Review NIB Health Insurance Policy Options

Published: March 28, 2019

NIB is one of Australia’s largest and fastest growing private health funds in Australia, with a market share of 8.3% as of 2019. Established over 65 years ago, NIB serves more than 1.5 million customers Australia-wide.

However, whether NIB will be a good health insurance provider for you and your family depends on your unique requirements and what you can afford. You might want to compare NIB quotes with similar policies from other big health funds in Australia before deciding.

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NIB health insurance plans

The NIB health fund offers a wide range of health insurance products, including a wide range of Hospital and Extras policies that cover treatments and services received inside and outside of the hospital. With NIB private health insurance, you can tailor your cover to suit you and your family’s unique requirements by combining your choice of Hospital cover with the Extras policy you want.

NIB Hospital cover options

The health fund provides you with 5 Hospital options to choose from, with the Basic plan being the cheapest and the Gold option the most comprehensive. Depending on your policy, you can usually choose either a $250 or $500 co-payment. However, for dependent children under the age of 21, there is nil excess.

Consider your age, health and family dynamic before choosing your choice of NIB Hospital cover.

Basic Essential Hospital Plus

Provides the minimum benefit payable for rehabilitation, psychiatric services and palliative care, plus additional hospital services, including:

  • Emergency ambulance cover
  • Immediate necessary treatment needed because of an accident.
  • Joint reconstructions.
  • Treatment and/or removal of hernia, appendix, tonsils, adenoids and grommets.
  • Gastroscopy and colonoscopy.
  • Investigation and treatment of female reproductive system, for example, endometriosis.
  • Investigation and treatment of a miscarriage or termination of pregnancy.
  • Dental surgery.

Bronze Starter Hospital Plus

This budget-friendly Hospital plan provides coverage for everything listed in the Basic Essential's policy, plus an additional 18 hospital services, such as the investigation and treatment of:

  • Kidney and bladder.
  • Medically necessary plastic and reconstructive surgery.
  • Musculoskeletal diseases, disorders and injuries. For example, carpal tunnel and fractures.
  • Ear, nose and throat.
  • Blood and blood-related conditions.
  • Brain, spinal cord and peripheral nervous system, such as epilepsy and Parkinson’s disease.
  • Medically necessary breast surgery.
  • Prostate cancer, male sterilisation and circumcision.
  • Cancer, including chemo, radiotherapy and immunotherapy.
  • Digestive system, including gall bladder and bowel.
  • Lungs and lung condition, such as asthma and lung cancer.
  • Diabetes management.
  • Insulin pumps.
  • Pain management with devices.
  • Skin and skin-related conditions.

Bronze Standard Hospital Plus

The Bronze Standard policy also provides full coverage for:

  • Palliative care.
  • Rehabilitation services.
  • Heart, heart-related conditions and vascular system, which includes varicose veins.
  • Treatment and correction of hearing loss.

Silver Advantage Hospital Plus

NIB’s Silver Hospital plan is generally geared toward more senior Australians, as it provides coverage for:

  • Dialysis and chronic kidney failure.
  • Joint replacement, such as shoulder, knee, hip and spinal disc.
  • Removing cataracts and replacing with an artificial lens.
  • Investigation and treatment of your back, neck and spine. For example, sciatica and herniated discs.

Gold Top Hospital

NIB's Gold Hospital plan is for you if you want to be covered for everything or want to start a family because it includes:

  • Pregnancy and birth-related services.
  • Assisted reproductive services. For example, IVF and GIFT.
  • Weight loss surgery, such as gastric banding.
  • Full cover for the treatment and care of patients with psychiatric, mental, behavioural or addiction disorders.

Take note: Information retrieved from NIB.com.au (March 2019). For a more comprehensive list of services and procedures covered inside a hospital, please read the policy's Standard Information Statement (SIS).

Extras cover

NIB Extras can help you cover the costs of general treatments and services received outside of the hospital, for example, a new pair of glasses and dental procedures. If you or one of your family members regularly require one of the ancillary benefits listed below, then having Extras cover can make a difference, because Medicare doesn't typically pay for these types of services.

Core Extras

Receive 60% back, up to your annual limit:

  • Ambulance coverage – no limit
  • General dental - $600
  • Major dental - $600
  • Optical - $250
  • Physiotherapy - $350
  • Acupuncture - $600 limit.

Core Extras Boost

Higher annual limits. Claim 60% back:

  • Ambulance coverage – no limit
  • General dental - $700
  • Major dental - $1,000
  • Optical - $300
  • Physiotherapy - $450
  • Acupuncture - $600

Core and Wellbeing Extras

Access a fuller range of general treatments and claim 60% back on each visit:

  • Ambulance coverage – no limit
  • General dental - $600
  • Major dental - $600
  • Optical - $250
  • Physiotherapy - $350
  • Psychology - $300
  • Acupuncture - $300
  • Gym memberships - $150
  • Chiro/Osteopathy - $300
  • Dieticians and nutritionist - $300
  • Artificial & health aids - $250

Top Extras

The most comprehensive Extras options that gives you 75% back on each visit, up to your annual limit:

  • Ambulance coverage – no limit
  • General dental - $1,000
  • Major dental - $1,300
  • Orthodontia - $800
  • Optical - $350
  • Physiotherapy - $600
  • Podiatry - $600
  • Psychology - $500
  • Acupuncture - $400
  • Antenatal & postnatal services - $250
  • Occupational therapy - $480
  • Speech therapy - $450
  • Hearing aids - $1,200
  • Artificial & health aids - $500
  • Home nursing services - $200
  • Gym memberships - $200
  • Chiro/Osteopathy - $500
  • Dieticians and nutritionist - $600
  • Non-PBS - $500

Source: NIB.com.au (March 2019)

Important: Consult the policy booklet and SIS for any disclaimers and restrictions, for example, some services are only cover the cost of consultations up to your annual limit.

NIB Hospital cover and Extras waiting periods

Ambulance waiting period

1 Day for approved ambulance transportation.

Hospital waiting periods

12 months
  • Pre-existing medical conditions
  • Pregnancy and birth-related services
2 months
  • Psychiatric treatment
  • Rehabilitation
  • Palliative care
1 day
  • Accidental injury

NIB Extras waiting periods

36 months
  • Hearing aids and Cochlear implants
12 months
  • Dental specialist services, for example, orthodontia
  • Non-specialist orthodontia
  • Dentures, including maintenance and repairs
  • Endodontic services and periodontics surgical
  • Artificial aids
6 months
  • Optical
  • Healthier Lifestyle benefit
2 months
  • General dental
  • Physiotherapy
  • Chiropractic
  • Acupuncture
  • Psychology
  • Non-PBS pharmaceuticals

Frequently asked questions and answers

How to claim NIB health insurance?

Once you’ve served the required waiting period, you can start claiming benefits. You can lodge a NIB health insurance claim online using their online services or the NIB app downloaded to your smartphone. Alternatively, you can claim on-the-spot at a provider by using your health fund card or download a claim form from their website and mail it to them.

Be sure to provide your customer number that’s on the front of your NIB card when claiming for Hospital and general services.

Is ambulance cover available?

Yes, NIB ambulance cover provides emergency transportation by state ambulance in most circumstances. However, you may not be covered for transport between hospitals if the transfer is not medically necessary as determined by your treating doctor.

What is NIB dental insurance?

NIB Dental Care offers eligible patients up to 100% cash back on dental check-ups, including examinations, scale and cleaning, fluoride treatment and bite-wing x-rays. With locations in NSW, ACT, Victoria and Queensland, Dental Care centres are open 6 to 7 days a week and emergency appointments are available every day.

Where to get a NIB health insurance quote?

You can get a personalised NIB private health insurance quote by visiting their website and applying online or give them a call directly. Alternatively, fill in the ComparingExpert health insurance quote form, and a specialist will give you a call to help your compare NIB quotes with other significant health insurance companies in Australia.

Where can you find a NIB provider?

The private health insurer has agreements in place with most Australian private hospitals and a list of Extras providers. Go to the NIB website and search for a health care professional in your area by selecting your postcode or by viewing:

  • Medical specialist registered to participate in MediGap.
  • First Choice Network to find a dentist or optical provider.
  • Visitors medical services for international policy holders requiring a medical professional.

What does NIB health insurance stand for and who owns them?

The insurer is a shareholder-owned company that started in 1952, with a group of like-minded workers at BHP Steelworks in Mayfield. This group of people came together to set up the Newcastle Industrial Benefits (NIB). NIB Health Funds Ltd. operates in all Australian states and territories on a for-profit basis.

Does the health fun cover gym membership?

Under the fund's Healthier Lifestyle benefit, available on NIB Wellbeing Extras and Top Extras, specific weight management programs, gym/fitness centres, Pilates and Yoga classes, that are recognised by the insurer, are generally available to members.

How to cancel your NIB health insurance policy?

To cancel a health insurance policy from NIB, the policyholder must notify NIB in writing, or call them directly. Alternatively, you can cancel face-to-face at any NIB retail centre. The cancellation will take effect from the date on which you give notice and must follow the terms and conditions as set out in your policy.

Ask an Expert?

4 Comments

  • Naomi Turnbull |

    Hello. I have been overseas for the last 3 years (and a bit) in which my company provided expat insurance – does this cover private health insurance or do I need to restart? I previously had private health insurance for over 10 years prior to that.

    • SPECIALIST
      Anneke Van Aswegen |

      Hi Naomi,

      Thank you for your question. I would love to help you, but I require a bit more information and some clarity. What I first want to know is, did you mean you are an Australian citizen who has lived abroad for 3 years or have you been living in Australia for 3 years as an expatriate?

      I suggest filling in the quote form above so that a specialist health insurance consultant can give you a call and take you through the process step-by-step.

  • DJ |

    Does NIB cover Osteo appointments?

    • SPECIALIST
      Anneke Van Aswegen |

      Hi DJ,
      If you have Extras cover that includes Osteopathy, you’ll generally be able to claim a portion of the appointment and treatment costs.

      For example, NIB Top Extras provides cover for Osteopathy, however, as with most health funds, a 2 month waiting period will usually apply before you are able to claim for this benefit.

      While Osteopathy is covered by most private health funds in Australia, the amount you can claim varies from fund to fund and depends on your choice of basic, medium or comprehensive extras cover.

      Review and compare extras cover options from a variety of health funds to ensure you are getting the best policy at the best possible price. Simply fill in the form above and a health consultant will give you a call to take you through all the options available to you.