Doctors and Specialists

Your health cover will help you pay for doctors and specialists. In Australia your doctor is called a GP (or ‘General Practitioner’).

Doctor visits 100% of the government-recommended fee (known as the 'MBS') for general practitioner (GP) consultations which are not part of a hospital stay. Note: If your GP charges more than the recommended fee, you will be required to pay the difference (known as a 'gap').

Specialist services Benefits will depend on your level of cover, starting from 85% of the government-recommended fee (MBS) for specialist services including pathology, radiology and other specialists providing treatment which is not part of a hospital stay.

Hospital

As a nib customer you have the choice of being admitted to a public or private hospital. Private hospitals allow you to avoid long public hospital waiting lists and allow you to choose your preferred specialist.
Public hospital
The amount set by State and Territory health authorities (referred to as the 'gazetted rate') for services charged to patients who are not Australian residents. If the hospital charges higher than the gazetted rate you may experience significant out of pocket expenses.
Includes:
- shared ward accommodation, theatre fees and same day services
- accident and emergency services
- post-operative services and related medical treatments which don't require a hospital stay

Private hospital
100% of the rate nib has established with the hospital through a contract. Includes:
- private or shared room accommodation
- theatre fees and same day services

Note: If you choose to be treated in a private hospital nib does not have a contract with, you will be required to pay any difference between the default benefit and the hospital accommodation cost. nib Agreement Private Hospital.

Emergency Ambulance

nib will pay for emergency and medically necessary ambulance transport provided by a state or territory ambulance service anywhere in Australia. Call out fees (where you are treated at the scene and transport is not required) are also covered. ‘Emergency’ and ‘medically necessary’ is determined by the attending doctor. 100% of medically necessary transport provided by a State and Territory Ambulance Service.

Accident

“Accident” means an event leading to bodily injury caused solely and directly by violent, accidental, external and visible means and resulting solely, directly and independently of any cause.
Waiting Period: No wait

Prescription Medication

nib will help you pay for some prescription medications. Prescription medication is medicine that a doctor has prescribed to treat an illness. Up to $50 per prescription item listed on the Pharmaceutical Benefits Scheme (PBS), after you pay the PBS Patient contribution. You can claim up to $300 per person per calendar year, capped at $600 for families.

Vaccines

Immunisations and Allergy Vaccines
Up to 50% back per claim, up to the yearly limits for Immunisations and Allergy Vaccines listed on the National Immunisation Program Schedule – includes Human Papillomavirus (HPV).
Annual limits apply: $100 yearly limit for singles, $100 per person, up to a $200 yearly limit for couples and families.

Infertility treatments

Infertility treatments like assisted reproductive services or in-vitro fertilisation and secondary conditions related to infertility treatments

Treatments by dentists, physiotherapists, chiropractors or any other Extras service providers (unless directly related to a hospital admission and completed in hospital), or other Extras services such as glasses, hearing aids or artificial aids.

Waiting periods apply if you are new to health insurance. You need to serve the waiting periods before you are entitled to receive the benefits