How To Get A Nib Insurance Policy

Transcription

1 Corporate Choosing your He alth COVer health cover for the real world it s worth it

2 Welcome to nib At nib, we believe Private Health Insurance should be easy to understand, easy to claim on and most of all, good value. So, we ve created this guide to help you make the right choice, and to help you get great value from your Corporate health cover. Please read this guide and keep it handy to refer to in the future. NOTE: Before joining any nib health cover, read this guide carefully to choose which cover is most appropriate for your needs. The information contained in this brochure is current as at 1 April 2012 and should be read in conjunction with the nib Using Your Health Cover brochure. Rules and benefit levels may change from time to time. If you would like to know more please contact us on Contents Over 800,000 Aussies can t be wrong The hard work has been done What are you looking for? and Extras Covers Basic Saver Covers young people for those things that really matter. Family Basic Saver For families on a budget, who need cover for the kids. Basic Plus Great for young people who want more cover for things like major dental. Mid Plus Suitable for those not planning a family, who want more hospital cover. Family Plus For the family, who need more cover, like major dental and optical. Plus For those thinking about kids and want cover for a range of Extras. Top Cover For those who want the best hospital cover with 75% back on Extras. Premier Plus The highest level of hospital cover with 85% back on Extras. Other Covers Just Top nib hospital only cover. No Extras included. Ambulance Only Covers you for an expensive ride. Premium Extras The best when it comes to Extras. Value Added Services nib Dental Care Centres nib Eye Care Centres nib Value Life Insurance nib Funeral Plan nib Bill Relief nib Travel Insurance How you can save on your nib cover Join nib nib online services nib mobile claiming Things you need to know about hospital cover Everyday Extras Important information Terms and conditions it s worth it

3 life is full of WHAT IFS? THE answer IS NO WORRIes Over 800,000 Aussies can t be wrong So why choose nib? nib is one of Australia s fastest growing health funds more people are choosing nib. We now provide health cover to over 800,000 Australians. We have over 50 years experience providing health cover. We have a range of affordable health cover products to suit where you re at in life. We are committed to supporting your health and wellbeing so you can continue to lead an active lifestyle. In the end, it s about helping you enjoy a healthy life. so, let s get started...

4 The hard work s been done Let s make the most of it Let s face it, comparing health cover can be hard work, wouldn t it be great if someone did it for you? Your employer has done it for you, and has seen the great value nib can provide you. Looking after your health can be expensive that s why your workplace has negotiated a deal with nib to provide you with a great range of health cover at the best price (we call this mates rates). Everyone is different that s why nib has a great range of health cover to suit where you re at in life (all you have to do is choose). So what s in it for you? nib s range of Corporate health covers are only available to you, your workmates and your family. Depending on the cover you choose, you will get 50%, 65%, 75%, or 85% of the cost of the service back every time you claim on Extras (up to the Annual Limit), for things like dental and physio, it s that easy. There s something for everyone, it doesn t matter who you are or what you do there s a cover to suit your needs (and your wallet). Call grouphealth@nib.com.au 5

5 What are you looking for? The best possible price... Basically, people fall into 4 categories... We call them lifestages, and for each one, there are a range of covers to choose from, with prices to match. The different lifestages are: Which is fine, we just want to make sure you re getting the best possible cover. After all, you can t put a price on your health. How to choose the right cover for you. Depending on where you re at in life, there are features you ll want from your health cover, and ones you won t for example, not many 22 year olds need hip replacements. Cover for singles Cover for couples Cover for single parent families Cover for families There are two types of Private Health Insurance: Cover Choosing a hospital cover is important. The level of hospital cover you choose determines the types of procedures and services you re covered for (like removal of tonsils, childbirth, heart surgery etc). The higher the level of cover, the more procedures you will be covered for. Our covers are affordable because we ve carefully chosen what is included and excluded for each. You can find out more about hospital cover on page 44. Extras Cover You don t need to be sick to benefit. Extras cover is for services you can use everyday to stay healthy like going to the dentist, a visit to the physio, or a new pair of glasses. Medicare doesn t adequately cover many of these services, so we help you pay for them. We have a range of covers that pay benefits as a percentage of the cost to you, so you know what you get back every time. Even better, the higher your cover, the more services you re covered for and the more you get back. You can find out more about Extras on page 48. Great news! Most nib health covers give you both hospital and Extras cover. When it comes to choosing the best cover, we keep it simple. Getting to know your health cover. It s important to know how your cover works and how you can keep your policy details up to date. We have a range of health covers to suit your needs, wherever you are in life. Cover for: Singles your nib policy covers one person only Couples your nib policy covers you + your partner Families and single parent families your nib policy is for you + your partner + all unmarried kids or students up to age 21. A family policy will also cover single parent families. Kids studying? They re covered until they turn 25. If your have dependants who are over 21 and under 25, who are studying full time and aren t married or in a de facto relationship, they can still be covered by your policy. We call them Student Dependants. We ll send you a Student Dependant Registration Form when they turn 21, and then each year until they turn 25, so they stay covered. Student Dependants can be added to all family policies at no extra cost provided they are studying full time. Once your dependants no longer meet the Student Dependant criteria, they ll need to take out their own nib health cover. 6 Call grouphealth@nib.com.au Call grouphealth@nib.com.au 7

6 CHOOSE your COVer Only want cover for hospital or ambulance? Check out our covers from page 29. I only want basic cover for the things that matter. $950* worth of Extras paid back as 50% of the cost Basic Extras including general dental and optical Low level hospital cover I could save tax basic saver singles couples PAGE 12 We mostly want cover for the kids but don t want to spend too much. $1320* worth of Extras paid back as 50% of the cost Covers the basics like removing tonsils and some dental Low level hospital cover No cover for pregnancy FAmily basic saver single parents families PAGE 14 I m not thinking of having kids, but I want more cover with major dental. $2450* worth of Extras paid back as 65% of the cost More Extras including major dental Medium level hospital cover I could save tax basic plus singles couples PAGE 16 I don t need cover for pregnancy but want more than the basics. $2550* worth of Extras paid back as 65% of the cost More than basic Extras, especially dental and optical Cover for hospital services we may need, like heart surgery Medium level hospital cover Mid Plus singles couples single parents families PAGE 18 We want cover for all the family and are thinking of having kids in the future. $3000* worth of Extras paid back as 65% of the cost More than the basics, especially dental and optical Cover when we start a family or have more kids Medium level hospital cover FAmily plus couples single parents families PAGE 20 I want cover for pregnancy and more than the basics. $2350* worth of Extras paid back as 50% of the cost More than the basics, especially dental and optical Cover for starting a family High level hospital cover HospiTAl plus singles couples single parents families PAGE 22 I want total peace of mind by having the best nib cover. $5500* worth of Extras paid back as 75% of the cost Wide range of Extras including comprehensive dental cover Total peace of mind for being covered for unexpected health problems High level hospital cover Top Cover singles couples single parents families PAGE 24 I want total peace of mind by having the best nib cover. $5500* worth of Extras paid back as 85% of the cost Wide range of Extras including comprehensive dental cover Total peace of mind for being covered for unexpected health problems High level hospital cover * per person, per calendar year (capped at 4 times the annual limit for single parent/family policies) premier plus singles couples single parents families 8 Call grouphealth@nib.com.au Call grouphealth@nib.com.au 9 PAGE 26

7 EXtras OVerVIEW Combined and Extras covers Extras Only Extras you can use every day cover is included on most nib health covers though the level of benefits varies between covers. BasIC saver family basic saver BasIC plus MID plus family plus Plus top Cover premier plus PreMIum extras Waiting periods Ambulance* 1 day *Ambulance cover is not included in health cover for QLD or TAS residents as ambulance services are provided by state government schemes. Extras (paid as % of cost) 50% 50% 65% 65% 65% 50% 75% 85% 65% General dental Major dental Orthodontia Optical Physiotherapy Exercise physiology Chiropractic Osteopathy Natural therapies Speech therapy Podiatry Orthotics Orthoptics (eye therapy) Dietetics Home nursing Occupational therapy (and 1 for oral surgery on Basic Saver) Antenatal & postnatal services * * * * * Pharmaceutical prescriptions Psychology Hearing aids Artificial aids Healthier lifestyle Total Extras value $950^ $1,320^ $2,450^ $2,550^ $3,000^ $2,350^ $5,500^ $6,150^ $4,650^ ^per person, per calendar year (capped at 4 times the annual limit for single parent/family policies) months 36 months 1 6 months Note: Extras are subject to annual limits and some services share a combined limit. Service limits may apply to some Extras. *Antenatal and Postnatal services are paid at 100%. Call grouphealth@nib.com.au 11

8 basic saver Covers young people for those things that really matter Basic, Ambulance and Extras. INCLUSIONS the ONLY services covered extras benefits 50% of the cost to you up to the annual limit. EXCLUSIONS the services not covered paid as singles ( capped at $500 for singles per ( capped at $500 for singles per couples for couples per for couples per Immediate treatment after an accident (see page 49 for more detail) Removal of teeth (including wisdom teeth) Minor knee, hip & shoulder investigations Removal of tonsils Removal of appendix Minor hernia surgery Ambulance cover Refer page 30 under Ambulance Only Restrictions apply Any services not shown as an Inclusion or Exclusion are limited to Public Benefits (details page 45). Extras benefits Pregnancy & birth related services Assisted reproductive services (e.g. IVF) Infertility investigations All eye surgery (e.g. cataracts, pterygiums, squints) Major joint replacement (e.g. artificial knee/hip) Gastric banding & obesity surgery Renal dialysis Cosmetic surgery (to enhance appearance) Spinal fusion surgery You get 50% of the cost back Annual Limit (per person per Waiting Period General dental (includes oral surgery) $450 e.g. oral examination, scale and clean, fillings, basic extractions, oral surgery (12 month waiting period for oral surgery). Optical $200 6 months e.g. frames, lenses, contact lenses. Physiotherapy/Exercise physiology/chiropractic $200 Natural therapies (consultations only) $100 Including acupuncture, herbalism, naturopathy, homeopathy, nutrition, remedial massage, myotherapy, bowen therapy & shiatsu. Covers young people for those things that really matter. Note: The hospital services shown are examples only and intended to be used as a guide. We suggest that your carefully read Going to page 4 of the Using Your Health Cover brochure for more information. Please be aware that some procedures may not be covered. You should always check with nib before you go to hospital to find out if you ve got the cover you need. In some cases there may be some drugs and surgical items that are not covered. Waiting periods may apply for hospital and Extras services - even if you are an existing nib customer or transferring from another fund. For more information on hospital cover and waiting periods, see page Call grouphealth@nib.com.au

9 FaMILy basic saver Great value health cover for families on a budget, who need cover mostly for the kids. extras benefits paid as 50% of the cost to you up to the annual limit. single parents families INclUSIONS the ONLY services covered EXCLUSIONS the services not covered 14 Immediate treatment after an accident (see page 49 for more detail) Removal of teeth (including wisdom teeth) Removal of tonsils Removal of appendix Minor hernia surgery Grommets in ears Removal of adenoids Minor eye surgery (e.g. squints, pterygiums) Ambulance cover Refer page 30 under Ambulance Only Call grouphealth@nib.com.au Pregnancy & birth related services Assisted reproductive services (e.g. IVF) Infertility investigations Major eye surgery (e.g. cataracts) Major joint replacement (e.g. artificial knee/hip) Gastric banding & obesity surgery Renal dialysis Cosmetic surgery (to enhance appearance) Spinal fusion surgery Restrictions apply Any services not shown as an Inclusion or Exclusion are limited to Public Benefits (details page 45). You don t pay an excess for kids under 21 years of age. See page 44 for details. Note: The hospital services shown are examples only and intended to be used as a guide. We suggest that your carefully read Going to page 4 of the Using Your Health Cover brochure for more information. Please be aware that some procedures may not be covered. You should always check with nib before you go to hospital to find out if you ve got the cover you need. In some cases there may be some drugs and surgical items that are not covered. Waiting periods may apply for hospital and Extras services - even if you are an existing nib customer or transferring from another fund. For more information on hospital cover and waiting periods, see page 44. Extras benefits You get 50% of the cost back General & major dental Annual Limit* (per person per $500 (combined limit) Waiting Period (General dental) 1 (Major dental) General dental includes oral examination, scale and clean, basic extractions, fillings. Major dental includes crowns & bridges, implants, orthodontia, oral surgery. Optical $220 6 months e.g. frames, lenses, contact lenses. Physiotherapy/Exercise physiology/chiropractic $300 Pharmaceutical prescriptions $100 Benefits paid once the maximum PBS charge has been deducted. Benefits do not apply to prescriptions dispensed to hospital inpatients. Natural therapies/speech therapy/podiatry $200 Including speech therapy. Consultations only on the following: acupuncture, herbalism, naturopathy, podiatry, homeopathy, nutrition, remedial massage, myotherapy, bowen therapy and shiatsu. *Total benefit claimable for each service capped at 4 times the per person annual limit for single parent/family policies.

10 basic plus Great for young people who aren t thinking about kids, but who want more cover, like major dental. paid as extras benefits 65% of the cost to you up to the annual limit. singles ( capped at $500 for singles per couples for couples per ( capped at $500 for singles per for couples per INclUSIONS examples of services covered EXCLUSIONS the services not covered Immediate treatment after an accident (see page 49 for more detail) Removal of teeth (including wisdom teeth) Knee, hip & shoulder investigations Knee & shoulder surgery (e.g. cartilage repair) Removal of tonsils Removal of appendix Hernia surgery Digestive disorders (e.g. stomach ulcers) Colonoscopies & bowel surgery Kidney stone & gall stone removal Minor eye surgery (e.g. squints, pterygiums) Ambulance cover Refer page 30 under Ambulance Only Major eye surgery (e.g. cataracts) Major joint replacement (e.g. artificial knee/hip) Gastric banding & obesity surgery Renal dialysis Cosmetic surgery (to enhance appearance) Antenatal services performed by a midwife or physio in a public & private hospital Spinal fusion surgery Restrictions apply The following services are limited to Public Benefits (details see page 45) Pregnancy & birth related services Assisted reproductive services (e.g. IVF) Infertility investigations Heart surgery (e.g. stents, open heart surgery) Psychiatric conditions (e.g. depression, eating disorders, drug & alcohol rehabilitation) Rehabilitation programs. Note: The hospital services shown are examples only and intended to be used as a guide. We suggest that your carefully read Going to page 4 of the Using Your Health Cover brochure for more information. Please be aware that some procedures may not be covered. You should always check with nib before you go to hospital to find out if you ve got the cover you need. In some cases there may be some drugs and surgical items that are not covered. Waiting periods may apply for hospital and Extras services - even if you are an existing nib customer or transferring from another fund. For more information on hospital cover and waiting periods, see page 44. Extras benefits You get 65% of the cost back Annual Limit (per person per Waiting Period General dental $500 e.g. oral examination, scale and clean, fillings, basic extractions. Major dental $600 1 e.g. root canal therapy, gum disease, crowns & bridges, implants, dentures, orthodontia, oral surgery. Optical $250 6 months e.g. frames, lenses, contact lenses. Physiotherapy/Exercise physiology/chiropractic/osteopathy $350 Natural therapies (consultations only) $200 Including acupuncture, herbalism, naturopathy, homeopathy, nutrition, remedial massage, myotherapy, bowen therapy & shiatsu. Pharmaceutical prescriptions $200 Benefits paid once the maximum PBS charge has been deducted. Benefits do not apply to prescriptions dispensed to hospital inpatients. Psychology $200 No benefits for tests, assessments or couple/group sessions or if a benefit has already been claimed through Medicare. Healthier lifestyle $150 6 months nib approved weight management, quit smoking and health management programs, first aid courses, preventative health tests. 16 Call grouphealth@nib.com.au Call grouphealth@nib.com.au 17

11 mid plus Health cover for those not planning to have kids and who want more cover for the unexpected. paid as extras benefits 65% of the cost to you up to the annual limit. singles ( capped at $500 for singles per ( capped at $500 for singles per couples for couples per for couples per single parents families INCLUSIONS examples of services covered EXCLUSIONS the services not covered Immediate treatment after an accident (see page 49 for more detail) Removal of teeth (including wisdom teeth) Knee, hip & shoulder investigations Knee & shoulder surgery (e.g. cartilage repair) Removal of tonsils Removal of appendix Hernia surgery Digestive disorders (e.g. stomach ulcers) Colonoscopies & bowel surgery Kidney stone & gall stone removal Minor eye surgery (e.g. squints, pterygiums) Heart surgery (e.g. stents, open heart surgery) Rehabilitation programs Renal dialysis Ambulance cover Refer page 30 under Ambulance Only Pregnancy & birth related services Assisted reproductive services (e.g. IVF) Infertility investigations Major eye surgery (e.g. cataracts) Major joint replacement (e.g. artificial knee/hip) Gastric banding & obesity surgery Cosmetic surgery (to enhance appearance) Spinal fusion surgery Restrictions apply Psychiatric conditions (e.g. depression, eating disorders, drug & alcohol rehabilitation) are limited to Public Benefits (for details see page 45). Note: The hospital services shown are examples only and intended to be used as a guide. We suggest that your carefully read Going to page 4 of the Using Your Health Cover brochure for more information. Please be aware that some procedures may not be covered. You should always check with nib before you go to hospital to find out if you ve got the cover you need. In some cases there may be some drugs and surgical items that are not covered. Waiting periods may apply for hospital and Extras services - even if you are an existing nib customer or transferring from another fund. For more information on hospital cover and waiting periods, see page 44. You don t pay an excess for kids under 21 years of age. See page 44 for details. Extras benefits You get 65% of the cost back Annual Limit* (per person per Waiting Period General dental $500 e.g. oral examination, scale and clean, fillings, basic extractions. Major dental $600 1 e.g. root canal therapy, gum disease, crowns & bridges, implants, dentures, orthodontia, oral surgery. Optical $250 6 months e.g. frames, lenses, contact lenses. Physiotherapy/Exercise physiology/chiropractic/osteopathy $350 Natural therapies (consultations only) $200 Including acupuncture, herbalism, naturopathy, homeopathy, nutrition, remedial massage, myotherapy, bowen therapy & shiatsu. Pharmaceutical prescriptions $300 Benefits paid once the maximum PBS charge has been deducted. Benefits do not apply to prescriptions dispensed to hospital inpatients. Psychology $200 No benefits for tests, assessments or couple/group sessions or if a benefit has already been claimed through Medicare. Healthier lifestyle $150 6 months nib approved weight management, quit smoking and health management programs, first aid courses, preventative health tests. *Total benefit claimable for each service capped at 4 times the per person annual limit for single parent/family policies. 18 Call grouphealth@nib.com.au Call grouphealth@nib.com.au 19

12 FaMILy plus For those who want more cover for things like dental and optical now, and are thinking of having kids in the future. paid as extras benefits 65% of the cost to you up to the annual limit. couples for couples per single parents families for couples per INCLUSIONS examples of services covered Immediate treatment after an accident (see page 49 for more detail) Removal of teeth (including wisdom teeth) Knee, hip & shoulder investigations Knee & shoulder surgery (e.g. cartilage repair) Removal of tonsils Removal of appendix Hernia surgery Grommets in ears Removal of adenoids Minor eye surgery (e.g. squints, pterygiums) Colonoscopies & bowel surgery Digestive disorders (e.g. stomach ulcers) Kidney stone & gall stone removal Pregnancy & birth related services* Antenatal services performed by a midwife or physio in a public & private hospital Ambulance cover Refer page 30 under Ambulance Only EXCLUSIONS the services not covered Major eye surgery (e.g. cataracts) Major joint replacement (e.g. artificial knee/hip) Gastric banding & obesity surgery Cosmetic surgery (to enhance appearance) Spinal fusion surgery Restrictions apply The services listed below are limited to Public Benefits (details see page 45): Assisted reproductive services (e.g. IVF) Infertility investigations Heart surgery (e.g. stents, open heart surgery) Renal dialysis Psychiatric conditions (e.g. depression, eating disorders, drug & alcohol rehabilitation) Rehabilitation programs. IMPORTANT INFORMatION * Benefit Limitation Periods apply on pregnancy & birth related services if you currently do not have Private Health Insurance If you are considering Family Plus, this means that the benefits payable on pregnancy & birth related services are subject to Benefit Limitations and are limited to Public Benefits only during your first 24 months of cover (but after serving the standard hospital waiting periods). For more information on Public Benefits see page 45 Note: The hospital services shown are examples only and intended to be used as a guide. We suggest that your carefully read Going to page 4 of the Using Your Health Cover brochure for more information. Please be aware that some procedures may not be covered. You should always check with nib before you go to hospital to find out if you ve got the cover you need. In some cases there may be some drugs and surgical items that are not covered. Waiting periods may apply for hospital and Extras services - even if you are an existing nib customer or transferring from another fund. For more information on hospital cover and waiting periods, see page 44. You don t pay an excess for kids under 21 years of age. See page 44 for details. Extras benefits You get 65% of the cost back Annual Limit* (per person per Waiting Period General dental $500 e.g. oral examination, scale and clean, fillings, basic extractions. Major dental $600 1 e.g. root canal therapy, gum disease, crowns & bridges, implants, dentures, oral surgery. Orthodontia $250 1 e.g. braces (increasing by $100 per calendar year to a Lifetime Limit of $1500). Optical $250 6 months e.g. frames, lenses, contact lenses. Physiotherapy/Exercise physiology/chiropractic/osteopathy $350 Natural therapies/speech therapy/podiatry/orthotics $300 Including speech therapy and orthotics. Consultations only on the following: acupuncture, herbalism, naturopathy, podiatry, homeopathy, nutrition, remedial massage, myotherapy, bowen therapy and shiatsu. Pharmaceutical prescriptions $300 Benefits paid once the maximum PBS charge has been deducted. Benefits do not apply to prescriptions dispensed to hospital inpatients. Psychology $200 No benefits for tests, assessments or couple/group sessions or if a benefit has already been claimed through Medicare. Healthier lifestyle $150 6 months nib approved weight management, quit smoking and health management programs, first aid courses, preventative health tests. Antenatal & postnatal services (by a midwife in a private practice) $ % back for antenatal and postnatal services in a private practice, up to your annual limit. *Total benefit claimable for each service capped at 4 times the per person annual limit for single parent/family policies. 20 Call grouphealth@nib.com.au Call grouphealth@nib.com.au 21

13 plus For a high level of private hospital cover plus a great range of Extras. extras benefits 50% of the cost to you up to the annual limit. singles ( capped at $500 for singles per couples for couples per single parents families ( capped at $500 for singles per for couples per INclUSIONS examples of services covered EXCLUSIONs the services not covered Immediate treatment after an accident (see page 49 for more detail) Knee, hip & shoulder investigations Knee & shoulder surgery (e.g. cartilage repair) Removal of tonsils Removal of appendix Hernia surgery Grommets in ears Removal of adenoids Digestive disorders (e.g. stomach ulcers) Colonoscopies & bowel surgery Kidney stone & gall stone removal Minor eye surgery (e.g. squints, pterygiums) Antenatal classes performed by a midwife or physio in a public & private hospital Ambulance cover Refer page 30 under Ambulance Only Gastric banding & obesity surgery Spinal fusion surgery Cosmetic surgery (to enhance appearance) Restrictions apply Psychiatric conditions (e.g. depression, eating disorders, drug & alcohol rehabilitation). Important Information Benefit Limitation Periods apply if you currently do not have Private Health Insurance. If you are considering Plus, during your first 24 months of cover (but after the standard hospital waiting periods have been served) the services below are subject to Benefit Limitations. This means that the benefits payable on these services are limited to Public Benefits only until the benefit limitation periods have been served. Pregnancy & birth related services Assisted reproductive services (e.g.ivf) Infertility investigations Heart surgery (e.g. stents, open heart surgery) Major joint replacement (e.g. artificial knee/hip) Rehabilitation programs Renal dialysis Major eye surgery (e.g. cataracts) For more information on Public Benefits see page 45. Note: The hospital services shown are examples only and intended to be used as a guide. We suggest that your carefully read Going to page 4 of the Using Your Health Cover brochure for more information. Please be aware that some procedures may not be covered. You should always check with nib before you go to hospital to find out if you ve got the cover you need. In some cases there may be some drugs and surgical items that are not covered. Waiting periods may apply for hospital and Extras services - even if you are an existing nib customer or transferring from another fund. For more information on hospital cover and waiting periods, see page 44. You don t pay an excess for kids under 21 years of age. See page 44 for details. Extras benefits You get 50% of the cost back Annual Limit* (per person per Waiting Period General dental $500 e.g. oral examination, scale and clean, fillings, basic extractions. Major dental $600 1 e.g. root canal therapy, gum disease, crowns and bridges, implants, dentures, oral surgery, orthodontia. Optical $250 6 months e.g. frames, lenses, contact lenses. Physiotherapy/Chiropractic/Osteopathy/Exercise physiology $350 Natural therapies (consultations only) $200 Including acupuncture, herbalism, naturopathy, homeopathy, nutrition, remedial massage, myotherapy, bowen therapy & shiatsu. Healthier lifestyle $150 6 months nib approved weight management, quit smoking and health management programs, first aid courses, preventative health tests. Pharmaceutical prescriptions $200 Benefits paid once the maximum PBS charge has been deducted. Benefits do not apply to prescriptions dispensed to hospital inpatients. Antenatal & postnatal services (by a midwife in a private practice) $ % back for antenatal & postnatal services in a private practice, up to your annual limits. *Total benefits claimable for each service capped at 4 times the per person annual limit for single parent/family policies. 22 Call grouphealth@nib.com.au Call grouphealth@nib.com.au 23

14 Top Cover For those who want total peace of mind by having the best nib cover. INCLUSIONS examples of services covered extras benefits paid as 75% of the cost to you up to the annual limit. singles Nil ( capped at $500 for singles per ( capped at $500 for singles per couples Nil for couples per for couples per single parents Nil families Nil Immediate treatment after an accident (see page 49 for more detail) Removal of teeth (including wisdom teeth) Knee, hip & shoulder investigations Knee & shoulder surgery (e.g. cartilage repair) Removal of tonsils Removal of appendix Hernia surgery Back surgery (e.g. slipped disc) Digestive disorders (e.g. stomach ulcers) Colonoscopies & bowel surgery Kidney stone & gall stone removal All eye surgery (e.g. cataracts, squints, pterygiums) Heart surgery (e.g. stents, open heart surgery) EXCLUSIONS the services not covered Cosmetic surgery (to enhance appearance) Grommets in ears Removal of adenoids Rehabilitation programs Pregnancy & birth related services Antenatal services performed by a midwife or physio in a public & private hospital Infertility investigations Assisted reproductive services (e.g. IVF) Psychiatric conditions (e.g. depression, eating disorders, drug & alcohol rehabilitation) Major joint replacement (e.g. artificial knee/hip) Renal dialysis Gastric banding & obesity surgery Ambulance cover Refer page 30 under Ambulance Only You don t pay an excess for kids under 21 years of age. See page 44 for details. Note: The hospital services shown are examples only and intended to be used as a guide. We suggest that your carefully read Going to page 4 of the Using Your Health Cover brochure for more information. Please be aware that some procedures may not be covered. You should always check with nib before you go to hospital to find out if you ve got the cover you need. In some cases there may be some drugs and surgical items that are not covered. Waiting periods may apply for hospital and Extras services - even if you are an existing nib customer or transferring from another fund. For more information on hospital cover and waiting periods, see page 44. Extras benefits You get 75% of the cost back Annual Limit* (per person per Waiting Period General dental $600 e.g. oral examination, scale and clean, fillings, basic extractions. Major dental $ e.g. root canal therapy, gum disease, crowns & bridges, implants, dentures, oral surgery. Orthodontia $350 1 e.g. braces (increasing by $100 per calendar year to a Lifetime Limit of $2800). Optical $300 6 months e.g. frames, lenses, contact lenses. Physiotherapy/Exercise physiology/chiropractic/osteopathy $550 Natural therapies (consultations only) $250 Including acupuncture, herbalism, naturopathy, homeopathy, nutrition, remedial massage, myotherapy, bowen therapy & shiatsu. Pharmaceutical prescriptions $500 Benefits paid once the maximum PBS charge has been deducted. Benefits do not apply to prescriptions dispensed to hospital inpatients. Psychology $300 No benefits for tests, assessments or couple/group sessions or if a benefit has already been claimed through Medicare. Hearing aids & artificial aids $ months Ask nib about details of specific restrictions and replacements. Waiting periods determined by type of aid. Healthier lifestyle $250 6 months nib approved weight management, quit smoking and health management programs, first aid courses, preventative health tests. Other therapies $400 Speech therapy, podiatry consultations, orthoptics (eye therapy), dietetics, home nursing, occupational therapy. Antenatal & postnatal services (by a midwife in a private practice) 100% back for antenatal & postnatal services in a private practice, up to your annual limits. *Total benefit claimable for each service capped at 4 times the per person annual limit for single parent/family policies. 24 Call grouphealth@nib.com.au Call grouphealth@nib.com.au 25

15 premier plus nib s highest level hospital cover with Extras paid back as 85% of the cost. INCLUSIONS examples of services covered extras benefits paid as 85% of the cost to you up to the annual limit. singles Nil ( capped at $500 for singles per ( capped at $500 for singles per couples Nil for couples per for couples per single parents Nil families Nil Immediate treatment after an accident (see page 49 for more detail) Removal of teeth (including wisdom teeth) Knee, hip & shoulder investigations Knee & shoulder surgery (e.g. cartilage repair) Removal of tonsils Removal of appendix Hernia surgery Grommets in ears Removal of adenoids Back surgery (e.g. slipped disc) Digestive disorders (e.g. stomach ulcers) Colonoscopies & bowel surgery Kidney stone & gall stone removal All eye surgery (e.g. cataracts, squints, pterygiums) Heart surgery (e.g. stents, open heart surgery) EXCLUSIONS the services not covered Cosmetic surgery (to enhance appearance) Rehabilitation programs Renal dialysis Pregnancy & birth related services Antenatal services performed by a midwife or physio in a public & private hospital Infertility investigations Assisted reproductive services (e.g. IVF) Major joint replacement (e.g. artificial knee/hip) Psychiatric conditions (e.g. depression, eating disorders, drug & alcohol rehabilitation) Gastric banding & obesity surgery Ambulance cover Refer page 30 under Ambulance Only You don t pay an excess for kids under 21 years of age. See page 44 for details. Note: The hospital services shown are examples only and intended to be used as a guide. We suggest that your carefully read Going to page 4 of the Using Your Health Cover brochure for more information. Please be aware that some procedures may not be covered. You should always check with nib before you go to hospital to find out if you ve got the cover you need. In some cases there may be some drugs and surgical items that are not covered. Waiting periods may apply for hospital and Extras services - even if you are an existing nib customer or transferring from another fund. For more information on hospital cover and waiting periods, see page 44. Extras benefits You get 85% of the cost back Annual Limit* (per person per Waiting Period General dental $700 e.g. oral examination, scale and clean, fillings, basic extractions. Major dental $ e.g. root canal therapy, gum disease, crowns & bridges, implants, dentures, oral surgery. Orthodontia $500 1 e.g. braces (increasing by $100 per calendar year to a Lifetime Limit of $2800). Optical $400 6 months e.g. frames, lenses, contact lenses. Physiotherapy/Exercise physiology/chiropractic/osteopathy $650 Natural therapies (consultations only) $300 Including acupuncture, herbalism, naturopathy, homeopathy, nutrition, remedial massage, myotherapy, bowen therapy & shiatsu. Pharmaceutical prescriptions $500 Benefits paid once the maximum PBS charge has been deducted. Benefits do not apply to prescriptions dispensed to hospital inpatients. Psychology $300 No benefits for tests, assessments or couple/group sessions or if a benefit has already been claimed through Medicare. Hearing aids & artificial aids $ months Ask nib about details of specific restrictions and replacements. Waiting periods determined by type of aid. Healthier lifestyle $250 6 months nib approved weight management, quit smoking and health management programs, first aid courses, preventative health tests. Other therapies $450 Speech therapy, podiatry consultations, orthoptics (eye therapy), dietetics, home nursing, occupational therapy. Antenatal & postnatal services (by a midwife in a private practice) 100% back for antenatal & postnatal services in a private practice, up to your annual limits. *Total benefit claimable for each service capped at 4 times the per person annual limit for single parent/family policies. 26 Call grouphealth@nib.com.au Call grouphealth@nib.com.au 27

16 OTHER COVers Just The highest nib hospital only cover, the best when going to a private hospital. I ve got it covered! Overview Ambulance cover refer page 30 under Ambulance Only Could help you save tax refer page 39 IMPORTANT INFORMatION INclUSIONS examples of services covered Immediate treatment after an accident (see page 49 for more detail) Knee, hip & shoulder investigations Knee & shoulder surgery (e.g. cartilage repair) Removal of tonsils Removal of appendix Hernia surgery Grommets in ears Removal of adenoids Back surgery (e.g. slipped disc) Digestive disorders (e.g. stomach ulcers) Colonoscopies & bowel surgery Kidney stone & gall stone removal Minor eye surgery (e.g. squints, pterygiums) (capped at $500 for singles and $1000 for couples/families per (capped at $500 for singles and $1000 for couples/families per Benefit Limitation Periods apply if you currently do not have Private Health Insurance. If you are considering Just, during your first 24 months of cover (but after the standard hospital waiting periods have been served) the services below are subject to Benefit Limitations. This means that the benefits payable on these services are limited to Public Benefits only. For more information on Public Benefits see page 45. Pregnancy & birth related services Assisted reproductive services (e.g.ivf) Infertility investigations Heart surgery (e.g. stents, open heart surgery) Major joint replacement (e.g. artificial knee/hip) Psychiatric conditions (e.g. depression, eating disorders, drug & alcohol rehabilitation) Gastric banding & obesity surgery Rehabilitation programs Renal dialysis Major eye surgery (e.g. cataracts) Please call us on for more information. EXCLUSION the services not covered Cosmetic surgery (to enhance appearance) Antenatal services performed by a midwife or physio in a public & private hospital You don t pay an excess for kids under 21 years of age. See page 44 for details. Note: The hospital services shown are examples only and intended to be used as a guide. We suggest that your carefully read Going to page 4 of the Using Your Health Cover brochure for more information. Please be aware that some procedures may not be covered. You should always check with nib before you go to hospital to find out if you ve got the cover you need. In some cases there may be some drugs and surgical items that are not covered. Waiting periods may apply for hospital and Extras services - even if you are an existing nib customer or transferring from another fund. For more information on hospital cover and waiting periods, see page Call grouphealth@nib.com.au 29

17 Ambulance only Because Medicare doesn t cover the cost of an expensive ride. Benefits are only payable for ambulance services within Australia that are: PreMIum extras For those who want the best when it comes to Extras. Overview Great range of Extras services Ambulance cover refer page 30 under Ambulance Only extras benefits paid as 65% of the cost to you up to the annual limit. Provided by a State or Territory Ambulance Service; and Defined by the relevant service provider as emergency ambulance transport; or Where an ambulance is called to attend an emergency but on arrival is no longer required; or Defined by a treating doctor as medically necessary transport. IMPORTANT INFORMatION Ambulance services are provided for Queensland and Tasmanian residents under state based schemes. Ambulance cover is not included in health cover for residents of these states. Extras benefits You get 65% of the cost back Annual Limit* (per person per Waiting Period General dental $600 e.g. oral examination, scale and clean, fillings, basic extractions. Major dental $ e.g. root canal therapy, gum disease, crowns and bridges, implants, dentures, oral surgery. Orthodontia $300 1 e.g. braces (increasing by $100 per calendar year to a Lifetime Limit of $1500). Optical $300 6 months e.g. frames, lenses, contact lenses. Physiotherapy/Chiropractic/Osteopathy/Exercise physiology $500 Also want to claim on everyday Extras like Dental or Optical? Check out our other covers from page 12. Natural therapies (consultations only) $250 Including acupuncture, herbalism, naturopathy, homeopathy, nutrition, remedial massage, myotherapy, bowen therapy & shiatsu. Healthier lifestyle $200 6 months nib approved weight management, quit smoking and health management programs, first aid courses, preventative health tests. Hearing aids & Artificial aids $ months Ask nib about details of specific restrictions and replacements. Waiting periods determined by type of aid. Psychology $300 No benefits for tests, assessments or couple/group sessions or if a benefit has already been claimed through Medicare. Pharmaceutical prescriptions $400 Benefits paid once the maximum PBS charge has been deducted. Benefits do not apply to prescriptions dispensed to hospital inpatients. Other therapies $400 Speech therapy, podiatry consultations, orthoptics (eye therapy), dietetics, home nursing, occupational therapy. Antenatal & postnatal services (by a midwife in a private practice) 100% back for antenatal & postnatal services in a private practice, up to your annual limits. *Total benefits claimable for each service capped at 4 times the per person annual limit for single parent/family policies. 30 Call grouphealth@nib.com.au Call grouphealth@nib.com.au 31

18 nib dental care centres News to put a smile on your face. Get 100% of any cost back for dental check-ups* It s easy to keep your smile in top shape. If you have nib Extras cover, you could be entitled to 100% of any cost back for dental check-ups* at nib Dental Care Centres. Each check-up includes an examination, scale, clean and fluoride treatment (worth over $130). Limits apply so make sure you check your annual limits and service limits with nib on Comprehensive dental care services nib Dental Care Centres offer a full range of dental treatments at competitive prices. In addition to general dentistry for things like check-ups and fillings, other services such as cosmetic and restorative dentistry, surgical dentistry and orthodontics are also available. We also have emergency appointments for accidents and toothaches. Locations If you live or work in or near Newcastle, Sydney, Wollongong or Melbourne you can visit an nib Dental Care Centre and save on dental treatments. For a list of locations visit nib.com.au or call for an appointment today. nib Dental Care Centres welcome nib customers and the general public. Did you know that if you are an nib customer with Extras cover you can also access nib benefits on dental services at Pacific Smiles Dental Centres. For a list of locations visit pacificsmilesdental.com.au nib eye care centres Two great offers to choose from at nib Eye Care Centres Get 100% back on complete glasses ~ To help you see value from your nib Extras cover, nib has introduced a range of complete single vision prescription glasses where you can claim 100% back that means no out of pocket expenses. There are 3 ranges of complete single visions glasses in store where you can claim 100% back. The range you can choose from depends on your level of nib health cover. The higher the level of your cover, the wider the range of glasses you can choose from. Or get a 20% storewide discount If you are an nib policyholder with Extras cover, you are entitled to a 20% storewide discount at any nib Eye Care Centre. The 20% discount is redeemable on all full-priced prescription glasses, contact lenses and sunglasses. That s just another way nib is helping you get value from your health cover. Bulk billed eye testing nib Eye Care Centres offer bulk billed eye tests by highly trained Optometrists. They also provide contact lens fitting appointments for those patients who prefer contact lenses to glasses. You have perfect vision? nib Eye Care Centres stock designer, sports and fashion sunglasses. So why not come in and treat yourself to a new look. Locations If you live or work in or near Sydney or Newcastle, you can visit an nib Eye Care Centre and save. For a list of locations visit nib.com.au or call for an appointment today. *Refer to page 56 for terms and conditions. ~,, Refer to page 56 for terms and conditions. 32 Call grouphealth@nib.com.au Call grouphealth@nib.com.au 33

19 Protect your family nib offers a range of life insurance plans that can help your family maintain financial security. Leave them up to $1,000,000 If you rely on the life insurance cover available with your superannuation, on average this could mean a payout of around $70,000. That s not a whole lot in today s economy. Financial experts suggest that you ll need around 10 times your annual income for your family not to face financial hardship^. nib Value Life Insurance can provide your family with up to $1,000,000 worth of cover. Exclusive to nib Customers nib premium protection and will kit When you take out either nib Value Life Insurance or an nib Funeral Plan, you ll automatically receive nib Premium Protection for up to 6 months. This means in the event that a serious accidental injury leaves you unable to perform your daily activities, we ll reimburse your nib health cover and waive your nib Value Life or nib Funeral Plan premiums for up to 6 months (or up to $750 for nib Funeral Plan, whichever comes first**). If you take out either nib Value Life Insurance or an nib Funeral Plan, we ll also supply you with a free Will Kit that could help save your family from unnecessary stress and legal fees. You can be protected in a matter of minutes. For a quick quote call or visit nib.com.au Here are some additional benefits: Cover from less than $1 a day*. Simple phone or online application. No medical tests required. Terminal illness benefit. Worldwide cover 24/7**. Now there s no need to stop living if you stop earning Ever thought of how you d meet your rent, loan repayments and household expenses if you were left without an income for months, or even years? Get up to $15,000 funeral cover # The average cost of a funeral is around $6,000, with many ending up costing considerably more. With most funeral expenses due up front, could your family find that sort of money within 24 hours? An nib Funeral Plan can help relieve the financial burden. An nib Funeral Plan provides your family with a lump sum payout which they can use however they choose. And conveniently, claims are normally paid out within 24 hours of the claims requirements being received. Here s what else it offers: Cover from just $2.31 per week. Simple phone or online application. No medical or blood tests. Flexible payment options., *, **, # Refer to page 56 for terms and conditions. Guaranteed acceptance for Australian residents aged day money back guarantee. nib s new Bill Relief cover is a great way to keep the bills paid if circumstances force you to take time out. From around $3* a week you can help meet your financial commitments if you become sick or injured, or if you suddenly find yourself made redundant. Perhaps the best thing about nib Bill Relief is that everyone s eligible. You don t have to be working full time nib Bill Relief is for homemakers, students and the self-employed too. Here are some additional benefits: Up to $3,000 cover a month, to spend as you like. Cover for up to 24 months for illness and injury (excludes pre-existing medical conditions). Cover for up to 3 months if you re made redundant from work. Guaranteed cover over the phone in minutes. For a wide range of common injuries and serious illnesses there are no waiting periods. Premiums are generally Tax deductible Reassuring 30 day money back guarantee. Now you can afford to protect your income and way of life from the unexpected with flexible nib Bill Relief cover to suit your pocket. Don t leave your lifestyle to chance, give us a call on or visit nib.com.au. *, ** Refer to page 56 for terms and conditions. 34 Call grouphealth@nib.com.au Call grouphealth@nib.com.au 35

20 nib travel InsuranCE Be a little bit green next time you travel. Ask for a no obligation quote today As well as looking after your health cover needs, nib can also offer travel insurance to cover you while you re away. nib Travel Insurance can provide you with cover for things like: 24/7 emergency assistance. Overseas medical and dental expenses. Some cancellation expenses. Additional travel and accommodation expenses. Travel delay expenses. Personal liability. Lost or stolen passports and travel documents. You plan the trip, we ll plant the tree When you take up any nib Travel Insurance plan, nib will pay for a tree to be planted through Greenfleet to help offset the carbon footprint of your travels. Call or visit nib.com.au for a no obligation quote today. 5% discount for nib customers Refer to page 56 for terms and conditions. 36 Call grouphealth@nib.com.au Call grouphealth@nib.com.au 37