Glossary
Accident (relating to nib hospital cover) An accident, in relation to nib hospital cover, is 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 other cause.
If you're in an accident, you and the attending doctor in hospital must complete an Accident Form (available from nib).
For customers with Basic Saver, Basic Plus, Mid Plus, Family Plus, Family Basic Saver, or Young at Heart Mid: if you have an accident, you’ll be covered for hospital services normally excluded or restricted on your health cover, provided you have been formally admitted as an inpatient and the services are undertaken during the first admission to hospital. This admission must be within 24 hours of the accident’s occurrence. For any subsequent admissions resulting from the accident, exclusions or restrictions under your cover will apply.
Accommodation Includes the hospital bed, patient meals and nursing care in a hospital. It doesn’t include treatment by health professionals such as doctors. Admission To get treatment for an illness or condition as a private patient in a registered public, private or day hospital you must be admitted by a medical practitioner.
Treatment in the emergency room of a private hospital is not an admission. Annual benefit limits This is the maximum amount nib will pay, and/or the number of times you can claim, for each Extras service over a certain period of time. Most limits are for a calendar year. At the beginning of each calendar year, your annual benefit limits are renewed allowing you to claim again. Antenatal Classes – childbirth education classes that are run by a midwife or physiotherapist (in private practice) prior to the birth of the baby. Antenatal classes teach breathing and birthing techniques to help during childbirth.
Visits – a consultation between an expectant mother and her midwife (in private practice) where for example, the mother has her blood pressure checked and the baby’s heart rate is monitored. Artificial Aids An aid/appliance (e.g. nebuliser, blood glucose monitor or wheelchair) or prosthesis (e.g. mammary prosthesis following mastectomy, or a wig required as a result of medical treatment). An extensive list of items covered is available by calling
13 14 63 or by emailing us. Items must be ordered by a medical practitioner (doctor). Items supplied by a public hospital are not covered. Benefit Benefits are the dollar amount nib pays when you make a claim for an item or service covered by your nib health cover. How much you get depends on the type of cover you have, what your doctor, hospital or provider charges and your choice of doctor, hospital or provider. Benefit Limitations Some nib covers require a customer (who is new to private health cover) to be with nib for a period of 24 months before certain hospital services are included as part of their cover. During the first 24 months of cover (but after the standard hospital waiting periods have been served), benefits payable for these services will be limited to Public Hospital Benefits only. Calendar year January 1 to December 31. Dietetics Services provided by a registered dietitian. Does not include membership in diet clubs/programs such as Weight Watchers. Endodontia The treatment and prevention of disease in the tooth pulp. Includes root canal therapy. Excess An excess is the amount you elect to pay towards your hospital admission, before we pay a benefit. It's one of the things you can't claim back. Selecting an excess means your premiums are lower.
The excess is only payable if you, or someone on your policy, go to hospital - it does not apply to Extras cover.
Depending on your health cover, you'll have to pay the excess each time you are admitted to hospital. But we cap it to a set amount per year. The amount varies depending on your health cover.
Important - Please note that if you change your cover to a lower excess and you’re still serving waiting periods, your previous hospital cover excess may apply. See Hospital Waiting periods for more information
Good news for families.
If you’re on a selected family cover, you won’t pay an excess if one of your child dependants (up to 21 years of age) has to go to hospital.
Before going to hospital, you should always check your cover's hospital excess.
Exclusions Some procedures are excluded from some hospital covers – which means you won’t be covered in a public or private hospital and won’t receive a benefit from nib for that procedure. Always check with nib before you go to hospital to find out if you've got the cover you need. Extras Extras are the out of hospital services included in your nib health cover. Depending on your health cover, these include things like dental, physio, chiro, glasses and frames, remedial massage, acupuncture and natural therapies.
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