Changes to how private room stays in NSW public hospitals are covered

From 1 October 2026, if you’re admitted to a NSW public hospital as a private patient and choose to stay in a private room, you may need to pay the difference between the private room rate and the shared ward rate. This could increase your out-of-pocket costs.

• If you have Gold tier cover or are a GU Health member, this change does not affect you. You’ll continue to be covered the same as you are today for a private room where one is available.

• All other Hospital cover: if you have a planned admission as a private patient to a NSW public hospital from 1 October 2026 and you choose to stay in a private room, you may need to pay the difference between the private room rate and the shared ward rate. This could result in out-of-pocket costs.

This change will not affect your treatment, your healthcare team or access to a private room if it’s clinically necessary for your care. It only changes how accommodation is funded in NSW public hospitals.

If you have Gold tier cover or are a GU Health member, nothing changes. If you choose to be treated in a private room, you'll continue to be covered where one is provided.  

Members with overseas student health cover or overseas worker cover aren't affected. However, if you are an international member who also has an Australian health insurance policy that includes Hospital cover, these changes may apply to you. We’ll contact you directly if you’re affected.

If you have any other level of cover, including members with Hospital cover held through an nib underwritten brand, including Qantas Health Insurance, AAMI Health Insurance, Apia Health Insurance, Real Health Insurance, Australian Seniors Health Insurance, Suncorp Health Insurance and ING Health Insurance, then this change may affect you.

This change does not affect any waiting periods you're required to serve under your existing policy.

The changes apply to planned admissions from 1 October 2026.

The changes will not affect members admitted to a NSW public hospital as a private patient before 1 October 2026.

A private room is a single room just for you. A shared ward is a room you share with other patients. Either way, you get the same clinical care from the same medical team.

No. This will not affect your clinical care, treatment decisions, access to hospital services, your healthcare team or access to a private room if it’s clinically necessary for your care. You'll still choose your hospital and your doctor. The only thing changing is the accommodation rate nib pays towards private rooms where a member chooses to stay in one.

No, the cost of your medical care, including your procedure, your doctors and the services you claim for, isn't changing. The only thing changing is the accommodation rate nib pays towards private rooms where a member chooses to stay in one. If you're an affected member and choose to stay in a private room when you have a planned admission to a NSW public hospital, you may be charged out-of-pocket costs by your admitting hospital.

No, this isn't a change to your product or policy. It's a change to our funding of private room accommodation charges in a NSW public hospital. Your cover and the services you're entitled to claim stay the same.

If you're admitted to a public hospital, you can usually choose to be treated as a public patient under Medicare or use your private health cover as a private patient. As a private patient, you use your private health cover, which may give you more choice over your treating doctor and, in some cases, your admission timing. Being treated as a private patient can involve costs such as an excess or gap fees, so it's worth understanding what you'd pay before you decide.

From 1 October 2026, if you're an affected member and choose a private room, you may need to pay the difference between the private room rate and the shared ward rate.

Always check what you're covered for before going to hospital by logging into your member account. Your hospital can also explain any out-of-pocket costs before you're admitted.

Yes, you may still choose a private room where available. For affected members, we'll pay the shared ward accommodation rate. Your admitting hospital may require you to pay the difference between the private room rate and the shared ward rate. This could increase your out-of-pocket costs.

This change will not affect your access to a private room if it’s clinically necessary for your care. We recognise the value of private rooms for patient care, privacy and infection control. Private rooms are best allocated by your treating clinicians based on clinical need and room availability, regardless of your private health insurance. 

Yes. nib will continue to cover private room accommodation benefits, including on Gold tier cover. 

If private room accommodation is important to you, it's worth reviewing whether your current cover still meets your needs. You can compare your cover options in your member account or contact us to discuss available cover options. 

If you need emergency treatment at a hospital, your health comes first. The hospital will focus on providing the care you need, so you won't be expected to choose a room before receiving urgent treatment.  

If you’re admitted as a private patient, the hospital will allocate your room based on your care, needs and availability. If affected members choose to be treated in a private room and one is available, the admitting hospital may charge out-of-pocket costs for the accommodation.

From 1 October 2026, if you have a planned admission to a NSW public hospital as a private patient, it’s worth contacting the hospital for updated informed financial consent to understand any potential out-of-pocket costs. Any out-of-pocket amount payable will be determined by the hospital and may vary between hospitals. Your hospital can provide informed financial consent before admission.

These changes will not affect planned admissions in a NSW public hospital before 1 October 2026.

In most cases, claiming for hospital works the same way it does today. When you're treated in a NSW public hospital, the hospital usually bills us directly for your accommodation, so there's nothing extra you need to do. The only difference is the amount we pay towards a private room (excluding Gold cover and GU Health members). If you're being admitted as a private patient, the hospital will usually claim on your behalf and can let you know about any out-of-pocket costs.  

No, this change doesn't affect your premium. Health insurance premiums are reviewed separately each year and any changes must be approved by the Australian Government as part of the industry's annual premium review process. If your premium changes in the future, we'll let you know in advance.

Before going to hospital, use the Going to Hospital tool in the nib App or your member account for help understanding your options, choosing a hospital and reducing potential out-of-pocket costs.

We know getting value from your cover matters. Healthcare costs are continuing to rise. This change helps us manage those rising costs while keeping your cover valuable for the long term. 

No, we'll keep covering accommodation for privately insured members treated in NSW public hospitals. These hospitals are an important part of the healthcare system and play a vital role in caring for our members. This change only affects the amount we pay towards a private room for some admissions. It doesn't change our ongoing support for members receiving treatment in public hospitals.