Our Hospital Cover

What is Hospital cover?

Hospital cover helps you avoid public hospital waiting lists, pays benefits towards the cost of private treatment and, subject to availability, allows you to:

  • Stay in a private room
  • Choose the specialists who treat you
  • Attend the nib Agreement Private Hospital of your choice
  • Decide with your doctor when you'll be treated

Afford the private hospital treatment you want

These are a few examples of what private hospital procedures could cost you without health insurance.* Do you have this kind of money to spare?

$3,057 for removal of tonsils
$45,326 for coronary bypass surgery
$25,277 for hip replacement surgery
$22,733 for knee replacement surgery
*Average charge to nib Customers for procedures in a private hospital (rounded to the nearest $1), in 2015. Correct as at March 2016. Average costs include all charges for the total hospital procedure (including and not limited to Medical, Hospital and Prostheses, but not including surgeons’ and specialists’ charges).

Avoid public hospital waiting lists

nib Hospital cover allows you and your doctor to decide when you’ll be treated. These are a few examples of the average wait times for treatment in a public hospital under Medicare:

14 days for coronary bypass surgery
109 days for hip replacement surgery
124 days for removal of tonsils
191 days for knee replacement surgery
*Source: Australian Institute of Health and Welfare, Australian hospital statistics 2014-15: elective surgery waiting times. Waiting times at the 50th percentile. Report dated October 2015.

The nib difference

Accidental injury cover

Seek treatment at a hospital Emergency Department within 24 hours of an accident & if you need to be admitted, you’ll receive benefits in line with our top hospital cover for the next 90 days.

Emergency ambulance

No annual limits on Emergency Ambulance transportation - excludes residents of QLD and TAS who have ambulance services provided by their State Ambulance Schemes.

No excess for kids

You won't need to pay the excess for dependant children under 21 if they need to go to hospital.

Compare our Hospital covers

 
Basic Hospital
$250 | $500
Standard Hospital
$500
Advantage Hospital
$250 | $500
Top Hospital
$250 | $500
Hospital Excess Options
Accidental Injury

The immediate necessary treatment required as a result of an accident. To be covered you must provide documented proof that you have sought treatment at a hospital emergency department within 24 hours of the accident. If further treatment in hospital is needed as an admitted patient, you will need to be re-admitted to a hospital within 90 days of the initial visit. For example:

  • if you were sent home with bandaging or a half-plastered limb so that swelling can reduce before a full cast is applied to the injured limb

Waiting Period: 1 day

Ambulance (Unlimited Emergency)

If you need immediate medical attention and your condition means that you cannot be transported in another way, you are covered for:

  • Emergency Ambulance transport to hospital provided by a State or Territory Ambulance service
  • Emergency Ambulance call out fees (where the customer is treated at the scene by paramedics and it is determined that transport to hospital is not required)
  • Transport between hospitals when the transfer is required as a result of the existing hospital not specialising in the treatment required
  • 100% of the cost. Additionally, no hospital excess is applicable for this service

Waiting Period: 1 day

Disclaimer: Residents of Queensland and Tasmania who have Ambulance services provided by their State Ambulance Schemes are not covered.
Appendix Removal

Treatment for appendicitis (inflamed appendix). This includes:

  • surgical removal of the appendix

Waiting Period: 12 months (2 months for ailments / conditions that are not pre-existing)

Colonoscopies

Medical procedure to examine the large intestine (colon) and/or to diagnose and investigate:

  • cancer of the colon (bowel cancer)
  • colon polyps
  • unexplained abdominal pain

Waiting Period: 12 months (2 months for ailments / conditions that are not pre-existing)

Dental Surgery

Teeth extractions where a hospital admission is required for a general anaesthetic. This may include:

  • surgical removal of impacted wisdom teeth

Waiting Period: 12 months (2 months for ailments / conditions that are not pre-existing)

Gastroscopies

Medical procedure to examine the oesophagus (throat), stomach and duodenum (first part of the small intestine). Gastroscopies can be used to diagnose and investigate:

  • difficult or painful swallowing
  • pain in the stomach
  • bleeding
  • ulcers
  • cancers

Waiting Period: 12 months (2 months for ailments / conditions that are not pre-existing)

Grommets in Ears

Surgical insertion of ventilation tubes in the ear drum to treat chronic ear infection.

Waiting Period: 12 months (2 months for ailments / conditions that are not pre-existing)

Gynaecological Services

Procedures dealing with the health of the female reproductive system (uterus, vagina and ovaries) where not related to infertility. This may include:

  • abdominal or vaginal hysterectomy
  • endometriosis

Waiting Period: 12 months (2 months for ailments / conditions that are not pre-existing)

Hernia Repair

Surgery to repair a hernia. A hernia is the protrusion of organs, such as intestines, through a weakened section of the abdominal wall. The most common sites are:

  • in the groin
  • abdominal areas such as the navel

Waiting Period: 12 months (2 months for ailments / conditions that are not pre-existing)

Joint Investigations

Surgery to examine the inside of a joint for accurate diagnosis and removal of loose bodies. This may include the investigation of the:

  • knee
  • shoulder
  • elbow
  • ankle

Waiting Period: 12 months (2 months for ailments / conditions that are not pre-existing)

Joint Reconstructions

Surgery to reconstruct damaged ligaments. This may include the reconstruction of the:

  • knee
  • shoulder

Waiting Period: 12 months (2 months for ailments / conditions that are not pre-existing)

Tonsils & Adenoids Removal

Treatment and surgery to remove the tonsils and adenoid glands. Infections of the tonsils and adenoids can lead to:

  • breathing problems
  • snoring
  • in children, can lead to middle ear infections

Waiting Period: 12 months (2 months for ailments / conditions that are not pre-existing)

Brain Surgery

Surgery to treat conditions of the brain or skull. This may include:

  • removing a brain tumour
  • bleeding (haemorrhage) in the brain
  • blood clots (hematomas) in the brain
  • weaknesses in blood vessels (brain aneurysm repair)
  • craniotomy

Waiting Period: 12 months (2 months for ailments / conditions that are not pre-existing)

Cancer Surgery & In-hospital Treatment

Surgery to remove cancer and cancer treatments which are PBS approved for the specific type of cancer being treated (dependent on your level of cover). This may include:

  • surgery
  • radiation (radiotherapy)
  • chemotherapy

Waiting Period: 12 months (2 months for ailments / conditions that are not pre-existing)

Heart Procedures

The medical treatment or surgical procedure for cardiac conditions such as heart disease, arrhythmias, congenital defects. This may include:

  • surgical insertion of pacemakers and defibrillators
  • stent insertion
  • coronary angioplasty and artery bypass grafts
  • heart transplants
  • operations for congenital defects and heart valve defects

Waiting Period: 12 months (2 months for ailments / conditions that are not pre-existing)

Palliative Care
MBP

The care of patients with serious illness to relieve pain. Palliative Care:

  • provides relief from pain and other distressing symptoms
  • does not hasten or postpone death
  • supports people to live as actively as possible until death

Waiting Period: 2 months

Minimum Benefits Payable (MBP) means there will be significant out-of-pocket costs for this treatment if you're attending a private hospital. If a treatment important to you is listed as MBP, we recommend you consider a higher level of cover. MBP is the minimum amount of benefits that nib is required to pay under the Private Health Insurance Act, to or on behalf of a customer for hospital treatment under a Hospital cover.
Rehabilitation
MBP

Intensive physical therapy and re-conditioning treatment at a specialist rehabilitation facility for a patient with an impairment or disability for which the goal of treatment is functional improvement. This may be:

  • following a joint replacement
  • stroke recovery
  • cardiac rehabilitation

Waiting Period: 2 months

Minimum Benefits Payable (MBP) means there will be significant out-of-pocket costs for this treatment if you're attending a private hospital. If a treatment important to you is listed as MBP, we recommend you consider a higher level of cover. MBP is the minimum amount of benefits that nib is required to pay under the Private Health Insurance Act, to or on behalf of a customer for hospital treatment under a Hospital cover.
Stroke Treatment

Treatment for a stroke. A stroke or CVA is the rapid loss of brain function(s) due to disturbance in the blood supply to the brain. This can be due to lack of blood flow (ischemia) caused by a:

  • blockage (thrombosis, arterial embolism)
  • haemorrhage

Waiting Period: 12 months (2 months for ailments / conditions that are not pre-existing)

Back Surgery

Surgery to treat back abnormality or injury. This includes:

  • spinal fusion
  • discectomy (surgical removal of a herniated disc)

Waiting Period: 12 months (2 months for ailments / conditions that are not pre-existing)

Eye Treatments

Surgery and treatment relating to the eye. This may include:

  • cataract removal
  • lens-related services

Waiting Period: 12 months (2 months for ailments / conditions that are not pre-existing)

Joint Replacements

Surgery to replace a joint in the body with an artificial prosthesis. This can be the replacement of the entire joint or a component of it. This may include the replacement of the:

  • hip
  • knee
  • shoulder

Waiting Period: 12 months (2 months for ailments / conditions that are not pre-existing)

Renal Dialysis

Treatment to replace the function of the kidneys. Primarily used by people with temporary or permanent renal failure.

Waiting Period: 12 months (2 months for ailments / conditions that are not pre-existing)

Assisted Reproductive Services

Inpatient services relating to egg retrieval and implantation. This includes:

  • IVF
  • GIFT

Waiting Period: 12 months (2 months for ailments / conditions that are not pre-existing)

Disclaimer: Any consultations with an obstetrician and ultrasounds in the lead up to delivery attract a Medicare rebate only. Outpatient specialist fees or other outpatient fees in relation to assisted reproductive services (for example, laboratory and storage fees) are not covered.
Infertility Investigations

Surgery to investigate a female's fallopian tubes and the condition of uterus and ovaries in relation to infertility. It can also treat conditions effecting fertility such as:

  • endometriosis
  • tubal microsurgery
  • removal of fibroids
  • correction of uterine abnormalities

Waiting Period: 12 months (2 months for ailments / conditions that are not pre-existing)

Obesity and Weight Loss Surgery

Surgery to reduce the capacity of the stomach as a treatment for morbid obesity. This may include:

  • gastric banding surgery
  • stomach bypass

Waiting Period: 12 months (2 months for ailments / conditions that are not pre-existing)

Pregnancy & Birth Services

Inpatient services relating to childbirth or complications during pregnancy. This may include:

  • child birth
  • early labour
  • pregnancy induced diabetes
  • hypertension

Waiting Period: 12 months

Disclaimer: Any consultations with an obstetrician and ultrasounds in the lead up to delivery attract a Medicare rebate only.
Psychiatric Treatment
MBP
MBP
MBP
BLP

Treatment of mental illness or addiction in a psychiatric facility. This may include treatment for:

  • mood disorders
  • eating disorders
  • drug and alcohol detoxification
  • addiction therapy

Waiting Period: 2 months

Minimum Benefits Payable (MBP) means there will be significant out-of-pocket costs for this treatment if you're attending a private hospital. If a treatment important to you is listed as MBP, we recommend you consider a higher level of cover. MBP is the minimum amount of benefits that nib is required to pay under the Private Health Insurance Act, to or on behalf of a customer for hospital treatment under a Hospital cover.

Benefit Limitation Period (BLP) means that if you’re new to residential health insurance there will be significant out-of-pocket costs if you go to hospital for this treatment in your first 12 months on the policy.

After serving the 2 month waiting period, your benefit will be limited to “Minimum Benefits Payable” for the following 10 months. After this period of time you are entitled to the full benefit claimable for the treatment.

Cosmetic Surgery

Under all nib covers, no benefits are payable towards procedures or hospital costs associated with cosmetic surgery to enhance appearance.

Additional Hospital Services
 

Looking for Extras cover?

  • Dental
  • Optical
  • Physiotherapy
  • and more…
Compare Extras covers
Compare Extras covers

Important Information

Hospital excess

The amount you agree to pay toward your hospital admission, before we pay a benefit. Choosing a higher excess will reduce your premium.

Each adult on the policy will only pay one excess per calendar year if they go to hospital, no matter how many admissions they may need.

There is no hospital excess for dependant children under 21 years of age. An excess is not payable on Extras cover.

Waiting periods

Before you can start claiming, you must be in your chosen cover for a set period of time (known as a waiting period). nib customers can only claim benefits after they have served the relevant waiting period.

For procedures relating to pre-existing conditions, the waiting period is 12 months. If you are switching from another health fund or cover option, nib will recognise waiting periods already served.

Pre-existing conditions

When a customer has displayed signs or symptoms of a condition not previously covered at any time during the 6 months prior to joining nib or upgrading their Hospital cover, this condition is said to be pre-existing.

A medical practitioner appointed by nib will determine if a condition is pre-existing once they have reviewed relevant information, such as reports from the customer’s own doctor.

Out of pocket expenses
Out of pocket expenses refer to the difference between what nib pays for, and the total cost of your stay in hospital. No matter what cover you have, it’s possible you’ll have to pay something towards going to hospital.

Related links

What else am I covered for when I am in hospital?

When admitted to hospital as an inpatient, your private health insurance will reduce the out-of-pocket expenses you will have for the accommodation, care and supplies associated with your stay.

What will be covered?

You're covered for the below services as an admitted private patient in any nib Agreement Public or Private Hospital. Out-of-pocket expenses may be incurred, however, for some services. Please see the Policy Booklet for more information.

Accommodation

Cover for private or shared accommodation includes:

  • day surgery
  • overnight accommodation
  • special care unit accommodation (intensive care, coronary care or neonatal care)
Operating Theatre

Fees and charges associated with use of the operating theatre for surgery.

Doctor’s surgical fees and in-hospital consultations

Consultations with a doctor while you are in hospital. This includes all costs for:

  • surgical fees
  • in-hospital consultations

Some out-of-pocket expenses may be incurred.

Prostheses (Surgically implanted)

Equipment or a device that is surgically implanted by a medical practitioner to improve health outcomes (e.g. an artificial hip or knee). You are able to receive a benefit for surgically implanted prostheses, when the following applies:

  • the prosthesis is on the approved Federal Government Prosthesis Schedule
  • you are covered for the related procedure/surgery. For example, if you are covered for heart, then you will be covered for the implant of a pacemaker or stent
  • you are admitted to hospital as an in-patient

Some out-of-pocket expenses may be incurred.

Allied health services

Allied health services that are received in hospital include:

  • physiotherapy
  • hydrotherapy
  • occupational therapy

Some out-of-pocket expenses may be incurred.

Prescriptions

Prescription medications required for specific treatment when in hospital. Some medications that aren't on the Pharmaceutical Benefits Scheme (PBS) may not be covered.

Ward-drugs and sundry medical supplies

Pharmaceuticals and medical supplies used throughout your stay in a hospital ward including:

  • bandages
  • pain killers
Nursing care

Care from nurses throughout your stay in hospital.

What won't be covered?
Hospital excess

A hospital excess is the amount you elect to pay towards the cost of a hospital stay before any benefits are payable by nib. You only pay an excess if you or someone on your policy goes to hospital. There is no hospital excess for dependant children under 21 years of age. The excess applies once per person per calendar year and is payable directly to the hospital prior to your admission.

Extra fees & charges

Additional fees may be charged by the hospital for care and treatment associated with your stay. These are not covered and may include:

  • private hospital emergency or out-patients fees
  • admission or booking fees charged by a specialist or the hospital
  • private room accommodation for a same day procedure
Services listed as policy exclusions

Any service listed as excluded on a customer’s policy is not covered. This includes:

  • procedures within waiting periods
  • cosmetic procedures to enhance appearance
Additional or specialised nursing care

If you require additional or specialised nursing care, extra charges may apply. Examples of such care includes:

  • special nursing
  • services provided exclusively or primarily for the care or treatment of a mentally disabled person who is not a private patient in a hospital
  • services rendered in a nursing home
  • respite care
Additional medications & procedures

If you require additional medications or procedures, extra charges may apply. These include:

  • pharmaceuticals that are not available under the Pharmaceuticals Benefits Scheme (PBS)
  • oral contraceptives
  • autologous blood collection and storage
  • procedures performed in a doctor’s surgery
Extra services

Services that aren’t directly related to your treatment and care. These include:

  • beauty services
  • phone calls
  • TV hire
  • car parking
  • luxury rooms
  • take-home items e.g. crutches
Services not recognised by Medicare

Services, drugs or disposable items which may be used in a hospital but that are not recognised by Medicare. These are considered experimental and are not covered e.g. some items associated with robotic surgery