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8 of the most commonly asked health insurance questions

6 minute read
3 young men researching common private health questions

We all turn to good old Google when we're feeling confused or need a quick answer to a lingering question. So, we decided to look at the most ‘Googled’ health insurance questions and answer them in one easy place.

Consider your health insurance search over!

1. What is hospital cover?

Hospital cover helps to pay the costs of your hospital accommodation, treatments you receive while in hospital, and your doctors’ fees when receiving medical treatment as a private patient. In-hospital services listed on the Medicare Benefits Schedule (MBS) are covered by private hospital insurance policies; however, some policies will exclude certain services to help keep the price low for customers. This is why it’s so important that you have the right level of cover for your personal circumstances. To organise a cover review, call nib on 13 16 42.

2. What are 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’. 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 government is responsible for setting the maximum hospital waiting periods that health funds can have to make it as fair as possible for all Australians.

For more information, visit our waiting periods section.

Young woman researching private health insurance

3. How do health insurance claims work?

If you’ve got private health insurance, it’s important to know what you are and aren’t covered for – that way you know what you can claim.

There are two types of health insurance claims, hospital claims and Extras claims.


Before you head into hospital, ask your doctor to provide a breakdown of your procedure. This breakdown will give you an idea of what services you’ll be receiving throughout your stay in hospital.

Once you receive the breakdown, give nib a call so we can let you know exactly what you’re covered for, whether your policy has a hospital excess and whether there’ll be any out-of-pockets.

After your procedure, the hospital may send your bill directly to nib as your private health insurer to pay. This should be hassle-free for you as we’ll take care of all the paperwork.

However, if you are given a hospital bill, you should submit a two-way claim form to Medicare which will ensure that Medicare and nib pay their portions of the bill.

If your hospital visit is covered by other forms of insurance, such as worker’s compensation, medical negligence, or public liability, or another party is liable (for example in a car accident), you’ll be eligible to receive benefits directly from your general insurer and not your private health insurer.

Most health funds, including nib, offer a range of Health Management Programs available at no additional charge to eligible customers. These programs are designed to support customers going home from hospital safely, whilst improving physical and mental wellbeing. They also aim to help a patient recover quicker post-hospitalisation.


If you’re making Extras claims – like when you buy a new pair of glasses – it’s often processed automatically at the point of sale when you swipe your membership card, so long as your provider has a HICAPS terminal.

If not, we’ve made it easy to make a claim using the nib app on your iPhone or Android smartphone. Simply open the app, snap a photo of your receipt and hit submit! You can also make a claim online through Online Services.

Once you’ve served any applicable waiting periods, you’ll be able to start claiming Extras. Depending on the level of health cover you choose, you’ll be eligible to receive between 50-75% of the cost back per Extras claim, until you reach your annual limit.

So, if you’re getting a dental check-up that costs $200 and your policy gives you 60% back on Extras, we’ll contribute $120 towards the costs.

4. How much is health insurance?

The cost of health insurance policies varies across insurers, based on the level of cover you choose. It’s important to remember that in most situations, the more you’re covered for, the higher your premium will be – so cheapest isn’t always best.

5. How do I save on health insurance and how do I keep health premiums low?

At nib, we don’t want you paying more than you should for your private health insurance, so we recommend contacting us for a policy review to ensure you’re not covered for things you don’t need.

Another simple way to save is by looking at how you pay your premium. We offer discounts of up to 4% to customers who set up automatic direct debits from their bank account (discount not available on Ambulance Only cover).

When looking at your private health insurance policy, it’s vital to check what level of excess you’ve got. Often you can lower your premium by choosing a higher excess. On some of our nib hospital covers, you can choose from either a $250 or $500 excess. From 1 April 2019, you'll be able to increase your excess to $750 as part of the private health insurance reforms. To find out more about your excess options, give us a call on 13 16 42.

Girl at cafe googling common private health insurance questions

6. How does the private health insurance rebate work?

If you currently hold private health insurance, you could be eligible to receive a rebate from the Australian government. The Australian Government Rebate amount is tiered depending on your individual income (if you’re single), or your family’s income. This rebate can be used to reduce your premiums, or claimed as a tax credit when you lodge your tax return with the Australian Taxation Office (ATO).

7. Is there a tax penalty for not having health insurance?

If you are single and have a taxable income of $90,000 or more, or are a couple, family or single parent family that has a taxable income of more than $180,000 a year, and do not have hospital cover, you will be required to pay a Medicare Levy Surcharge of between 1% and 1.5% of your total income, depending on your income tier.

8. Does health insurance cover x-rays?

Most health insurers will cover the costs of x-rays you receive while you’re an admitted patient (or in-patient) in a private hospital. However, you are generally not covered for out-patient x-rays.

If you’re thinking about getting private health insurance with nib, you can get a quote online, or call us on 13 14 26 to discuss your options.

If you have questions about your existing nib policy visit Online Services or call us on 13 14 26.

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