Top Hospital

Hospital Excess:
  • For people who want comprehensive cover, including pregnancy
  • Cover for all Medicare recognised hospital services
  • Planning a family? We’ve got you covered

Pregnancy and Birth Related Services

Assisted Reproductive Services
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

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)

Adenoids (Removal)

Treatment and surgery to remove the adenoid glands. This procedure is often combined with the removal of tonsils. Infections of the adenoids and tonsils 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)

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)

Ambulance (Unlimited Emergency)

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

  • unlimited emergency ambulance transport
  • where an ambulance is called to attend an emergency but on arrival is no longer required
  • medically necessary transport (as defined by the treating doctor)

Waiting Period: 1 day

Disclaimer: Emergency and medically necessary ambulance transport is paid at 100% of the cost. No hospital excess is applicable for this service.
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)

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)

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)

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: Consultations with an obstetrician or fertility specialist will attract a Medicare rebate only.
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)

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)

Obesity 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)

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)

Palliative Care

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

Cancer 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)

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

Disclaimer: Minimum Benefits Payable (MBP) for Palliative Care means that nib will pay minimum benefits if treatment is provided in hospital and no Medicare benefit is payable for that part of the treatment. Minimum benefits are equivalent to what is paid for a private patient receiving treatment in a shared ward of a public hospital. There will be significant out of pocket costs for attending a private hospital for these services.
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)

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.
Cosmetic Surgery

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

Psychiatric Treatment

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

  • depression
  • eating disorders
  • drug and alcohol rehabilitation

Waiting Period: 2 months

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)

Psychiatric Treatment (MBP)

Treatment of mental illness or addiction in an accredited hospital (psychiatric facility). This may include treatment for:

  • depression
  • eating disorders
  • drug and alcohol rehabilitation

Waiting Period: 2 months

Disclaimer: Minimum Benefits Payable (MBP) for Psychiatric Treatment means that nib will pay minimum benefits if treatment is provided in hospital and no Medicare benefit is payable for that part of the treatment. Minimum benefits are equivalent to what is paid for a private patient receiving treatment in a shared ward of a public hospital. There will be significant out of pocket costs for attending a private hospital for these services.
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)

Rehabilitation

Physical therapy and exercise treatment at a rehabilitation facility following an inpatient admission. This may include:

  • stroke recovery
  • strengthening of joints and limbs
  • cardiac rehabilitation

Waiting Period: 2 months

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)

Rehabilitation (MBP)

Physical therapy or treatment at a rehabilitation facility following an inpatient admission. This may include:

  • stroke recovery
  • strengthening of joints and limbs
  • cardiac rehabilitation

Waiting Period: 2 months

Disclaimer: Minimum Benefits Payable (MBP) for Rehabilitation means that nib will pay minimum benefits if treatment is provided in hospital and no Medicare benefit is payable for that part of the treatment. Minimum benefits are equivalent to what is paid for a private patient receiving treatment in a shared ward of a public hospital. There will be significant out of pocket costs for attending a private hospital for these services.
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)

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)

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)

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)

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)

Tonsils (Removal)

Surgical removal of the tonsils and often also the adenoid glands. This procedure is also known as a tonsillectomy and may be recommended for reasons such as:

  • recurrent episodes of tonsillitis
  • tonsillitis-induced middle ear infections, especially in children
  • enlarged tonsils leading to breathing difficulties

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

This Hospital cover includes additional services

As well as hospital stays for these commonly claimed procedures, nib also provides Hospital cover for all other Medicare recognised services that aren’t listed as an exclusion on this product.

This means that you will have reduced out-of-pocket expenses for treatment as a private patient in a public or private hospital.

Contact us for more information about specific Medicare services.

MBP refers to Minimum Benefits Payable for applicable services received as an admitted hospital patient as required by the Private Health Insurance Act 2007. Benefits paid are the equivalent to those paid for private patients receiving treatment in a shared ward of a public hospital. There will be significant out of pocket costs for attending a private hospital for these services.

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 Product Disclosure Statement 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

When can I claim?

There is a period of time (known as a waiting period) that applies to your level of cover before you can start claiming.

Waiting periods you have already served will be recognised when switching from another provider.

Waiting Periods
Item Waiting Period
Accidental injury 1 day
Ambulance services 1 day
Conditions requiring hospitalisation that aren't pre-existing 2 months
Psychiatric, rehabilitation or palliative care services 2 months
Pre-existing ailments/conditions (where the symptoms were evident at any time during the 6 months immediately prior to joining as determined by nib’s Medical Practitioner) 12 months
Pregnancy & birth related services 12 months

Bundled

60% Back
  • The Extras people use most
  • 60% of the cost back every time, up to your annual limit
  • Visit the provider of your choice
Core Waiting Period Annual Limit
Ambulance 1 day No limit
If you need immediate medical attention and your condition means that you cannot be transported in another way, ambulance covers you for:
  • unlimited emergency ambulance transport
  • where an ambulance is called to attend an emergency but on arrival is no longer required
  • medically necessary transport (as defined by the treating doctor)
Disclaimer: Emergency and medically necessary ambulance transport is paid at 100% of the cost. No annual limit is applicable for this service.
Dental (General) 2 mth $600
Diagnostic and other preventative procedures (not covered under Preventative dental) completed to help you keep on top of your oral health. This is routine dental that includes:
  • fillings
  • basic extractions (excluding wisdom teeth)
  • x-rays
Disclaimer: Doesn't include more complex treatments or procedures such as orthodontic work, endodontic treatment (root canal therapy), crowns or bridges. See Dental (Major).
Dental (Major) 12 mth $600
Complex dentistry procedures such as:
  • crowns and bridges
  • root canal therapy
  • removal of wisdom teeth
  • dentures
  • implants
Dental (Preventative) 2 mth No limit
Preventative dental treatment to help you maintain your oral health with no annual limits. This includes selected:
  • examinations
  • scale and clean
  • fluoride treatments
Disclaimer: No annual limit is applicable for this service. For more diagnostic and preventative dental procedures see Dental (General).
Optical 6 mth $250
Correction of visual impairment such as long or short sightedness. Examples of treatment include:
  • prescription glasses
  • contact lenses
Physiotherapy 2 mth $350
Treatment by a physiotherapist which uses physical means to relieve pain, regain range of movement, restore muscle strength and return patients to normal activities of daily living.
Disclaimer: Benefits are only payable for consultations with a physiotherapist.

Waiting periods & annual limits

A maximum of two bundles can be added to Core
For our highest level of Extras cover, we recommend Top Extras
Family
Antenatal & Postnatal Services 2 mth $200
Antenatal refers to services provided before having a baby and postnatal refers to services provided after having a baby. The services provided are generally undertaken by a midwife but can also be taken by a physiotherapist and may include:
  • preparing for labour and birth
  • assisting with a baby that won't settle or breastfeed properly
Disclaimer: Benefits are only payable for consultations with a midwife, physiotherapist or lactation consultant in private practice. Benefit paid at 100% of cost up to annual limit.
Health Aids (Family) 12 mth $250
Artificial and health aids that may be useful for children. These include:
  • nebuliser (asthma)
  • irlen lenses (dyslexia)
  • peak flow meter (asthma)
  • spacers (asthma)
Occupational Therapy 2 mth $300
Therapy which assists people to overcome limitations caused by injury or illness, emotional or psychological difficulties, developmental delay or the effects of aging. This can include:
  • rehabilitation in skills of self care
  • physical rehabilitation
  • cognitive and memory assessment
  • stress management and relaxation
Disclaimer: Benefits are only payable for consultations with an occupational therapist.
Orthodontia (Family) 12 mth $350
A form of specialty dentistry focusing on realigning teeth and bites. Examples include:
  • braces
  • plates
Disclaimer: The annual limit on this service starts at $350 and increases by $100 per calendar year to $1,500 lifetime limit.
Podiatry & Orthotics 2 mth $200
Podiatrists specialise in the prevention, diagnosis and treatment of disorders and conditions of the feet and lower limbs. Orthotics are devices prescribed by a podiatrist that are placed into the shoe to control or correct abnormal lower limb motions and alignment. Conditions treated by a podiatrist include:
  • complications with arthritis affecting the legs and feet
  • skin and nail disorders
  • corns and calluses
  • ingrown toenails
Disclaimer: This cover is for podiatrist consultations and prescribed devices only. Benefits are not payable for surgery in a doctor's or podiatrist's rooms.
Preventative Tests 6 mth $100
Screening tests to help with the early detection of health conditions. These tests can include:
  • thin prep (additional testing following a pap smear)
  • bowel screening
  • bone density testing
Speech Pathology 2 mth $350
The diagnosis, management and treatment of people who are unable to effectively communicate or who have difficulty with feeding and swallowing. Speech pathologists help a range of people, including:
  • kids who have difficulty making themselves understood verbally
  • those who stutter
  • stroke sufferers
Disclaimer: Benefits are only payable for consultations with a speech pathologist.
Wellbeing
Chiro & Osteo 2 mth $300
Chiropractic treatment involves manipulation based therapy to treat conditions related to the nerves, skeleton and muscles. Ostepathic treatment includes manipulation of the body to promote mobility and balance. Chiropractors and osteopaths are useful for:
  • back and neck pain
  • sciatica
  • frequent headaches
  • joint pains and muscle strains
  • work-related, repetitive strain and sports-related injuries
Disclaimer: Benefits are only payable for consultations with a chiropractor or osteopath.
Dietary Advice 2 mth $300
Dietitians and Nutritionists educate people on appropriate diet, menu planning and preparation of food to enhance and maintain optimum health.
Disclaimer: Benefits are only payable for consultations with a dietitian or nutritionist. Food items are not covered.
Health Aids (Wellbeing) 12 mth $250
Artificial and health aids that may be useful for active people or those suffering from joint injuries. The following aids are covered:
  • hip, knee, ankle, foot and ankle-foot orthoses
  • knee brace
  • shoulder brace
  • finger, hand, arm & elbow orthoses/splints
  • joint fluid replacement
Healthier Lifestyle 6 mth $400
This benefit is designed to allow you to claim on items that assist your health and wellbeing as prescribed by your GP or nib recognised provider. Benefits are payable for the following services:
  • gym memberships
  • yoga and pilates classes
  • personal training
  • weight management programs (Jenny Craig, Weight Watchers)
Disclaimer: To claim on health management items, you'll need your GP or nib registered provider to sign a Health Management Program Supporting Evidence form. This cover is for consultations only (food or supplementary items are not covered).
Natural Therapies 2 mth $400
Treatments that work on the physical and emotional body to relieve pain and improve health and wellbeing. Services include:
  • remedial massage
  • acupuncture
  • naturopathy
  • herbalism
  • myotherapy and shiatsu
Disclaimer: Benefits are only payable for consultations with your natural therapy practitioner.
Preventative Tests 6 mth $100
Screening tests to help with the early detection of health conditions. These tests can include:
  • thin prep (additional testing following a pap smear)
  • bowel screening
  • bone density testing
Psychology 2 mth $300
Group or individual consultations with a psychologist. Psychology services are commonly sought for:
  • marital, family or relationship problems
  • stress or pain
  • fears, phobias, anxiety and panic attacks
  • sexual difficulties
  • eating and weight control problems
Disclaimer: A benefit is not payable for tests (e.g. psychometric testing).
Young At Heart
Dietary Advice 2 mth $300
Dietitians and Nutritionists educate people on appropriate diet, menu planning and preparation of food to enhance and maintain optimum health.
Disclaimer: Benefits are only payable for consultations with a dietitian or nutritionist. Food items are not covered.
Health Aids (YAH) 12 mth $250
Artificial and health aids that may be useful for people over the age of 55. The following aids are covered under this product:
  • surgical stockings and pressure garments
  • CPAP machine and parts
  • erectile dysfunction pump
  • walking frames and hip protectors
  • blood pressure monitor and coagulation checks (blood clots)
  • macular degeneration aids
Hearing Aids 36 mth $500
A battery-powered, electronic device that makes listening easier for people with hearing loss.
Pharmaceutical Prescriptions 2 mth $400
This benefit only covers nib approved items that are not part of the Pharmaceutical Benefits Scheme.
Podiatry & Orthotics 2 mth $200
Podiatrists specialise in the prevention, diagnosis and treatment of disorders and conditions of the feet and lower limbs. Orthotics are devices prescribed by a podiatrist that are placed into the shoe to control or correct abnormal lower limb motions and alignment. Conditions treated by a podiatrist include:
  • complications with arthritis affecting the legs and feet
  • skin and nail disorders
  • corns and calluses
  • ingrown toenails
Disclaimer: This cover is for podiatrist consultations and prescribed devices only. Benefits are not payable for surgery in a doctor's or podiatrist's rooms.
Preventative Tests 6 mth $100
Screening tests to help with the early detection of health conditions. These tests can include:
  • thin prep (additional testing following a pap smear)
  • bowel screening
  • bone density testing

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