Southern Cross Health Society has named Jan O’Keefe (pictured) as its next chief executive officer, effective February 1, 2027. O’Keefe succeeds Nick Astwick, who has led the organisation for approximately a decade. The announcement, made on July 28, 2026, follows a formal executive recruitment process conducted by the Society’s board.
For insurance professionals, the appointment warrants close attention. O’Keefe takes the role during a period defined by record claims volumes, medical cost inflation running far above global benchmarks, documented losses across most market participants, and a significant regulatory transition that will require active implementation from her first month in the role.
The Financial Services Council’s (FSC) 2026 State of the Sector report recorded 1.35 million health insurance covers in New Zealand, with $2.545 billion paid in health insurance claims in the year to September 2025. FSC chief executive Kirk Hope told RNZ in May 2026 that most health insurers were making a loss, with claims becoming more frequent and treatment costs rising sharply since the COVID-19 era.
Medical cost inflation is the structural driver. According to Aon’s 2026 Global Medical Trend Rates Report, medical plan costs in New Zealand are projected to rise 18% in 2026, up from 17% in 2025 – nearly double the global average of 9.8% and above the Asia-Pacific forecast of 11.3%. Aon attributes the elevated rate to an ageing population, a growing burden of chronic diseases, increased healthcare utilisation driven by delays in the public health system between 2023 and 2025, and the adoption of advanced medical technologies.
Compounding the cost environment is sustained pressure on the public health system. As of mid-2025, more than 36,000 people were waiting beyond the government’s four-month target for elective treatment, and over 74,000 were waiting for a first specialist assessment, according to data cited by Smiths Insurance. Health New Zealand’s target is for 95% of patients to receive elective treatment within four months – actual performance was running at approximately 60% as of early 2025, according to RNZ.
Southern Cross accounts for approximately 60% of the New Zealand health insurance market by claims value, based on FSC data cited in the Society’s 2025 annual report. In FY25, it paid out $1.706 billion from $1.811 billion received in premiums – a return rate exceeding 94% – while recording a net deficit after tax of $51.8 million, with the health insurance arm contributing a $56.9 million shortfall, according to the Society’s published FY25 results. That deficit represented a $42.2 million improvement on the prior year’s $88 million group deficit.
The Society processed a record 3.8 million claims in FY25, a 16% increase in volume year-on-year. AIA New Zealand, another market participant, reported $177.31 million in health insurance claims for the year ended December 2025, up from about $167 million a year earlier. Its latest Claims Compass attributed rising claims costs to pressure on the public health system, improved diagnostic capability and treatment options, and medical inflation.
The membership outlook adds another challenge. IBISWorld forecasts private health insurance membership to reach approximately 1.436 million in 2025-26 but says growth will remain constrained by employment conditions and household budget pressures. With medical inflation projected to reach 18% in 2026, any future premium pricing decisions will need to balance rising claims costs against maintaining membership across Southern Cross’s approximately 951,808 members.
One of the more concrete near-term challenges is regulatory. The Contracts of Insurance Act 2024 – the most significant reform of New Zealand insurance contract law in decades – passed into law on November 15, 2024, and comes into full effect on November 15, 2027, according to the Ministry of Business, Innovation and Employment (MBIE). In May 2026, the Financial Markets Authority (FMA) issued a letter directly to insurers stating that “while the Act does not come into force until November 2027, we expect insurers to be actively preparing now,” including gap and impact assessments, identifying areas requiring redesign, and embedding the Act’s requirements into “governance, risk management, and assurance frameworks.” The FMA added that early preparation was crucial in managing delivery risk. O’Keefe starts on February 1, 2027. The Act takes effect nine months later. For an incoming CEO, that implementation timeline is not peripheral – it is an immediate operational priority.
O’Keefe joins from HBF Health, Australia’s second-largest not-for-profit health fund, where she serves as chief commercial officer. HBF reported group revenue of A$2.32 billion and $1.87 billion in claims paid to approximately 1.2 million members in its 2025 annual report – a structurally comparable organisation in its member-based, for-purpose model. Before joining HBF, O’Keefe held senior roles at Medibank Group and I-MED Radiology Network, Australia’s largest diagnostic imaging provider, which operates more than 250 clinics across Australia and New Zealand and performs more than 6 million procedures annually. Her experience spans both health insurance and healthcare delivery, aligning with Southern Cross’s expansion into healthcare services, including its 50% ownership of virtual GP platform CareHQ, which delivered more than 50,000 appointments in 2024, according to a Ministry of Health aide-mémoire. Southern Cross also rolled out a national diagnostic imaging pricing structure during FY25.
Board chair Chris Black said the process had been comprehensive. “Jan’s experience across health insurance, healthcare delivery, and customer-led organisations made her a standout candidate. She brings a unique combination of experience, leadership capability, and values to build on the strong foundations established over the past decade and lead the Society through its next phase of growth and development,” Black said.
O’Keefe, returning to New Zealand after 15 years overseas, said: “It is a privilege to return home to New Zealand to lead an organisation that has such an important place in the lives of its members.” For the market, the question O’Keefe must resolve is whether a dominant, structurally deficit-running insurer can manage 18% medical inflation, a record claims environment, an affordability-sensitive membership base, and a significant regulatory implementation – simultaneously, and from day one.
