How is a health insurance claim assessed?
Find out how your claim is assessed and what’s involved
In Australia, we’re lucky to have a public health care system – Medicare – that gives us access to medical services, subsidised prescriptions and free care as a public patient in a public hospital.
Regardless of whether you’re treated in a private or public hospital, if you’re admitted as a private patient, Medicare pays 75% of the Medicare Benefits Schedule (MBS) fee for medical costs associated with your treatment and your private health insurance pays the remaining 25% of the MBS fee.
So, if you need to make a Medicare claim – what’s the simplest way to do it?
At nib, we like to keep things simple, so we’ve put together an easy-to-follow guide for claiming Medicare.
An out-patient is someone who receives medical treatment, but has not been admitted to hospital. If you’re an out-patient, you can claim Medicare by following these steps:
An in-patient is someone who is admitted to hospital for treatment. To claim Medicare as an in-patient, follow these steps:
If you're an nib member heading to hospital soon, make sure you check out our Going to Hospital page. This tool gives you information on health insurance, tips on how to reduce any out-of-pocket expenses and helpful questions to ask your specialist. To find out the details of your current policy, chat to someone about your upcoming hospital visit or get some guidance, call us on 13 16 42.