nib health insurance - overseas student health cover information Insurance history

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1800 775 204                   it                                                                        wo

     nib health funds limited abn 83 000 124 381
Head Office 22 Honeysuckle Drive Newcastle NSW 2300   2                                                                  3
                                                                                            TAbLE Of CONTENTS
                                                                                            Why you need nib OSHC
                                                                                                                     rstand and use
                                                                                            nib OSHC is easy to unde
                                                                                                                     l choice for you
                                                                                            Why nib OSHC is the idea
                                                                                                                       y things
                                                                                            nib OSHC helps pay for man
                                                                                            Who can be covered by nib
                                                                                            nib OSHC cover is extensiv
                                                                                            Waiting periods
                                                                                            What’s not covered by nib
                                                                                            nib OSHC Extras for more
                                                                                                                     as you need it
                                                                                            Get nib OSHC for as long
                                                                                                                      to date
                                                                                             Keeping your nib OSHC up
                                                                                             Starting your nib OSHC
                                                                                                                        health fund
                                                                                             Moving to nib from another
                                                                                             What happens next?
                                                                                             Do it all online
                                                                                             How to claim for medical

                                                                                             Other ways to claim from

                                                                                                                      to hospital?
                                                                                             What happens when you go
                                                                                             Looking after your cover
                    0pm                       ice Monday to Friday 8am-8.3                                                                     23
  We’re here to help. And we’re at your serv                                                  New nib OSHC customer

  Saturday 8am-1pm (AEST).
                                                                                              What to do if your situation

  • Call us on 1800 775 204
                                                                                                                        ut nib
                                                                                              Important information abo
                                           ralia, please call +61 2 4914 114
  • If you’re calling from outside of Aust                                                    Got a question or need to
                                                                                                                        know more?

  • Email                                                                  Glossary
                                            and speak to one of our retail consultan
  • Visit an nib retail Centre
   • Fax us on +61 2 4929 6362                                                                                                          it’s
The information contained in this brochure is current at time of issue, 23 November 2009.
WELCOME                                                                                   IT’S EASY TO UNDErSTAND
                                                                                          AND EASY TO USE
We hope you have an exciting and enjoyable time in Australia.
                                                                                          Our OSHC is easy to understand, easy to join and easy to use. And you can do
Taking care of your health is essential for a happy and successful visit to a new         almost everything online or over the phone.
country. That’s why it makes good sense to have private health insurance such as nib
Overseas Student Health Cover (OSHC).
This brochure explains why you need nib OSHC, what’s covered and what’s not.              WHY nib OSHC IS THE IDEA
It also tells you what you need to do, how easy it is to join and how to claim benefits
(a benefit is the money you get back from nib.)
                                                                                          CHOICE fOr YOU
If there is anything you don’t understand or if you want to know more, visit                 nib is one of Australia’s leading health insurers, with over 50 years in the or call 1800 775 204.                                                        health insurance industry

There may be words and terms you don’t understand so we’ve included a glossary               We provide health insurance to over 700,000 customers around Australia
on page 32.                                                                                  Our reputation is excellent with more people choosing nib everyday
Please read this brochure carefully and keep it in a safe place                              Our award-winning Customer Service Team is dedicated to making your
for future reference.                                                                        private health insurance easy to understand

                                                                                             A proud heritage of providing great value health insurance and fantastic service

                                                                                             We understand what you need as an international student and will give
                                                                                             you health information and services to help you make the most of your
                                                                                             stay in Australia
It is a condition of your student visa that you’re covered by an Overseas Student
                                                                                             Also, you can get a 5% discount if you pay for 13 months cover or more in advance
Health Cover OSHC policy while you’re living and studying in Australia.

An nib OSHC policy is ideal. It’s private health insurance designed especially for
students like you. It will help you pay for medical and hospital treatment you may
need should you get sick or have an accident while you’re studying here.

Australia’s ‘Medicare’ health system does not cover international students. Without
private health insurance such as nib OSHC, you would have to pay the full cost
of any medical expense or hospital stay. This could add up to many thousands
of dollars.

   A stay in one of 400 nib Agreement Private Hospitals throughout Australia

   A stay in any public hospital in Australia

   Medical services required in hospital

   Theatre fees should you need to have surgery

   Surgically implanted prostheses

   Visits to the doctor (general practitioners or specialists)

   Ambulance transport

   Part of the cost of prescription drugs

For a detailed description of what we cover you for, please go to page 6.

bY nib OSHC?
You can get a Single Policy or a Family Policy.

   A Single Policy covers only you

   A Family Policy covers you, your partner and any dependent children under 18 if
   they live with you in Australia and are listed on your student visa

Your other relatives such as sisters and brothers, parents or guardians are not covered
under your nib OSHC. If they are living with you while you are studying, they will need
to get their own health insurance.

For more information visit or call 1800 775 204.

nib OSHC will help pay the cost of most medical and hospital treatments you may
                                                                                              Service                            Benefits per service
need while you’re studying in Australia.
                                                                                             Continued from previous table
Important!                                                                                   • accident and emergency services
Call us first if you need to go to hospital, or start a new medical treatment to check         where applicable
what you are covered for.
                                                                                             • outpatient medical and post
                                                                                               operative services
  Service                                      Benefits per service
 Out of hospital medical services
                                                                                             Surgically implanted prostheses     nib pays:
 Doctors                                      nib pays 100% of the Medicare
                                                                                             on the Australian Government        • full cover for any ‘no-gap’
 (General Practitioner consultations)         Benefits Schedule Fee
                                                                                             Prostheses Schedule                   prostheses item listed on
                                              (see Glossary – page 32)
                                                                                                                                   the Australian Government
 Specialist services including Pathology,     nib pays 85% of the Medicare                                                         Prostheses Schedule
 Radiology and Specialists                    Benefits Schedule Fee
                                                                                                                                 • or the minimum benefit for
                                              (see Glossary – page 32)
                                                                                                                                   ‘Gap-permitted prostheses’
 In hospital medical services
                                                                                             Prescriptions medicines
 Medical services provided in a               nib pays 100% of the Medicare
                                                                                             Prescription Medicines              nib pays:
 hospital including doctors, specialists,     Benefits Schedule Fee
 pathology and radiology                      (see Glossary – page 32)                       (prescribed by your doctor and      • Up to $50 per prescription item
                                                                                             listed on the Pharmaceutical          (after you pay the
 Public Hospital                              nib pays 100% of the cost                      Benefits Scheme)                      patient contribution)
 • shared ward accommodation,                 (at the rate determined by State and                                               • Claim up to $300 per person per
   theatre fees and same day services         Territory health authorities for services                                            calendar year (capped at $600
 • accident and emergency services            charged to a patient who is not an                                                   for families)
                                              Australian resident)
 • outpatient medical                                                                        Ambulance services
                                              (see Glossary – page 32)
                                                                                             Ambulance Transport                 nib pays 100% for ambulance
 nib Agreement Private Hospitals or           nib pays 100% of the cost
                                                                                             (deemed medically necessary by a    transport deemed medically necessary
 day surgeries                                (if you choose to be treated in a
                                                                                             doctor and provided by a State or   by a doctor
 • the full cost of private or shared         non-contracted private hospital you’ll
                                              be required to pay any difference              Territory Ambulance Service)
   room accommodation
 • theatre fees and same day services         between the OSHC benefit, which
                                              is 100% of the MBS, and the                    Confused or need more information?
 • up to the MBS fee for treatment by
                                              hospital cost)
   your doctor                                                                               Visit or call 1800 775 204.

                                                                                         6                                                                           7
WAITING PErIODS                                                                              WHAT’S NOT COVErED
                                                                                             bY nib OSHC
Sometimes you have to wait before you can claim money for services covered under
your nib OSHC – this is called a waiting period.                                              Infertility treatments like assisted reproductive services or in-vitro fertilisation and
                                                                                              secondary conditions related to infertility treatments
Waiting periods apply from the date you arrive in Australia or the date you joined nib
(whichever is the later date).                                                                Pregnancy and birth related services if your visa length is less than 3 months

If you are transferring from another health fund in Australia then the waiting periods you    Treatments that fall within waiting periods (see page 8)
may have already served will be taken into account.
                                                                                              Services not covered by Medicare such as cosmetic surgery, laser eye treatment or
Our waiting periods are:                                                                      experimental surgery

   12 months for pre-existing conditions, unless life threatening (see glossary on            Treatment outside of Australia or arranged before arriving in Australia
   page 32 for a definition of pre-existing conditions)
                                                                                              Transportation into or out of Australia
   12 months for treatments relating to an existing disability or secondary condition
                                                                                              Services and treatments which are covered by compensation or damages of any
   relating to the pre-existing condition
                                                                                              kind (like workers compensation or third party insurance)
There are NO waiting periods for:                                                             Luxury hospital rooms and other non-essential items like TV hire, beauty treatments
   Accidents and emergency treatment                                                          and phone calls

   Out-of-hospital medical services such as a visit to the doctor                             Extras services – treatments by dentists, physiotherapists, chiropractors or any
                                                                                              other Extras service providers (unless directly related to a hospital admission and
Remember – before you are admitted to hospital always call us first to check your             completed in hospital), or other Extras services such as glasses, hearing aids or
benefit entitlement.                                                                          artificial aids

If you don’t understand or need more information,
visit or call 1800 775 204.

                                                                                      8                                                                                                  9
GET nib OSHC ExTrAS                                                                         GET nib OSHC fOr AS
fOr MOrE SErVICES                                                                           LONG AS YOU NEED IT
Your nib OSHC only covers you for hospital and medical treatment. It doesn’t help           You must pay for your nib OSHC cover on or before the start date of your student visa.
pay for Extras services like visits to the dentist, glasses or physiotherapy. However, if
you add nib OSHC Dental Plus cover to your nib OSHC, you will be covered for these          You need OSHC cover for the period listed on your student visa.
services and get 50% of the cost back every time you claim, up to the annual limits.
                                                                                               If your student visa length is less than 12 months you must pay for your nib
OSHC Dental Plus                                                                               OSHC upfront
Extra benefits – you get 50% of the cost back                                                  If your student visa is longer than 12 months you can choose to make the payment
                                                                                               upfront to cover the whole period of your visa, or make the minimum payment for
                                               Annual               Waiting                    12 months cover and renew your health insurance after 12 months
                                               limits               periods
                                                                                               If your partner and/or dependent children are coming with you to Australia you will
 General Dental
                                                                                               need to pay a family premium at the same time before they can be covered
 e.g. Oral examination, scale & clean,               $500                2 months
 fillings, extractions                                                                      For more information, visit or call 1800 775 204.
 Major Dental                                                                               Your nib OSHC is valid while you hold a current student visa, are living in Australia and
 Root canal therapy, gum disease,                    $600               12 months           your premium payments are up to date.
 crowns & bridges, implants, orthodontia
                                                                                            Your nib OSHC stops on the date you leave Australia permanently, or the date you
 Optical                                                                                    cease to hold a student visa, or on the expiry date shown on your Health Insurance
                                                     $250                6 months
 e.g. Frames, lenses, contact lenses                                                        Certificate, whichever comes first.
 Physio/ Chiro/ Osteo/ Exercise                                                             If your student visa becomes invalid then your nib OSHC also becomes invalid.
                                                     $350                2 months
 Physiology                                                                                 Let us know if your circumstances change and we’ll give you a refund in
 Natural Therapies                                                                          Australian dollars.
 Including acupuncture, herbalism,
 naturopathy, homeopathy, nutrition,                 $200                2 months
 remedial massage, myotherapy, Bowen
 therapy & shiatsu
 Healthier Lifestyle
 nib approved weight management,
 quit smoking and health management                  $150                6 months
 programs, first aid courses,
 preventative health tests

                                                                                      10                                                                                          11
IT’S IMPOrTANT TO KEEP                                                                    STArTING YOUr nib OSHC
                                                                                          Log onto to join online and use your credit card to pay for your
It is a requirement of your student visa that your nib OSHC is continuous for the term    nib OSHC.
of your visa. If you allow your nib OSHC to lapse and you want to renew it, you have to
pay the premiums for the lapsed period.                                                   Here are two other ways to get nib OSHC:

If you don’t have OSHC or you let it lapse, your student visa could be cancelled. Worse      Call 1800 775 204
still, if you have an accident or need medical help you’ll have to pay the full cost of      Visit an nib Retail Centre
your medical expenses. This could be very expensive. A stay in hospital could cost you
thousands of dollars.                                                                     It’s good to pay upfront

Your nib OSHC is valid while you hold a current student visa, are                         We recommend that you pay upfront for the duration of your student visa, so you can
living in Australia and your payments are up to date.                                     rest easy and not have to think about it again.

                                                                                          Also, you can get a 5% discount if you pay for 13 months cover
                                                                                          or more in advance.

                                                                                          MOVING TO nib frOM ANOT
                                                                                          AUSTrALIAN HEALTH fUND

                                                                                          If you are currently with another Australian health insurer and want to transfer to nib,
                                                                                          we’ll take this into account when assessing your waiting periods for nib.

                                                                                          You’ll need to give us a ‘Clearance Certificate’ from your current health fund. This will
                                                                                          help us understand how long you’ve had appropriate health insurance in Australia.

                                                                                          If your cover with another health insurer has lapsed, you’ll have to pay for the lapsed
                                                                                          period to continue your cover. You can pay for the lapsed period with your previous
                                                                                          health insurer or pay for the equivalent period with nib.

                                                                                  12                                                                                             13
WHAT HAPPENS NExT?                                                                        DO IT ALL ONLINE

Once you join nib, the rest is easy.                                                      With nib Online Services you can manage your health insurance from the comfort of
                                                                                          your home.
  Go to and give us your Australian home address. We’ll then
  send you your nib OSHC Customer Card. You need this card to claim for medical           Our website is full of useful information and services to help
  services or when you are admitted to hospital. If you have a family policy your         you make the most of your health insurance.
  partner also receives a Customer Card
                                                                                          With nib Online Services you can:
  We’ll send you a Health Insurance Certificate that describes who’s
  covered on your policy and the period of cover. You’ll need to check that everything       View and update your policy details
  in the Health Insurance Certificate is correct. If it isn’t, call nib on 1800 775 204      Pay or renew your nib OSHC premium
  immediately and we’ll help you update your cover
                                                                                             Find an nib Agreement Private Hospital
  We’ll register you for nib Online Services when you join nib. It’s a ‘customer only’
  area of that lets you see your nib OSHC policy and health                  Find an nib Retail Centre
  insurance details, make claims for out of hospital medical services, and more.
                                                                                             View your payment details and history
  Please visit to create a password to access
  nib Online Services                                                                        Claim for medical services (up to $300 per session)
  Set up a ‘Direct Credit Authority’ account in Online Services so we can deposit your
  benefits (the money you claim back) into your nominated Australian bank account

                                                                                    14                                                                                     15
HOW TO CLAIM fOr                                                                           OTHEr WAYS TO
MEDICAL ExPENSES                                                                           CLAIM frOM nib
Step 1                                                                                     Download an OSHC Claim Form from
                                                                                           Complete and sign your Claim Form and then:
Call nib or visit to check your cover
                                                                                             Visit an nib Retail Centre to submit the claim
Go to or call us on 1800 775 204 before you have any
treatment to make sure the medical treatment and the provider are recognised by nib          Mail your claim to us at the following address (no stamp needed)
and that you are entitled to receive a benefit when making a claim.                          nib Claims Processing
                                                                                             Reply Paid 62208
Step 2                                                                                       Locked Bag 2010
                                                                                             Newcastle, NSW 2300
Visit the medical provider
                                                                                           If you have any questions or want more information about how
Once you’ve checked your cover and benefit entitlements, it’s ok to visit your provider
                                                                                           to make a claim, call 1800 775 204.
and receive your treatment.
                                                                                           Claims must be submitted within two years of the date
Usually you need to pay the provider upfront, either before or right after you get the
treatment. Make sure they give you a fully itemised receipt (on the provider’s official    of service.
letterhead) so that you can claim your benefit.

Step 3

Online claiming for medical services after your visit

If you have an itemised receipt you can claim through nib Online Services after your
treatment. You can claim for a wide range of medical services up to a combined limit
of $300 in benefits at any one time. And nib Online Services is conveniently open all
day, everyday.

                                                                                      16                                                                        17
We understand that going to hospital can be a scary experience. We’ll help by giving          Step 2
you the support and information you need to make it easy to organise and claim for
your expenses.                                                                                Talk to your doctor about the possible costs

Here’s what to do if you need to go to hospital:                                              Even if you have served all your waiting periods it’s possible that you’ll have to pay
                                                                                              part of the cost of going to hospital. It’s usually the difference between what nib pays
Step 1                                                                                        for and the total cost of your hospital stay. These costs are called ‘out-of-pocket
                                                                                              expenses’ and they can’t be claimed back (see page 37 in the glossary for more
Call nib to check your cover                                                                  information on ‘out-of-pocket expenses’).

Under nib’s OSHC you will be covered for most services in hospital, but the hospital          Find out what’s covered and what’s not
you go to, your waiting periods and whether your payments are up to date will affect
what’s covered.                                                                               Get your doctor or hospital to itemise the costs and explain your treatment in detail
                                                                                              beforehand so you know what’s covered and what out-of-pocket expenses you might
When you find out that you’re going to hospital and the name of that hospital, call us        have to pay for.
on 1800 775 204 to find out what’s covered.
                                                                                              Your doctor must get your full agreement on your treatment and its costs before you
What if you haven’t served your waiting periods?                                              go to hospital (where possible). This is called ‘informed financial consent’.

If you need to go to hospital before your waiting periods are over then nib will need to      Once you have talked through the treatment with your doctor and have agreed to the
be sure the reason you are going is not for a pre-existing condition. This means you          treatment and its costs, your doctor will help arrange an admission date with
had no signs or symptoms before you arrived in Australia.                                     the hospital.

If your condition is not pre-existing, or if you are admitted to hospital because of an       Step 3
accident (and you and the attending doctor have completed the appropriate forms),
then you’ll be covered under your nib OSHC (see page 6 for more detail about what’s           Going into hospital
covered in hospital).
                                                                                              To be covered by your nib OSHC you’ll need to tell the hospital (or day surgery/
Contact us as soon as you know that you’re going to hospital. There are some forms            facility) that you have private health insurance with nib. It helps to have your OSHC nib
that you and your doctors need to complete and it could take some time to get all             Customer Card with you.
the information.
                                                                                              The hospital will give you a National Private Patient Claim Form to fill out before you
Do you have a pre-existing condition?                                                         are admitted. This is a legal document and the hospital uses this form to claim your
                                                                                              hospital expenses after you’ve been to hospital.
If your illness or condition is pre-existing, there is a 12 month waiting period before
benefits will be paid for your hospital treatment, unless the ailment, illness or condition   The hospital should then check with nib that you have appropriate health insurance
is life threatening. This means that you will need to pay for the entire cost of your         and that you have served the waiting periods for your treatment, although this may
hospital stay.                                                                                happen shortly after you are admitted.

                                                                                       18                                                                                           19
Step 4

Coming out of hospital

When you get out of hospital you can expect at least two bills – one from the hospital,
and the other/s from your doctors and/or specialists.

Hospital bills

The hospital usually sends the bill directly to nib, or you may receive the bill when you
leave hospital.

If you get a bill from the hospital it could be for one of many different reasons:

   The hospital hasn’t confirmed if you’re covered for the treatment

   The hospital doesn’t have an agreement with nib

   You’re within waiting periods for the procedure

   The treatment is for a pre-existing condition

   The treatment is excluded on your cover

Call us on 1800 775 204 if you are not sure why you’ve
been billed.

Doctors’ bills

You may also get sent doctors or specialists bills. nib will give you a cheque made
out to your doctor (providing you were eligible to receive benefits for the treatment).
Whatever remains unpaid from the account (i.e. what nib doesn’t pay) is what you
need to pay to your doctor.

Find out if your claim has been paid

For peace of mind, call us and ask for a statement.

LOOKING AfTEr YOUr CO                                                                       NEW nib OSHC
                                                                                            CUSTOMEr CArDS
Checking your cover and updating your information
                                                                                            To get a new Customer Card, log on to our website and select the nib card button,
You can check the details of your cover by logging onto nib Online Services or calling      select who the card is for and why it is being re-issued. The new card will be sent to
1800 775 204. You can also update your address and other personal information.              your Australian home.
Removing people from your policy                                                            Or call us on 1800 775 204 and we’ll arrange for a new card to
You must let us know if there have been any changes to who is listed on your policy         be sent to you.
or student visa.
                                                                                            Renewing your cover
Partner Authority                                                                           If you didn’t pay upfront for the entire duration of your student visa, you can renew
You are the policyholder of your nib OSHC and are legally responsible for the policy.       your OSHC by logging onto and select ‘Renew’ to renew your
Anything we send about the cover will be addressed to you.                                  policy with a credit card.

However, if you have a Family nib OSHC policy then you can also give your partner           Other easy ways to renew:
(as listed on your policy) authority to operate the policy – known as ‘Partner Authority’
                                                                                               Download an Application Form and send it to us
If you do this then they can make claims on behalf of anyone listed on the policy
including you and your children. They can also make changes or make enquiries about:           Call 1800 775 204
   Policy details such as address and phone number                                             Visit an nib Retail Centre
   Level of cover                                                                              You can also renew through your educational institution. Talk to your International
                                                                                               Student Administrator to find out more
   Payment methods
                                                                                            You need to give us a copy of your Certificate of Enrolment or passport to show that
   Adding dependant children to the policy
                                                                                            your current student visa is valid and up to date.
Without Partner Authority your partner can only make claims for his or herself. You can
give your authority or remove it at any time. This information is recorded and we will      Important: update your student visa (if you need to) before your nib OSHC expires.
confirm Partner Authority before giving any details or making changes requested by
                                                                                            Check your cover by logging onto nib Online Services or
your partner.
                                                                                            calling 1800 775 204.

                                                                                   22                                                                                           23
Suspending your cover while you’re out of Australia

If you’re going to another country for two or more months while you’re covered by nib
OSHC you can ask to suspend your policy. Contact us a couple of weeks before you
leave. You’ll have to show us your boarding pass to and from your destination within
30 days of your return so we can reactivate your policy. You won’t be able to claim for
any services while your policy is suspended.

Getting your money back if you don’t need cover after all

We can refund all or part of your nib OSHC contributions if:

   You paid for cover but did not come to Australia

   You applied with us for an extended stay that was not approved by the Department
   of Immigration and Citizenship

   Your student visa was not extended, was cancelled or a renewal/extension
   was refused

   You need to leave Australia before the end of your studies and approved period
   of stay

   You were not resident in Australia for a continuous period of 3 months or more
   whilst holding a student visa

   You are granted permanent residence in Australia and apply for a refund. We’ll
   refund your nib OSHC from the date your residency was granted

   You can provide proof of cover with another OSHC provider

Refund forms can be downloaded from

It’s a bit boring, but it’s good to know the legal details about your health insurance.    As well as collecting personal information directly from you, we may also collect
                                                                                           personal information from other nib companies or health service providers including
nib’s Privacy Policy                                                                       health insurers, government agencies, private and public hospitals, and doctors and
                                                                                           medical specialists.
nib is committed to protecting your privacy and any personal information we collect
from you. nib has implemented measures to comply with its obligations under the            How do we use your information?
Privacy Act 1988 (Cth).
                                                                                           nib uses your personal information in accordance with the National Privacy Principles.
Why we collect your personal information                                                   The information we collect is used to:
We collect your personal information primarily to enable us to provide health benefits        Provide you with health and related services
and related services to you. nib may also use this information to promote or market
its current and future health and related services to you or for any other purpose            Determine your eligibility to receive an nib health or related service
permitted under the Privacy Act 1988 (Cth).
                                                                                              Promote and market nib’s current and future health and related services
What personal information do we keep?
                                                                                              Conduct research (including but not limited to customer surveys) concerning nib’s
The personal information nib holds will depend on whether you are a customer and              current and future health and related services
which services you have used. Information may include:

   Name, address, contact details, date of birth

   Payment details

   Current or past details of private health insurance, including level of cover

   Claim details

   Financial institution account details

   Pre-existing condition information

How does nib collect my personal information?

We may collect personal information directly from you when:

   You complete an application form to become an nib customer

   You ask for information concerning nib’s services in person, phone or online

   You make a claim

                                                                                      26                                                                                      27
If nib uses your personal information for direct marketing or research purposes we will       nib will not disclose your personal information to anyone, other
do so in accordance with the Privacy Act 1988 (Cth) and any correspondence sent               than as above, unless:
to you will give you the opportunity to ‘opt out’ of receiving any further marketing or
research correspondence.                                                                         You give us permission to do so

Third party use of your personal information                                                     Your safety or the safety of others in the community is at risk, or nib is required or
                                                                                                 permitted by law
nib may be required to disclose your personal information to:
                                                                                              How to access your personal information?
   Other nib companies
                                                                                              You have a right to access your personal information. You may request details of
   Health service providers including health insurers, government agencies, private           your personal information by contacting nib’s Privacy Officer on 13 14 63 or at
   and public hospitals, and doctors and medical specialists                        
   nib’s contractors and service providers performing services including (but                 How to make sure your personal information is accurate
   not limited to) marketing, market research, mail-house services, and product
   development services                                                                       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.
nib may also be required to disclose your personal information to other individuals on        If you believe that any personal information nib holds about you is not accurate,
your nib policy. At the time of joining nib, the policyholder (i.e. the person applying for
                                                                                              complete or up to date, please contact nib’s Privacy Officer on 13 14 63 or
the policy) authorises nib to share information with other individuals on the nib policy.
This means we may make the customer aware, for example, the details of all benefits
and services claimed on the policy.                                                           Your personal information is 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.

                                                                                              Need more information?

                                                                                              For further information regarding this Privacy Policy or any other steps nib has taken
                                                                                              to protect your personal information or privacy, please contact nib’s Privacy Officer on
                                                                                              13 14 63 or at

                                                                                              Changes to this Privacy Policy

                                                                                              nib reserves the right to change this Privacy Policy from time to time. This Privacy
                                                                                              Policy was last updated June 2009.

                                                                                       28                                                                                            29
                                                                                         GOT A qUESTION
                                                                                         Or NEED TO KNOW MOrE?
Principle rules and by-laws

  You can’t have the same type of health insurance with more than one health insurer     We’re here to help. And we’re at your service
  (e.g. you can’t have an OSHC package with 2 health insurers). But you can have         Monday-Friday 8am-8.30pm, Saturday 8am-1pm (AEST).
  OSHC cover with one health insurer and Extras only cover with another
                                                                                             Call us on 1800 775 204. If you’re calling from outside of Australia please
  Benefits will only be paid for claims which meet nib criteria                              call +61 2 4914 1146

  nib reserves the right to recover any money paid in error or obtained fraudulently,        Email
  or by any other means contrary to nib’s rules                                              Visit an nib Retail Centre and speak to one of our retail consultants
  Your customer number needs to be quoted on all claims. You’ll find it on the front         Fax us on 02 4929 6362
  of your nib OSHC Customer Card

  Benefits are only paid if the claim is made within 2 years of when you received the    Complaints
  service or treatment
                                                                                         We care about what you think. So if you have a complaint or are disappointed with our
  Customers will not be paid any benefits if they are not financial. nib policies are    performance or service please let us know as soon as possible.
  un-financial if premiums are in arrears. nib may cancel policies that are more than    You can contact us in one of the following ways:
  two months in arrears
                                                                                             Call us on 1800 775 204
Benefits are not payable for:                                                                Email
  Policy applications or claims where false or inaccurate information is supplied            Write to nib:
                                                                                             Reply paid 62208
  Services by providers not registered with nib                                              Locked Bag 2010
                                                                                             Newcastle NSW 2300
  Services where a customer is eligible to receive benefits from workers’
  compensation or third party insurance                                                      Fax: (02) 4927 2142

  Services given to customers of a provider’s family, or to a provider’s business
  partner and family. This also applies to people not independent from the provider’s    nib will make every possible effort to resolve your complaint to your satisfaction. In the
  practice (e.g. employees)                                                              event that you are not satisfied with the outcome of your complaint you can contact the
                                                                                         Private Health Insurance Ombudsman (PHIO):
                                                                                             Phone: 1800 640 695
                                                                                             Mail: Level 7, 362 Kent St, Sydney NSW 2000
                                                                                             For more information about PHIO visit:

                                                                                         nib health funds limited abn 83 000 124 381
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GLOSSArY                                                                                    Extras
                                                                                            Out of hospital services’ like dental, physio, chiro, glasses and frames, remedial
                                                                                            massage, acupuncture and natural therapies.
We know there’s a chance you won’t understand all the health insurance terms and
phrases we’ve used. So here are some definitions!
                                                                                            The Federal Government has a schedule of fees for medical services, called the
Accident (relating to nib hospital cover)                                                   Medicare Benefits Schedule (MBS). nib OSHC covers you for 85-100% of the MBS
An event leading to bodily injury caused solely and directly by violent, accidental,        fee. The ‘gap’ occurs when doctors and specialists charge more than the MBS or
external and visible means and resulting solely, directly and independently of any          more than nib pays, leaving you with an out-of-pocket expense.
other cause.
                                                                                            General practitioner
Accommodation                                                                               A doctor who treats patients in general practice for a wide range of issues. General
Includes the hospital bed, patient meals and nursing care in a hospital. It does not        practitioners do not specialise in any particular type of treatment.
include treatment by health professionals such as doctors.
                                                                                            Informed Financial Consent
Admission                                                                                   Informed Financial Consent means you are told in writing about, and consent to, the
To get treatment for an illness or condition as a private patient in a registered public,   cost of hospital treatment before being provided with that treatment. You should be
private or day hospital you must be admitted by a medical practitioner. Treatment in        told the treatment’s cost before you are admitted to hospital to enable your informed
the emergency room of a private hospital is not an admission.                               financial consent to be given.

Annual benefit limits                                                                       In-patient
The maximum amount nib will pay for a service over a calendar year. At the                  A patient receiving treatment that requires a stay in hospital, admitted for the day
beginning of each calendar year, your annual benefit limits are renewed allowing you        or overnight.
to claim again.
Benefit                                                                                     The Australian Government’s health care program that provides health care for
Benefits are the dollar amount nib pays when you make a claim for an item or service        Australian citizens and residents.
covered by your nib OSHC. How much you get depends on your choice of doctor,
                                                                                            Medicare Benefits Schedule Fee (MBS)
hospital or provider and what your doctor, hospital or provider charges.
                                                                                            The MBS is the amount set by the Federal Government for the purpose of paying
Calendar Year                                                                               Medicare benefits. nib will pay 100% of the MBS for medical services rendered for
January 1 to December 31.                                                                   hospital in-patient services, provided the procedure is not excluded on your cover.

                                                                                            nib will also cover 85% of out-patient medical services. You pay the amount by which
Clearance Certificate
                                                                                            your doctor’s charges exceed the Medicare schedule fee, or the benefit paid by nib,
Is a form you request from your health insurer when switching to another health
                                                                                            known as the ‘gap’.
insurer. It outlines your health insurance history and claims history. nib will need this
documentation if you are switching to us from another OSHC provider.                        nib Agreement Private Hospital
                                                                                            A private hospital that has negotiated charge agreements with nib. This provides for
                                                                                            in-patient accommodation fees including bed, theatre and labour ward fees (subject
Some treatments are excluded from some hospital covers so you won’t receive a
                                                                                            to the length of your visa), and intensive and coronary care. If you are treated at a
payment from nib for them. Always check with nib before you go to hospital to find out
                                                                                            hospital other than an nib Agreement Private Hospital you will incur out of pocket
if you have cover for the treatments you’re about to receive.

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expenses for most hospital related services. Before receiving hospital treatment call      Partner
1800 775 204 to confirm your benefit entitlements.                                         A person who has been authorised to enter and remain in Australia with the
                                                                                           policyholder, and who lives with the policyholder as their spouse or partner and is listed
nib Recognised Provider                                                                    on the student visa.
You should contact nib before getting any treatment to make sure the provider is
recognised by nib and that you are entitled to receive a benefit if making a claim.        Partner Authority
                                                                                           The policyholder has the option of giving their partner, as nominated on the policy
nib encourages providers to offer high-quality products and services at competitive        application, authority to operate the policy. This lets the partner make claims on behalf
prices to customers. nib neither takes nor assumes any responsibility for the product      of all people on the policy, and make some changes to or make enquiries about the
and/or service provided. You should rely on your own enquiries and seek any                policy. Without partner authority a partner can only make claims for themselves.
assurance or warranties directly from the provider.
                                                                                           Patient contribution
Non Agreement Hospitals                                                                    The amount that you have to contribute for a pharmaceutical prescription before nib
Private hospitals that nib does not have contractual arrangements with.                    will pay a benefit.

OSHC Insured Person                                                                        Pharmaceutical Benefits Scheme (PBS)
All persons covered under your nib OSHC policy, including the OSHC policyholder or         Many medicines cost much more than the price you pay, but the Federal Government
other OSHC holders (including adults and dependent children).                              pays most of it for you. The Government does this through the PBS. It’s available to
                                                                                           Australian residents and eligible visitors from countries with reciprocal arrangements
OSHC policy
                                                                                           with Australia. For more information about the PBS visit
The relationship between a customer and nib, once nib OSHC is taken out, is called an
OSHC policy.                                                                               Pharmaceutical prescriptions
                                                                                           nib will pay a Pharmaceutical Prescriptions benefit when:
OSHC Policyholder
The person who first applied for the policy is known as the policyholder and in whose         The drug is only available on prescription; and
name the nib OSHC policy is taken out. All correspondence relating to your nib OSHC           The drug is listed on the Australian Register of Therapeutic Goods (ARTG); and
policy is addressed to the policyholder.                                                      The name of the drug does not appear in the Schedule of Pharmaceutical Benefits

Out-of-pocket expenses                                                                     A Pharmaceutical Prescriptions benefit will NOT be paid if the drug is:
Some charges and fees aren’t covered by nib. For example, nib won’t pay for medical           Listed as a contraceptive
fees above the MBS fee (‘the gap’) or some personal items like toiletries, newspapers         Mixed to form a compound drug
and long distance and mobile phone calls provided in hospital. These are billed to
you by your doctors and the hospital. nib can tell you what you are covered for, but       Pre-existing condition
you should ask your hospital and your doctors what your out-of-pocket expenses             An illness or condition where the signs or symptoms were evident (whether or not
might be.                                                                                  diagnosed by a doctor) prior to your arrival in Australia.

Out-patient                                                                                Premiums
A patient that doesn’t require admission or an overnight stay in a hospital.               Payments an nib customer is required to make to nib.

Paramedical services                                                                       Private hospitals
Services received in hospital including pharmacy, physiotherapy, hydrotherapy and          Privately owned and operated hospitals.
occupational therapy.

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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 prosthesis.

A professional or organisation that provides a health service, like hospitals, doctors,
dentists, acupuncturists and others, including:
(a) Hospitals; and
(b) Medical practitioners; and
(c) Providers of:
   (i) recognised ambulance services;
   (ii) recognised pharmaceutical items

Public hospitals
Government owned and operated hospitals.                                                               nib proudly supports and
                                                                                                complies with The Private Health
Retail Centre                                                                                       Insurance Code of Conduct.
                                                                                               A copy of the Code is available at
A shopfront or kiosk where customers can visit to join, renew their policy, make a claim
or speak with one our consultants.

A doctor who specialises in treating patients in a particular category, for example a
doctor who specialises in treating people with some form of heart condition.

Theatre fees
Costs of procedures performed in an operating room of a hospital or day
surgery facility.

Waiting period
The time you have to be in your nib OSHC before nib will pay benefits for services
included in your health insurance.

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