Health insurance: the problem with claims tied to the level education of the provider

Health insurance can be a driver for health treatment claims costs. Take this simple summary of the ear wax removal scenario sent to us by a person claiming on their health insurance. This is a common requirement for older people, and the claim situation indicates ways in which insurance may drive the wrong behaviour in procedure costs:

  • There are range of people competent to complete assessment of the need and to complete ear wax removal including, for example, registered audiologists, registered nurses and others such as enrolled nurses and presumably audiologists who, for whatever reason, might not be on the audiologist register.
  • There is a fee for the procedure. For example, Ear Health charge Gold Card superannuitants a discounted rate of $59.
  • A claim can be submitted to a major health insurer for the consultation and the procedure.
  • The amount the insurer will refund depends upon who does the consultation and procedure, up to approximately $200 for a registered audiologist, $30 for a Registered Nurse, and zero for anyone else that completes exactly the same procedure. We presume this is a cost control measure - but we suspect it is working precisely in reverse of how it is intended to operate.
  • Hence, competence is not the measure used to determine whether a claim will be admitted, and the rate of reimbursement, rather the educational / professional status of the individual doing the consultation and ear wax removal.

In our view, this leads to a perverse outcome as it appears on the face of it to be in the interests of the client to insist that an audiologist complete the procedure, even at a higher cost, if necessary, because the full cost can then almost certainly be claimed in contrast to the situation where a Registered Nurse or someone else does the work.

We think this is the worst outcome for everyone, as the audiologist spends expensive time doing menial work, the insurer pays out a higher amount, and the client presumably ends up with a risk of higher premiums or reduced discounted premiums because of claims.

One is tempted to suggest that somewhere a registered audiologist has already figured out that they could complete a very quick assessment, charge like a wounded bull, and passes the client on to someone else in-house to do the cleaning at no extra charge. Could other examples be given: of course.

Quotemonster update and more daily news

Quotemonster has gone through a major upgrade over the weekend, including the following changes:

  • Big improvements to Advicemonster: much more document layout and content control to make your SOA more yours than ever before
  • Ease of use improvements: new menu structure so it is easier to find what you want (including more than 900 old policy documents, plus funeral plan research and more)
  • Clearer to read text and layout: making it easier to view the research
  • Simpler back-end billing processes: if you subscribe you should notice very quick response on the credit card billing and invoicing process

The upgrade has taken some time, of course. We continually monitor the site and check for issues with the newly installed features, but if you think something is not right and want to bring it to our attention, please let us know using the help function on the site, email, or call. If you need something urgently and just want it now you can always click the button to go back to the old site as an interim measure.

Try out the new Quotemonster site at your usual link.

More daily news:


Quality Product Research: Medical - proposed rating Grief & Funeral Support


We have recently conducted a review on our Death/Funeral item within medical. To align with all our other benefits, we have renamed this item “Grief and Funeral Support.”

Item weightings

Amount score: how much would be paid as a percentage of our total estimated value of claims over the estimated typical policy life.

This is difficult to determine within medical as multiple claims for different benefits could be made during the life of a policy. To combat this, we have created a claims model which assumes that an insured person will hold their medical cover for approximately 12 years, during this period, they will make a total of $30,000 worth of claims (if you would like more details please feel free to ask us for a copy of the model). This is only an assumed amount for our model, based on a typical claim pattern for commonly claimed services. In reality, the amount could be less or more.

Frequency: how often the benefit would be paid.

Incidence: how likely the benefit is to be claimed.

Please see our table below for details figures listed by each provider. Should you wish to send us through any data that can help us to revise this model please feel free to email us.

Sub-items rating review

Please find our proposed definition re-rate below:

GriefYour feedback

We value getting your feedback on how these wordings are being applied to claims you may be aware of. Please email us with details of any recent claims to help us update our understanding.

Doreen Dutt, Research Manager, Quality Product Research Limited,

nib completes purchase of Kiwi Insurance and more daily news

Kiwi Group Holdings Limited (KGH) today announced it has completed the sale of its life insurance business, Kiwi Insurance Limited (Kiwi Insurance), to nib NZ holdings limited (nib New Zealand) for NZ$45 million. More from the Kiwi Group media release:

The sale was announced in November 2021 subject to regulatory approvals which have now been received.  

Under the deal, nib New Zealand has acquired all the shares in Kiwi Insurance and entered an exclusive partnership with Kiwibank (a wholly owned subsidiary of KGH) where the bank will refer its retail customers to nib for their life and living insurance needs. 

Kiwibank Chief Executive Steve Jurkovich said Kiwi Insurance customers did not need to do anything as a result of the sale and that they were in good hands with nib. 

“I’m excited about this new partnership with nib which will allow Kiwibank to continue to deliver on its purpose of making Kiwi better off, whether that’s getting into a home or having the right insurance in place to protect what matters most,” Mr Jurkovich said.  

nib New Zealand Chief Executive Officer, Rob Hennin said they were committed to providing a seamless transition and ongoing great service to current customers including honouring all current policy benefits. 

“We look forward to welcoming current customers into the nib family and offering all Kiwi access to a suite of life and living insurance covers in line with our purpose of your better health,” Mr Hennin said. 

Advisers I spoke with were still not aware of the purchase of a life insurer by a major health insurer and expressed interest in the prospect of the creation of another 'full range' insurer to join AIA and Partners Life.


More daily news:

Financial Services Council announced that, in partnership with the Commission for Financial Capability, it had begun “a three-month, pan-sector campaign to take meaningful action to improve the financial wellbeing of our wāhine.”

Vehicle insurers are seeing a return to pre-pandemic claims costs.

ANZIIF has announced two new board members.


Assisted dying service data reporting and more daily news

The first data report from the assisted dying service has been issued. Although future reports will cover a three month period, the first one covers slightly longer because the start date for the service was not aligned with a quarter end - so it covers 7 November 2021 to 31 March 2022. In summary, this is what has happened: 

Between 7 November 2021 and 31 March 2022, 206 people applied for assisted dying. As at 31 March:

  • 59 people were still in the process of assessment or preparation for assisted dying
  • 81 people did not continue the process (due to being ineligible, withdrawing or dying of their condition)
  • 66 people had an assisted death.

In September of 2020 we estimated that the End of Life Choice Act could see around 240 people use the service each year. It is probably too early to say with any accuracy based on only one quarter's numbers whether that estimate is a good one. However some of the wilder ideas about usage are not yet supported by the numbers.

For more information check out the Ministry of Health's data page on the subject.

More daily news

  • Waikato-Tainui has partnered with Southern Cross Health Insurance (Southern Cross) to offer health insurance to its 14,000 kaumaatua and help facilitate better health outcomes for its tribal members
  • Fidelity Life has appointed three senior business development managers to co-ordinate the work of the others: congratulations to Gary Binnie, Michelle O'Connell, and David Telfer on their appointment
  • AIA reports that Bill Lisle, AIA Regional Chief Executive, and past Director and Regional Chief Executive for AIA Australia and NZ from 2017 to March 2022 has died.


Quality Product Research: Medical - when the selected excess doesn't match the plan excess

Recently we have been challenged by several advisers on how we can rate a benefit where an insurer applies an excess, which is lower than the plans selected excess. 

For example, we refer to the Major Diagnostic wording in Partners Life Private Medical Cover. A client may decide to select a $2,000 excess to reduce cost or ensure coverage for high-cost treatments. However, the excess applied for claims under this benefit will either be nil (if the client has selected a nil excess) or $250. In comparison, the client may not even be eligible to make this claim in this scenario with a competing insurer or in some cases be surprised that an excess is required for a claim to be accepted. This is a significant and valuable difference that we are interested in showing in our Research.  

We would love to hear your insights and how you think we could incorporate this into our Research rating. A while ago we added a sub-item “Diagnostics excess is not limited but matches plan excess” which you are able to see in your Detailed Head-to-Head comparison, but we do need a new and innovative way to show the value of this so welcome any feedback you are willing to offer.

Please email your ideas to

Quality Product Research: Medical - Major review process commenced for UCR Limit


Medical insurance is one of the most hotly contested areas of product comparison. Adjustments are made frequently to our Research to keep up with changes, however it’s still a complex and difficult product to compare. Following a challenge by a rated company to our methodology for assessing UCR/EMP/network limits, it’s time we reviewed the method of how insurers apply UCR Limits and have therefore started the process of a major review of this item.

Theme of review

We would like to begin by renaming the item from “UCR Limits” to "Network or market price limits/UCR"

Our review seeks to categorise and evaluate the impact of the following:

1) No requirement to use specified providers/network and no UCR/EMP

2) Requirement to use specified providers/network

3) UCR/EMP applied to all costs (including specified providers /network)

4) UCR/EMP applied to only non-network costs

5) UCR/EMP applied only specific sets of costs (e.g., overseas)

Review process

We will begin by alerting insurers of our plan to review, including the five points above anticipating they will respond with which applies to their product with appropriate references to their policy document.

Once all required information has been collected, we will make the appropriate changes to our database and share our new rating on our social platforms for further feedback.

Your feedback

We value getting your feedback on how these wordings are being applied to claims you may be aware of. Please email us with details of any recent claims to help us update our understanding.

Doreen Dutt, Research Manager, Quality Product Research Limited,

New Year, new research: expanded and updated research database and product range details...

The Quotemonster team is back on deck for the new year and ready to support your quoting and Research needs.

On our last day of business, we uploaded database version 14.7 to Quotemonster which contained the following changes:

> Fidelity’s range of enhancements effective 15 November 2021  

  • Updated policy wording, brochures, and application forms are also available in the “Documents” tab within your Research comparison screen   
  • Funeral Fund was withdrawn from this date however a static Research rating for this can be found in your "Research Tools" tab 
  • More information on these enhancements can be found here 

> Updates to our Research include:

Within Trauma:

  • Chronic Lung Disease
  • HIV Medically Acquired renamed to HIV

Within Medical:

  • Specialist Consultation – (minor correction to guide score)
  • Imaging
  • Mental Health
  • Physiotherapist (applies to Southern Cross Wellbeing 2)

> Updates to our website include:

  • Research for Life Income/Family Protection has been enabled for AIA, Cigna, Fidelity, and Partners Life

And the biggest upgrade will be an entire site refresh scheduled for early 2022!

Happy Crunching!