsidized prescriptions for children of six years of age or younger.

Public healthcare also covers maternity. If you are pregnant, you are eligible for public care for the duration of the pregnancy and up to six weeks after the birth.

“No Fault” Insurance Scheme

Public health insurance also covers any accidents you may have. The government has a “no fault” insurance scheme known as Accident Compensation Corporation (ACC). It covers the cost of any accident you may have, whether or not you apply for public or private healthcare. Let the receptionist and doctor know that your situation is accident related, so you can get a lower cost for consultation. Co-payment may apply if the cost of the treatment is above what is covered by the ACC.

What is Not Covered?

Dental care for adults, or optometry are not covered by public healthcare.

How Does Healthcare Work in New Zealand?

New Zealand’s healthcare system has three levels of care: primary, secondary, and tertiary.

Primary healthcare includes the family doctor, dentists, pharmacists, and allied health, which encompasses physiotherapists, podiatrists, counseling, and other medical services. Family doctors and practice nurses can be found in Medical Centers, also called Primary Health Organizations (PHO). Medical Centers typically work as independent practices. These are your first and most important point of contact with the New Zealand health system, except for emergency care.

Primary Care

Primary care also refers to the first general treatment of symptoms or medical concerns, such as the flu, bone fractures, skin rash, or acute medical conditions. These services are provided in public hospitals and clinics and are free of charge, but always check your eligibility.

Secondary Care

Secondary care includes hospital services, either public or private, and specialist care. Most secondary and tertiary care—which includes cancer treatment, plastic surgery, and other procedures—is provided by publicly owned hospitals. However, patients have a choice to access either public or private services, which may depend on preference or the availability of the services. To access these levels of care, you would typically need a referral from a GP.

If you need to visit a doctor in short notice and are unable to book an appointment with your family doctor, you can go to a Private Urgent Care Clinic, or an Accident and Medical (A&M). There are higher costs associated with these services. If emergency care is needed, you will be referred to a Public Hospital Emergency Department.

In general, New Zealand’s public healthcare is very inclusive and user-centered. There is a telephone line you can assess free of charge to get immediate help from a registered nurse, called Healthline. The majority of medical care providers offer translations or language support, to get the support for a trained interpreter, which is usually free.

Hospitals in New Zealand

Hospitals in New Zealand are usually equipped with the latest medical devices and have highly qualified medical professionals. For emergencies, you may visit an Emergency Department (ED) of a public hospital, or Accident and Medical Clinics, also called A&M, which will treat emergencies and urgent care cases, such as car crashes, bone fractures, or other accidents.

Ambulance Services in New Zealand

Ambulance services don’t belong to any hospital or government organization but are rather provided by a charitable organization called St John. You may have to pay to use these services.

Where can I Get Medication in New Zealand?

Your medicines are obtained from pharmacies that you can find in your community. For subsidized prescription medications, you will be given a prescription from your doctor. This prescription charge has the cost of 5 NZD (3 USD).

Healthcare Costs in New Zealand

Public hospitals and specialists are free for eligible individuals. If you are unsure if you qualify, check your eligibility here. However, most services do come with a cost, whether you are eligible for healthcare or not.

Costs of General Practitioner (Family Doctor) Care

Same costs apply when visiting a General Practitioner, although they vary whether you are enrolled or registered. Being enrolled with a GP means you pay much lower costs than simply being registered.

Visiting the doctor will cost about 50 NZD (32 USD), but this may vary between localities and practices, as each medical center sets their own prices. You may also be asked to pay for laboratory tests, depending on the purpose, so always confirm with your GP.

Children under 13 years of age may consult with a GP for free or at a low cost.

Costs of Specialist Care

If you visit a public specialist, the service is free of charge. However, this usually entails being put on a waiting list and waiting up to four months for a consultation.

Consultations with private specialist doctors and hospitals start from 150 NZD (100 USD) for a first consultation.

Costs of Prescription Medication

Prescription medication has a cost, even if it is subsidized. Each prescription item costs 5 NZD (3 USD). If your medicine isn’t entirely subsidized, you will need to pay more.

Once you and your family have paid for 20 prescriptions in a year, starting on the first of February, you won’t have to pay for more prescriptions after that. You can read more on the Prescription Subsidy Scheme here.

In most pharmacies, prescriptions for 14-year-olds or younger are free of charge.

Costs of Emergency Care

If you go to an Accident and Medical Clinic, you will have to pay for medical care. However, you may be covered by the ACC, if it is accident related.

This applies to ambulances as well. If you meet the criteria to be covered by the ACC, ambulance services are free, otherwise, you may have to pay.

Costs for People who do not Qualify for Public Healthcare

If you are not eligible for healthcare, you will have to pay for any medical services, although you will not be refused emergency care if you are unable to pay. As international students or some workers who do not hold a visa don’t meet the criteria for eligibility, these should take out health insurance while in the country.

New Zealand Healthcare System: Pros and Cons

Overall, healthcare in New Zealand is very high-quality. Provided you have been granted residency in the country for at least two years, you should be able to enjoy free healthcare in the country.

However, one of the major cons of the healthcare system is its exclusivity. There are some criteria you must meet to qualify for public healthcare, and if you are not eligible for public healthcare, will not be able to take out private health insurance either. This leaves foreigners and temporary expats with the option of getting international health insurance, or traveler’s insurance to safeguard having to pay full costs of medical care.

Another downside of the public healthcare system is the long waiting times for non-emergency procedures. This is typically the reason why New Zealanders and expats take out private health insurance so that they can jump the queue on elective surgeries or procedures.

An Overview of Private Health Insurance

Do You Need Health Insurance in New Zealand?

Generally, you do not need to take out private health insurance in New Zealand, just like most New Zealanders. However, if you have private health insurance, you can enjoy the advantages of faster and more personalized medical care and still benefit from public healthcare.

You should consider getting health insurance if:

• You wish to avoid long waiting lists for procedures that are not considered emergencies.
• You wish for more freedom over the choice of medical professionals or where you will be receiving treatment.

Before you take out medical insurance, check if your employer includes it as a possible benefit. You should also check if your country’s health department has any reciprocal cover agreement with New Zealand.

If you do not qualify for both public or private health insurance, you may need to take international or travel medical insurance.

Types of Health Insurance Plans

There are two types of common policies offered by insurers in New Zealand:

• Comprehensive policies cover all the common medical costs, including consultations with family doctors, and prescriptions.
• Other policies may add on the first, to include specific combinations of specialist care, non-urgent surgery, laboratory testing, or dental services.

Some health insurance providers expats should check out are:

• Southern Cross Health Society;
• Sovereign;
• Accuro Health Insurance.

What is Good Health Insurance Coverage?

Overall, a good insurance plan would cover all your major medical expenses, except for excess, which is part of the hospital bill paid by the patient. It should cover surgeries, GP charges, hospital charges, tests, and specialist care. It could also pay for a number of “major diagnostic” tests such as MRI or CT scans or angiograms.

Average Cost of Health Insurance in New Zealand

As with any country, prices of health insurance plans in New Zealand vary slightly based on each individual case. For example, a 30 year old male, non-smoker may pay less than a 30 year old male who is a smoker. Payments will also change based on whether you chose a 500 0r 2,000 NZD excess (300 or 1,200 USD).

Bi-weekly payment plans will range between 15 t0 30 NZD (9 to 20 USD).

How to Find a Doctor or Dentist

How to Find a Family Doctor

Your first point of contact for any medical situation is your GP. Since you can choose your GP, it is important to do your research. This can be based on location, preferred language, or recommendations from friends, family, ethnic associations, or organizations such as the Citizens Advice Bureau (CAB).

Still, it is recommended that you pick a medical center next to where you live. This is because not all GPs in a given practice will take in new patients, and usually priority is given to patients who live or work in their area. To find a GP nearest you, you can visit Healthpoint.

Once you have picked your GP, you would go to their practice or medical center and either enroll or register with them. To make an appointment, simply call your chosen medical center and ask for a consultation.

Enrolling vs. Registering with a General Practitioner

Enrolling with a GP has the benefit of cheaper doctor visits, as well as lower costs on prescription medicines, whereas simply registering would mean paying higher costs.

However, enrollment is only available to eligible individuals. For example, an international student is not eligible for healthcare, they would be allowed to register with a family doctor, but not enroll. If you are eligible for public healthcare in New Zealand and you wish to enroll, make sure you bring documentation that proves your eligibility.

How to Find Specialists

To see a specialist through the public healthcare system, you will need your family doctor to arrange an appointment, which is known as a referral. There is usually a waiting list for specialists and procedures, which can be several-months-long, except for emergency cases.

When you register for your consultation, you will be given a letter with an appointment date and time. Most hospitals expect you to call in advance to confirm your appointment.

You will not be expected to pay for attending a public hospital, as long as you are eligible.

How To Find a Dentist

To find a dentist, you would have to research and compare different private services. There is no fixed or recommended fee for dentists appointments. Make sure you ask in advance about the costs of the treatments you need, to be properly informed.

There are a number of websites you can visit to find a dentist near you, such as Dental Council, or Healthy Smiles.

Average Waiting Time to See A Doctor in New Zealand

Waiting times in New Zealand are not extremely worrisome, but may still weigh on your decision to get private insurance.

Here are the maximum waiting times for several medical services:

• Ten days to inform if a patient will be assessed by a specialist.
• Six months from the referral for a first specialist assessment.
• Six months for treatment.
• Six months for clinical review of patients that have not been accepted for treatment but have been placed under “active” review.

Giving Birth in New Zealand

If you are planning on giving birth in New Zealand as a non-resident, read about the requirements before you apply for a temporary visa while pregnant.

Having a Baby in New Zealand as a Foreigner

Giving birth as a foreigner in New Zealand may be expensive if you are not eligible for public healthcare. If you are not sure you are, check your eligibility here.

Generally, all it takes to qualify for public healthcare is a work visa that allows you to live in New Zealand for two years. If you do not qualify for public healthcare yourself, you may still have free maternity care through the status of your husband, civil union partner, or de facto partner. However, they must be a New Zealand or Australian citizen, a permanent resident, or the holder of a permanent resident visa, or working visa.

Cost of Having a Baby in New Zealand

To give birth in New Zealand, you would need at least 9,000 NZD (5,900 USD). This is required in case you do not qualify for public healthcare, and you would need proof that you have this amount and are able to support yourself financially. You can show evidence that you are able to fully pay for your maternity and your stay in New Zealand through bank statements, bank drafts, credit cards, or travelers’ cheques.

Giving Birth in New Zealand without Health Insurance

If you are not eligible for public healthcare, you may have to pay the full expenses of your maternity and show evidence that you can do so. Alternatively, you have the option of free maternity care if you come to New Zealand under the care of a sponsor or third party who can guarantee coverage of your expenses.

Benefits of Giving Birth in New Zealand

New Zealand’s healthcare system is very advanced, so you should expect good quality care when it comes to seeing your maternity through. Your Lead Maternity Carer (LMC) will provide medical care throughout your pregnancy, be there when you give birth, and provide care for 4 to 6 weeks after your baby is born. They should also inform you of the procedures and timings for screenings, such as for different kinds of trisomy and other conditions.

If you are working while pregnant, you are entitled to up to ten days of unpaid special leave, to take medical appointments, prenatal classes, or other maternity-related appointments. You will also be entitled to parental leave, which is covered under Working in New Zealand.

Giving Birth in New Zealand for Citizenship

New Zealand has restricted Birthright Citizenship. A child born in New Zealand may only acquire citizenship if one of the parents is a citizen or has permanent residence status.

When you register your child, their citizenship is registered as well. Make sure you register the child correctly, by providing the following information on the notification of birth for registration:

• Name and birth of the child
• Name, birth, occupation and citizenship of both parents

Giving Birth in New Zealand as a Permanent Resident

Permanent residents enjoy the right to free healthcare in New Zealand. That means your maternity would be fully covered by the public healthcare system.

You are advised to choose a maternity carer as soon as you know about the pregnancy. You have the option of choosing a midwife, which is preferred by most parents in New Zealand, an obstetrician, or even a general practitioner specialized in childbirth. If you do opt for a midwife, you can choose one online, or you can ask your family doctor about midwives near your area.

Keep in mind that specialist doctors, such as obstetricians, are not covered by the public healthcare system, which means you would have to pay for these services yourself.