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').
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.
100% of the government-recommended fee (MBS) for medical treatment provided in a hospital including doctors, specialists, pathology and radiology.
100% of the rate State and Territory health authorities recommend for services charged to a patient who is not an Australian resident. Includes:
100% of the rate nib has established with the hospital through a contract. Includes:
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 OSHC benefit and the hospital accommodation cost. Find a nib Agreement Private Hospital.
100% of medically necessary transport provided by a State and Territory Ambulance Service.
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.
Prostheses listed on the Australian Government Prostheses Schedule as "no-gap prostheses". We'll also pay the minimum benefit for prostheses listed as "gap permitted".
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.
Services not covered by Medicare such as cosmetic surgery, laser eye treatment or experimental surgery
Treatment outside of Australia or arranged before arriving in Australia.
Services and treatments that are covered by compensation or damages of any kind (like workers compensation or third party insurance).
Luxury hospital rooms and other non-essential items like TV hire, beauty treatments and phone calls.
Just fill in a refund form and we will refund all or part of your payment if any of the following occur: