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.
If you need to go to hospital for a service that has a Benefit Limitation Period (BLP) on your health cover, there will be significant out-of-pocket costs for your treatment during this period.
BLPs only apply to newly insured customers, so if you're changing covers or switching to nib from another residential health cover, you won't be affected. BLPs do not apply to Department of Veterans' Affairs gold card holders either. They're also only on certain health covers for certain services so check your cover information carefully, or contact us to find out more.
The time period that a BLP applies for will vary depending on your health cover, as will the amount you'll be able to claim back on services that have a BLP. Once the BLP is finished, you'll be entitled to the full benefit claimable from us for that treatment.
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. Restricted Benefits vary by State and Territory, the type of hospital and type of treatment provided.