Nurses & Midwives Health Insurance Review
Nurses & Midwives Health Insurance offers five hospital policies, two extras plans and a combined cover package for members of the nursing profession and their families.
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Nurses & Midwives Health is the only health fund exclusively serving the Australian nursing and midwifery community. It offers a suite of hospital and extras covers that can be selected individually or combined into a package to provide cover that suits your unique needs.
- A competitive option for families who want access to pregnancy and childhood support services.
- Good for people with health issues who want access to healthy lifestyle programs to help them get back on track.
- If you're after just bare bones cover and aren't interested in wellness programs, you may want to compare other health insurance plans.
Review by our senior health insurance writer James Martin
Who is Nurses & Midwives Health Insurance?
Nurses & Midwives Health is the only Australian health fund that caters specifically to the needs of nurses and midwives around the country. Established in 2016 by Teachers Health Fund, it aims to offer affordable cover and a wide range of benefits to suit members at every life stage. This allows you to take control of your wellbeing and access the health care you need.
Who can join Nurses & Midwives and why?
Membership of Nurses & Midwives Health is open to Australian nurses, midwives and their families. To be eligible for membership you will need to be, or have been in the past, any of the following:
- A registered nurse
- A registered midwife
- An enrolled nurse
- A nurse practitioner
- A psychiatric nurse
- A mothercraft nurse
- An assistant in nursing
- An assistant in midwifery
- A nursing student undergoing training, a student nurse or a trainee enrolled nurse
- An employee whose job is to provide nursing care or services, or to assist in the provision of nursing care or services
You will also need to be a current or former member of a state or territory based nursing/midwifery union approved by the fund.
If you meet the above criteria, membership of Nurses & Midwives Health is also open to your family members, including your spouse, children, siblings, parents and grandchildren.
Members can then choose from a range of hospital and extras cover options, which can be combined together or purchased as standalone cover.
What health insurance options are available?
- Basic Hospital (Basic Plus). This goes beyond the government's minimum requirement for Basic cover by not only offering restricted cover for psychiatry, rehabilitation and palliative care but also offering full cover for dental surgery, joint reconstructions and hernia/appendix, and ambulance rides (including non-emergency). It also offers restricted cover for most other clinical categories except insulin pumps.
- Mid Hospital (Basic Plus). This policy covers a wide range of services and has no exclusions. Instead, it provides restricted cover for 11 clinical categories like pregnancy, joint replacements and kidney dialysis. It also covers emergency and non-emergency ambulance rides.
- Mid Silver Plus. This provides cover for all services required for a silver rating, plus excludes pregnancy and joint replacements, so saves money for those who don't want cover for these services.
- Top Silver Plus. This product gives you comprehensive cover with only one restriction: hospital psychiatric services. It includes cover for services including pregnancy, heart procedures, and hip or knee joint replacements.
- Gold Hospital. This offers full cover for all 38 clinical categories required for a Gold policy including pregnancy, insulin pumps, in-hospital psychiatry, heart issues and more. It also covers emergency and non-emergency ambulance rides.
- Essential Extras. Essential Extras Cover is designed to offer an affordable level of cover for common, everyday services not covered by Medicare. These include general and major dental, optical, acupuncture, remedial massage, chiro, osteo, physio, and non-PBS pharmaceuticals. Emergency ambulance cover is also included, as are Healthy Lifestyle benefits for expenses like gym memberships and health screening services.
- Top Extras. Top Extras cover from Nurses & Midwives Health provides generous benefit limits for a wide range of general treatments, including general and major dental, orthodontics, optical, acupuncture, myotherapy, chiro, osteo, physio, speech therapy, podiatry, non-PBS pharmaceuticals, medical appliances and hearing aids. Emergency ambulance cover is also included, as are Healthy Lifestyle benefits for expenses like gym memberships and health screening services.
- StarterPak (Basic Plus) This pre-made package covers both hospital and extras. It's designed for the young and active so comes with a fairly basic level of cover. You'll find cover for common surgeries such as ACL surgery in here as well as benefits for dental.
To help eligible Nurses & Midwives Health Health members access a range of support services, the following help is available for people who:
- Are going to hospital
- Are leaving hospital
- Are having a baby
- Are managing a chronic condition
- Need weight management support
- Need mental wellness support
Nurses & Midwives runs a New Family Program for members with hospital cover who have served all their waiting periods. The aim is to help families navigate through pregnancy and early childhood with the support and education they need to thrive.
- online antenatal and early parenting courses
- telephone support from a trained Safe Sleep Space consultant
- an AROMABABY skincare learning support pack.
Nurses & Midwives extras cover includes a range of Healthy Lifestyle Benefits including cover for gym memberships, disease management subscriptions, health screening services, weight loss services and more. Other services include:
- Care coordination. A phone-based program with you and your GP to develop a tailored action plan based on your health goals.
- Mental wellness. Telephone support from mental health professionals, tailored to your personal needs. This can include developing strategies to build resilience, manage anxiety, depression and more.
- Nutrition plans. Telephone support from a Teachers Healthcare Services Accredited Practising Dietitian to help manage and control chronic conditions.
- Osteoarthritis management. An 18 week program designed to relieve the symptoms of osteoarthritis, from weight loss programs to pain management education.
- Recovery at home. To help you get home sooner, you might be able to access hospital at home and rehab at home programs.
How to make a claim
If you need to make a hospital claim, the process differs depending on whether or not your doctor participates in Nurses & Midwives' Access Gap Cover Scheme. If the doctor does participate, they'll send your bill to Nurses & Midwives for payment. If your doctor is not part of the scheme, you'll need to take the bill to Medicare, who will process the claim. Then you'll send your bill to Nurses & Midwives who will pay their share.
There are several ways to make extras claims:
- On the spot by swiping your membership card at the provider's HICAPS terminal (if they have one)
- Via the Nurses & Midwives mobile app
- By submitting a claim form via post or email.
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