Restrictions, waivers & MBP

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 member 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 members to upgrade their Hospital cover and waive the standard two month waiting period to access full benefits for psychiatric treatment.

This waiver is only available to members who have held hospital cover for at least the previous two months, have not previously used their waiver with us or any other fund, have been admitted to a hospital and are under the care of an addiction medicine specialist or consultant psychiatrist.

Members 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.

Restrictions

If a procedure on your policy is listed as "restricted," we'll only pay what's called a Public Hospital Benefit. In practice, this means you'll be covered for treatment in a shared ward of a public hospital, but the amount we pay towards a private room, whether in a public or private hospital, can vary depending on your state and our hospital agreements, and won't cover the full cost. Since we'll only cover part of the cost for a restricted procedure, you'll need to pay the difference yourself.

The best way to avoid surprises is to check exactly what you're covered for before you go to hospital. You can do this quickly in your member account or the nib App, or give us a call

Podiatric surgery restrictions

It’s important to know exactly what you’re covered for if you need podiatric surgery. Please note you will not be covered for theatre or specialist fees for procedures performed by a podiatric surgeon as these services are not eligible for a rebate through Medicare.

Restricted Hospital Benefits Only
If you are covered for Restricted Hospital Benefits Only, your hospital accommodation will be covered as a private patient in a shared ward in a public hospital.

Included Hospital Benefits Only
If you are covered for Included Hospital Benefits Only, your hospital accommodation will be covered as a private patient in an nib Agreement Hospital or a public hospital. If you choose to attend a non-agreement private hospital, you could experience significant out of pocket costs.

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