Private Health Information Statement - Combined policy

Hospital Plus - Silver Plus $250 Excess

nib Health Funds Ltd.

Monthly Premium

$1,190.99 #

(before any rebate, loading or discount)

Covers two adults & dependants, including non-student dependants (3 or more people, only 2 of whom are adults)

Available in South Australia

Closed to new members

# You may be entitled to an Australian Government rebate on the above premium. Your premium may also include a Lifetime Health Cover loading, an age-based discount or an insurer discount. Check with your insurer for details.

This policy covers children, students up to and including the age of 30 and non-students up to and including the age of 30, as well as persons with a disability who qualify as a child, student or non-student in these age ranges.

Hospital cover

This policy exempts you from the Medicare Levy Surcharge.

This policy provides accident cover - check with your insurer for details.

This policy does not provide benefits for travel or accommodation (outside of hospital).

This policy includes cover for

Hospital Cover Legend
Assisted reproductive servicesEye (not cataracts)Pain management
Back, neck and spineGastrointestinal endoscopyPain management with device
BloodGynaecologyPalliative care
Bone, joint and muscleHeart and vascular systemPlastic and reconstructive surgery (medically necessary)
Brain and nervous systemHernia and appendixPodiatric surgery (provided by a registered podiatric surgeon – limited benefits)
Breast surgery (medically necessary)Implantation of hearing devicesPregnancy and birth
CataractsInsulin pumpsRehabilitation
Chemotherapy, radiotherapy and immunotherapy for cancerJoint reconstructionsSkin
Dental surgeryJoint replacementsSleep studies
Diabetes management (excluding insulin pumps)Kidney and bladderTonsils, adenoids and grommets
Dialysis for chronic kidney failureLung and chestHospital psychiatric services
Digestive systemMale reproductive system
Ear, nose and throatMiscarriage and termination of pregnancy

This policy does not include cover for

Hospital Cover Legend
Weight loss surgery

The benefits paid for hospital treatment will depend on the type of cover you purchase and whether your fund has an agreement in place with the hospital in which you are treated. See ‘Agreement Hospitals’ on privatehealth.gov.au for which hospitals have arrangements with your insurer – https://privatehealth.gov.au/dynamic/agreementhospitals.

Under this policy, you may have to pay out-of-pocket costs above what you get from Medicare or your private health insurer. Before you go to hospital, you should ask your doctors, hospital and health insurer about any out-of-pocket costs that may apply to you.

The following payments may also apply for hospital admissions

Excess: You will have to pay an excess of $250 per admission. This is limited to a maximum of $1000 per year.

Excess payments do not apply to hospital admissions for dependants.

Co-payments: No co-payments

The following waiting periods for hospital admissions apply to new or upgrading members

Waiting periods:

  • 2 months for palliative care, rehabilitation and hospital psychiatric treatments, even if pre-existing
  • 12 months for other pre-existing conditions
  • 12 months for pregnancy and birth (obstetrics)
  • 2 months for all other treatments

Gap Cover

This provider offers 'known gap' or 'no gap' cover for medical bills for this product.

The Medical Costs Finder lets you find out more about the cost of specialist medical services.

For further information about this policy see

https://my.nib.com.au/product-collateral/14

General Treatment Cover

By using our FirstChoice providers, you may have lower out-of-pocket costs on many allied health services. A list of "preferred providers" is available from the health insurer. See https://www.nib.com.au/find-a-provider.

This policy includes General treatment (Extras) cover for

General treatment legend
Note, for items marked with an asterisk *: Non PBS Pharmaceuticals: benefit paid after current PBS patient contribution deducted. Antenatal benefit limits apply to antenatal classes conducted by a midwife and antenatal classes provided by a hospital.
TreatmentWaiting period (months)Benefit limits (per 12 months unless otherwise stated)Examples of maximum benefits
General dental2$500 per personPeriodic oral examination - 50% of charge
Scale & clean - 50% of charge
Fluoride treatment - 50% of charge
Major dental12$600 per person
(combined limit for major dental & endodontic)
Surgical tooth extraction - 50% of charge
Full crown veneered - 50% of charge
Endodontic12Filling of one root canal - 50% of charge
Orthodontic12$200 per person
$1,000 lifetime limit
Braces for upper & lower teeth, including removal plus fitting of retainer - 50% of charge
Optical6$250 per personSingle vision lenses & frames - 50% of charge
Multi-focal lenses & frames - 50% of charge
Non PBS pharmaceuticals2$200 per personPer eligible prescription - 50% of charge
Physiotherapy2$350 per person
(combined limit for physiotherapy, chiropractic, exercise physiology, osteopathy & other services)
Initial visit - 50% of charge
Subsequent visit - 50% of charge
Chiropractic2Initial visit - 50% of charge
Subsequent visit - 50% of charge
Acupuncture2$200 per person
(combined limit for acupuncture, remedial massage, chinese medicine & other services)
Initial visit - 50% of charge
Subsequent visit - 50% of charge
Remedial massage2Initial visit - 50% of charge
Subsequent visit - 50% of charge
Ante-natal/Post-natal classes*2$100 per personInitial visit - 100% of charge
Subsequent visit - 100% of charge
Chinese medicine2Combined limit - see AcupunctureInitial visit - 50% of charge
Subsequent visit - 50% of charge
Exercise physiology2Combined limit - see PhysiotherapyInitial visit - 50% of charge
Subsequent visit - 50% of charge
Health management / Healthy lifestyle2$150 per personHealth management - 50% of charge
Osteopathy2Combined limit - see PhysiotherapyInitial visit - 50% of charge
Subsequent visit - 50% of charge
Myotherapy: combined limit of $200 with acupuncture, remedial massage and Chinese herbalism. Healthier Lifestyle includes nib approved weight management, quit smoking and health management programs (gym, personal trainer), preventative health tests.

This policy does not include General treatment (Extras) cover for

General treatment legend
Blood glucose monitorsPodiatryOther treatments - check with your insurer
Hearing aidsPsychology

Other features of this general treatment cover

High level of private hospital cover plus a great range of Extras. Of course, you can see your choice of provider, but by choosing a FirstChoice provider, you may have less to pay towards the cost of your treatment. We’ve created the FirstChoice network to help you access quality healthcare and a better deal for you and your family. We’ve locked in lower costs with our FirstChoice providers, so you can enjoy competitive treatment fees when you visit the dentist or a discount the next time you claim for glasses.

For further information about this policy see

https://my.nib.com.au/product-collateral/14

Ambulance cover

In South Australia this policy provides:

Emergency: Unlimited with a waiting period of 1 day.

Call-out fees:  will be paid for each attendance, including emergency treatment without transport to hospital.

Other features of this ambulance cover

All our health covers include unlimited emergency ambulance (1 day waiting period on all emergency ambulance). Emergency ambulance is when you need immediate transport by a State or Territory ambulance to get to a hospital or other facility for urgent medical treatment. No annual limits for emergency ambulance apply.

For further information about this policy see

https://my.nib.com.au/product-collateral/14

Disclaimer

The information contained in this Private Health Information Statement was provided by the insurer and is intended as general information. It may not take into account your particular circumstances. For information please contact the insurer.

Covered

For information on what is covered under each category, see https://www.privatehealth.gov.au/categories

Restricted

Restricted categories partially cover your hospital costs as a private patient in a public hospital. You may incur significant expenses in a private room or private hospital.

Not Covered

These categories are not covered by this policy.