Private Health Insurance Standard Information Statement - Combined Policy
This Statement provides basic information for the purposes of comparison only. For full explanation of this combined
hospital and general treatment policy please contact the health insurer on 13 14 63 or visit http://www.nib.com.au.
HEALTH INSURER: NIB Health Funds Ltd.
WHO IS COVERED:
One adult
PRODUCT NAME:
Top Cover $500 Excess
MONTHLY PREMIUM: #
$308.70 (before any rebate or loading)
M
EDICARE
L
EVY
S
URCHARGE
:
Exempt
AVAILABLE FOR:
Residents of Tasmania
# You may be entitled to an Australian Government rebate on this premium. Your premium may include a Lifetime Health Cover loading and/or an insurer discount
depending on your individual circumstances. Check with your insurer for more details.
Hospital Component
The following applies to the hospital component for the Top Cover $500 Excess policy from NIB Health Funds Ltd..
WHAT'S COVERED IF I HAVE
TO GO TO HOSPITAL ?
Hospital treatment, including accommodation as a private patient in a private or public hospital
Doctors' bills in hospital (see below)
(Ambulance is covered by State government)
WHAT SERVICES ARE NOT
COVERED AT ALL ?
(Exclusions)
WHAT SERVICES ARE ONLY
COVERED TO A LIMITED
EXTENT ?
(Restrictions, Benefit Limitation
Periods)
Hospital treatment for which Medicare pays no benefit eg most cosmetic surgery
No restrictions or benefit limitation periods
HOW LONG ARE THE WAITING
2 months for palliative care, rehabilitation and psychiatric treatment
12 months for treatments relating to other pre-existing ailments
12 months for obstetric treatments
2 months for all other treatments
PERIODS FOR NEW AND
UPGRADING MEMBERS?
WILL I HAVE TO PAY
ANYTHING IF I GO TO
HOSPITAL ?
(Excesses, Co-payments,
Medical/Hospital gaps)
WHAT OTHER FEATURES
DOES THIS POLICY HAVE?
EXCESS: You will have to pay an excess of $500 per admission. This is limited to a maximum of
$500 per year.
EXTRA COST PER DAY (CO-PAYMENTS): No co-payments
DOCTORS' AND HOSPITAL BILLS: Almost 9 out of 10 medical services paid for by this health insurer
in Tasmania have no out-of-pocket expenses. You may also have to pay other costs depending
upon:
the doctor(s) chosen
the treatment you are having
the hospital you go to
Before you go to hospital, you should ask your doctor, hospital and health insurer about
any out-of-pocket costs that may apply to you.
This policy also includes nil excess for child dependants under 21.
NIB/J25A/T0500S issued 24 March 2016
www.PrivateHealth.gov.au
General Treatment Component
The following applies to the general treatment component for the Top Cover $500 Excess policy from NIB Health Funds Ltd..
PREFERRED SERVICE PROVIDER ARRANGEMENTS: This health insurer does not operate a preferred provider scheme in this State.
SERVICES
COVER
DENTAL
General dental
WAITING PERIOD
(MONTHS)
BENEFIT LIMITS
(PER 12 MONTHS)
2
$600 per policy
EXAMPLES OF MAXIMUM BENEFITS
Periodic oral examination - 75% of charge
Scale & clean - 75% of charge
Fluoride treatment - 75% of charge
Surgical tooth extraction - 75% of charge
(combined limit for major dental, endodontic Full crown veneered - 75% of charge
& other services)
Filling of one root canal - 75% of charge
$1,200 per policy
Major dental
12
Endodontic
12
Orthodontic
12
OPTICAL (eg prescribed
$500 per policy
$2,800 lifetime limit
6
$300 per policy
Single vision lenses & frames - 75% of charge
Multi-focal lenses & frames - 75% of charge
NON PBS PHARMACEUTICALS
2
$500 per policy
Per eligible prescription - 75% of charge
PHYSIOTHERAPY
2
$550 per policy
Initial visit - 75% of charge
Subsequent visit - 75% of charge
CHIROPRACTIC
2
PODIATRY
2
PSYCHOLOGY
2
ACUPUNCTURE
2
spectacles / contact lenses)
NATUROPATHY
2
REMEDIAL MASSAGE
2
HEARING AIDS
36
B LOOD GLUCOSE MONITORS
12
AMBULANCE
n/a
Braces for upper & lower teeth, including removal
plus fitting of retainer - 75% of charge
(combined limit for physiotherapy, chiropractic
Initial visit - 75% of charge
& other services)
Subsequent visit - 75% of charge
$400 per policy
Initial visit - 75% of charge
$300 per policy
Initial visit - 75% of charge
Subsequent visit - 75% of charge
(combined limit for podiatry & other services) Subsequent visit - 75% of charge
$250 per policy
Initial visit - 75% of charge
Subsequent visit - 75% of charge
(combined limit for acupuncture, naturopathy, Initial visit - 75% of charge
remedial massage & other services Subsequent visit - 75% of charge
Sub-limits apply)
$800 per policy
2 appliance(s) every 5 years
Initial visit - 75% of charge
Subsequent visit - 75% of charge
Per hearing aid - 75% of charge
(combined limit for hearing aids, blood
glucose monitors & other services - Sub-limits Per monitor - 75% of charge
apply)
Covered by State government
Benefit paid after current PBS patient contribution deducted
OTHER FEATURES: Additional Healthier Lifestyle benefit available up to $250 per person per calendar year to use on nib approved
weight management, quit smoking and health management programs, first aid courses. Full details are provided on nib.com.au or
call our Customer Care on 13 14 63
NIB/J25A/T0500S issued 24 March 2016
www.PrivateHealth.gov.au