7 Comments 7 Commentsby 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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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.