HEALTH INDUSTRY TERMS
means 2 people in a relationship who are not legally married to each other, but are recognised as couple on a genuine domestic basis.
Defacto
means a policy of private health insurance between a Policyholder and us.
Policy
Scale: Policy holder and spouse/partner
Couples Policy
Scale: Only the policyholder
Single Policy
means an amount of money a Policyholder is required to pay to us in respect of a specified period of cover for a Product under a Policy.
PREMIUM
is a person who:(a) is not a Policyholder;(b) is aged between 21 and up to 25 years;(c) is not in full-time study;(d) is not married or in a defacto relationship; and(e) who the Policyholder has nominated to stay on the Policy for a fee.
Adult Dependant
means an amount of money payable from the Fund to or on behalf of a Customer, in respect of approved expenses incurred by a Customer for Treatment.
Benefit
Scale: Policy Holder, Spouse/Partner & 1 or more children.
Family Policy
Scale: consists of policy holder and 1 or more children
Single Parent Family Policy
Customers who transfer from another fund or another nib policy will not need to reserve any portion of waiting periods already served for services equivalent to those covered by the previous fund or policy.
Continuity
means the maximum amount of Benefits payable for a specific good or service in a Calendar Year.
Depending on the cover, a Family Cap may apply. This means that the total benefits claimable for each Extras service are limited to 4 times the per person limit for all Family policies.
Annual Limit
means the maximum amount of Benefits payable for a specific good or service provided to a Customer over the lifetime of the Customer.
Lifetime Limit
Helps cover the cost of everyday services to stay healthy
EXTRAS COVER
Scale: Policyholder and with one or more Adult Dependants
Extended Family Policy
is the recognition of claiming history from a previous fund. Any limits previously used with the previous fund is recognised when joining nib.
Portability
is where the Policyholder gives their Partner, authority to operate the Policy. This lets the Partner make claims on behalf of all people on the Policy, and make some changes to or make enquiries about the Policy. Without Partner Authority a Partner can only make claims for themselves.
PARTNER AUTHORITY
means an amount of money a Policyholder is required to pay to us in respect of a specified period of cover for a Product under a Policy.
PREMIUM
Provides cover for services not generally covered by medicare
EXTRAS COVER
which cover do we refer to where the privately insured patients can choose to be treated as a public or private patient.
HOSPITAL COVER
is a child that is placed with a person or family to be cared for, usually by local welfare services or by court order. Foster Children can also be children who are in their grandparents, aunty or uncles or extended families care.
Foster Child
means a defined group of Benefits which are payable to a Customer under their chosen level of health cover, subject to relevant rules, for approved expenses incurred by a Customer and in respect of which Premiums are payable at the Premium Rates.
Product
An adopted child is a person who is not a Policyholder or Partner and who:
(a) is aged under 21 years of age; and
(b) is not married and does not have a defacto Partner.
(c) who has legally taken to be raise by another person(s) as one of their own.
Adopted Child
Enumerate the 5 scales under policy categories
single policy
couples policy
single parent family policy
family policy
extended family policy
Means:(a) Hospitals; and(b) General Treatment providers that:i. are registered or hold a license under relevant State or Territory legislation to provide the General Treatment sought;ii. are professionally qualified, or a current member of a professional body recognised by us;iii. are in private practice; andiv. satisfy any other criteria reasonably required by us to pay Benefits for General Treatment provided by the provider.
Recognised Provider
means a period of time during which a Policyholder must continuously hold a Policy for a particular Product before a Customer under that Policy has an entitlement to receive a Benefit under that Product.
Waiting Period