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 [email protected] 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 [email protected] Call [email protected] 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 [email protected] Call [email protected] 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 [email protected] 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 [email protected]

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 [email protected] 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 [email protected] Call [email protected] 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 [email protected] Call [email protected] 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 [email protected] Call [email protected] 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 [email protected] Call [email protected] 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 [email protected] Call [email protected] 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 [email protected] Call [email protected] 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 [email protected] 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 [email protected] Call [email protected] 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 [email protected] Call [email protected] 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 [email protected] Call [email protected] 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 [email protected] Call [email protected] 37

21 How you can save Ways to save on your nib health cover. Federal Government Rebate If you re an Australian resident who is eligible for Medicare, by joining an nib health cover you can receive the Federal Government Rebate, and save big time. Eligible customers can claim a minimum 30% Rebate. Most nib customers claim the Rebate upfront as it reduces the amount they pay to nib. All customers on the policy must be eligible to be able to claim a minimum 30% rebate. You can choose to wait and claim the Rebate when you lodge your tax return, or visit a Medicare office to receive cash or cheque. There are different levels of Rebate, depending on the age of the oldest person on your nib policy. Someone say save? Join early and avoid paying more for your cover Under Lifetime Health Cover (LHC), you ll pay a 2% loading on top of the normal premiums for each year you don t have hospital cover, over age 31. This isn t just with nib, but every health fund. By joining a hospital cover by age 31, and staying with it, you ll avoid paying the 2% annual loading (it s like being 31 forever). If you wait until you re 40, you ll pay 20% more than someone on the same cover who joined when they were 31. After 10 years of continuous hospital cover all loadings are waived. It ll cost you a lot The most you ll pay Age of the oldest person on your policy Federal Government Rebate Feeling the pinch 64 years or younger 30% 65 to 69 35% 70 or older 40% The extra costs kick in here Starting to get pricey refer to page 31 of the Using Your Health Cover brochure for more information on Lifetime Health Cover and saving tax. Want more info? Ask us, or visit the Department of Health and Ageing website at Save Tax with the right nib cover If your taxable income is above the Medicare Levy Surcharge thresholds, and you do not have an appropriate level of private hospital cover, you may have to pay the Medicare Levy Surcharge. This is an additional 1% in tax (on top of the Medicare Levy we all have to pay). The good news is you can avoid the Medicare Levy Surcharge (and pay less tax) by joining an nib health cover with a hospital excess of $500 or less for singles, and $1000 or less for couples/ families, per calendar year. For more information about the Medicare Levy Surcharge, visit the Department of Health and Ageing at or the Australian Taxation Office at 38 Call [email protected] 39

22 join nib When you join nib from another health fund, you will be given continuity of cover. You can start claiming immediately when you join if: your nib health cover includes services currently available to you you ve served all the required waiting periods with your current fund you haven t used all your annual benefits with your current fund and you have completed the Clearance/Cancellation Certificate request. If you have cancelled your policy with another fund, you will need to join nib within 59 days to enjoy the benefit of continuity of cover. If you have used part or all of your annual benefits with your current fund, nib will adjust your benefits accordingly. Any accumulated benefits and loyalty bonuses from your current health fund are not transferable to your nib health cover. Check your Medicare Card nib policies are available to all people. If you have a Reciprocal Medicare card or do not have a Medicare Card you will not receive full hospital benefits from your nib health cover. When you join nib please ensure your name is entered as it appears on your Medicare card. This helps avoid any problems with future claiming and applicable of your 30% rebate (if eligible). Joining nib is easy as... Whether you call, contact us online or visit an nib Retail Centre, you can look forward to genuine service. This is because the people at nib are nib customers too, they understand the importance of providing excellent service and how to get value from being a customer of nib. You can: Call us on Monday to Friday 8am 8.30pm (AEST) Saturday 8am 1pm (AEST). Check your company s health plan website for details 24 hours, 7 days. [email protected] Visit an nib Retail Centre and speak to one of our retail consultants Monday to Friday, 9am 5pm. How to change your nib cover Whether your nib cover is for singles, couples, single parents or families it makes sense to always check that you ve got the right cover to suit where you re at in life. You may need to change your cover if you re moving interstate, getting older, getting married or starting a family. Let us know when these and other important events are happening so we can help you stay on the right cover. Call us on Looking for Standard Information about your health cover? nib is required by law to give you product information in a standard format known as a Standard Information Statement. nib s Standard Information Statements are available from nib.com.au, or call or visit an nib Retail Centre. 40 Call [email protected] Call [email protected] 41

23 nib ONLINE SerVICes The customers only area that s not just for claims. Jump the queue with nib Online Services When you join any nib health cover, visit nib.com.au or call to instantly register for nib Online Services and manage your cover at a time and place that suits you. Some of the many benefits View your nib policy and health cover details. Update your contact details. Add and maintain your banking details. Pay your premiums by credit card. View and print your payment and claims records, and order statements or a new nib card Make claims for a wide range of Extras services including general dental, optical, physio, chiro, acupuncture, remedial massage and more Plus so much more. Upload or fax in your online claiming receipts For greater convenience and to get your claims processed faster, nib now accepts scanned and faxed receipts when you make an online claim. Simply complete your claim online and you will be asked how you would like to submit your receipts to us at the end of the process. nib mobile CLaIMIng nib Mobile Claiming. Greater convenience faster claiming If you love being out and about, then you ll love nib s new iphone App and mobile site. They let you claim on selected Extras, wherever you are. First, register for online services Register for Online Services at nib.com.au or by calling and set up a Direct Credit Account. This lets us put benefits up to $300 at a time directly into your bank account. Don t forget to first check your service is covered and that you ve served your waiting periods at nib.com.au before you claim. Claim on your iphone or mobile Once you ve registered for nib Online services, just follow these simple steps. Step 1: Download the free app from the App Store or go to nib.com.au on the web browser on your phone. Step 2: Select Make a claim and fill in the fields. You ll need your receipts to enter details like your provider number and item numbers. Step 3: Enter your customer Number and Password and tap Login. Step 4: Click Submit and you ll be paid directly into your bank account within a couple of days. We ll send you a Reply Paid envelope so you can post us your receipts after you ve submitted your claim. Plus, do even more on your phone. You can also get a health cover quote, view and update your policy details and find your nearest nib Retail Centre, Eye Care Centre, Dental Care Centre or nib agreement hospital. To claim on your mobile or through the nib App for iphone you will need to be registered for Online Services. Visit nib.com.au or call us on with your customer number to register. Visit nib.com.au to watch a video showing how easy it is to claim on your mobile. Apple and the Apple logo are trademarks of Apple Inc., registered in the U.S. and other countries. iphone is a trademark of Apple Inc. 42 Call [email protected] Call [email protected] 43

24 things you need to know About hospital cover. Your nib hospital cover helps pay for these things in hospital depending on your cover: hospital bed meals nurses operating theatre fees birthing suite (depending on your cover) The ins and outs of being a patient intensive care doctors and specialists services (including tests) government approved, surgically implanted prostheses (e.g. artificial hip). In general, health funds do not cover out-patient treatment unless specified on your level of cover and we have a specific agreement with the provider for a service. nib will not cover you where Medicare covers the fee or for emergency department fees. nib hospital cover provides benefits when you are an admitted patient. This includes admission for day and overnight. As treatment at an emergency department does not require an admission, charges and fees from emergency are not payable. other services note requiring admission include visits to your GP and specialists etc. excess, and what it means. If you have to pay an excess on your hospital cover, this is the minimum amount you have to pay towards your hospital stay, each time you re admitted. This can get pricey if you go to hospital regularly, or if the unexpected happens. So, we ve capped your hospital excess to a maximum amount per year (this varies depending on your health cover). The good news? The higher your excess, the cheaper your health cover. And, if you re on a selected family cover, you won t pay an excess if one of your child dependants (under 21 years of age) has to go to hospital. Waiting Periods. Good things come to those who wait. Before you can start claiming for hospital services, you must be in your chosen cover for a set period of time, (known as a Waiting Period). Customers can only claim benefits after they have served their waiting periods. This is necessary to keep health cover fair. Waiting periods protect existing customers who pay premiums to a fund over time, for when they might need health cover. If we didn t have waiting periods, people might join a fund to claim for a planned item and then leave. If you re an existing nib customer and change your cover or if you transfer from another fund, please be aware that waiting periods may apply for hospital services. Waiting periods also apply for any pre-existing conditions. For more information about pre-existing conditions and applicable waiting periods, call nib on Waiting Periods Service Accidental injury Ambulance services Other hospital services, except those listed Psychiatric care, rehabilitation or palliative care services (whether or not for a pre-existing condition) Other pre-existing ailments/conditions ie. an illness or condition where the symptoms were evident at any time during the 6 months immediately prior to joining nib Obstetric conditions Note: Your cover may exclude some of these procedures. Waiting Periods 1 day 1 day 1 1 Restrictions. Access not all areas. Some covers have certain hospital services listed as restrictions. This is when the amount of benefits we pay for the service is limit to Public Benefits. In these cases, nib will contribute a minimal amount to your accommodation fees but will not contribute anything towards the theatre fees. This means you will have a significant out of pocket. You should always check with nib before you undergo a procedure to check exactly what you re covered for. Please note you will not be covered for theatre or surgeons fees for procedures performed by a podiatrists as these services are not eligible for a rebate through Medicare. Some nib covers have Benefit Limitation Periods, which require a customer to be with nib for a period of 24 months before certain hospital servcies are included as part of their cover. This means there is a period of time where the benefits payble on some services are restricted to Public Benefits only. Public Benefits A Public Benefit is the level of benefit which will cover you for a stay in a shared ward of a public hospital. But it will not go anywhere near paying for the cost for a stay in a private room in a public hospital or a stay in a private hospital, you will pay large out of pocket expenses to cover the difference in costs (for more details see page 44). (Things you need to know continued next page) 44 Call [email protected] Call [email protected] 45

25 things you need to know Cont. Out of pocket expenses Even with our highest level of hospital cover, you may have to pay something for going to hospital. They re known as out of pocket expenses because they come from your pocket. This is the difference between what nib pays and the total cost of your stay in hospital. How nib can help you with out of pocket expenses The total cost of your stay in hospital depends on the hospital you chose, your doctors and your specific procedure. If you contact nib before choosing a hospital, we can explain ways you can keep costs down and even avoid out of pocket expenses all together by: checking if you have the right level of cover helping to cap doctors costs with nib s MediGap Scheme providng you with access to a network of nib Agreement Private s. nib MediGap Scheme The nib MediGap Scheme aims to eliminate the gap for nib customers. We ve built up a network of doctors and specialists who charge nib directly, at no additional cost to you. Medicare still pays 75% of the Medicare Benefits Schedule (MBS) and nib pays the remaining 25% plus an agreed amount set by the nib MediGap Schedule (but not for the excluded procedures). Visit nib.com.au to search for providers who participate in the nib MediGap Scheme or call for more information. nib Agreement Private s nib provides a network of private hospitals we have agreements with to protect you from paying out of pockets expenses when you receive your hospital bill we call these nib Agreement Private s. There is more information about going to hospital and your hospital cover in the nib Using Your Health Cover brochure which is sent when you become an nib customer. The guide is also available at nib.com.au or you can pick up a copy at an nib Retail Centre. 46 Call [email protected] Call [email protected] 47

26 every day extras Your health cover can offer more than just peace of mind for hospital. Having Extras cover will help pay for the cost of things like dental, optical, physiotherapy and more. For services received and products purchased in Australia only. We want you to get the greatest value from your Extras, so here s some more things you should know. Waiting Periods. Good things come to those who wait. Before you can claim for your Extras, you must be in your chosen cover for a set period of time (known as a Waiting Period ). Waiting periods are necessary to keep health cover fair. Waiting periods protect existing customers who pay premiums to a fund over time for when they might need health cover. If we didn t have waiting periods, people might join a fund to claim for a planned item and then leave. If you ve only recently joined a health fund, or taken out Extras cover for the first time or chosen a higher level of Extras cover, it s pretty likely waiting periods will apply to some Extras services on your cover. Make sure you check the waiting periods on your cover as you can t claim until a waiting period is over. Take it to the limit With Extras, we put an annual limit on how much we ll pay and/or the number of times you can claim for Extras, over a certain period of time. Most limits are for the calendar year. At the beginning of each year, your benefit limits are renewed, and you can start to claim again. A higher level of cover gives you higher limits to claim from. There is more information about Extras in the nib Using Your Health Cover brochure which is sent to you when you become a customer. The guide is also available at nib.com.au or you can pick up a copy at an nib Retail Centre. Please explain... Accidents and the 7 day rule nib s accident cover is intended to cover the immediate neccessary treatment required as the result of an accident. An accident, in relation to nib hospital cover, is an event leading to bodily injury caused solely and directly by violent, accidental, external and visible means and resulting solely, directly and independently of any other cause. If you re in an accident, you and the attending doctor in hospital must complete an Accident Form (available from nib). For customers with Basic Saver, Family Basic Saver, Basic Plus, Family Plus, Mid Plus, Top Cover, Premier Plus, Young at Heart Mid, Young at Heart Top: If you have an accident and need further treatment in hospital as an inpatient, you ll be covered as long as you have documented proof that you sought treatment at a hospital emergency department within 24 hours of the accident. To ensure that you are covered by our accident rule, you need to be re-admitted to a hospital within 7 days of your initial visit. This could mean being admitted as an inpatient or sent home to be admitted later (for example, you may be sent home with bandaging or a half-plastered limb so that swelling can reduce before a full plaster cast is applied to the injured limb). Any additional other hospital treatment that takes place within 7 days after being discharged from the hospital will also be covered. After this 7 day period any additional hospital treatment will be paid as per the level of benefits on your cover, for example, some benefits may be excluded or restricted. Medicare Benefits Schedule (mbs). The Federal Government has a schedule of fees for medical services, called the Medicare Benefits Schedule (MBS). This is the amount set by the Federal Government for the purpose of paying Medicare benefits. Medicare will pay 75% of the MBS for medical services rendered for hospital in-patient services. nib will pay the other 25%, provided the procedure is not excluded on your cover. If Medicare doesn t pay a benefit, an nib benefit is not payable. and the GAP The GAP occurs when doctors and specialists charge more than the MBS, leaving you with an out of pocket expense. If your doctor/specialist does not use the nib MediGap Scheme, you will have to pay the amount by which your doctor s charges exceed the schedule fee (called the GAP ). You can avoid paying a GAP if your doctor agrees to treat you as an nib MediGap patient. Home Nursing Services provided by a registered general trained nurse in private practice for the treatment of illness, disease, incapacity or disability when the patient is totally dependant on nursing care. It does not include services such as Mothercraft, Tresillian or Karitane nursing or a nurse-housekeeper during recovery after illness. Pharmaceutical Benefits Scheme (Pbs) Many medicines cost much more than the price you pay but the Federal Government pays most of it for you. The Government does this through the PBS, nib does not pay for medicines on the PBS. It s available to Australian residents and eligible visitors from countries with reciprocal arrangements with Australia. For more information about the PBS visit health.gov.au Pharmaceutical Benefits Scheme (Pbs) charge This is the maximum amount set by the Federal Government that a consumer pays towards the cost of a PBS drug. The PBS charge is reviewed annually by the Government. Pharmaceutical Prescriptions (relating to nib Extras benefits) nib will pay a Pharmaceutical Prescriptions benefit once the maximum PBS charge has been deducted and when the drug is: dispensed by a registered pharmacy in private practice or doctor only available on prescription, and listed on the Australian Register of Therapeutic Goods (ARTG), and published within the MIMS Schedule as S4 or S8, and not listed in the Schedule of Pharmaceutical Benefits Scheme (PBS). The amount customers will be paid will depend on their cover (see description of cover). For compound drugs, all components must be listed on the ARTG and published within the MIMS Schedule as S4 or S8 OR the Poisons Schedule and be non-pbs. A Pharmaceutical Prescriptions benefit will not be paid if the drug is: a prescription dispensed to hospital inpatients listed as a contraceptive available over the counter, even when prescribed. Prostheses A prosthesis is a surgically implanted item like an artificial knee or hip joint. Some government approved, surgically implanted prosthetic items are on a no gap list, while others are not fully covered and you may have an out of pocket expense. nib recommends you contact your hospital or doctor to discuss your options prior to seeking any treatment involving a prosthesis. 48 Call [email protected] Call [email protected] 49

27 Important information It s nice to know the details are here if you need them... Principle Rules You cannot have the same type of health cover with more than one health fund (e.g. you cannot have a and Extras package with 2 health funds). But you can have hospital only cover with one health fund and Extras only cover with another. Claims will only be paid if they meet nib criteria. nib reserves the right to recover any money paid in error or obtained fraudulently, or by any other means contrary to nib s rules. Your customer number needs to be quoted on all claims you ll find it on the front of your nib card. Claims are only paid if the claim is made within 2 years of when you received the service or treatment. Customers will not be paid any benefits if they are not financial. Policies are unfinancial if premiums are in arrears. nib may cancel policies that are more than in arrears. We believe it s important you and your family have the right cover. So, should you change your mind, nib has a cooling off period, just call us within 30 days of starting your cover. We will transfer you to another cover of your choice, or refund your premiums at your request, provided you have not made any claims. Privacy Policy nib is committed to protecting the privacy and security of the personal information we collect. nib has implemented measures to comply with its obligations under the Privacy Act 1988 (Cth). This section explains how nib may use personal information. Why does nib collect my personal information? We collect personal information primarily to enable us to provide health benefits and related services. nib may also use this information to promote or market its current and future health and related services for any other purpose permitted under the Privacy Act 1988 (Cth). If the information provided to us is not accurate or complete, we may not be able to provide an accurate quote, or provide benefits for the requested health or related services. What personal information does nib keep? The personal information nib holds will depend on whether you are a customer or a provider and which services you have used. Information may include: Name, address, contact details, date of birth. Payment history. Current or past details of private health insurance including level of cover. Claim details. Federal Government Rebate registration details. Medicare number. Provider Registration details. Financial Institution account details. Pension/Health Care card numbers. Employment details. Pre-existing condition information. How does nib collect your personal information? nib may collect personal information directly (in person, by phone, electronically or online) when: you apply to become an nib customer or registered provider you request information concerning nib s services a claim is lodged you participate in a health management program. In addition to collecting personal information directly from you, nib may collect personal information from other nib companies or health service providers, private health insurers, government agencies (such as Medicare), private and public hospitals, doctors and medical specialists, state registration boards and professional associations. nib also collects information from other companies, such as market research companies, but only where you have provided your consent to the company to be contacted by third parties. How does nib use personal information? nib uses personal information in accordance with the National Privacy Principles. The information we collect is used to: provide benefits for health and related services determine eligibility to provide or receive an nib health or related service promote and market nib s current and future health and related services promote and market existing and future other co-branded products and services conduct research (including but not limited to customer surveys) concerning nib s current and future health and related services. 50 Call [email protected] Call [email protected] 51

28 Important information Cont. If nib uses personal information for direct marketing or research purposes it will do so in accordance with the Privacy Act 1988 (Cth) and any correspondence sent to you will give you the opportunity to opt out of receiving any further marketing or research correspondence. Will my personal information be given to anyone else? In providing nib s health and related services and using personal information in accordance with this Policy, nib may be required to disclose your personal information to: Other nib companies. Health service providers including private health insurers, government agencies, private and public hospitals, doctors and medical specialists, state registration boards and professional associations. nib s contractors and service providers performing services including (but not limited to) marketing, market research, mail-house services, and product development services. nib s existing and future strategic partners in respect of co-branded products and services nib may also be required to disclose your personal information to other individuals on your nib policy, or to individuals to whom you have granted authority to act on your behalf. At the time of joining nib, the person applying for the nib policy authorises nib to share information with other individuals on the policy. This means we may make the policyholder aware of, for example, the details of all benefits and services claimed on the policy. nib will not disclose your personal information to anyone, other than as above, unless: you authorise nib to do so your safety or the safety of others in the community is at risk, or nib is required or permitted by law. How do I obtain access to my personal information? You have a right to access your personal information. nib generally makes this information available in standard formats, such as your claims or contributions statements. You can also access your personal information via nib s secure online services. If you re a policyholder you can request details of your personal information by contacting , visiting a Retail Centre or by ing us. If you re a provider you can request details of personal information by contacting the Provider Hotline , or by [email protected] Is my personal information accurate? Can it be corrected? The accuracy of your personal information is important to us. nib will take reasonable steps to ensure your personal information is accurate, complete and up to date, but we rely on you to advise us of any changes to your contact details and any other personal information. If you believe that any personal information nib holds about you is not accurate, complete or up to date, please contact us immediately. Is my personal information secure? nib takes all reasonable steps to ensure your personal information is kept secure. nib only permits its authorised personnel to access your personal information, and information will only be disclosed to third parties where they have the appropriate authority. Need more information? For further information regarding this Privacy Policy or to raise any issues or concerns about the steps nib has taken to protect your personal information or privacy, please contact nib s Privacy Officer by calling or [email protected] Changes to this privacy policy nib reserves the right to change this Privacy Policy from time to time. This Privacy Policy was last updated August Direct Debit Service Agreement nib s commitment to you nib will give you at least 14 days notice in writing if there are changes to the details of your debit. Any information about your account will remain confidential, except where required to complete direct debits with your financial institution. When the due date is not a business day, nib will debit your account on the first working day after the due date. Your commitment to us It is your responsibility to: ensure your nominated account can accept direct debits (Privacy Policy continued next page) 52 Call [email protected] Call [email protected] 53

29 Important information Cont. ensure there are enough funds available in your account to make the payment on the due date tell us if your account details change, or if the account is transferred or closed arrange a different payment method if nib cancels the debit arrangements ensure all account holders of the nominated account sign the Direct Debit Request tell us your new credit card expiry date. Your rights You can change the debit arrangements in line with the terms and conditions of your nib policy. You must tell us at least 7 working days before the next due date for any of the following: stopping a payment deferring a payment suspending any future payments altering the Direct Debit nominated account details cancelling the debit arrangement completely. Also, you may cancel, stop or dispute a drawing with your financial institution. Enquiries and disputes If you have any enquiries about your direct debit, call the nib Customer Care Centre on If you believe a debit has been made incorrectly, please contact us immediately. Call the nib Customer Care Centre on or Write to nib health funds, Reply Paid 62208, Locked Bag 2010, Newcastle NSW If you are not happy with nib s response you can write to the nib Customer Service Team at the above address. Not all accounts held with a financial institution are available to be drawn on under the Bulk Electronic Clearing System, ask your financial institution if you are unsure whether your account can accept Direct Debits. Before you complete your Direct Debit Request, it is best to check account details against a recent statement from your financial institution to ensure the details on your Direct Debit Request is completed correctly. Ask your financial institution if you are unsure about your account details. Please enquire of your financial institution, if you are uncertain when your financial institution processes an amount we draw under your Direct Debit Request on a day which is not a business day. Calendar year January 1 to December 31. To find an nib preferred provider visit nib.com.au for details. nib recommends regularly reviewing your nib health cover to ensure it continues to meet your requirements. Call us for a health cover review, to check you re on the right health cover for your needs. If you have a pre-existing condition and want to know what your options are, please refer to page 10 of the Using Your Health Cover brochure or call us on nib has a process for dealing with complaints to ensure you re heard. Call us on , or if your prefer write to the nib Customer Service Team: Reply paid Locked Bag 2010 Newcastle NSW 2300 fax: (02) Other information nib reserves the right to determine how you give instructions to stop or alter your direct debit details (e.g. written, verbal or electronic). nib reserves the right to cancel direct debit arrangements if your financial institution dishonours debits, and to arrange a different payment method with you. The details of your direct debit arrangement are contained in your Direct Debit Request. nib will rely on those details to process your payments until you tell us otherwise. 54 Call [email protected] Call [email protected] 55

30 Terms and conditions nib Dental Care page 30 nib Dental Care Centres and Pacific Smiles Dental Centres are owned and operated by Pacific Smiles Group Limited ABN *Payment by nib of dental benefits is subject to serving relevant waiting periods, annual limits and service limits. Check your cover at nib.com.au or call The dental check-up covers an examination, scale, clean and fluoride treatment (dentures not included). The services provided will be deducted from your annual limits and/or service limits. nib Eye Care page 32 nib Eye Care Centres are owned and operated by The Optical Company (NSW) Pty Ltd abn ~ Ability to claim 100% back on complete glasses is dependent upon your nib product, waiting periods, available annual limits and prescription. Check your nib cover by calling Complete glasses with 100% back packages only include single vision lenses and frames from a selected range. The selection of frames available to you will vary depending upon your level of nib health cover. Complete glasses with 100% back must be purchased as one complete package. You cannot pay the difference between a 100% back complete glasses package and an otherwise available product benefit. Complete glasses with 100% back packages are only available after relevant waiting periods have been served. Where annual limits are insufficient, you will not be entitled to a 100% back complete glasses package. If you re not entitled to the 100% back on complete glasses package, you can purchase a pair of glasses from the range, however your standard product benefits will apply to your purchase (no gap benefits will not be payable). Tinting, coating or hardening of lenses is not included as part of the 100% back on complete glasses package. Complete glasses with 100% back products are not available in conjunction with any other offer or discount. Contact lenses, prescription sunglasses and Safety Glasses do not form part of the complete glasses packages. The selection of complete glasses with 100% back package frames may vary from store to store. Complete glasses with 100% back packages are only available at nib Eye Care Centres. Benefits must be confirmed via the Point of Service terminal or by contacting nib on before glasses in the complete glasses range can be supplied. Optical benefits are subject to waiting periods and annual limits. Check your cover at nib.com.au or call Policyholder discount is not valid with any offer, discount or package other than a rebate from nib health funds. Bulk Billed eye tests are subject to Medicare limits. nib proudly supports and complies with The Private Health Insurance Code of Conduct. A copy of the Code is available at privatehealth.com.au/codeofconduct nib Life Insurance page 34 The information in this brochure is general advice only and does not take into account your personal financial situation, needs or objectives. Please consider the Product Disclosure Statement for terms and conditions from the insurer TAL Life Limited ABN AFSL before deciding whether the product is suitable for you. nib health care services pty ltd ABN is an authorised representative (AR ) of TAL Direct Pty Limited ABN AFSL , which promotes this product. **Conditions and exclusions apply. ^Rice Walker Actuaries, Analysis of Insurance Needs, May TNS Research, Investigating the issue of underinsurance in Australia, August *Cost of cover is based on the amount of cover taken, your age, gender and smoking status. nib Funeral Plan page 34 The information in this brochure is general advice only and does not take into account your personal financial situation, needs or objectives. Please consider the Product Disclosure Statement for terms and conditions from the insurer TAL Life Limited ABN AFSL before deciding whether the product is suitable for you. nib health care services pty ltd ABN is an authorised representative (AR ) of TAL Direct Pty Limited ABN AFSL , which promotes this product. **Conditions apply. #Cover is for Accidental Death only during the first 12 or 24 months depending on your choice. After the Accidental Death period, and while premiums are paid when due, you are covered for any cause of death, with no exceptions. nib Bill Relief page 35 The information in this brochure is general advice only and does not take into account your personal financial situation, needs or objectives. Please consider the Product Disclosure Statement for terms and conditions from the insurers TAL Life Limited ABN AFSL and ACE Insurance Limited ABN AFSL before deciding whether the product is suitable for you. nib health care services pty ltd ABN is an authorised representative (AR ) of TAL Direct Pty Limited ABN AFSL , which promotes this product. Conditions, exclusions and waiting periods apply. *Premiums increase with age and cover. Please seek your own independent tax advice. nib Travel Insurance page 36 nib health funds limited abn AR is an authorised representative of AGA Assistance Australia Pty Ltd ABN AFSL trading as Allianz Global Assistance. Travel Insurance is underwritten by Allianz Australia Insurance Limited ABN AFSL and issued and managed by Allianz Global Assistance. nib acts as an agent of Allianz Global Assistance not as your agent. Any advice here does not take into consideration your objectives, financial situation or needs, which you should consider before acting on our recommendations. You should read and consider the Product Disclosure Statement (available at nib Retail Centres, nib.com.au/travel or call us on ) before deciding whether to purchase any product. Allianz Global Assistance pay nib a commission, which is a percentage of your premium. Ask us for more details before we provide you with more services on this product. This promotion is correct as at time of publication and nib reserves the right to withdraw it at any time. Limit of one tree per policy. For more than 50 years nib has been committed to promoting and supporting healthy Australian communities. In 2008, the health fund reaffirmed this commitment through the establishment of nib foundation a not-forprofit charitable organisation that supports programs aimed at improving the health and wellbeing of all Australians. Since its establishment, the foundation has committed more than $6 million to fund programs through National and Community Grants. The program partners offer a diverse range of services, each falling within nib foundation s focal areas of support including: carers, young people, wellbeing, equity and access, education and training. For further information visit nibfoundation.com.au 56 Call [email protected] Call [email protected] 57

31 any questions? more info? call us for a chat... customer care centre mon-fri 8am-8.30pm. sat 8am-1pm (AEST) [email protected] or visit an nib Retail Centre check your company s health plan website for details it s worth it nib health funds limited abn Head Office 22 Honeysuckle Drive Newcastle NSW 2300 nib242301_0412