Legal Stuff

Rules, principles 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.
• Benefits will only be paid for claims which meet nib criteria.
• nib reserves the right to recover any money paid in error or obtained fraudulently, or by any other means contrary to nib's rules.
• Your customer number needs to be quoted on all claims - you'll find it on the front of your nib card.
• Benefits 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. nib policies are unfinancial if premiums are in arrears. nib may cancel policies that are more than 2 months in arrears.
• We believe it's important you and your family have the right cover. So, if you change your mind, just call us within 30 days of starting your cover. We will transfer you to another cover of your choice, or refund your premiums at your request, provided you have not made any claims.

Benefits are not payable for:

• Policy applications or claims where false or inaccurate information is supplied.
• Services by providers not registered with nib
• Services where a customer is eligible to receive benefits from workers' compensation or third party insurance
• Services given to customers of a provider's family, or to a provider's business partner and family. This also applies to people not independent from the provider's practice (e.g. employees)
• Services like examinations for life insurance, health certificates, mass immunisation, health screens and other expenses incurred for services required by employers.

Direct Debit 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 at 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

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.

Your nib card

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 where you can claim for any compensation from another party (e.g. workers compensation, third party insurance)
• 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.

Fraud

How we're protecting your premiums

We've got your best interests at heart by taking fraudulent activities seriously. We investigate inappropriate behaviour, detect where incorrect benefits are paid, and do our best to stop it from happening again, so the majority of customers don't end up paying more.

What is Fraud?

Fraud happens when a person receives a benefit payment they aren't entitled to, or uses false and/or misleading information to claim a benefit.

The problem is that it ends up costing everyone else, usually through increased premiums, and by using up your annual benefit limits. That's bad on both counts.

For example:

• A health care provider might claim for services that weren't performed or necessary
• An nib customer might let people not listed on the policy claim for benefits or send in false receipts to make a claim

What you can do

• Never leave your nib card with a provider - treat it like a credit card.
• Report lost or stolen cards immediately by calling us on 13 14 63.
• Get a receipt for all electronic claims (like HICAPS or IBA)
• Before each service, check that the:
  • Provider is an nib recognised provider (if unsure call 13 14 63)
  • Provider is qualified. (if unsure ask to see certificate of qualifications)
• Always check your receipt. Make sure the:
  • Name of patient and date of birth is correct
  • Name of provider is the provider who treated you.
  • Date of service is correct
  • Services received match the receipt

Report any suspicious activity to:

You can choose to remain anonymous. nib will support and protect the privacy of anyone who provides information.

nib Website Privacy Policy

nib recognises the importance of protecting your privacy. Our website privacy policy sets out how nib may collect, use or disclose information about you when you use this website, and your associated rights.

For further information regarding how nib complies with its obligations under the Privacy Act 1988 (Cth) to protect your information, please refer to nib's Privacy Policy.