17 of the most commonly asked health insurance questions
When health insurance gets confusing, it’s easy to feel overwhelmed by all the information out there. That’s why we’ve rounded up the most searched health insurance questions and answered them in one easy place.
1. What is Hospital cover?
Hospital cover helps cover the costs when you go to hospital, this includes your accommodation, treatments and any doctors’ fees you might need to pay.
Private hospital insurance covers in-hospital services on the Medicare Benefits Schedule (MBS). Some covers exclude certain treatments or procedures, and this is why it’s important to select the right level of cover for your individual needs and circumstances.
2. What are waiting periods?
A waiting period is the time you’ll have to wait before you can start claiming any benefits. These waiting periods apply for both hospital and Extras cover.
Waiting periods might apply if you take out a new health insurance policy or upgrade your cover. Want to know how long hospital waiting periods are? Here’s a breakdown of the maximum waiting periods for some of our hospital benefits:
12 months for pre-existing conditions and pregnancy
Two months for psychiatric care, rehabilitation and palliative care (whether pre-existing or not)
Two months for all other treatments.
3. How do I make a health insurance claim if I go to hospital?
To make a health insurance claim for Hospital cover, the first step is asking your GP or specialist for a breakdown of your procedure. This will give you an idea of what services you’ll receive when you’re in hospital.
Next, give us a call so we can let you know:
What you’re covered for
If your policy has a hospital excess
If you need to pay any out of pocket costs.
After your procedure, the hospital may send your bill to nib as your private health insurer to pay. This should be hassle-free as we’ll take care of assessing your claim. But if you have a hospital bill for medical services, like an anaesthetist, you should submit a two-way claim form to Medicare. This form makes sure that Medicare and nib pay their portions of the bill so we can continue assessing your claim..
If another type of insurance or third party is covering your hospital visit, you may receive benefits from the general insurer or the workers or accident compensation scheme. For example, if you get into a car accident, then the Transport Accident Commission may cover your hospital treatment.
4. How do I make a health insurance claim for my extras?
You can often make an Extras cover claim2 at the point of sale by tapping your physical or digital nib membership card. For example, when you’re paying for your slick new glasses, you can tap your nib card to make a claim. But this only works if your provider has a HICAPS terminal.
If your provider doesn’t have a HICAPS terminal, then don’t worry. We’ve made it easy to make a claim using the nib App on your phone. Open the app, snap a photo of your receipt and hit submit! You can also make a claim online through the member account page.
Once you’ve served any waiting periods, you can start claiming Extras. Depending on your cover, the amount you receive back per Extras claim can vary based on the recognised Provider, but you will receive a percentage back up to your annual limit.
5. How much is health insurance?
The cost of health insurance policies varies across insurers and depends on the level of cover you choose. Usually, the higher the cover, e.g. Gold, the more premium you will pay- so the cheapest option isn’t always the best. This is why selecting the right cover that suits your life stage is always the best option, and we are happy to help with those choices. Our covers start from $19 a week for a single in NSW on Basic Hospital cover.3
6. What is excess and how does it affect my monthly payments?
Having an excess helps keep health insurance premiums cheaper. The higher your excess amount is, the lower the premium. You’ll only pay excess if you’re admitted to hospital as a private patient and with nib, you have the option to choose your own excess amount.
7. What can I do to reduce my monthly premiums?
There are different ways you can reduce your monthly premiums. At nib, we recommend getting in touch so we can make sure you’re getting the right cover that meets your needs. This ensures you’re only paying for the services that you actually need.
When reviewing your private health insurance cover, it’s vital to check what level of excess you’ve got. You can generally lower your premium by choosing a higher excess dependent on your cover. Your excess options can vary from $250, $500, $750 (singles) and $1,500 (couples or families).
8. How does the private health insurance rebate work?
If you have private health insurance, you could receive a rebate from the Australian Government. The Australian Government Rebate amount depends on your individual income (if you’re single), or your family’s income. You can use this rebate to reduce your premiums or claim it as a tax credit when you lodge your tax return.
9. Is there a penalty for not having health insurance?
There are two downsides to not having health insurance. The first is potentially paying a Medicare Levy Surcharge (MLS). You may need to pay the MLS if you:
You are single and have a taxable income of at least $101,000 or are a couple, family or single parent family that has a taxable income of at least $202,000
You don’t have Hospital cover.
If you meet these criteria, then you will need to pay an additional 1% and 1.5% of your total income, depending on your individual circumstances.
The second thing to keep in mind is Lifetime Health Cover loading. This is a 2% loading on top of your health insurance premium for every year after you’ve turned 31 that you have not held private health insurance cover. You’ll need to pay this loading for 10 consecutive years before it’s removed, and the maximum loading is 70%. This means you might pay thousands of extra dollars if you held off on getting private health cover.
Related: Lifetime Health Cover article
10. Does health insurance cover x-rays?
Most health insurers will cover the costs of x-rays if you have them as a private hospital patient or inpatient. But you’re not generally covered for outpatient x-rays.
11. How does hospital cover differ from the public hospital system?
You can have treatment in a public hospital as a public patient for free if you’re an Australian resident or otherwise eligible. However, as a public patient, you do not have the option to choose your doctor, hospital or the timing of your treatment. That’s where hospital cover comes in. At nib, our hospital cover gives you access to a network of recognised specialists for your procedure and nib Agreement Hospitals to choose from, so you can pick what’s best for you and your treatment. Plus, our cover includes unlimited emergency ambulance cover4 and our Accidental Injury Benefit.5
If you need surgery, the wait times for non-emergency treatment in the public system can be months. And without private health cover, getting treated in a private hospital can be expensive. With nib, you can skip the public hospital waiting lists and get back to doing the things you love faster.
12. Does health insurance cover wisdom teeth removal?
With nib, many of our extras covers include benefits for wisdom teeth removal. If you need to have your wisdom teeth removed, check out our First Choice network to lower your out-of-pocket costs. It’s our community of selected health providers who can give you quality healthcare at an affordable price.
Related: Wisdom teeth: To remove or not to remove?
13. Why do I need Hospital cover?
Hospital insurance helps bridge the gap that the public hospital system leaves. So, you can get the treatment you need without joining a public hospital waiting list. You’ll be able to choose your doctors, specialists and when you receive your treatment. Plus, you may be covered for accidents with the nib Accidental Injury Benefit6 and you’ll receive emergency ambulance cover too.
14. What level of cover do I need?
The level of cover you need will depend on a few factors. To start with, ask yourself some questions about your lifestyle, family and why you want health cover. Here are a few questions to think about:
Are you starting or growing your family?
Is your child turning 21?
Are you turning 31?
Have your health needs changed?
If you aren’t sure what cover is right for you, give our award-winning member service team a call on 13 16 42.
15. What age should I take out health insurance?
When it comes to how old you should be before you take out health insurance, there’s no one-size-fits-all answer. Everybody is different and your health insurance should fit where you’re at in life. However, there are financial perks if you take out hospital cover and you’re under 30. Eligible nib members receive a 2% discount for every year you're under 30, capped at 10% off for those aged 18–25.
Lifetime Health Cover loading encourages young people to take out hospital cover early. If you don’t have private hospital insurance by 1 July following your 31st birthday, you’ll pay a 2% loading for every year you’re over 30 when you do take out cover.8
Related: Lifetime Health Cover loading: What does it mean for private health insurance?
16. How do I switch to nib from another insurer?
Switching to nib from another fund is super easy. You can get a quote with nib online in just a few minutes. Once you’ve signed up with us, we’ll handle the rest. We’ll contact your previous insurer on your behalf. It’s the easiest breakup ever.
17. How do I join with nib for the first time?
Ready to join nib? You can become an nib member online or over the phone. Getting a quote online takes just a few minutes. If you’re joining an Australian Residents Health Insurance policy, you’re entitled to a 30-day cooling-off period. This means if you choose not to continue with your cover, we’ll refund your full premium (as long as no claims have been made).
So, if you’re ready to make the switch or sign up, get in touch with our team today on 13 16 42.
1Available to eligible nib members who’ve held hospital cover for 12 months and served their relevant waiting periods. Additional eligibility criteria apply to individual programs.
2Benefits are only paid for services from nib recognised providers. A recognised provider is someone who provides a health service, like a dentist, optometrist, remedial massage therapist or physiotherapist who meet the following criteria: (i) They must work in a private practice; and (ii) They must have professional qualifications recognised by nib. For more information and to find a nib recognised provider, visit our Extras Covers.
3Price is based on a Single in NSW who wants to start their cover from 1 July 2025. The price includes the Australian Government Rebate for a Single aged <65 with a taxable income of $101,000 or less in the financial year ending 30 June 2026. 4% direct debit discount, 0% age-based discount, $750 excess per calendar year and assumes a Lifetime Health Cover loading of 0% for your hospital price.
41 day waiting period applies. Not available to: (i) QLD residents who have ambulance services provided by their State ambulance schemes; (ii) TAS residents who are covered under state ambulance schemes in TAS and when travelling in mainland Australia except SA and QLD; or (iii) pension and health care card holders who have ambulance services provided by State ambulance schemes (check entitlements with Centrelink if unsure).
5Accidental Injury Benefit is available on selected Hospital covers. Members receive benefits in line with nib's Gold Hospital cover for 90 days after the accident if members present for treatment with a medical practitioner or at a hospital emergency department within 72 hours of the accident. Benefit may apply after the member has been admitted as an inpatient (but within 90 days of the Accident). Excludes consultations and treatments performed at an Emergency Department. Additional T&Cs apply.
6Members receive benefits in line with nib's Gold Hospital cover for 90 days after the accident if members present for treatment with a medical practitioner or at a hospital emergency department within 72 hours of the accident. Benefit may apply after the member has been admitted as an inpatient (but within 90 days of the Accident). Excludes consultations and treatments performed at an Emergency Department. Additional T&Cs apply.
7To be an eligible member you must be aged between 18 and 29 (inclusive) and not a dependent child under the age-based discount policy.
8Lifetime Health Cover (LHC) is a Government initiative aimed at encouraging people to take out private hospital cover earlier in life, and maintain it. The loading applies for 10 years of continuous hospital cover. For every year you put off signing up for hospital cover, another 2% will be added up to a maximum of 70%. So if you wait until you’re 40, you’ll pay 20% more than someone on the same cover who joined when they were 31. For more information on LHC, visit Lifetime Health Cover loading.