|
About your nib cover
- Are there any sources of information about my rights as a privately
insured customer?
- When are benefits payable?
- When are benefits not payable?
- How do I submit feedback or a complaint?
- How do I know what my hospital benefits will be?
- What am I covered for if I need to go to hospital?
- How do I change my nib cover?
- What is an nib agreement private hospital?
- Will nib pay my health care benefits when I travel overseas?
- What payment options are available?
- What are some of the principal rules and by-laws?
- What is the Private Patients' Charter?
- What is the nib Loyalty Bonus?
- What are pre-existing ailments and conditions?
- What is an nib recognised Provider?
- What's NOT covered in hospital?
- Who is covered by my health cover?
- Where do I find a Standard Information Statement (SIS)?
1. Are there any sources of information about my rights as a privately insured customer?
The Private Patients' Hospital Charter, outlines what customers can expect from doctors,
hospitals and their health fund. Copies of the charter are available from nib.
The Private Health Insurance Ombudsman, is an independent body, established to deal
with enquiries about private health insurance and to help resolve complaints. Services
are provided free of charge. Initial inquiries/complaints should always be directed
to nib and we will do our utmost to resolve the issue for you.
If you need to contact the Ombudsman you can phone 1800 640 695, write to Level
7, 362 Kent St, Sydney NSW 2000, email: info@phio.org.au
or visit their website www.phio.org.au.
2. When are benefits payable?
A benefit is the payment you receive when you claim for an item or service covered
by your policy. Benefits payable are listed in your health cover details. If
the cost of the service is less than the listed benefit then the lesser amount is
payable. Benefits are only payable for services provided to people covered by your
policy.
If you are transferring from another health fund and have used up part or all of
your annual benefit limits, nib will take this into account in determining your
entitlements for the remainder of the calendar year. Where the benefit is higher
than paid by your previous fund, the lower benefit will be paid until the appropriate
nib waiting period has been served.
Customers should call 13 14 63 or email
nib to check benefit entitlements before service/treatment begins.
3. When are benefits not payable?
- Pre-existing ailments or conditions, the sign or symptoms which were apparent 6
months prior to joining nib (whether or not diagnosed by a doctor). Where necessary,
information will be sought from the relevant doctor and any fees raised by the doctor
will not be paid by nib. This rule applies for 12 months continuous cover from
the joining date or when a customer upgrades to a higher cover. In this instance,
benefits are limited to the lower package until 12 months has been served
in the higher cover.
- Policy applications or claims where false or inaccurate information is supplied.
- Obstetric conditions within 12 months of joining nib, or when a customer transfers
from a cover without obstetrics to a cover with obstetrics.
- Professional services provided to members of the provider's family or to a provider's
business partner / family members or other people not independent from the practice.
Only wholesale material costs involved in the provision of the service are payable.
- Certain professional services which are excluded from benefits such as examinations
for life insurance, certificates of health, mass immunisation, health screening
services and those expenses incurred for services required by employers etc.
- Services that are for treatment where a customer or dependant has received or established
a right to receive a payment by way of compensation or damages. Where rights to
receive payments by way of compensation or damages have not been determined, nib
may make provisional payments of benefits pending the determination or settlement
of the claim. nib has the right to recover any such payments made once a determination
or settlement has been granted.
- Any period where the customers' premiums are in arrears.
- Services by providers
not recognised by nib. Call 13 14 63 or
email nib to check your provider is recognised by nib before receiving treatment.
- Services not recognised by nib.
- Services listed as excluded on your product.
4. How do I submit feedback or a complaint?
At nib we welcome feedback and complaints, as we learn more about satisfying customers
and what could improve our services and products. You can:
- Call 13 14 63. Customer Care Consultants are available Monday to Friday, 8.00am to
8.30pm (EST), and Saturday, 8.00am to 1.00pm (EST).
- Email Us to submit your feedback
- Visit an nib Retail Centre
and speak to one of our retail consultants.
If you prefer to express your complaint in writing, or if you don't feel your complaint
has been resolved, write to the nib Customer Relations Team:
- Reply Paid 62208, Locked Bag 2010, Newcastle NSW 2300
- Fax (02) 4927 2142
nib will make every possible effort to resolve your complaint to your satisfaction.
In the event that you are not satisfied with the outcome of your complaint,
you can contact the Private Health Insurance Ombudsman (PHIO)
5. How do I know what my hospital benefits will be?
Before going into hospital, email
nib or call 13 14 63. You will need to check if you're covered for the procedure,
if you're using an nib agreement private hospital, and if you'll incur any 'out
of pocket' expenses.
Click here for more information about going to hospital.
6. What am I covered for if I need to go to hospital?
- After 35 days of continuous hospitalisation (readmission within 7 days or less to
the same or another hospital is also classed as continuous), a certificate from
your doctor is required confirming the need for continued acute hospital care in
order to maintain your full hospital benefits. If this certificate is not issued,
benefits payable will be reduced to the Nursing Home Type patient benefit.
- Paramedical services provided to a private hospital in-patient such as physiotherapy,
pharmacy, and exceptional drugs will be paid contract benefits and customers will
bear any excess cost.
- Procedures not normally requiring hospital treatment (type C procedures) without
valid certification are not covered.
- Significantly lower hospital benefits are payable where procedures are not recognised
by Medicare for benefit purposes (e.g. laser eye surgery and reversal of sterilisation).
- Psychiatric patient cover is limited to
- on a day only basis, up to 30 days per calendar year
- on an overnight basis, up to 65 days per calendar year (day only admissions are
included in this 65 day limit)
- Once these limits have been reached, or where readmission for these conditions occurs
within the same calendar year, lower benefits are payable.
- Products Basic Saver, Family Basic Saver, Mid Plus, Family Plus, Basic Plus, Safeguard,
Bodyguard, Public Hospital Plus Extras and Public Hospital pay significantly lower
benefits for psychiatric services. Benefits are equivalent to the basic default
benefit set by the Commonwealth Government.
- Just Hospital pays significantly lower benefits for psychiatric services during the
benefit limitation period. Benefits during the benefit limitation period are equivalent
to the basic default benefit set by the Commonwealth Government.
- Rehabilitation patient cover is limited to
- on a day only basis, up to 30 days per calendar year
- on an overnight basis, up to 65 days per calendar year (day only admissions are
included in this 65 day limit)
- Once these limits have been reached, or where readmission for these conditions occurs
within the same calendar year, lower benefits are payable.
- Products Basic Saver, Family Basic Saver, Family Plus, Basic Plus, Safeguard, Bodyguard,
Public Hospital Plus Extras and Public Hospital pay significantly lower benefits
for rehabilitation services. Benefits are equivalent to the basic default benefit
set by the Commonwealth Government.
- Just Hospital pays a significantly lower benefit for rehabilitation services during
a benefit limitation period. Benefits during the benefit limitation period are equivalent
to the basic default benefit set by the Commonwealth Government.
7. How do I change my nib cover?
Email nib, call 13 14 63 or
visit an nib retail centre
for assistance. If you are moving interstate you'll need to check how this may affect
your cover.
Got the right cover?
Whether you have nib cover Just for You, for Both of You or For All of You, it makes
sense to always check that you've got the right cover to suit where you're at in
life. If you're not sure, give us a call on 13 14 63 or visit one of our
retail centres, and we'll help you get the cover that's right for you.
8. What is an nib agreement private hospital?
An nib agreement private hospital is one which has negotiated charge agreements.
Subject to your level of cover, this provides for in-patient accommodation fees
including bed fees, theatre and labour ward, intensive and coronary care. We are
continually adding hospitals
to this list.
Customers who choose to use a non-agreement private hospital will incur out-of-pocket
expenses for most hospital related services.
Before receiving hospital treatment phone 13 14 63 or
email nib to confirm your benefit entitlements.
9. Will nib pay my health care benefits when I travel overseas?
Travel insurance that covers a
wide range of benefits can be arranged by nib.
All nib health covers provide hospital and/or Extras benefits for services received
in Australia only.
10. What payment options are available?
nib offers a range of flexible payment methods, including:
 |
Direct Debit |
Automatic direct debit from your bank, building society or credit union cheque or
savings account gives you a discount of up to 4% (not available on Ambulance Only
cover). Download a Direct Debit
Authority |
 |
Credit Card DD |
Automatic direct debit from your Bankcard, MasterCard, Visa, American Express or
Diners Club account. Download a
Credit Card Direct Debit Authority |
 |
nib Phone pay |
Call 1300 650 678, 24 hours a day 7 days a week and just follow the prompts
to pay using your Bankcard, MasterCard, Visa, American Express or Diners Club card. |
 |
nib Retail Centre |
Visit a retail centre to make
your payment. Cash, cheque and credit cards are accepted. |
 |
BPay |
If you usually pay at a Retail Centre, you can use BPAY to pay via the internet
or phone banking. The nib Biller Code is 364158 and Reference Number is your customer
number. These details will be displayed on your payment slip. |
 |
Post billpay |
Visit your nearest Australia Post office and present your nib card when
making your payment. |
 |
Australia Post |
Take your nib card and pay by cash, cheque, credit card or EFTPOS |
 |
Mail |
Mail us a cheque made payable
to "nib health funds" |
11. What are some of the principal rules and by-laws?
- You can't have the same type of health cover with more than one health fund (e.g.
you can't have a Hospital and Extras package with 2 health funds). But you can have
hospital only cover with one health fund and extras only cover with another.
- Claims will only be paid if they meet nib criteria.
- nib reserves the right to recover any money paid error or obtained fraudulently,
or by any other means contrary to nib's rules.
- Your policy number needs to be quoted on all claims - you'll find it on the
front of your nib card.
- Claims are only paid if the claim is made within 2 years of when you received the
service or treatment.
- Customers will not be paid any benefits if they are not financial. Policies are
unfinancial if premiums are in arrears. nib may cancel policies that are
more than 2 months in arrears.
Direct Debit request Service Agreement
1. nib's commitment to you
- nib will give you at least 14 days notice in writing if there are changes to the
details of your debit.
- Any information about your account will remain confidential, except where required
to complete direct debits with your financial institution
- When the due date is not a business day, nib will debit your account on the first
working day after the due date.
2. Your commitment to us
It is your responsibility to:
- Ensure your nominated account can accept direct debits
- Ensure there are enough funds available in your account to make the payment on the
due date
- Tell us if your account
details change, or if the account is transferred or closed
- Arrange a different payment method if nib cancels the debit arrangements
- Ensure all account holders of the nominated account sign the
Direct Debit Request
- Tell us your new credit
card expiry date.
3. Your rights
You can change the debit arrangements in line with the terms and conditions of your
nib policy. You need to tell
us least 7 working days before the next due date for any of the following:
- Stopping a payment
- Deferring a payment
- Suspending any future payments
- Altering the Direct Debit nominated account details
- Cancelling the debit arrangement completely
4. Enquiries and Disputes
If you have any enquiries about your direct debit, or if you believe a debit has
been made incorrectly, please contact us immediately.
Call the nib Customer Care Centre on 13 14 63 ,
email us or write to:
nib health funds
Reply Paid 62208, Locked Bag 2010,
Newcastle NSW 2300.
If you are not happy with nib's response you can write to the nib Transactions
Manager at the above address.
5. Other information
- nib reserves the right to determine how you give instructions to stop or alter your
direct debit details (e.g. written, verbal or electronic).
- nib reserves the right to cancel direct debit arrangements if your financial institution
dishonours debits, and to arrange a different payment method with you.
- The details of your direct debit arrangement are contained in your Direct Debit
Request. nib will rely on those details to process your payments until you tell
us otherwise.
nib Card Conditions of Use
By using your nib card, you agree:
- To be bound by the by-laws and rules of nib, including any changes we make to these
rules in the future
- To tell us if any information
on your card is incorrect
- To show additional ID if requested by a provider
- To use your card to claim for services used to treat you or someone listed on your
card
- To tell us if you are claiming
for treatment that relates to an accident, or if you can claim for any compensation
from another party (e.g. workers compensation)
- That your nib card does not confirm that you are a financial customer
- That your policy details must be confirmed by nib before we can pay any claims
- To let nib share information with other people listed on the nib policy. This
means we may make other customers aware, for example, of some benefits and services
claimed on the policy.
More important info about your nib card
- Your card is not transferable
- Don't leave your card with any provider or other party
- Your card is the property of nib - you must return it if asked
- You must return or destroy your card if your nib policy is cancelled
- You must tell us immediately
if you lose your card or if it is stolen.
12. What is the Private Patients' Charter?
This publication outlines what customers can expect from doctors, hospitals and their
health fund. Copies are available from any nib Retail Centre, by calling 13 14 63
or by email.
13. What is the nib Loyalty Bonus?
The nib Loyalty Bonus program
rewards you for each year you are an nib customer, based on your level of cover.
It's our way of saying 'thank you'.
The nib Loyalty Bonus gives you greater value from your health cover, and gives
you the freedom to manage your rewards when you need them.
Once you've reached the annual benefit limit on any of your essential everyday extras
(such as dental, optical, physiotherapy and natural therapies) you can use your
nib Loyalty Bonus 'dollars' to increase the amount you can claim per year.
Any unused bonus dollars can be rolled over to the next year, up to your cover's
maximum limit.
14. What are pre-existing ailments and conditions?
A pre-existing ailment/condition is an illness or condition where the signs or symptoms
were evident (whether or not diagnosed by a doctor) at any time during a period
of 6 months immediately prior to the time of joining a health fund. This is an industry
standard rule applied by all health funds for the protection of existing customers
If the ailment, illness or condition is considered to be pre-existing, you'll have
to wait 12 months before you can use your hospital cover for treatment provided
your product covers the treatment.
If you have had a lower level of hospital Cover before your current nib Hospital
Cover, you'll get benefits at the lower level, provided your cover doesn't have
any restricted or excluded services.
If you want to know more about how we check pre-existing conditions and ailments,
and what your options are, please
contact us.
15. What is an nib recognised Provider?
Benefits are paid for services by providers recognised by nib.
The providers must be in private practice and services performed in their own consulting
rooms. Providers are required to meet certain criteria in order to be recognised
by nib (e.g. professional qualifications, membership of a professional association
recognised by nib, holders of a provider number issued by the Commonwealth).
It is recommended that customers contact
us before undergoing treatment to determine if their provider is recognised
by nib.
nib encourages providers to offer high-quality products and services at competitive
prices to customers.
nib neither takes nor assumes any responsibility for the product and/or service
provided.
Customers should rely on their own enquiries and seek any assurance or warranties
directly from the provider of the service or product.
nib benefits are limited to one benefit per patient, per provider, per day. If a
provider performs multiple visits/services within one consultation, the treatment
that attracts the higher benefit will be paid. Where multiple visits/services are
performed on the same day at different times by the same provider then only one
visit/service is payable (e.g. morning and afternoon visit/service).
Sometimes, providers are recognised by nib only for specific Extras. For example,
nib might recognise a provider for Acupuncture, but not for remedial massage. This
means you couldn't claim remedial massage, but could claim Acupuncture.
16. What's NOT covered in hospital?
- private room accommodation for same day procedures
- luxury room surcharge
- tv hire, telephone calls, newspapers, magazines etc.
- beauty salon services
- massage and aromatherapy services
- respite care
- take home items e.g. crutches, drugs etc
- experimental treatments
- procedures normally performed in a doctor's surgery
- private hospital emergency fees
- donated blood, blood products, blood collection and storage
- special nursing e.g. your own private nurse
- out-patient services
nib does not cover all hospital expenses. For more information on fees which are
not covered by nib, contact nib.
17. Who is covered by my health cover?
Whoever first applied for your nib health cover is the 'policyholder'. They
are legally responsible for the policy, and anything we send will be addressed
to them. Anyone else who's listed on your policy is also covered.
We have a range of products to suit your needs, wherever you are in life.
Cover for:
- Just for you - cover for singles. Your policy is for a single person only.
- Both of you - cover for couples. Your policy is for you + your partner
- All of you - cover for all the family. Your policy is for you + your partner
+ all unmarried kids or unmarried students up to age 21.
If you have dependants who are aged between 21 and 25,
who are studying full time and aren’t married
or in a de facto relationship, they can still be covered by your policy.
We call them Student Dependants.
We’ll send you a Student Dependant Registration
Form when they turn 21, and then each year until they turn 25, so they stay covered.
18. Where do I find a Standard Information Statement (SIS)?
nib has Standard Information Statements for all our health covers. They give information
about our products in a format that's being used by all health funds.
Click here to find a Standard Information Statement.
|