How is a health insurance claim assessed?
Find out how your claim is assessed and what’s involved
When it comes to your health insurance, things with your current fund might not be working out the way you thought they would.
If you’re not getting the value or service you were hoping for it may be time to consider switching to nib – but before you call your current health fund to say ‘it’s not you, it’s me’, read up on some of the biggest questions you might have when it comes to transferring your health insurance.
At nib, we believe that private health insurance should be simple.
Private health insurance should be easy, right? So we make choosing the right cover and getting a quote as simple as possible. You can get a quote online in minutes and, once you’re ready to sign up, you can sit back knowing that we’ll contact your previous fund on your behalf.
Under the Private Health Insurance Act, when you switch to nib your previous fund is required to send us a Transfer Certificate within 14 days. The Transfer Certificate outlines details of your previous cover, including any waiting periods you’ve served, the type of cover you had and your claims history. You can start claiming on services that you’re eligible for as soon as we receive this certificate.
If you’re transferring to a policy that has an equivalent or lower level of benefits, you won’t have to re-serve any waiting periods on the services covered with your previous fund. We’ll also recognise partially served waiting periods – so even if you’ve only served three months of a 12 month waiting period, we’ll make sure that the three months still count when you transfer to us.
The benefits you have claimed with your previous fund this year will be deducted from your new nib policy. We work by calendar year at nib, so if you’ve got an annual limit of $1,000 for major dental treatment and you’ve already claimed $400 this calendar year, you’ll still have $600 remaining.
Already made a hospital claim this calendar year with your previous fund? Don’t worry; if you’ve switched to a policy that has the same level of excess (or a lower excess) and you’re readmitted to hospital this year, you won’t have to pay your excess again with nib.
If you’ve transferred to a policy with a lower level of excess, your new excess amount will kick in two months following your transfer to nib. The exception to this is if you’re admitted to hospital for a pre-existing condition within your first 12 months with nib after switching, then your previous higher excess will be applicable.
If you’re transferring your Hospital Cover to nib you can rest assured that your Lifetime Health Cover loading won’t be affected so long as you haven’t taken a break that will exceed your ‘absent days’ between transferring health covers.
If you’ve got LHC loading, we will recognise the years you’ve had private Hospital Cover for. This means we will know when you have hit the magic 10 year mark to remove your loading and reduce your premiums.
If you’ve paid your private health premiums in advance and decide to transfer your policy to nib, your old health fund should refund you the money you’ve paid in advance.
The best thing to do is to cancel any direct debit arrangements you have previously made with your financial institution and then leave the rest to us! nib will contact your previous health fund to advise them that you have decided to switch and to request your transfer certificate.
Are you serious about your health? At nib, we can tailor your cover to include the things that are important to you and it only takes a few minutes to get a quote.