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Restrictions, Waivers & MBP

Sometimes a procedure isn't included or excluded on your cover - confusing, right? Here are the definitions for the main ones you'll see in some of our health covers.

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 members 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 members 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.

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

For procedures listed as "restricted" on your policy, we 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).

We 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.

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.

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