nib Health Funds Ltd.

Gold $200 Excess

Name: Gold $200 Excess
Brand: nib Health Funds Ltd.
Price: 840.58 AUD

$840.58 / month

(Before Rebate, Discount & Loading)

Available in QLD

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You may be entitled to an Australian Government Rebate on the above premium. Your premium may also include a Lifetime Health Cover Loading, an Age-based Discount or an insurer discount. Check with your insurer for details.

This policy covers: Two adults (and no-one else).

Policy ID: NIB/J16/Q0400C

Source: Private Health Information Statement (PHIS)

This policy exempts you from the Medicare Levy Surcharge.
This policy does not provide accident cover.
This policy does not provide benefits for travel or accommodation outside of hospital.

Covered

Restricted Cover

Not Covered

This policy includes cover for

Assisted reproductive services

Back, neck and spine

Blood

Bone, joint and muscle

Brain and nervous system

Breast surgery (medically necessary)

Cataracts

Chemotherapy, radiotherapy and immunotherapy for cancer

Dental surgery

Diabetes management (excluding insulin pumps)

Dialysis for chronic kidney failure

Digestive system

Ear, nose and throat

Eye (not cataracts)

Gastrointestinal endoscopy

Gynaecology

Heart and vascular system

Hernia and appendix

Hospital psychiatric services

Implantation of hearing devices

Insulin pumps

Joint reconstructions

Joint replacements

Kidney and bladder

Lung and chest

Male reproductive system

Miscarriage and termination of pregnancy

Pain management

Pain management with device

Palliative care

Plastic and reconstructive surgery (medically necessary)

Podiatric surgery (provided by a registered podiatric surgeon)

Pregnancy and birth

Rehabilitation

Skin

Sleep studies

Tonsils, adenoids and grommets

Weight loss surgery

The benefits paid for hospital treatment will depend on the type of cover you purchase and whether your fund has an agreement in place with the hospital in which you are treated. See ‘Agreement Hospitals’ on privatehealth.gov.au for which hospitals have arrangements with your insurer – https://privatehealth.gov.au/dynamic/agreementhospitals.

Under this policy, you may have to pay out-of-pocket costs above what you get from Medicare or your private health insurer. Before you go to hospital, you should ask your doctors, hospital and health insurer about any out-of-pocket costs that may apply to you.

The following payments may also apply for hospital admissions

Excess: You will have to pay an excess on admission. This is limited to a maximum of $200 per person and $400 per policy per year.

Co-payments: No co-payments

The following waiting periods for hospital admissions apply to new or upgrading members Waiting periods:

2 months for palliative care, rehabilitation and hospital psychiatric treatments, even if pre-existing
12 months for other pre-existing conditions
12 months for pregnancy and birth (obstetrics)
2 months for all other treatments

Gap Cover

This provider offers 'known gap' or 'no gap' cover for medical bills for this product. The Medical Costs Finder (https://www.health.gov.au/resources/apps-and-tools/medical-costs-finder) lets you find out more about the cost of specialist medical services.

For further information about this policy see: https://my.nib.com.au/product-collateral/26

By using our FirstChoice providers, you may have lower out-of-pocket costs on many allied health services. A list of "preferred providers" is available from the health insurer. See https://www.nib.com.au/find-a-provider.

This policy includes General treatment (Extras) cover for

Treatment & waiting period (months)

Benefit limits per 12 months unless otherwise stated

Examples of maximum benefits

Acupuncture 2

$900 per person

combined limit for acupuncture, ante-natal/post-natal classes, chiropractic, exercise physiology, eye therapy (orthoptics), occupational therapy, osteopathy, physiotherapy, speech therapy & other services

sub-limits apply

Initial visit: $21
Subsequent visit: $11

Ante-natal/Post-natal classes 2

$900 per person

combined limit for acupuncture, ante-natal/post-natal classes, chiropractic, exercise physiology, eye therapy (orthoptics), occupational therapy, osteopathy, physiotherapy, speech therapy & other services

Initial visit: $11
Subsequent visit: $11

Blood glucose monitors 12

$600 per person

Per monitor: $180

Chinese medicine 2

$170 per single policy $340 per couple/family policy

combined limit for chinese medicine & remedial massage

Initial visit: $19
Subsequent visit: $18

Chiropractic 2

$900 per person

combined limit for acupuncture, ante-natal/post-natal classes, chiropractic, exercise physiology, eye therapy (orthoptics), occupational therapy, osteopathy, physiotherapy, speech therapy & other services

sub-limits apply

Initial visit: $25
Subsequent visit: $22

Dietetics/dietary advice 2

$250 per person

Initial visit: $27
Subsequent visit: $25

Endodontic 12

Non-specialty Endodontia: $400; Specialty Endodontia: $600, $1600 per Lifetime; Service Limits Apply

Filling of one root canal: $80

Exercise physiology 2

$900 per person

combined limit for acupuncture, ante-natal/post-natal classes, chiropractic, exercise physiology, eye therapy (orthoptics), occupational therapy, osteopathy, physiotherapy, speech therapy & other services

Initial visit: $40
Subsequent visit: $35

Eye therapy (orthoptics) 2

$900 per person

combined limit for acupuncture, ante-natal/post-natal classes, chiropractic, exercise physiology, eye therapy (orthoptics), occupational therapy, osteopathy, physiotherapy, speech therapy & other services

Initial visit: $28
Subsequent visit: $25

General dental 2

General Dental/Major Dental: Multiple Limits, Sub-Limits, Shared Limits and Service Limits Apply; See insurer for details

combined limit for general dental & major dental

Fluoride treatment: $19
Scale & clean: $50
Surgical tooth extraction: $71.5
Periodic oral examination: $21

Health management / Healthy lifestyle 6

$125 per Single Policy $250 per Family Policy

Health management: 100% of charge

Hearing aids 36

$560 per person

Hearing aid: $560

Home nursing 2

$750 per person

Initial visit: $72
Subsequent visit: $72

Major dental 12

General Dental/Major Dental: Multiple Limits, Sub-Limits, Shared Limits and Service Limits Apply; See insurer for details

combined limit for general dental & major dental

Full crown veneered: $700

Non PBS pharmaceuticals* 2

$600 per person

Per eligible prescription: $60

Occupational therapy 2

$900 per person

combined limit for acupuncture, ante-natal/post-natal classes, chiropractic, exercise physiology, eye therapy (orthoptics), occupational therapy, osteopathy, physiotherapy, speech therapy & other services

Initial visit: $29
Subsequent visit: $28

Optical 6

$300 per person

Multi-focal lenses & frames: $290
Single vision lenses & frames: $230

Orthodontic 12

Non-specialty Orthodontia: $350, $1050 per Lifetime; Specialty Orthodontia: $350, increasing by $100 per calendar year to $2800 per Lifetime

Braces for upper & lower teeth, including removal plus fitting of retainer: 100% of charge

Orthotics (podiatric orthoses) 2

$200 per person

Orthotics supply & fit: $100

Osteopathy 2

$900 per person

combined limit for acupuncture, ante-natal/post-natal classes, chiropractic, exercise physiology, eye therapy (orthoptics), occupational therapy, osteopathy, physiotherapy, speech therapy & other services

Initial visit: $25
Subsequent visit: $23

Physiotherapy 2

$900 per person

combined limit for acupuncture, ante-natal/post-natal classes, chiropractic, exercise physiology, eye therapy (orthoptics), occupational therapy, osteopathy, physiotherapy, speech therapy & other services

sub-limits apply

Initial visit: $40
Subsequent visit: $35

Podiatry 2

$300 per person

Initial visit: $25
Subsequent visit: $21

Psychology 2

$300 per person

Initial visit: $45
Subsequent visit: $40

Remedial massage 2

$170 per single policy $340 per couple/family policy

combined limit for chinese medicine & remedial massage

Initial visit: $19
Subsequent visit: $18

Speech therapy 2

$900 per person

combined limit for acupuncture, ante-natal/post-natal classes, chiropractic, exercise physiology, eye therapy (orthoptics), occupational therapy, osteopathy, physiotherapy, speech therapy & other services

Initial visit: $29
Subsequent visit: $27

Vaccinations 2

$100 per person

Per service: $16

Acupuncture

Waiting period: 2 months

Benefit limits per 12 months unless otherwise stated

{$900 per person}

{combined limit for acupuncture, ante-natal/post-natal classes, chiropractic, exercise physiology, eye therapy (orthoptics), occupational therapy, osteopathy, physiotherapy, speech therapy & other services}

{sub-limits apply}

Examples of maximum benefits

{Initial visit: $21}

{Subsequent visit: $11}

Ante-natal/Post-natal classes

Waiting period: 2 months

Benefit limits per 12 months unless otherwise stated

{$900 per person}

{combined limit for acupuncture, ante-natal/post-natal classes, chiropractic, exercise physiology, eye therapy (orthoptics), occupational therapy, osteopathy, physiotherapy, speech therapy & other services}

Examples of maximum benefits

{Initial visit: $11}

{Subsequent visit: $11}

Blood glucose monitors

Waiting period: 12 months

Benefit limits per 12 months unless otherwise stated

{$600 per person}

Examples of maximum benefits

{Per monitor: $180}

Chinese medicine

Waiting period: 2 months

Benefit limits per 12 months unless otherwise stated

{$170 per single policy $340 per couple/family policy}

{combined limit for chinese medicine & remedial massage}

Examples of maximum benefits

{Initial visit: $19}

{Subsequent visit: $18}

Chiropractic

Waiting period: 2 months

Benefit limits per 12 months unless otherwise stated

{$900 per person}

{combined limit for acupuncture, ante-natal/post-natal classes, chiropractic, exercise physiology, eye therapy (orthoptics), occupational therapy, osteopathy, physiotherapy, speech therapy & other services}

{sub-limits apply}

Examples of maximum benefits

{Initial visit: $25}

{Subsequent visit: $22}

Dietetics/dietary advice

Waiting period: 2 months

Benefit limits per 12 months unless otherwise stated

{$250 per person}

Examples of maximum benefits

{Initial visit: $27}

{Subsequent visit: $25}

Endodontic

Waiting period: 12 months

Benefit limits per 12 months unless otherwise stated

{Non-specialty Endodontia: $400; Specialty Endodontia: $600, $1600 per Lifetime; Service Limits Apply}

Examples of maximum benefits

{Filling of one root canal: $80}

Exercise physiology

Waiting period: 2 months

Benefit limits per 12 months unless otherwise stated

{$900 per person}

{combined limit for acupuncture, ante-natal/post-natal classes, chiropractic, exercise physiology, eye therapy (orthoptics), occupational therapy, osteopathy, physiotherapy, speech therapy & other services}

Examples of maximum benefits

{Initial visit: $40}

{Subsequent visit: $35}

Eye therapy (orthoptics)

Waiting period: 2 months

Benefit limits per 12 months unless otherwise stated

{$900 per person}

{combined limit for acupuncture, ante-natal/post-natal classes, chiropractic, exercise physiology, eye therapy (orthoptics), occupational therapy, osteopathy, physiotherapy, speech therapy & other services}

Examples of maximum benefits

{Initial visit: $28}

{Subsequent visit: $25}

General dental

Waiting period: 2 months

Benefit limits per 12 months unless otherwise stated

{General Dental/Major Dental: Multiple Limits, Sub-Limits, Shared Limits and Service Limits Apply; See insurer for details}

{combined limit for general dental & major dental}

Examples of maximum benefits

{Fluoride treatment: $19}

{Scale & clean: $50}

{Surgical tooth extraction: $71.5}

{Periodic oral examination: $21}

Health management / Healthy lifestyle

Waiting period: 6 months

Benefit limits per 12 months unless otherwise stated

{$125 per Single Policy $250 per Family Policy}

Examples of maximum benefits

{Health management: 100% of charge}

Hearing aids

Waiting period: 36 months

Benefit limits per 12 months unless otherwise stated

{$560 per person}

Examples of maximum benefits

{Hearing aid: $560}

Home nursing

Waiting period: 2 months

Benefit limits per 12 months unless otherwise stated

{$750 per person}

Examples of maximum benefits

{Initial visit: $72}

{Subsequent visit: $72}

Major dental

Waiting period: 12 months

Benefit limits per 12 months unless otherwise stated

{General Dental/Major Dental: Multiple Limits, Sub-Limits, Shared Limits and Service Limits Apply; See insurer for details}

{combined limit for general dental & major dental}

Examples of maximum benefits

{Full crown veneered: $700}

Non PBS pharmaceuticals*

Waiting period: 2 months

Benefit limits per 12 months unless otherwise stated

{$600 per person}

Examples of maximum benefits

{Per eligible prescription: $60}

Occupational therapy

Waiting period: 2 months

Benefit limits per 12 months unless otherwise stated

{$900 per person}

{combined limit for acupuncture, ante-natal/post-natal classes, chiropractic, exercise physiology, eye therapy (orthoptics), occupational therapy, osteopathy, physiotherapy, speech therapy & other services}

Examples of maximum benefits

{Initial visit: $29}

{Subsequent visit: $28}

Optical

Waiting period: 6 months

Benefit limits per 12 months unless otherwise stated

{$300 per person}

Examples of maximum benefits

{Multi-focal lenses & frames: $290}

{Single vision lenses & frames: $230}

Orthodontic

Waiting period: 12 months

Benefit limits per 12 months unless otherwise stated

{Non-specialty Orthodontia: $350, $1050 per Lifetime; Specialty Orthodontia: $350, increasing by $100 per calendar year to $2800 per Lifetime}

Examples of maximum benefits

{Braces for upper & lower teeth, including removal plus fitting of retainer: 100% of charge}

Orthotics (podiatric orthoses)

Waiting period: 2 months

Benefit limits per 12 months unless otherwise stated

{$200 per person}

Examples of maximum benefits

{Orthotics supply & fit: $100}

Osteopathy

Waiting period: 2 months

Benefit limits per 12 months unless otherwise stated

{$900 per person}

{combined limit for acupuncture, ante-natal/post-natal classes, chiropractic, exercise physiology, eye therapy (orthoptics), occupational therapy, osteopathy, physiotherapy, speech therapy & other services}

Examples of maximum benefits

{Initial visit: $25}

{Subsequent visit: $23}

Physiotherapy

Waiting period: 2 months

Benefit limits per 12 months unless otherwise stated

{$900 per person}

{combined limit for acupuncture, ante-natal/post-natal classes, chiropractic, exercise physiology, eye therapy (orthoptics), occupational therapy, osteopathy, physiotherapy, speech therapy & other services}

{sub-limits apply}

Examples of maximum benefits

{Initial visit: $40}

{Subsequent visit: $35}

Podiatry

Waiting period: 2 months

Benefit limits per 12 months unless otherwise stated

{$300 per person}

Examples of maximum benefits

{Initial visit: $25}

{Subsequent visit: $21}

Psychology

Waiting period: 2 months

Benefit limits per 12 months unless otherwise stated

{$300 per person}

Examples of maximum benefits

{Initial visit: $45}

{Subsequent visit: $40}

Remedial massage

Waiting period: 2 months

Benefit limits per 12 months unless otherwise stated

{$170 per single policy $340 per couple/family policy}

{combined limit for chinese medicine & remedial massage}

Examples of maximum benefits

{Initial visit: $19}

{Subsequent visit: $18}

Speech therapy

Waiting period: 2 months

Benefit limits per 12 months unless otherwise stated

{$900 per person}

{combined limit for acupuncture, ante-natal/post-natal classes, chiropractic, exercise physiology, eye therapy (orthoptics), occupational therapy, osteopathy, physiotherapy, speech therapy & other services}

Examples of maximum benefits

{Initial visit: $29}

{Subsequent visit: $27}

Vaccinations

Waiting period: 2 months

Benefit limits per 12 months unless otherwise stated

{$100 per person}

Examples of maximum benefits

{Per service: $16}

The General Dental annual limit includes multiple sub-limits, and for some sub-limits lifetime limits apply. Combined Other Therapies (annual limit of $900) includes acupuncture (sub-limit of $200 per person or $400 per family), antenatal services, chiropractic/osteopathy (sub-limit of $400), exercise physiology, eye therapy, occupational therapy, physiotherapy and speech pathology. Natural Therapies ($170 singles $340 family groups) includes Chinese herbalism, myotherapy and remedial massage. Artificial aids ($600) includes e.g. spacer, peak flow meter, nebuliser, blood pressure monitor, Irlen lens. Healthier Lifestyle includes nib approved weight management, quit smoking and health management programs (gym). Postnatal services are not covered under this product. Psychology has a sublimit of $150 for Digital Cognitive Behavioural Therapy (CBT). PLEASE REFER TO FACTSHEET FOR FULL DETAILS.

This policy does not include General treatment (Extras) cover for

Audiology

Other features of this general treatment cover: Gold provides all the benefits of Top Private Hospital cover with a range of Extras. Of course, you can see your choice of provider, but by choosing a FirstChoice provider, you may have less to pay towards the cost of your treatment. We’ve created the FirstChoice network to help you access quality healthcare and a better deal for you and your family. We’ve locked in lower costs with our FirstChoice providers, so you can enjoy competitive treatment fees when you visit the dentist or a discount the next time you claim for glasses.

For further information about this policy see: https://my.nib.com.au/product-collateral/26

Gold $200 Excess

Policy ID: NIB/J16/Q0400C

Hospital Cover

Extras Cover

Ambulance cover

Insurer Details

nib Health Funds Ltd.

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