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Orthodontia claiming

Each product that covers orthodontia has a starting annual limit. You are able to claim up to this starting annual limit once you have served your 12 month waiting period for orthodontia.

For each calendar year that you are with nib, the orthodontia annual limit will increase by $100, even if you haven’t had cover for orthodontia previously. For example, if you join an nib Extras cover with a starting annual limit of $800, after the 12 month wait has been served you are entitled to $900 in your second year with nib and $1000 in your third year and so on and so on.

Each of our products also has a lifetime limit on the orthodontia benefit which means you can only claim up to this amount whilst you are a customer. Once you reach this lifetime limit you are unable to make any further claims for orthodontia.

How do I make a claim for my orthodontic treatment through nib?

  1. Claim for your orthodontic benefits via the HICAPS terminal at your orthodontist. Just swipe your nib card and all you have to pay is the difference. Other claiming options are also available.
  2. If you are considering orthodontic treatment, please contact us so we can discuss your benefits with you. Each different nib policy will deliver a different benefit. You may also have a greater benefit dependent upon the number of years of cover you have had with nib.
  3. Send us a copy of your treatment plan. We can use this to quote you an estimate based on the payments you are required to make and the length of your treatment.

If you pay for your orthodontia up front or pay a large lump sum during the course of your orthodontic treatment, you can continue to claim for orthodontia in the following years; as long as you are still undergoing active treatment (i.e. if you still have your braces on). We will continue to pay your orthodontic benefits up to your annual limit and the lifetime limits that are applicable to your policy.

Frequently asked questions

Q: I’m a long-time member of nib but recently upgraded my nib health cover to include orthodontia - does my loyalty count towards how my orthodontia limit is calculated?

A: Yes. For example, if you have been with us for 10 years on a cover that does not include orthodontia and you upgrade to a cover that does include orthodontia, you will be entitled to 10 years of benefits for orthodontia, but can only make a claim for it once the 12 month waiting period has been served.

Q: If I switch health funds will my previous orthodontia benefits be carried over?

A: If you are switching from another health fund and had orthodontia included on your previous health cover, the length of time you held cover for orthodontia with your previous health fund will be recognised, and your orthodontia annual limit will be automatically increased.

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