17 of the most commonly asked health insurance questions

We all turn to good old Google when we're feeling confused or need a quick answer to a lingering question. So, we decided to look at some of the most ‘Googled’ health insurance questions and answer them in one easy place – consider your health insurance search over.

1. What is hospital cover?

Hospital cover helps to pay the costs of your hospital accommodation, treatments you receive while in hospital, and your doctors’ fees when receiving in-hospital medical treatment as a private patient.

In-hospital services listed on the Medicare Benefits Schedule (MBS) are covered by private hospital insurance policies; however, some policies will exclude certain services to help keep the price lower for members. This is why it’s so important that you have the right level of cover for your personal circumstances. To organise a cover review, call nib on 13 16 42.

2. What are waiting periods?

When you take out a health insurance policy for the first time, or upgrade your cover, waiting periods will apply before you can claim for some services. Maximum waiting periods for hospital cover are 12 months for pre-existing conditions and pregnancy, two months for psychiatric care, rehabilitation and palliative care (whether pre-existing or not) and two months for all other treatments. Waiting periods also apply for extras.

3. How do health insurance claims work?

If you’ve got private health insurance, it’s important to know what you are and aren’t covered for – that way you know what you can claim.

There are two types of health insurance claims, hospital claims and extras claims.

Hospital

Before you head into hospital, ask your doctor to provide a breakdown of your procedure. This breakdown will give you an idea of what services you’ll be receiving throughout your stay in hospital.

Once you receive the breakdown, give nib a call so we can let you know exactly what you’re covered for, whether your has a hospital excess and whether there’ll be any out-of-pocket expenses.

After your procedure, the hospital may send your bill directly to nib as your private health insurer to pay. This should be hassle-free for you as we’ll take care of all the paperwork. However, if you are given a hospital bill for medical services (for example, specialists, anaesthetist, pathologist or radiologist), you should submit a two-way claim form to Medicare which will ensure that Medicare and nib pay their portions of the bill.

If your hospital visit is covered by other forms of insurance, such as worker’s compensation, medical negligence, or public liability, or another party is liable (for example in a car accident), you’ll be eligible to receive benefits directly from the general insurer or the workers or accident compensation scheme and not your private health insurer.

nib offers a range of Health Management programs Health Management Programs available at no additional charge to eligible members¹. These programs are designed to support members going home from hospital safely, whilst improving physical and mental wellbeing and help a patient recover quicker post-hospitalisation.

Extras

If you’re making Extras cover claims – like when you buy a new pair of glasses – it’s often processed automatically at the point of sale when you swipe your membership card, so 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 member account page.

Once you’ve served any applicable waiting periods, you’ll be able to start claiming extras. Depending on the level of health cover you choose, you’ll be eligible to receive a varying amount of the cost back per extras claim with recognised providers², until you reach your annual limit.

An example: if you’re getting a dental check-up that costs $200 and your policy gives you 60% back on extras, we’ll contribute $120 towards the costs.

4. How much is health insurance?

The cost of health insurance policies varies across insurers, based on the level of cover you choose. It’s important to remember that in most situations, the more you’re covered for, the higher your premium will be – so cheapest isn’t always best. However, if you are looking for a Basic Hospital cover, nib offers policies for a single from $19 a week.³

5. What can I do to reduce my monthly premiums?

At nib, we don’t want you paying more than you should for your private health insurance, so we recommend contacting us for a to ensure you’re not covered for things you don’t need.

Another simple way to save is by looking at how you pay your premium. We offer discounts of up to 4% to members who set up automatic direct debits from a cheque or savings account (discount not available on Ambulance Only cover).

When looking at your private health insurance policy, it’s vital to check what level of excess you’ve got. Often you can lower your premium by choosing a higher excess. Australian residents can select an excess of up to $750 for singles and $1500 for couples or families. To find out more about your excess options, give us a call on 13 16 42.

6. How does the private health insurance rebate work?

If you currently hold private health insurance, you could be eligible to receive a rebate from the Australian Government. The Australian Government Rebate amount is tiered depending on your individual income (if you’re single), or your family’s income. This rebate can be used to reduce your premiums, or claimed as a tax credit when you lodge your tax return with the Australian Taxation Office (ATO).

7. Is there a penalty for not having health insurance?

If you are single and have a taxable income of $97,000 or more, or are a couple, family or single parent family that has a taxable income of more than $194,000 a year, and do not have Hospital cover, you will be required to pay a Medicare Levy Surcharge (MLS) of between 1% and 1.5% of your total income, depending on your income tier.

There’s also the Lifetime Health Cover loading which is a 2% loading on top of your health insurance premium for every year after you’ve turned 31 that you’ve put off taking up private health cover. You’ll be required to pay the loading for 10 consecutive years before it ceases and the maximum loading is 70% - which can end up being thousands of extra dollars you’ll be charged when you do take out private health cover.

For more information, check out our article: Lifetime Health Cover article

8. Does health insurance cover x-rays?

Most health insurers will cover the costs of x-rays you receive while you’re an admitted patient (or inpatient) in a private hospital. However, you are generally not covered for outpatient x-rays.

9. How does hospital cover differ from the public hospital system?

You can be treated in a public hospital as a public patient for no charge if you are an Australian resident or otherwise eligible, however sometimes it doesn’t give you the opportunity to get back to work and play as quickly as you’d like to after an injury.

That’s where hospital cover steps in. Not only does hospital cover include unlimited emergency ambulance cover⁴, meaning you won’t be charged if you need to call an ambo in an emergency, but if you’re with nib, you’ll also receive our Accidental Injury Benefit⁵.

If you require 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 isn’t cheap. With nib, you can skip the public hospital waiting lists, meaning you can get back to doing the things you love – whether it be working, playing sports or socialising again – a whole lot quicker.

These are just a few key differences between private hospital cover and the public health system. For more information, check out our article, Top reasons you need your private health insurance.

10. How do I join with nib for the first time?

Ready to join nib? You can become an nib 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, meaning if you choose not to continue with your cover, we’ll refund your full premium (as long as no claims have been made).

11. How do I switch to nib from another insurer?

Switching from another fund is also super easy. You can get a quote with nib online in just a few minutes. Once you’ve signed up with us, you can sit back and relax – we’ll contact your previous insurer on your behalf. It’s the easiest breakup ever.

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 in the future, check out nib’s nib First Choice network to minimise your out-of-pockets. It’s our community of specially-selected health providers who have agreed to provide nib members with quality healthcare and service at an affordable price for commonly claimed treatments.

13. Why do I need hospital insurance?

Hospital insurance helps bridge the gap that the public hospital system leaves – meaning you can access the treatment you need without joining a public hospital waiting list. You’ll be able to have a say in your doctors and specialist, you may be covered for accidents with the nib Accidental Injury Benefit⁶ and you’ll receive emergency ambulance cover so you won’t receive a bill if you need to call the ambos in an emergency.

For more information, we’ve put together a detailed explainer on why you might need private health insurance.

14. What level of cover do I need?

In order to decide what level of cover you might need, it’s important to ask yourself a few questions about your lifestyle, family and what you’re wanting your health cover for. 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’ approach. Everybody is different and we believe your health insurance should fit where you are at each life stage. However, there are financial perks if you take out hospital cover and you’re under 30. Called the age-based discount, eligible nib members receive a 2% discount for every year that you’re aged less than 30 up to a maximum of 10% off your policy if you’re aged between 18-25.

The Lifetime Health Cover (LHC) loading also encourages young people to take out hospital cover. If you don’t have private hospital insurance by July 1 following your 31st birthday, you’ll be charged a 2% loading for every year you’re over the age of 30 when you do take out insurance⁸. Related: Lifetime Health Cover loading: What does it mean for private health insurance?

16. What rebates can I get on health insurance?

There are a number of reasons why people take out private health cover and there are a number of government initiatives to encourage Aussies to hold hospital cover including the Medicare Levy Surcharge (MLS), Lifetime Health Cover (LHC) loading and Discounts for people under 30. Check out our dedicated Healthcare in Australia page for an explainer on each.

17. What is excess & how does it affect my monthly payments?

Having an excess is a way to keep health insurance premiums cheaper and generally 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 select your own excess amount – up to $750 per person. Want to find out more? Read all about excess with nib at our dedicated excess page or call 13 16 42 to chat with one of our experts.

If you have questions about your existing nib policy visit member account, the nib App or call us 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 on August 2024. The price includes the Australian Government Rebate for a Single aged <65 with a taxable income of $97,000 or less in the financial year ending 30 June 2025. 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.