Health Cover: Consumer Rights and Responsibilities

Do you know your rights and responsibilities as a health cover consumer?


When you sign a policy with a health insurer, you have both entered into a legally binding contract.  You both have a responsibility to act in good faith - that is, in an honest, fair and reasonable manner. You also have a duty of disclosure. This means that you must tell the insurer of any pre-existing conditions or illnesses.  The insurer can then impose a waiting period of up to 12 months on hospital and other care relevant to this condition.

If you deliberately lie in order to obtain immediate cover, the insurer may be entitled to declare the contract invalid, and refuse to pay any benefit.

Private health insurers outline extras available to their members in the Private Patients Hospital Charter. Contact the insurer for more details.

The Private Health Insurance Ombudsman is the person to be approached if a consumer has a complaint about private health insurance arrangements. For example, there may be concern about a health fund, private or public hospital, doctor or another provider of health services.

The ombudsman will deal with any such enquiries or complaints and will act independently. The ombudsman tends to deal with most complaints by phone, email and fax, with most disputes settled quickly. This is often because many complaints tend to result from misunderstandings. If the complaint is more than a ‘misunderstanding’ then the ombudsman contacts the health fund or body to seek an explanation and gain further suggestions for fixing the problem.

Click here for Ombudsman services in New Zealand.