nib Health Insurance Overview

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fund-iconOverview

nib’s health fund was first established in 1952 in Newcastle, and now services the needs of over one million people in Australia and New Zealand.

The fund also provides cover to more than 130,000 international students and workers in Australia. Plus, nib owns World Nomads Group, one of the top providers of travel insurance in Australia.

The fund offers a wide range of hospital and extras policies to suit different life stages and budgets.

Members have access to the nib Rewards program, with discounts and offers at over 150 retailers, as well as fitness programs that encourage healthy living.

fund-iconKey features

  • Access to the nib Rewards program
  • 100% back on dental and optical at selected providers
  • Wellness programs for members with chronic conditions

fund-iconHospital cover

Nobody chooses to go to hospital. But when you do, hospital cover will help you get the treatment you need, where and when you want it. It also helps to pay the bills, as fees for hospital rooms and specialists can add up.

Think about what services you’re likely to need, in line with your budget. If you earn over $90,000 individually or $180,000 as a couple, you could avoid paying the Medicare Levy Surcharge.

nib offers five hospital plans that are suitable for a variety of life stages and budgets. Each level of cover, from Basic to Gold, builds on the level before it.

Basic Essential
Hospital Plus

nib’s Basic cover offers minimal cover but allows you to avoid the Medicare Levy Surcharge, as well as offering some hospital services and emergency ambulance.

Key inclusions:

  • Tonsils, adenoids and grommets
  • Hernia and appendix
  • Joint reconstructions
Bronze Hospital Plus

More comprehensive than Basic policies, nib’s Bronze policy is designed for budget-conscious Aussies and is the fund’s most popular cover tier.

Key inclusions:

  • Diabetes management
  • Ear, nose and throat
  • Bones, joints and muscle
Silver Hospital

Comprehensive cover that includes many of nib’s most commonly claimed services. Excludes some of the more expensive hospital procedures you’re less likely to need.

Key inclusions:

  • Heart and vascular system
  • Plastic and reconstructive surgery (medically necessary)
  • Implantation of hearing devices
Silver Advantage
Hospital Plus

A policy for people who want extensive cover but don’t need pregnancy services, making it a viable option for families and the over 50s.

Key inclusions:

  • Cataracts
  • Joint replacements
  • Dialysis for chronic kidney failure
Gold Top Hospital

This is nib’s most comprehensive cover option, and must be purchased with extras cover. It covers all hospital procedures, making it suitable for those planning a family or simply wanting the top level of cover.

Key inclusions:

  • Pregnancy and birth
  • Assisted reproductive services
  • Weight loss surgery
  • Hospital psychiatric services

fund-iconAmbulance cover

All nib hospital cover options include emergency ambulance transportation with no annual limits (QLD and TAS residents are covered by their state schemes).

fund-iconExtras cover

extras-coverExtras reset

Extras cover helps you with bills for routine out-of-hospital treatments such as dental, optical, chiro and physio, and can come with rebates of up to 100%. Simply work out what you need and what you’re prepared to pay.

While we’ve summarised the key points of each plan below, it’s always worth digging a little deeper into any gap fees, how much you can claim back, and whether your preferred healthcare provider, such as your local dentist, has an agreement with the health fund.

If this feels a bit overwhelming, you can speak to one of our experts who can talk you through what’s included in each extras policy.

nib offers a number of extras cover tiers to suit a range of needs. The fund allows you to combine different tiers to make a policy suited to your particular needs. You can purchase extras on its own or combine it with hospital cover. Shown below are several of nib’s extras options.

Core Extras

Get a 60% benefit on a basic range of extras, including optical, physio and general, preventative and major dental. Comes with no limits of preventative dental treatment such as scales and cleans.

Core Extras Boost

This extras plan provides the same benefits as Core Extras, but is a little more expensive due to higher annual limits. For example, Core Extras Boost has a $1,000 limit on major dental versus $600 on the basic Core Extras plan.

Core and Wellbeing Extras

This option gives you 60% back on the same range as Core Extras, but has a wider range of additional services like psychology, remedial massage and chiro.

Top Extras

This is nib’s top tier extras plan, giving you 75% back on a full range of services and higher annual limits. This includes antenatal and postnatal services, orthodontics (braces) and podiatry.

fund-iconWaiting periods

To stop people signing up, claiming, then cancelling their health insurance, all insurers apply waiting periods. Generally, the more expensive the treatment, the longer you’ll wait. But keep an eye out for special deals with waiting periods reduced or waived.

Basic Essential Hospital Plus
Bronze Hospital Plus
  • 1 day – accidental injury benefit
  • 1 day – emergency ambulance
  • 2 months – hospital psychiatric services (restricted)
  • 2 months – rehabilitation (rehabilitation)
  • 2 months – palliative care (rehabilitation)
  • 2 months – other conditions requiring hospitalisation (that aren’t pre-existing conditions)
  • 12 months – other pre-existing ailments/conditions
Silver Hospital
Silver Advantage Hospital Plus
  • 1 day – accidental injury benefit
  • 1 day – emergency ambulance
  • 2 months – hospital psychiatric services (restricted)
  • 2 months – rehabilitation
  • 2 months – palliative care
  • 12 months – other conditions requiring hospitalisation (that aren’t pre-existing conditions)
  • 12 months – other pre-existing ailments/conditions
Gold Top Hospital
  • 1 day – accidental injury benefit
  • 1 day– emergency ambulance
  • 2 months – hospital psychiatric services
  • 2 months – rehabilitation
  • 2 months – palliative care
  • 2 months – other conditions requiring hospitalisation (that aren’t pre-existing conditions)
  • 12 months – other pre-existing ailments/conditions
  • 12 months – pregnancy and birth
Extras (common services)
  • 2 months – preventative dental
  • 2 months – general dental
  • 2 months – physiotherapy
  • 2 months – podiatry
  • 6 months – optical
  • 12 months – orthodontics
  • 12 months – major dental
  • 36 months – hearing aids

fund-iconMember benefits

All nib members have access to:

  • 100% back on optical and dental (up to your annual limit) when you visit an nib eye care or dental care centre
  • Discounts and offers at over 150 retailers through nib Rewards, including savings on groceries and gym memberships
  • Reduced out-of-pocket costs with providers that are part of the nib First Choice Network

fund-iconHow to claim

Generally, you’ll be able to make a claim on the spot at a provider. Otherwise, you can claim online, using the nib App or mailing in a claim form.

fund-iconHospital agreements

nib has agreements with an extensive network of private hospitals and day clinics across Australia. When comparing policies, it’s worth checking if your local hospitals and clinics are covered. Our specialists at Health Insurance Comparison can do this for you.

NSW – 188

Victoria – 145

Queensland – 101

South Australia – 52

Western Australia – 45

ACT – 14

NT – 3

Tasmania – 12

fund-iconCustomer service

nib Health received 69 complaints from 1 January to 30 March 2020. That’s 8.1% of complaints vs 8.6% market share, indicating customer service is a little above average.

fund-iconFAQs

No, nib is a for-profit fund.

Dependent children, adult dependants and student dependants of policy holders must be unmarried and not in a defacto relationship. To claim, all those listed on the policy must be Australian citizens, permanent residents or registered for Medicare.

Unless otherwise approved by nib, a person under 16 years of age is not eligible to be a policy holder.

Yes, you can sign up right here, right now. We’ll take care of the paperwork.
If you’re transferring to an nib policy that has an equivalent or lower level of benefits, you won’t have to re-serve any waiting periods on the services covered with your previous fund. nib will also recognise partially served waiting periods.
Yes, you can choose a lower or higher level of cover. If you move to a higher level of cover, you will usually need to serve waiting periods on the extra services and/or higher benefits
Most Australians are eligible to receive a rebate from the government. This will depend on your age and income. To learn what you’re entitled to, see this rebate table.
If you’re 31 or over, you usually need to pay 2% loading for each year you’ve gone without health cover since the 1st of July following your 31st birthday. You can find out more here.
Extras reset on 1 January each year.
Generally, 23. If they’re studying full time, dependents can be covered as a student under a family policy up to the age of 25. Children must not be married or living in a de facto relationship. Read our guide to learn more.
Visit nib.com.au or call 13 16 42.
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