MBP, BLP & Restrictions

Minimum Benefits Payable

Minimum Benefits Payable (MBP) means if you're attending a private hospital, there will be significant out-of-pocket costs for the treatment. If the treatment is limited to MBP and is important to you, we recommend you consider a higher level of cover.

MBP is the minimum amount of benefits that we are required to pay under the Private Health Insurance Act, to or on behalf of a customer for hospital treatment under a hospital cover. For Psychiatric Treatment, Palliative Care and Rehabilitation, minimal benefits are payable if no Medicare benefit is payable for that part of the treatment.

Mental Health Waiver

The Mental Health Waiver allows customers to upgrade their Hospital cover and waive the standard 2 month waiting period to access full benefits for Psychiatric Treatment. This waiver is only available to customers who have held hospital cover for at least the previous 2 months, have not previously used their waiver with us or any other fund, have been admitted to a hospital and is under the care of an addiction medicine specialist or consultant psychiatrist. Customers who are eligible to receive the Mental Health Waiver may backdate their cover change to access full benefits beginning on their date of admission, provided they contact us on or before the fifth business day after their date of admission. To find out more, call us.

Benefit Limitation Period

A Benefit Limitation Period (BLP) is a set period of time on a policy where a health insurer will only pay a minimum benefit for certain services, which can result in significant out of pocket costs for the customer.

From 1 July 2018, we've removed all BLPs from our products. If a BLP applied to your product and you received treatment prior to 1 July on a service that had a BLP, you may experience significant out of pocket costs for that treatment.

Restrictions

For procedures listed as "restricted" on your policy, nib will only pay a benefit called a Public Hospital Benefit. This means you will be covered in a shared ward of a public hospital, but it won't go anywhere near covering you for the cost of staying in a private room in public hospital (generally covers around 50% of the cost) or in a private hospital (generally covers between 5% and 30% of the cost).

nib will only pay for part of the restricted procedure, and you'll have to pay the difference. You may need a higher level of hospital cover if you think you may need to have a restricted procedure done in the future.

For example, if hip or knee replacements are restricted on your health cover and you go to private hospital for one of these procedures, your health cover will only pay a small part of your hospital costs. You'll have to pay considerable out-of-pocket expenses towards your treatment.

Please note you will not be covered for theatre or surgeons' fees for procedures performed by a podiatrist as these services are not eligible for a rebate through Medicare.

To see if any of these apply to your policy, please contact us. For more information, you can also see the Policy Booklet.