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What am I covered for in Hospital and in an emergency?

Unsure what you’re covered for when it comes to Hospital and emergency situations? We've answered some frequently asked questions.

Log in to check your cover

The easiest way to see what you are covered for is to log into your Member account or the nib App.

What is Hospital cover? 

It’s all in the name, with Hospital cover helping to cover your costs in hospital. Before heading off to hospital, take a look at our going to hospital, opens in a new tab guide to find out what options you have and learn how to get the most from your cover.  

What's covered when you go to the hospital?  

Both nib and Medicare may help cover the cost of your hospital fees. However, not all services will be covered, so see what is covered, opens in a new tab to find out more.  

Am I covered for an Emergency?  

Most of our health cover packages include unlimited emergency ambulances with a one-day waiting period*. Find out what's covered on our Ambulance cover, opens in a new tab page, or head to what to do in an emergency, opens in a new tab to find out more.  

How do I know if I'm covered for a hospital procedure or treatment?  

In your member account or nib App, you can search your medical item number in the Going to Hospital tool, opens in a new tab to see if you are covered for an inpatient procedure or treatment. Outpatient services such as seeing your General Practitioner or Pathologist cannot be confirmed via the tool. You can also read through our going to hospital, opens in a new tab guide to help you prepare for your upcoming admission. 

What are out-of-pocket hospital expenses?  

Out of pocket expenses, opens in a new tab are when you are charged more for a medical service than what you get back from your health cover and Medicare. These fees will depend on the specific hospital and doctor you choose. However, by choosing a specialist that participates in nib Medigap, opens in a new tab and an nib Agreement Hospital, you may be able to significantly reduce your out-of-pocket expenses. Use the find a provider, opens in a new tab tool to find a hospital or specialist in your area.  

What are in-patient vs. out-patient services in the hospital?  

The difference between inpatient and outpatient services depends on if a patient has been formally admitted to hospital for medical treatment. Whether you are an in- vs. out-patient will impact your hospital costs and cover. For more information, check out Inpatient Vs. Outpatient: What’s the difference?, opens in a new tab   

Does health insurance cover x-rays in hospital?  

Most of the time, x-rays you get while you’re an in-patient in hospital will be covered, but you are generally not covered for outpatient x-rays.   

How can I see which hospitals and specialists offer the best value? 

Use the find a provider, opens in a new tab search to find specialists and hospitals in our network in your local area. We have special agreements with providers in specific locations across Australia to help minimise your out-of-pocket costs for hospital visits. These arrangements apply to certain procedures and are exclusive to Australian residents. You may be able to access No Gap services if the procedure or treatment is covered by your policy (and you've completed any waiting periods). Out-of-pocket expenses like hospital excess and anesthetist fees may apply. Learn more about our No Gap and Known Gap networks., opens in a new tab 

What are the waiting periods for hospital treatments?  

Whenever you join or update your health cover, a ‘waiting period’ is in most cases, required. This is the time frame you must wait before claiming any benefits on your health cover. For more information, visit our waiting periods, opens in a new tab page.   

I’m an international member, am I covered for hospital? 

International members can check what they are covered for by logging into your Member account, opens in a new tab or the nib App, opens in a new tab. If you’re looking to switch, extend or join an nib health cover, check out our Overseas Student Health Cover, opens in a new tab (OSHC) or Overseas Visitors Health Cover, opens in a new tab (OVHC) to discover what is included in our international health covers.  

How do I review my Hospital cover? 

We recommend looking at your policy each year to ensure you're getting the right level of cover to suit your lifestyle. Log in to your member account or the nib App anytime to check what you're covered for and find the best health insurance for your needs. Here's a helpful article that explains how to review, update or change your cover, opens in a new tab in your member account or the nib App quickly and easily.

If you're an Overseas Student or Overseas Visitor, you'll need to call us on 13 16 42, opens in a new tab to talk about changes such as adding people to your policy.

* Emergency Ambulance cover is not available to: (i) QLD & TAS residents who have ambulance services provided by their State ambulance schemes; (ii) TAS residents who are covered under state ambulance schemes in TAS and when travelling in mainland Australia except NSW, SA or QLD; or (iii) pension and health care card holders who have ambulance services provided by State ambulance schemes (check entitlements with Centrelink if unsure).

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