NIB health insurance review: Everything you need to know

If the name sounds familiar, it’s because nib is one of Australia’s most well-known health insurance providers. Like other large funds, nib has an array of private health insurance options to choose from. It's likely you'll be able to find something that suits your specific needs.

Founded more than 70 years ago – initially for workers at the BHP Steelworks in Newcastle, nib today covers over one million Aussies. Given the sheer variety of services they offer, let’s dig into exactly what nib can do for you, how they stack up to other insurers and how to get the most out of your policy.

nib Private Health Insurance is a for-profit insurer in Australia that provides private health insurance for over a million residents. Established in the early 1950s, nib has since grown into one of the most recognisable brands in the country.

In addition to its swathe of health insurance policy options, nib also operates several other health funds. Think Qantas Health, Suncorp Health, ING Health, AAMI Health, Priceline, and Seniors Health Insurance. With such an established presence across multiple brands and other health funds, it’s no wonder nib has such a strong foothold in our local private health insurance sector.

nib Group is the parent company of nib Health Insurance, and it’s a publicly listed company on the Australian Securities Exchange (ASX). Being a for-profit insurer, nib’s main ambition is to generate profits for its shareholders. This sets it apart from some of the larger not-for-profit health funds like HCF.

Despite having a profit-driven approach – which could turn off some health insurance shoppers – nib is still committed to giving terrific value to its members through competitive policies and various benefits and discounts.

nib has numerous health insurance policies you can review at your leisure. Being such a large and successful health fund, it makes sense that they’d have a few different options that cater to individual health needs and budgets. But broadly speaking, you’ll want to start looking at your options by category – that is, hospital cover, extras cover and combined policies.

Taking out a standard hospital policy with nib means you’ll get cover for medical services in private hospitals as well as your choice of doctor/specialist, depending on the level of cover you end up going for. Hospital cover usually includes benefits for:

• In-hospital treatment costs like accommodation, theatre fees and specialist fees.
• Different levels of cover – Basic, Bronze, Silver, Gold and more – which vary in terms of what treatments are included (e.g. general surgery, maternity services, joint replacements, heart procedures, etc.).

On the other hand, extras cover is more about helping to cover the cost of out-of-hospital services – things that aren’t covered by Medicare. These include:

• Dental
• Optical (glasses and contact lenses)
• Physiotherapy
• Chiropractic care and osteopathy
• Alternative therapies (e.g. acupuncture)
• Podiatry
• Preventative care

Different extras cover policies will have different ranges of cover or limits to these services. Be sure to shop around and see which policies have services that you’ll actually use.

Like pretty much every other health insurer out there, nib also has combined hospital and extras cover. This ultimately means that members can have their cake and eat it too – with in-hospital and out-of-hospital healthcare needs covered.

While it’s true that this combo can be very cost-effective as well as convenient, especially for families or singles who require a mix of hospital and extras services, it’s also more expensive than the more basic plans.

• Hospital-related charges covered: nib covers approximately 85.9% of hospital-related charges, which means members can access private hospital services with very few out-of-pocket expenses.
• Medical services with no gap: Around 91.7% of medical services are covered with no gap, meaning members won’t pay anything beyond what Medicare and nib cover most of the time.
• Medical services with no gap or known gap payment made: 92.3% of services are covered either with no gap or with a known gap payment.
• General treatment (extras) charges covered: nib covers a very generous 57.5% of general treatment charges, giving a solid level of support for out-of-hospital services like dental and optical care, especially compared to some other major funds.

• Online and via the app: You can lodge claims through the nib online portal or the nib App, available for both iOS and Android devices. It’s quick and easy to do – just upload your receipts and then manage your claims digitally.
• HICAPS: For services like dental, physio and optical, you can usually claim on the spot using your specialist’s Health Industry Claims and Payments Service (HICAPS) terminal. Just swipe your nib membership card and your claim will be processed instantly.
• Mail: If you prefer, you can always mail in your claim form and the original receipts.

For specific services or larger claims, you might need to give nib some additional paperwork or have a waiting period applied, especially for new members or if you’re upgrading your level of cover.

If you decide that nib is no longer the right fit for your needs, here’s how to cancel your private health policy:

1. Contact nib: You can cancel your policy by contacting nib directly via phone (13 16 42) or through the nib online member portal. You’ll need to have your policy number on hand and confirm your cancellation request.
2. Provide notice: Depending on your policy terms, nib may request that a notice period be given before cancellation. It’s simply so they can process your cancellation without any ongoing premium payments.
3. Refunds: If you’ve prepaid your premiums, you might be eligible for a refund for the unused portion. nib will calculate this based on the date you cancel and the terms of your policy.

Always make sure you have alternative arrangements for your health cover (if needed), such as switching to another insurer or adjusting your cover to a different level.

There’s no denying that nib has a big range of health insurance options for its members to choose from, from hospital to extras to combined cover. It’s also very competitive in terms of the amount of cover it provides, as well as making the claims process super easy.

However, as with any health insurer, you’ll need to do your own research and be sure to read the PDS before signing on the dotted line. And remember, it never hurts to compare health insurance first before making your decision.