nib drops bombshell changes to policies
Advisers say this is the biggest impact they’ve seen on clients in decades.
Tuesday, September 30th 2025, 4:23PM 
7 Comments
by Ksenia Stepanova
nib NZ has surprised advisers with significant changes to some of its policies.
It has announced a 20% co-payment on specialist consultations and diagnostic tests from 24 November 2025. It has also removed multiple policy benefits.
nib will remove the Loyalty Check-Up Benefit, Public Hospital Payment Benefit, Loyalty Active Wellness Benefit, and Cover in Australia Benefit from selected policies. The 20% co-payment will apply to specialist consultations and diagnostic tests not listed in its Diagnostics Schedule.
nib says the changes are being made due to more frequent and complex claims.
Under the co-payment structure, a client undergoing a $2,000 CT scan would pay $400 upfront, with the remaining $1,600 subject to any applicable excess. If the excess is $500, the client's total out-of-pocket cost would be $900, with nib covering $1,100.
Pre-approvals issued before November 24 will only be honoured under existing policy terms if treatment occurs before that date. Any treatment on or after November 24 will be subject to the new terms, regardless of when pre-approval was granted.
nib is also updating policy wording to exclude coverage for treatment and procedures related to gender reassignment and gender dysphoria. The definition of 'congenital' will be updated on some products to include conditions recognised at birth or diagnosed within four months of birth.
nib NZ’s Ultimate Health Max product remains unchanged due to guaranteed wording. Similar changes are expected to be rolled out to group cover members in early 2026.
Core cover for private hospital admissions, surgery, and cancer care remains in place.
Advisers respond to the changes
Advisers have described these changes as “shocking” and the biggest impact they’ve seen on clients in decades.
Insurance People’s Katrina Church says she is very disappointed with the news.
“We are struggling with 30-60% increases and helping clients over this,” Church said. “Now, co-payments is beyond comprehension. There are multiple examples when excesses are charged incorrectly. How on earth are clients going to cope with co-payments?”
“However it is a classic example of industry being right,” she adds.
“Guaranteed wordings are the way to go! That way what we advise will not have the goal posts changed when clients can least afford it.”
Shore Insurance Services adviser Stella Huang says she is finding it difficult to communicate such unfavourable terms to clients.
“It gives the impression that nib is not focused on retaining its existing clients, and it feels particularly unfair to those with pre-existing conditions who have fewer options,” Huang says.
Steven A. Sequeira, with Ark Financial Services, described the premium increases followed by reduction of benefits as a “pincer move” that is squeezing policyholders, while competition with ACC and providers pushing list-patients into private care is straining the system.
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Comments from our readers
The unfortunate reality for nib is that they needed to do something, and this something wasn't quite what I anticipated.
As I have strongly stated elsewhere, client choice is the key issue here, allowing clients to select the changes that are appropriate for them.
A better approach, as we have seen with Major Medical in the past, is to add the options for clients to move. Add the options and adjust the premium accordingly.
Yes, it's painful, and there's work to be done to manage it, but clients retain the choice to pay more or accept lower levels of coverage. This is a far better approach to client-driven outcomes.
The UH/UHM range already has the 4-month diagnosis criteria, whereas the rest have variations without a time restriction for diagnosis. Meaning that things found later than 4 months that are considered congenital conditions could be excluded. This also reflects a more generous internal operating approach that wasn't in line with the wording.
On the gender dysphoria piece, I'm a little disappointed, as this is a condition that the WHO has redefined as a sexual health condition, not a mental health condition. It comes with a range of things that are medically necessary but are not gender affirming surgery.
This will make accessing treatment for those in this area more difficult when what's being treated has little to do with which gender they are. I can appreciate excluding gender affirming surgery due to cost and availability.
At the same time, a trans male needing a hysterectomy for medical reasons may find themselves with a battle to get general surgery available to women who don't identify in the same way. There's a grey area here, which is being made harder for a small minority of our community already fighting to be treated fairly.
I believe advisers are required to ensure their clients understand the ‘guaranteed versus non-guaranteed’ issue and potential consequences, so that they can make informed decisions about whether or not to accept advice/recommendations.
Once properly informed (and exceptional circumstances aside) how many clients would conclude that non-guaranteed products are nonetheless suitable?
There is much to consider, and much work required from advisers.
You would almost be better to have levels of cover on surgical or non-surgical as options, eg: $50k $100k, $200k etc.
That approach would at least give you more certainty than co-payments.
I really do think on this one, NIB should come forward and front advisers as they have placed us in a very awkward position.
Here are some figures from nib’s financial statements and investor presentations. (Working-day adjustments are my own calculations.)
Rolling 3-month premium increases: 1Q25 = 11%, 2Q25 = 13%, 3Q25 = 15%, 4Q25 = 17%, and 1Q26 projected at 22%.
Rolling 3-mth claims inflation: 1Q25 = 16%, 2Q25 = 17%, 3Q25 = 22%, 4Q25 = 20%.
Rolling 12-mth claims inflation (adjusted for working-days effect): 1H25 = 18.8%, 2H25 = 17.4%
Claims inflation from 1H25 – 2h25 (adjusted for working-days effect): 5.6%
Premium revenue: 1H24 = $182.4M, 2H24 = $188.8, 1H25 = $195.7M, 2H25 = $205.7M (in AUD)
Claims expense (net of reinsurance costs and recoveries, not adjusted for working days): 1H24 = $119M, 2H24 = $122.1M, 1H25 = $144.7M, 2H25 = $142.2M (in AUD)
Underlying Operating Profit (Loss): 1H24 = $11.3M, 2H24 = $7.8, 1H25 = ($10M), 2H25 = $7.1 (in AUD)
Summing up: In the last 2 years, only 1H25 was in the red. nib is already on the path back to profitability, and experience has shown them that the NZ policyholders can tolerate some pricing pain. (Ed Close, nib CEO and MD: “We are seeing strong resilience from that portfolio around the ability to absorb those significant premium increases.”) Why introduce more pain in the form of co-pays, and why now?
PS: Why hasn’t nib nz announced the FY25 result yet? For the last couple of years, the NZ half- and full-year results are announced within a day or 2 of the nib Group reports. FY25 for the Group was available on 25th August, yet nothing but crickets and co-pays on this side of the ditch.
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Worse still is just announcing it in an email and leaving it to advisers to field client backlash.
There may be another NZ-owned medical insurer that offers coverage for non-pharmac and reasonable plan limits, albeit with no guaranteed wording that may result in a good uplift from this. (not SX).
Just astounding. Group business is at risk as well as personal. The CEO should front-foot this and try to control the narrative, although it is a little late now.