How to know if your health insurance covers you in hospital

The 3 steps to finding out whether your procedure is covered

25 July 2018 3 minute read

Credit: nib Health Insurance

Life can be pretty good at blindsiding you – and unfortunately the unexpected doesn’t always result in an $18 million lottery win or a letter confirming you’re the long lost child of an Eastern European monarch.

If life does deal you a blow when it comes to your health, at nib we want to make things as simple as possible.

If you do find out you’re in need of surgery or medical treatment for a health condition, the last thing you want to be worrying about is whether or not you’re covered.

We want to help you prepare for the unexpected by putting together a few simple tips for checking that your private health insurance covers you for everything you need.

Do an annual health cover check to make sure your policy is still relevant for you and your family

1. Do a yearly check-up

Just like you organise a check-up with your GP, dentist or optometrist, it’s important to make sure that your health cover policy is still relevant for you and your family every 12 months. Have a think about whether your circumstances have changed (maybe you’ve finished starting a family, so might want to remove pregnancy from your cover inclusions?), whether there’s a family history of any conditions, or whether your age might mean you should reconsider your inclusions (for example, the majority of heart attacks occur in people over 45, so perhaps it’s time to move to a cover that includes heart disease?). You can call nib 13 16 42 for a cover review.

2. Contact nib if you need to go to hospital

If your GP or specialist has suggested that you may need to visit hospital for a procedure, give nib a call on 13 16 42. Not only can we talk you through the procedure and help you choose a specialist, but our experts can also give you ways to avoid out-of-pocket costs, questions to ask your specialist and a list of the health programs we have available to help you recover quicker.

For more information check out our article Going to hospital? Here’s why you should contact nib first.

A young woman in a hospital smiles at her doctor

3. Use our Going to Hospital tool

We’ve developed a tool to make the journey to hospital easier for our members. Our Going to Hospital tool can be used to find a specialist who participates in nib MediGap (meaning if they agree to use MediGap for your procedure, you won’t be charged any out-of-pocket expenses), find an nib Agreement hospital (we have agreements with most Aussie private hospitals to help save you money) and get an understanding of the average costs for a procedure like yours.

The tool also allows you to check whether your particular procedure is covered by your current policy and whether you have any waiting periods you need to serve. To find the tool log in to member account and click on the ‘Going to hospital soon? Learn more’ link.