How is a health insurance claim assessed?
Find out how your claim is assessed and what’s involved
If you’re not sure when your health insurance annual limits reset, we’re here to help. It can vary from health fund to health fund, but at nib, your annual limits reset each year on January 1st – it’s as simple as new year, new limits.
We want you to stay healthy all year 'round; so knowing how much you can claim on things like optical, physio and dental is essential.
Here are a few other FAQs that might help:
An annual limit is the total amount you can claim back on Extras like dental, optical and physiotherapy. There’s an annual 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).
A higher level of cover gives you higher limits to claim from, and they’re calculated per person, per calendar year.
Depending on the level of health cover you choose, you’ll get either 60% or 75% of the cost back on Extras like dental and optical every time you claim, until you reach your annual limit. So, if you visit your dentist for a filling and it costs $200, you know you’ll get 60% back with Core Extras — that’s $120 back in your wallet.
Some of nib’s older health covers work differently, so it’s always a good idea to check your product information in Online Services before claiming or call us on 13 14 26.
The benefits you have claimed with your previous fund this calendar year will be deducted from your new nib policy. 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.
If you’ve recently made the switch, your private health insurance annual limits will reset on 1 January.
If you’re making Extras claims – like when you get a check-up and clean at the dentist – it’s often processed automatically at the point of sale when you swipe your membership card, as 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 the nib Online Services page, via mail or in person at any nib retail centre.
No, you don’t have to have your claims in by December 31. We pay for claims up to two years from the date you had the service, so there’s no need to rush in your claims to take advantage of this year’s annual limits.
If you’re thinking of making an appointment, now is a good time.
To keep your out of pocket expenses low, our nib First Choice network should be your first port of call. It’s our community of specially-selected health providers who have agreed to provide nib members with quality healthcare at an affordable price.
You can choose to see the dentist or optical provider of your choice, but by choosing an nib First Choice provider, it simply means you could pay less.
Search the nib First Choice network now to find a provider.