How to check private health insurance coverage

Consider this your complete health cover guide.

08 March 2023 5 minute read

A women in her 50s wearing white glasses and a pale gray twin-suit looking at her phone and holding a mug of tea

Most of us have experienced car troubles – whether it’s an engine overheating on a road trip or a flat tyre on the way to work. You likely learned pretty quickly to start servicing your car regularly, because no one enjoys waiting in the sweltering summer sun for roadside assistance to come save the day.

Just like your car, it’s important to service your private health cover – because the last thing you want is to find is that you aren’t appropriately covered when you do require medical or hospital treatment.

At nib, we consider ourselves your health partner and, much like roadside assistance, we’re here to help when you need us most.

We’ve put together a complete guide on how to check your cover. Consider this like your annual car service… but for health cover.

Types of cover

In Australia, there are three main types of health insurance: Hospital cover, Extras cover and Combined (Hospital and Extras) cover.

Depending on the level of cover you select, with a private health insurance policy, you may be able to:

Be treated in a public or private hospital as a private patient
Have more choice when it comes to the treatment you receive in a private hospital setting, including where you stay and the doctor who performs your surgery (subject to availability)        
Receive a benefit for health services that are not covered by Medicare, including appointments with a physiotherapist, podiatrist or dentist
Be covered in an emergency for ambulance transport
Skip the public hospital waiting list if you find yourself in need of non-emergency surgery

How to check your coverage

At nib, we try to make it as easy as possible to check your cover, so we have a range of different ways to access it.

Check through the app

You probably have all you need to check your nib health cover in the palm of your hand! Simply log in to the nib App to view your current cover. You can also see your limits and usage – and update your cover if you need to.

Young man wearing a blue collared shirt sitting on his couch and looking through his phone.

Check online

Prefer to use your computer? You can access your policy information and make changes online by logging into member account.

Contact us

For those who prefer a chat, our health insurance consultants are available Monday-Friday between 8:00am-8:30pm and Saturday between 8:00am-1:00m on 13 14 63 or you can jump online and use our live chat.

For more guidance on reviewing your cover – including what to look for, check out our complete guide to reviewing your cover.

Usage limits

A usage limit (or annual limit) is the total amount that you can claim back on Extras like dental, optical and physiotherapy each year. There’s a limit on how much we’ll pay for specific treatments and services or in some cases a limit on the number of times you can claim for Extras over a certain period of time (this is called a service limit). Basically, a higher level of cover gives you higher limits to claim from, and they’re calculated per person, per calendar year.

An easy way to check the annual limits you have as part of your chosen level of health cover is to jump onto the nib App or log in to member account. You can also log in to these portals to see how much of your annual limits are still available, so you can keep track of your usage.

What's not usually covered

As an Aussie private health insurer, we’re required by law to not pay for medical services accessed out of hospital (or as an outpatient) including:

visits to a GP (general practitioner)
consultations with specialists in their rooms
diagnostic imaging and tests

To understand the difference between in-hospital treatment (inpatient) and treatment outside a hospital (outpatient), check out our article: What’s the difference between an inpatient and outpatient?

Consider waiting periods

Whenever you increase your level of health cover, or sign up for a new policy, you’ll be required to serve a 'waiting period’ for benefits that weren’t covered under the previous policy1. This is the time frame you’ll have to wait before you can start claiming benefits and it applies to both Hospital and Extras Cover at different levels.

The reason we have waiting periods is to protect our members by ensuring that individuals don’t join a health fund, claim immediately and then cancel their private health insurance as soon as they’ve received their benefits. This would mean we’d likely have to pass on the costs to our members by increasing premiums - potentially making health insurance unaffordable for many Aussies.

Our biggest tip? Just like you have a reminder to get your car serviced every 10,000 km, pop in a calendar note to check your health cover too. It can take as little as five minutes and might save you a whole lot of stress – and money – if you ever require treatment. And remember, if you need help, give our team a call on 13 16 42.