Skip to content

How to make a claim

You might need to make a claim after going to hospital or after using a service from your Extras cover. Most of the time you won’t even realise you’re claiming - just swipe your card after treatment and we’ll take care of it. If you do need to submit a claim, most the time you can snap a photo of your receipt to claim in the nib App or Online Services. If you have any questions about claiming, we’ve got the answers here.

Claiming after a hospital visit?

You generally won’t receive a hospital bill if your procedure was included on your health cover, you went to an nib Agreement Hospital and your doctors participated in MediGap. If you did receive a bill, please see our Hospital billing information for more detail, including how to claim it.

How do I make an Extras claim?

There are a few ways you can claim on your Extras benefits (like your visit to the dentist or physio appointment) but most members just swipe their nib card when they pay their provider.

Swipe your nib card Claiming on the spot at your provider is the easiest way to claim. If your provider has this service available, just hand over your nib card after your treatment and they’ll swipe it through their terminal. The amount nib can pay will be automatically calculated so you just pay the gap.

Claim online or in the app If claiming on the spot isn’t an option for you, you can either use the nib App or Online Services from your computer, phone or tablet to submit your claim.

Simply hit “claim now” in the nib App, take a photo of your receipt when prompted (make sure it’s not blurry and that all details can be read!) and submit. We’ll pay Extras benefits like dental and chiro straight into your account within five working days.

Make sure you have registered for Online Services so you can use the app to make your claims.

Other claiming options

Visit an nib Retail Centre Our friendly customer care consultants will talk to you about the convenient ways you can claim. Find your nearest nib Retail Centre.

By mail Complete an nib Claim Form, attach all of your original receipts and mail them to nib health funds, Locked Bag 2010, Newcastle NSW 2300.

Before you make a claim, you should check if any waiting periods apply, that your provider is a recognised provider with nib and if you have used your annual limits.

Frequently asked questions

Q: What details need to be included in my claim?

A: Use our checklist to make sure your claim meets all of the claiming criteria:

  • You’ve provided the original document (not copies).
  • The account is itemised (that is, all items and their charges have been listed separately on the account).
  • The account has been paid in full.
  • It’s on the provider’s official stationery or has the provider’s official stamp
  • For doctors' or specialists' bills, make sure you claim these with Medicare first. We can only pay a benefit for the services of doctors or specialists that you received while you were an admitted private patient in hospital.
  • For healthier lifestyle claims, ask your doctor to complete a Health Management form and submit this with your claim.
  • Make sure everything is written in English (this helps us process your claim faster).

Q: How can I find out how much I have left to claim?

A: You can check your remaining annual limits by going to the My Usage tab in Online Services or in the App, or you can contact us.

Q: Is there a time limit I need to make my claims by?

A: We only pay claims within 2 years of the date you had the service, so don’t delay.

Q: Where can I see my claims history?

A: You can login to Online Services or the App to view your claims history. In Online Services, you’ll find “Claims History” under the My Usage tab on the menu. In the App, you’ll find “My claims” listed in the navigation.

Q: What happens after I make a claim?

A: Claims made in Online Services will be processed within two business days. You’ll receive a text message once the claim has been paid into your account. If your claim has been rejected, you’ll receive a claim rejection letter via the preferred method of contact we have listed for you. To check or update your contact details, head to Personal Details in the My Policy section of Online Services or the App.

Q: Why was my claim rejected?

A: There are a number of reasons a claim may be rejected. According to our claims team, in 2018* the top reasons a claim was rejected are:

  • We don’t cover the service (Eg. aromatherapy, hypnotherapy or swimming lessons).
  • Information is missing from the receipt/s provided.
  • You don’t have the service included on your cover.
  • The photo of your receipt was blurry.
  • The service is covered by Medicare which means you must submit to Medicare first, and then complete your claim with us.

If you are unsure why your claim has been rejected, please contact us.

*Data from 1 January 2018 to 1 October 2018

Continue to the next page

Related articles

How do I claim Medicare and can I do it online?

Why do I have to pay a gap when being treated in hospital?

How to claim on the nib app