nib reports soaring health insurance claims in New Zealand

Health insurance claims for major medical procedures, particularly cardiac and cancer-related surgeries, were among the most expensive in New Zealand in December 2024, according to data from nib.

The costliest claim was for cardiac surgery at $103,000, followed by a cancer-related procedure at $102,000. Other high-value claims included multiple cardiac surgeries and spinal surgery.

Most expensive health insurance claims

The five highest health insurance claims for December were: 

The data highlighted the financial burden of major medical treatments and the role of private health insurance in covering high-cost procedures.

Cost pressures influence insurance uptake

While health insurance helps manage medical expenses, financial challenges are influencing coverage decisions.

A recent report by the Financial Services Council (FSC), “Money & You: Managing Risk Through Challenging Times,” suggests that cost-of-living pressures are affecting how New Zealanders approach insurance.

FSC chief executive Kirk Hope noted that many households remain underinsured.

“New Zealand continues to grapple with an underinsurance challenge, with 41% of respondents saying they hold life insurance and 39% health insurance,” he said. 

Despite relatively low coverage rates, more than 90% of insured individuals surveyed indicated they value their policies.

Gaps in financial preparedness and risk awareness

The FSC report also highlighted areas where many New Zealanders may be financially unprepared, including the following:

• Nearly 45% of respondents said they do not fully understand how financial risk and return are connected.
• A significant number of respondents reported concerns about the financial impact of losing their household’s primary income earner.
• More than 70% acknowledged that age and pre-existing conditions affect insurance premiums, but financial protection remained a primary reason for obtaining coverage.

Most insured individuals reported paying for their policies independently, while a smaller share received employer subsidies or full coverage.

Health insurance uptake on the rise, but affordability challenges persist

Despite financial concerns, private health insurance coverage has increased. In April 2024, the FSC reported that an additional 250,000 New Zealanders obtained health insurance in the past year, bringing the total number of insured individuals to 1.45 million as of 2023. The report linked this growth to factors such as an aging population and a rising life expectancy, now averaging 82 years.

However, affordability remains a key issue in insurance decisions.

“Despite green shoots in the economy, the cost-of-living crisis is still affecting decisions around life and health insurance, with affordability proving to be a barrier for many,” Hope said.