Private Health Information Statement - Combined policy

Classic Plus - Silver Plus $400 Excess

nib Health Funds Ltd.

Monthly Premium

$682.46 #

(before any rebate, loading or discount)

Covers 2 adults (and no-one else)

Available in NSW & ACT

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.

Hospital cover

This policy exempts you from the Medicare Levy Surcharge.

This policy does not provide accident cover or benefits for travel and 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 $400 per admission. This is limited to a maximum of $400 per person and $800 per policy per year.

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/31

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 *: Benefit paid after current PBS patient contribution deducted
TreatmentWaiting period (months)Benefit limits (per 12 months unless otherwise stated)Examples of maximum benefits
General dental2General Dental: Unlimited; Restorative: $450; Non-specialty Oral-Surgery: $350; Specialty Oral-Surgery: $350, $1,600 per Lifetime; (Service Limits Apply)Periodic oral examination - $21.00
Scale & clean - $35.00
Fluoride treatment - $19.00
Surgical tooth extraction - $65.00
Optical6$200 per personSingle vision lenses & frames - $140.00
Multi-focal lenses & frames - $190.00
Non PBS pharmaceuticals*2$450 per personPer eligible prescription - $45.00
Physiotherapy2$400 per person
(combined limit for physiotherapy, chiropractic, exercise physiology & osteopathy - Sub-limits apply)
Initial visit - $28.00
Subsequent visit - $26.00
Chiropractic2Initial visit - $25.00
Subsequent visit - $22.00
Psychology2$300 per personInitial visit - $45.00
Subsequent visit - $40.00
Remedial massage2$170 per person
(combined limit for remedial massage & dietetics/dietary advice)
Initial visit - $19.00
Subsequent visit - $18.00
Dietetics/dietary advice2Initial visit - $19.00
Subsequent visit - $18.00
Exercise physiology2Combined limit - see PhysiotherapyInitial visit - $28.00
Subsequent visit - $26.00
Health management / Healthy lifestyle6$100 per person up to $200 per policyHealth management - $100.00
Osteopathy2Combined limit - see PhysiotherapyInitial visit - $25.00
Subsequent visit - $23.00
The General Dental annual limit includes multiple sub-limits, and for some sub-limits lifetime limits apply. Waiting periods for Dental treatment range between 2 and 12 months. Healthier Lifestyle includes nib approved weight management, quit smoking programs, gym membership and personal training. Psychology has a sublimit of $150 for Digital Cognitive Behavioural Therapy (CBT).

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

General treatment legend
AcupunctureHearing aidsPodiatry
Blood glucose monitorsMajor dentalOther treatments - check with your insurer
EndodonticOrthodontic

Other features of this general treatment cover

A high level of hospital cover with a range of Extras, great for couples starting a family. 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/31

Ambulance cover

In NSW & ACT 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/31

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.