What's Not Covered

• 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 membership from the joining date or when a member upgrades to a higher cover. In this instance, benefits are limited to the lower package until 12 months membership has been served in the higher cover.
• Membership applications or claims where false or inaccurate information is supplied.
• Obstetric conditions within 12 months of joining NIB, or when a member 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 member 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 members' contributions 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.