Our Athlete Medical Insurance scheme
The scheme is provided by the nib Group policy and covers athletes’ eligible pre-existing conditions not already covered by ACC. It also offers full coverage for hospital, surgical and medical benefits plus specialist consultations and diagnostics such as MRI scans.
The athlete health insurance cover complements ACC (which supports athletes for accidental injuries) by covering injuries not covered by ACC, as well as illnesses and other medical conditions.
Keep reading to find the answers to some questions you might have…
Q. What do I have to do to become part of the HPSNZ/nib Group Health Plan?
A. Nothing. Unless you submit the online form saying that you wish to opt out, you will automatically be signed up to the scheme.
Q. Who pays the premiums for the policy?
A. HPSNZ will pay your premiums while you are a TAPS eligible athlete and for 6 months after support ends. After that you have an option to continue with the same policy if you pay the premiums yourself. You will then deal with nib directly.
Q. Is there any excess I would need to pay?
A. No – the premiums HPSNZ is paying for you provide total cover (i.e. there is no excess).
Q. What does the HPSNZ/nib scheme cover?
A. To get a detailed explanation of the covers and benefits, you should read the nib Policy document (click here to view). Note: the scheme is the Premier Business Base Cover with nil excess plus Specialist option – up to Page 43. In simple terms the following are covered (but please refer to the nib policy document for any limitations which may apply):
- Hospital-Surgical benefits in an approved Private Hospital
- Hospital-Medical benefits in an approved Private Hospital
- Cancer Treatment
- Specialist Consultations (e.g. dermatologist, asthma specialists, cardiac specialists etc.)
- Non-ACC diagnostics (e.g. X-ray, MRI scan, induced sputum test etc.)
- Ambulance transfer
- GP minor surgery
An easy to read brief fact sheet is here
E.g. Under this scheme, all costs (up to approved limits under the policy) would be covered.
A major benefit in this policy is that it covers all eligible pre-existing conditions – and these pre-existing conditions will still be covered if athletes choose to continue the policy after they retire. This is what makes it so attractive! Conditions that are not eligible are covered on Pages 69 – 74 of the policy document.
Q. What if I opt out now; can I join again later?
A. No you cannot re-join the HPSNZ/nib Group policy if you opt out now. You would need to deal with nib directly, and their standard rates and terms would apply (note this would not include any eligible pre-existing conditions which are included in the HPSNZ/nib policy).
Q. What happens once I retire or my TAPS from HPSNZ ends?
A. As per HPSNZ’s current medical duty of care arrangement, if you have been eligible for TAPS for at least 12 months and have a medical at the time your support ends, we will continue to provide treatment for any current complaints that are being treated for a period of 6 months. If you have been supported for less than 12 months, this is worked out on a pro-rata basis.
Separately from the treatment we are providing to you, we will continue to pay your premiums under the nib health insurance policy for 6 months after your TAPS support ends. If you receive any new injuries or illnesses (under the terms of the policy) within those 6 months, you will need to seek your own treatment and claim this directly from nib. nib will also allow you to join their scheme after this 6-month period and you will deal directly with them from then on. Note that if you want to continue with nib yourself and retain the pre-existing condition part of the policy, you will have needed to be in the scheme for at least 12 months (i.e. supported by HPSNZ for 6 months plus the 6 months we will pay after support ends.
Q. If I am in the scheme, can I opt out at any time?
A. Yes you can opt out at any time by notifying HPSNZ. Remember, you cannot re-join the HPSNZ/nib Group policy after you opt out.
Q. What if I get injured or ill while overseas?
A. Your travel insurance should cover your medical costs while overseas. However, when you return to NZ, any further medical costs under the terms of the policy will be covered (i.e. treatment must be in New Zealand as part of this policy, unless covered by the next question).
Q. What about getting injured or ill when travelling in Australia?
A. nib won’t cover any costs for any treatment that would normally be covered by ACC in New Zealand. If you obtain pre-approval for other treatments in Australia, then nib will cover up to 75% of the costs of receiving the same treatment in New Zealand.
Q. I live overseas for most of the year. Am I still eligible?
A. To be part of the scheme you need to be eligible for treatment in the New Zealand Public Health system. To see who is eligible for this click here (unless you live in Australia – see next Q & A.)
Q. What if I live most of the year in Australia and want treatment there?
A. Please email: firstname.lastname@example.org if you think this applies to you and we will discuss this further.
Q. What if I am aged under 18. It says in the nib policy that a parent or guardian needs to hold the policy (Clause 8.1.3).
A. Because HPSNZ is the Administrator of the policy, this clause will not apply to you while HPSNZ pays your premiums. If your HPSNZ support ends before you turn 18 and you wish to continue with the policy yourself, nib will arrange transfer of the policy to your parent or guardian.
Q. What if I currently have medical insurance with another insurance provider?
A. You can choose whether you wish to remain with that other provider (at your cost) and/or be part of the HPSNZ/nib scheme (at HPSNZ’s cost). You can be part of two policies but not claim on both for the same thing! If you are unsure about what to do you should contact an insurance broker. If you do not have one, here is an option for you:
Gema Hill: Email: email@example.com
Ph. 021 824 815
Q. What if I am currently insured with nib?
A. You can choose whether you wish to remain with nib in your current scheme (at your cost) and/or be part of the HPSNZ/nib scheme (at HPSNZ’s cost).
Q. Can I get my partner or children on the nib scheme?
A. Yes you can get this for your partner and children under the age of 21. nib will contact you directly and you will deal with them around this. The policy and benefits will be the same as for eligible athletes, so their eligible pre-existing conditions will be covered. However, you need to add your partner or dependent child within 90 days coming into the HPSNZ Group scheme, or within 90 days of entering into a partnership relationship or within 90 days of your child being born.
Q. How much is it likely to cost me to put my partner on the scheme?
A. The partner premiums differ depending on gender and age. nib will be able to give you the correct figure for this.
You need to add your partner or dependent child within 90 days of coming into the HPSNZ Group scheme or within 90 days of entering into a partnership relationship.
Q. Can I get any additional cover for my health insurance?
A. Yes. nib do have some additional options outlined in the nib policy document which you can purchase yourself (e.g. GP option, dental/optical options – from Page 44 on, in the policy). You will need to deal with nib directly on these and make claims directly with nib for any costs.
Q. I notice in the policy that if I take up the additional GP option with nib there is a stand down period of 90 days. Can I get around this?
A. Under the terms of the HPSNZ agreement we have negotiated a no stand down period for both the GP option and the Dental/Optical option.
Q. What information will HPSNZ receive from nib about any of my treatments?
A. HPSNZ receives high level quarterly reports from nib around types of treatments and costs of treatments but will not receive any information that can link treatments to any individual or sport.
Q. After I retire I want to travel overseas for a year. Can I put my insurance on hold?
A. After we stop paying the premiums, you can put your policy on hold for 6 months – although obviously you will not be able to make any claims on anything incurred while the policy is on hold. Any injury or illness that occurs while the policy is on hold will be covered when you re-instate the policy. The treatment will need to occur once the policy has been re-instated.