The surprising benefits of private health insurance for Australians

Private health insurance is a cost that can offer real benefits when you understand what you’re paying for. Citro partner nib explains 12 common benefits of having private health insurance.

By Citro partner nib

‍Australia is lucky to have great public health care through Medicare and the Commonwealth Seniors Health Care card, but private health insurance offers extras (and not just dental, physio or the odd massage).

Through Medicare, Australians can be treated in a public hospital as a public patient for no charge and receive subsidised prescription medicines and GP appointments.

However, Medicare doesn’t cover the cost of everything you might need to continue to be as healthy as possible. That’s where private health insurance comes in; it aims to fill in the gaps that Medicare leaves by helping you fund your healthcare needs.

Private health insurers are well aware they need to service their members and act as a ‘health care partner’ to help policy holders stay healthy.

Private health insurers are also there to guide people through the often-confusing health system.

What exactly does private health insurance offer?

There are 3 main types of private health insurance, including Hospital cover, Extras cover or a combined cover including both Hospital and Extras cover. 

Depending on the level of cover you select, with a private health insurance policy, you may be able to: 

• Be treated in a public or private hospital as a private patient 
• Have more choice when it comes to the treatment you receive in a private hospital setting, including where you stay and the doctor who performs your surgery (subject to availability)        
• Receive a benefit for health services that are not covered by Medicare, including appointments with a physiotherapist, podiatrist or dentist 
• Be covered in an emergency for ambulance transport 
• Skip the public hospital waiting list if you find yourself in need of non-emergency surgery

What private hospital cover can include and cover  

1. Benefits for your hospital stay

Combined with Medicare, if you’re an Australian resident, your hospital health insurance will help cover the costs associated with your treatment as a private patient.

nib supports its members to reduce any out-of-pockets associated with a hospital stay; so, if you think you might need to go to hospital in the future, call nib on 13 16 42 and discuss your options. 

If your chosen level of cover includes your procedure, and you attend one of the nib Agreement Hospitals, (or any public hospital as a private patient) nib will pay benefits towards:

• Hospital accommodation (i.e. your bed and a private room if there's one available)
• Operating theatre fees
• Intensive care fees
• Labour ward fees
• Meals
• Common treatments and support treatments¹
• Associated treatment for complications and associated unplanned treatment²

If you’re an nib member, you should always check that your procedure is covered before you go to hospital and contact nib so they can help you keep any extra expenses to a minimum.

2. Emergency cover if you need an ambulance 

If you’re in an emergency situation with an ambulance on the way, you might be in for the most expensive ride of your life. And, if you’re one of the 30% of Australians who think Medicare will cover the cost, you’re in for a shock.

If you’re not covered by your State Government, most of nib’s policies offer unlimited emergency ambulance cover on most of our health covers³ so if you sign up to nib, you’ll get the help you need, when and as often as you need it. Visit Ambulance cover to learn more.

3.   Insured for emergencies and post-emergency treatment

While public hospital healthcare (including emergency treatment) is free to all Australian citizens and most permanent residents, if you need further treatment after your initial admission, that’s when lengthy waiting times can apply. 

Waiting for treatment has the potential to impact so many aspects of your life, including your ability to work, so avoiding public hospital waiting lists could save you time and money. 

With nib’s Accidental Injury Benefit, you'll receive benefits related to the accident in line with nib’s Gold Hospital cover within 90 days after an accident if you seek treatment with a medical practitioner or attend an emergency department within 72 hours of the accident and are admitted to hospital. 

This includes admission to a private hospital or as a private patient in a public hospital. It’s offered with every level of nib Hospital cover⁴. 

4.   Skip waiting lists for public hospitals

Without the right Hospital cover, wait times for non-emergency treatment in the public system can be weeks and even months. 

And if you choose to go to a private hospital without the right cover, your treatment won’t come cheap. Taking out Hospital cover helps you avoid the long waiting lists you might experience in a public hospital. 

Data released by the Australian Institute of Health and Welfare showed that in 2020-21, the proportion of patients waiting more than a year on the elective surgery wait list increased to 7.6%⁵, with patients requiring a septoplasty (surgery to fix a damaged nose) waiting for a median of 330 days.

With the right level of nib Hospital cover, you choose when and where you get your surgery – meaning you can get back to work – and play – quicker.

What is covered with Extras private health insurance?

Most insurers offer a range of Extras covers to help choose one that’s right for you and your family.

There are some core inclusions that nib pay benefits towards across most of nib’s Extras policies:   

• Emergency ambulance⁶ 
• Preventative dental      
• General dental      
• Major dental      
• Optical  
• Physiotherapy

We know that everyone is different when it comes to their health, so nib also offers a range of Extras covers that can provide cover towards the cost of popular treatments like osteopathy, dietary advice and orthodontia. 

Most Australians benefit from private health insurance after the age of 31

The peace of mind that comes with private health insurance is beneficial at any age, but you might have heard that it’s beneficial to take out a policy before turning 31. 

That’s because if you don’t have Hospital cover by 1 July after your 31st birthday, you’ll pay a 2% Lifetime Health Cover loading (LHC) on top of the normal premiums for each year you don’t have Hospital cover up to 70%. 

The loading applies for 10 years of continuous Hospital cover.

This isn’t just with nib, but every health fund. So, if you wait until you’re 40, you’ll pay 20% more than someone on the same cover who joined when they were 31. 

Understand the Medicare Levy Surcharge (MLS) 

In addition, if your taxable income is above $93,000 ($186,000 for families) and you don’t have an appropriate kind of private health insurance, you may have to pay the Medicare Levy Surcharge. This is an additional 1% to 1.5% in tax on top of the Medicare Levy we all have to pay⁷. 

If eligible, you could avoid the Medicare Levy Surcharge – and pay less tax – by joining any nib Hospital cover and maintaining it for the full financial year. If you take out Hospital cover part-way through the financial year, (if eligible) you will avoid the surcharge for the period you held suitable Hospital cover. 

What nib covered for members 

There’s no denying private health insurance can be expensive, but hospital costs can be even more so. Without cover you could be paying out tens of thousands of dollars. 

Most private health insurers try to become a health partner, providing you with a range of tools, discounts and services over and above insurance to help you live a healthy life. 

Here are 5 other surprising perks and benefits that private health insurance can offer.

Health insurance benefit #1: finding the right provider for the lowest out-of-pocket cost

If your teeth are giving you grief, your eyesight has literally seen better days or your joints are aching, it can be tricky to work out which provider is going to be the best option for you for a check-up.

To help keep your out-of-pocket expenses to a minimum, nib has a First Choice network of specially-selected health providers who have agreed to provide nib members with quality healthcare at a reduced rate for insured members.

You can choose to see any dentist, optometrist or physiotherapist of your choice, as long as their qualifications are recognised by nib, but by choosing an nib First Choice provider, you'll be able to read reviews of practitioners to help inform your decision and book online.

Search the nib First Choice network now to find a provider.

Health insurance benefit #2: discount benefits and offers  

Who doesn’t love a good discount? If you’re sick of paying full price, then unlock access to a world of exciting benefits and exclusive offers through nib Rewards⁸. This members-only program can save you money and help you live better; it’s a total win-win.

With 100+ retailers (think Myer, JB Hi-Fi, The Iconic and Kmart), 500 Good Food Guide and Gourmet Traveller restaurants and serious savings on everything from groceries to gym memberships, nib Rewards helps insured members live a fun, healthy and rewarding life.

Interested? Find out how you can save with nib Rewards today

Health insurance benefit #3: help to stay healthy

nib want you to be at your healthiest. So, if you need a helping hand to manage your joint pain, weight, diabetes, heart health, anxiety or depression, you might wish to find out if you qualify for one of our Health Management programs at no additional cost for eligible members.

Healthy Weight For Life: This specialised knee and hip arthritis management program has been designed to help you better manage joint pain and get back to doing what you do best. The program includes over $800 worth of meal replacement products, personalised service and online support.

SilverCloud Health: Designed to support and promote positive behaviour change and mental wellness, SilverCloud Health gives users access to a range of mental health programs, as well as the ability to request personalised mental health advice from a health professional. Programs available include anxiety and depression management.

Cardihab: Designed by the Australian Heart Foundation and Australian Cardiac Rehabilitation Association guidelines, Cardihab is a cardiac rehabilitation program that you can use anywhere at any time. The program includes personalised mentoring from a registered nurse supporting your recovery, providing a care plan and answering some of your biggest questions post-treatment. 

Hospital Support Program: Going to hospital can be a stressful time. This phone-based program gives members access to an experienced registered nurse to help navigate the health system and understand your options before, during and after a hospital stay. This is designed to accompany the usual care provided by your specialist or GP.

Whether you need to get in shape, keep out of hospital or improve your mental wellbeing, our health management programs are delivered by qualified health professionals and can be tailored to suit your individual needs.

If you’re interested in nib’s health programs, call 1800 339 219 to discuss your needs and check to see if you’re eligible to participate⁹.

Health insurance benefit #4: discounts on other insurances

nib knows that experiencing new places, people and culture can have a positive effect on your health and wellness, so nib offers members 10% off nib Travel Insurance¹⁰ meaning you can continue living health first – from wherever your adventure takes you!

Health insurance benefit #5: help with paying the gap

nib works hard to make sure you have everything you need to stay healthy. But what happens if you need to go to hospital? 

That’s where nib MediGap can help. nib MediGap aims to eliminate any gap payments for specialist fees in hospitals across Australia. Ultimately, going to hospital is stressful enough and the last thing we want you to be worried about is your bill, so use nib’s MediGap provider search to find a provider in your area. 

The information on this page is general information and should not be used to diagnose or treat a health problem or disease. Do not use the information found on this page as a substitute for professional health care advice. Any information you find on this page or on external sites which are linked to on this page should be verified with your professional health care provider.