AIA release Claims Compass Report

AIA have released their second Claims Compass Report, covering data for the year ended 31 December 2024. AIA have over 797,000 Kiwi protected and accept 92% of all claims received.

In 2024, AIA paid out $829.6 million in claims, up $95 million on the previous year. Life accounted for 41% of all claims paid ($298.1 million), followed by Health ($167 million), Trauma ($139.5 million), Income Protection ($97.2 million) and Total Permanent Disablement ($23.9 million).

Life claims were up $34.6 million, Health claims were up $23.9 million and Trauma claims were up $22.4 million on the previous year. Increases in claims were put down to the combined impact of insurance levels increasing alongside inflation, more innovative treatment options with higher costs than established treatments, and growing demand for health services due to an aging population and growth in chronic diseases.

AIA NZ Chief Customer Officer, Maddie Sherlock said

“In New Zealand, we have observed increased rates of heart disease, cancer, diabetes, and poor mental health, brought about by worsening lifestyle factors such as diet and lack of exercise. These worsening public health trends lead to a higher demand for health services, which puts upward pressure on private health claims.”  

AIA have shone a spotlight on mental health. In 2024 $25.7 million was paid out towards mental health related claims, and $8.1 million for suicide claims. Mental health claims were highest for men aged 40 and 49 ($6.4 million), followed by men aged 50 – 59 (5.6 million). Sherlock said

“This big jump in claims for this age group reflects their life stage which is likely to be impacted by the weight of increased family, financial and professional responsibility and high demands upon their time.”

“This is the age where your overall health starts to be impacted by your nutrition, sleep and activity levels versus when you were younger. And your risk of lifestyle diseases increases. These changes can of course impact your confidence and overall mental wellbeing.”

The top AIA NZ mental health claims in 2024 were:

1. Depressive disorders 44%

2. Anxiety / panic disorders              14%

3. Post Traumatic Stress Disorder      4%

4. Chronic Fatigue Syndrome           3%

5. Chronic Pain Syndrome                2%

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Product changes at Chubb Life

Chubb Life have introduced a Moderate Trauma Cover option under Assurance Extra. Offering coverage for the same critical illness conditions, it is a more affordable alternative to Trauma Cover. Moderate Trauma Cover requires a higher level of severity to be met on 11 of the more common conditions to be eligible to claim. Customers have the option to take Moderate Trauma on its own or mix and match their cover level across both Trauma and Moderate Trauma Covers. They’ll also have the option to take out Continuous Trauma on both covers.

Chubb have also made enhancements to Assurance Extra Trauma Covers and Assurance Extra Business Life, Trauma, Complete Disablement and Monthly Disability Covers. Assurance Extra Trauma Covers have added a Newborn Children’s Benefit, Complimentary Children's Benefit conversion enhancement and added a feature allowing policyholders to convert Trauma Cover to Moderate Trauma Cover. Assurance Extra Business policies have had to Age 65 and to Age 70 level premium review periods added and the payment term options have been extended to include a two-year payment term for Replacement Labour.

Chubb Life has made changes to the underlying premium rates on their Specific Injury Cover under Assurance Extra, Assurance Extra Business, Business Assurance and Agribusiness Extra. The new underlying rates come into effect on 8 May 2025 and will see the average Specific Injury premium increase by $3.10 per month depending on gender, occupation and cover level.

They have also updated their non-medical codes and associated limits – reducing the number of medical code categories and removing several mandatory testing requirements, and making some improvements to limits. 

Chubb Life have also extended their 15% Lifetime Reward and 2 months’ free cover for new policies or cover increases under an existing eligible policy until 31 March 2026.

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nib New Zealand launches Ultimate Life & Living product range

nib New Zealand has launched Ultimate Life & Living, a suite of six new insurance products available exclusively through advisers.

The six new products are:

• Ultimate Life Insurance

• Ultimate Trauma Insurance

• Ultimate Income Protection Insurance (available in both Indemnity and Agreed Value)

• Ultimate Mortgage Protection Insurance

• Ultimate Total & Permanent Disability Insurance

• Ultimate Waiver of Premium

nib is introducing a simplified application process. The updated system, nibAPPLY, will allow advisers to quote and submit applications for health, life and living insurance products simultaneously, improving efficiencies.

Advisers must complete product training and accreditation to offer the new products. nib offers online modules for both new and experienced advisers.

For a limited time, new customers get a $300 credit on their nib Ultimate Life & Living Insurance policy after paying for their first month or more when processed through nibAPPLY before 30 June 2025.

For a limited time, existing nib health clients can get 10% off their Health Insurance premiums when they bundle Health with Ultimate Life & Living Insurance, when any member on an eligible health policy is issued with a new Ultimate Life & Living Insurance policy (subject to meeting minimum premium criteria). The discount applies to the total health policy premium excluding the policy fee and the offer is available exclusively through nibAPPLY until 30 September 2025.

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Product and pricing changes at Partners Life

Partners Life have announced a range of product changes, effective from 15 March 2025, aimed at giving customers more flexibility and the option to remove features if they don’t want to pay for them.

• The built-in Total and Permanent Disability (TPD) Benefit will become a TPD Option. If a client opts out of TPD, the premium for their monthly disability cover will reduce accordingly. This change applies to Mortgage Repayment Cover, Household Expenses Covers and Income Cover Agreed Value, Agreed Loss of Earnings and Indemnity Loss of Earnings.

• They have made changes to Trauma Cover and Moderate Trauma Cover for clients who have suffered an out of hospital cardiac arrest. They have removed obsolete medical requirements, and added current diagnostic tools used by medical staff to confirm a cardiac arrest has occurred. The wording has been updated to allow for new and future diagnostic tools.

• They have updated Trauma, Moderate Trauma and Severe Trauma Cover wordings to let clients know that Partners Life will notify them when they can exercise their Life Cover or Deferred Trauma Cover buy-back options.

Any beneficial enhancements to policy wordings are automatically applied to existing in-force policies under the Guaranteed Upgrade of Future Benefits feature.

In addition to the product changes, Partners Life have reviewed premiums, in light of increased volume and cost of medical claims. Premiums for Private Medical Cover including Specialists and Tests Option will increase by 18% and the policy fee will increase from $58.08 to $64.13 per annum, both from 22nd April 2025.

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What’s the biggest health claim paid for a procedure?

The health insurance industry has been experiencing a time of rising medical costs, where both volume of claims and inflation have been increasing. We’ve taken a closer look at individual claims values that a few insurers have released recently. As you can see from the data below, the costs of individual claims can be astronomical.

nib regularly publish their top 5 health claims by month. RiskinfoNZ has an article collating historical nib’s top health claims by month here.

nib’s top health claims for January 2025

Treatment                     Cost              Gender              Age

Spinal surgery               $101,000         Male                   16

Cardiac surgery           $85,000           Male                   46

Cardiac surgery           $56,000           Male                   70

Cardiac surgery           $54,000           Female               70

Digestive surgery          $53,000          Male                   72

nib’s top health claims for December 2024

Treatment                      Cost                Gender               Age

Cardiac surgery            $103,000          Male                   72

Cancer surgery             $102,000          Male                   77

Cardiac surgery            $93,000            Male                   80

Cardiac surgery            $88,000            Male                   76

Spinal surgery                $87,000            Male                   48

But these do not top the charts of what we are currently aware. Southern Cross’s most expensive surgical claims were $256,165 for a spinal fusion procedure and $127,191 for a breast reconstruction.

While Partners Life don’t release a similar monthly overview of their top claims, their ‘The story behind our claims’ slideshow highlights their largest single payouts since 2011. The most expensive claims paid out were a whopping $1.6 million+ for Total and Permanent Disability or Income cover; $2.9million +for Life cover; $3.2million + for Trauma cover and $982,000+ for Private Medical Cover.

While the majority of claims won’t cost anywhere near as much, what used to be ample caps of some older medical values don’t seem so rosy in light of recent inflation and surging claims costs. Yet we haven’t seen any insurers coming out and indexing claims caps. We think that’s wrong, and we’ll offer a score boost to the first insurer who offers indexed caps.

What types of claims have you heard of and how did they go? We would love to hear more from you, especially if you are a Quotemonster subscriber, through our adviser claims experience tool (check the side menu when you are next logged in).

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nib release launch date for Ultimate Life & Living

nib Ultimate Life & Living will launch on 28 March 2025. Details of the suite of products were released at nib’s nationwide adviser events last month, and advisers can complete their training and accreditation on the nib Learning Management System using their existing password.

Products available will include:

• Ultimate Life Insurance – cover to support a client’s loved ones if they die or are expected to die within the next 24 months;

• Ultimate Trauma Insurance – cover that extends beyond the initial diagnosis of a medical condition to support a client and their family’s well-being;            

• Ultimate Income and Mortgage Protection Insurance – pays a monthly amount if a client is unable to work because of illness or injury;

• Ultimate Total & Permanent Disability Insurance – focuses on the financial impact of lasting disability, so clients can rebuild their future with less financial strain;

• Ultimate Waiver of Premium – removes the burden of premium payments for a client if they’re disabled, ensuring their Ultimate Life & Living cover remains active.

 The full suite of products will be available for comparison on Quotemonster by the end of the month. You can find out about how Ultimate Life and Living works on Quotemonster at our forthcoming roadshows.

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nib to roll out life insurance offering next month

nib’s new Ultimate Life and Living products, which include life, trauma, TPD, income protection and mortgage protection will be available from next month. nib are currently running roadshows outlining its new products, but pricing will not be released until closer to the policies being in the market. QPR has rated the products, and they have come out favourably.

New customers buying bundled health insurance and Ultimate Life and Living policies will qualify for a 10% premium discount, while current members can qualify for multi-cover discounts ranging from 10% – 15%.

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The FSC has released its latest Money & You research

The Financial Services Council (FSC) has released their latest research report, Money & You: Managing Risk Through Challenging Times, which explores the attitudes of New Zealanders towards risk management. Some of the key findings are below.

• Only 41% of respondents had life insurance, 39% had health/medical insurance, 23% had trauma/critical illness insurance, 18% had total and permanent disability insurance.

• For the 12 months to 30 September 2024, FSC industry data showed 1,521,740 health insurance policies and 4,145,287 life insurance products (one person may have more than one policy e.g. life insurance, income protection insurance and total and permanent disability insurance policies).

• The majority (66%) who have life and health insurance consider it value for money.

• The biggest drivers of taking out life and health insurance policies are peace of mind and worry about financial consequences.

• The most common reason given for not having life and health insurance was that insurance is too expensive (74%), followed by being healthy and not seeing the need for it (14%), and not trusting insurance companies (13%).

• Cost of living meaning people can no longer afford insurance was the top reason given for no longer having insurance across life, trauma or critical illness, income protection, total and permanent disability and health/medical.

• For those without insurance, 64% would consider taking out an insurance policy if they had more money, 25% would take out an insurance policy if their health started declining and 18% would take out an insurance policy if they started a family. There is a gap in understanding of how insurance works, with only 3% of those who would consider taking out an insurance policy if their health started declining knew that they might not be able to get cover for certain health issues or they might face higher premiums because of them.

• The majority of health (61%) and life (77%) insurance policies are paid by individuals, with the remainder being partially or fully subsidised by employers.

• When it comes to health/medical insurance or life insurance being provided by employers, 54% really want this and a further 35% might possibly want this.

• 45% of respondents have a poor understanding of the relationship between risk and return.

2,002 online survey responses were collected during March 2024 and were representative of the NZ consumer population in terms of age, gender and income.

It is worth noting that as a low engagement product, life and health insurance is something that respondents find hard to recall accurately. That leads to interesting results - this survey contains a probable over-estimate of the number of people who own health insurance, and a probable under-estimate of the number of people who hold life insurance. But the recalled level of cover is, in itself, interesting. For example, if you think you do not have life, trauma, or income insurance, but in fact you do, you or your estate may fail to claim when you may be eligible to do so.

Readers interested in contrasting these survey results with data on the eligible population should contact us.

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Partners Life release claims statistics

Some interesting statistics have been released by Partners Life around claims. Since Partners Life launched in 2011:

• Partners Life have paid out more than 70,000 claims worth more than $1.25 billion.

• Their biggest monthly disability claim paid was for $1,617,691

• The longest running claim paid for monthly disability cover was 4,068 days and the average claim length was 293 days

• Partners Life paid 13,379 monthly disability cover claims totalling $225,954,755

• Their biggest life cover claim paid was for $2,964,706

• Partners Life paid 1422 life cover claims totalling $334,281,111

• Partners Life paid 51,827 private medical cover claims totalling $353,468,683

• Their biggest private medical cover claim paid was for $982,800

• Partners Life paid 3,948 trauma cover claims totalling $357,357,574

• Their biggest trauma cover claim paid was for $3,218,899

For the year ended 31 March 2024, Partners Life

• paid 93% of claims

• paid $51,020,381 of monthly disability cover claims cost across 3,332 claims paid

• paid $61,130,350 of life cover claims across 208 claims paid

• paid $71,705,905 of private medical cover claims across 12,891 claims paid

• paid $66,106,600 of trauma cover claims across 655 claims paid

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Southern Cross Health Society Group annual results released

Southern Medical Care Society Group has shared their annual results for the year ended 30 June 2024. By the numbers:

• Group deficit of $88.2 million after tax. $43.1 million of the deficit is attributable to a change in international financial reporting standards introduced this financial year. The balance of the deficit is driven by higher claims costs from a high inflationary environment combined with high member demand for private health services, particularly in the second half of the financial year.

• Group reserves of $470.7 million.

• Claims paid at a rate of $6 million per business day (up from $5.2 million in FY23).

• 15,196 net new members, with total membership now at 955,301.

• This represents 60% of the New Zealand health insurance market by customer numbers but 71% per cent of the value of all health insurance claims paid.

• 99% of claims were submitted electronically.

Southern Cross Health Insurance

• Reported a deficit of $99.1 million.

• Paid $1.498 billion in claims from $1.605 billion received in premiums.

• Claims costs increased 15% on FY23 (up 13.9% when adjusted for member growth).

• Premiums increased 9% on FY23 (up 6.6% when adjusted for member growth).

• 93.4 cents paid in claims from every dollar received in premiums (compared to an industry average excluding Southern Cross) of 73 cents.

• Operating costs grew by 4%, less than inflation.

• 3.2 million claims in FY24

• 50% of members claimed over the financial year.

• 39,326 virtual GP consultations with Care HQ.

• 4,635 annual health check-ups with MedPro.

• 4,016 online mental health sessions with Raise.

• Net promoter score of 53.7%.

 Nick Astwick, Chief Executive for Southern Cross Health Society said

“We have never been in more demand by our members as they prioritise their health needs, largely in the private system. In 2019 33% of our membership claimed, last year it was 50%.”

“The cost of claims in 2024 was steep and rapid, driven by a combination of price, volume, and the mix of claims. The growth in the volume of claims results from an increase in the number of members claiming, the frequency, and claims being made for more expensive procedures.”

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