Nib NZ’s new Chief Executive’s update on the reasoning behind recent changes made to the insurer’s health policy terms and conditions attracted much reader interest this week…
Nib NZ’s new Chief Executive Skye Daniels says recent changes made to its health policies aim to help keep its premiums affordable for claiming and non-claiming members, beyond just increasing premiums.
“We don’t make decisions like this lightly,” she says.
In response to questions from Riskinfo, Daniels says the changes vary by policy, depending on existing benefit inclusions and policy wording.
“The changes that are taking place are being made to ensure nib can deliver comprehensive and continued cover in the right areas for our members, such as hospital admissions, surgery, cancer treatments,” she says.
From 24 November 2025:
- Some non-core benefits will be removed from select policies, but core benefits, such as hospital admissions, surgery, and cancer treatment, are unaffected
- A 20% co-payment will apply to some benefits that cover specialist consultations and diagnostic tests
- Some policy wording has been updated to align with other nib policies
Asked about the rationale behind these particular changes, Daniels says nib NZ regularly reviews its products and pricing to ensure the business is sustainable and that it can provide New Zealanders with cover for years to come.
…Sometimes this means streamlining benefits to ensure premiums are sufficient to cover current and future claims…
“Sometimes this means streamlining benefits to ensure premiums are sufficient to cover current and future claims, and make sure our members have the right cover, in the right areas.”
She notes nib is facing the same issues as the rest of the New Zealand healthcare sector: sustained pressure from rising healthcare costs and increased claims utilisation.
“We know the number of Kiwis with private health insurance is increasing, and our ageing population is living longer but not necessarily healthier lives, which places the public system under increased pressure.”
…nib recognises that putting through high premium increases year-after-year can’t be the only approach to tackling the challenge of prolonged and unprecedented claims inflation…
Daniels says that overall, nib health insurance claims in the 12 months to 30 June 2025 increased by 24% “…with an average 2.08 claims made per policy compared to 1.68 previously. These combined increases reflect the growing demand for care, particularly as more New Zealanders turn to private health insurance to avoid longer wait times in the public sector.”
Asked whether advisers should expect more policy changes in the near future, Daniels says that “…nib recognises that putting through high premium increases year-after-year can’t be the only approach to tackling the challenge of prolonged and unprecedented claims inflation.”
She says the combination of medical cost inflation and claims inflation is driving what appears to be a structural shift in the health market that the company doesn’t expect to change in the short or medium term.
…We will continue to take proactive steps to ensure our products remain sustainable, regularly reviewing both pricing and product…
“We will continue to take proactive steps to ensure our products remain sustainable, regularly reviewing both pricing and product. That includes making targeted changes to reduce cost growth and protect access to essential care. We’re also focused on improving efficiency and supporting member health through prevention, all with the goal of keeping cover accessible in the long term.”
She says advisers have received detailed information about the changes, and all nib members will receive communication on changes made to their policy.
Asked for any message to advisers Daniels says: “We’ve been encouraged by feedback we’ve received regarding the decision to look at options that help keep premiums affordable for claiming and non-claiming members, beyond just increasing premiums. We don’t make decisions like this lightly.”
nib NZ’s communication to advisers included details around the changes including:
- Ultimate Health Max remains unchanged. With guaranteed wording, the product terms are fixed
- The following benefits will be removed from select policies: Loyalty – Check Up Benefit, Public Hospital Payment Benefit (under the Base Cover and GP Option), Loyalty – Active Wellness Benefit (under the GP Option and Specialist and GP Option) and Cover in Australia Benefit
- A 20% co-payment will apply to some benefits that cover specialist consultations and diagnostic tests. The co-payment doesn’t apply to tests listed in the Diagnostics Schedule. “For example, if your client is undergoing a covered procedure like a CT scan that costs $2,000, a 20% co-payment is applied first — that’s $400. The remaining $1,600 is then subject to any applicable excess. If their excess is $500, this will be deducted next. Your client would pay a total of $900, and we’d cover the remaining $1,100,” the letter to advisers says.