Are you a nurse or midwife? Find out how you can benefit from health insurance from Nurses & Midwives Health.
Nurses & Midwives Health is the only health fund exclusively for the needs of the Australian nursing and midwifery community. It offers a range of affordable private health insurance cover options to Australian nurses, midwives and their families, providing peace of mind and putting any profits towards the benefit of its members.
Nurses & Midwives Health 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.
Who can join Nurses & Midwives Health and why?
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.
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, or choose the combined hospital and extras cover of the StarterPak option.
What cover options are available?
Nurses & Midwives Health products are split into two types: hospital cover and extras cover.
Hospital cover
- Top Hospital. Top Hospital is the most popular and comprehensive hospital cover product from Nurses & Midwives Health. It covers an extensive range of services, including everything from joint replacements and pregnancy to heart procedures and includes emergency ambulance cover. You are entitled to your choice of doctor and your choice of agreement private hospital, while the product is available with your choice of a $0, $300 or $500 excess.
- Mid Hospital. Designed for those who want a wide range of benefits but also more affordable premiums than a Top policy, Mid Hospital includes all services covered by Medicare that are not listed as “restricted”. This means that while procedures such as tonsil removal, knee reconstructions and wisdom teeth removal are fully covered, other services such as pregnancy services are only covered in a shared room of a public hospital. An excess of $300 or $500 applies when you are hospitalised under this policy.
- Basic Hospital. This base-level hospital cover is designed for young and healthy members who don’t want to pay high premiums to receive cover for services they are unlikely to use. It covers your choice of doctor in a public hospital and five key procedures in a private hospital: removal of tonsils and adenoids, knee and shoulder investigations and reconstructions, appendicitis treatment, hernias, and removal of wisdom teeth. A $300 excess applies.
Extras cover
- 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, aromatherapy, naturopathy, 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, yoga classes and health screening services.
- 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, hearing aids, medical appliances and non-PBS pharmaceuticals. Emergency ambulance cover is also included, as are Healthy Lifestyle benefits for expenses like gym memberships, yoga classes and health screening services.
Combined cover
The above hospital and extras policies can be chosen as standalone products or combined to provide comprehensive cover. Alternatively, Nurses & Midwives Health also offers combined hospital and extras cover via the following product:
- StarterPak. This offers a basic level of combined hospital and extras cover and is designed for younger members who want value for money. It covers five essential private hospital services and covers common extras such as dental, optical, physio, chiro, complementary therapies and more.
What about exclusions, waiting periods and excesses
Just like any other health fund, there are certain situations and circumstances when Nurses & Midwives Health will not pay your claim. Some of the general exclusions that apply to hospital cover include:
- No cover for services that do not attract a Medicare benefit
- No cover for cosmetic surgery
- No cover when you are hospitalised outside Australia
- No cover for visits to your GP
- No cover when you have not served the relevant waiting period
You’ll also need to check the fine print associated with the hospital cover policy you choose to make sure you’re aware of which procedures and services are included in cover and which aren’t.
There are also situations when your extras claim will not be paid, such as if:
- It is for services received outside Australia
- You have exceeded your yearly or annual limit for a particular benefit
- The service provider is not recognised by Nurses & Midwives Health
- You lodge your claim more than two years after the date of service
- You have not served the relevant waiting period
- You do not provide an official receipt for the service
- The service was provided by someone related to you
- The service was not provided in a face-to-face setting (except telepsychology services provided by registered psychologists)
The next factor to look at when choosing a health fund is the waiting periods that apply. The following waiting periods apply to Nurses & Midwives Health Hospital Cover:
- Pre-existing conditions: 12 months
- Pregnancy and birth-related services: 9 months
- Psychiatric, rehabilitation and palliative care: 2 months
- All other hospital services: 2 months
- Emergency ambulance transport: 1 day
The following waiting periods apply to Nurses & Midwives Health Extras Cover:
- Orthodontia: 24 months
- Wheelchair purchase: 24 months
- Major dental: 12 months
- Medical appliances: 12 months
- Optical: 6 months
- Healthy Lifestyle benefits: 6 months
- All other services: 2 months
- Emergency ambulance transport: 1 day
If you are admitted to hospital, you will most likely need to pay an excess on your Nurses & Midwives hospital cover policy. However, the excess varies depending on the policy and excess amount you choose:
- Top Hospital is available with a $0, $300 or $500 excess
- Mid Hospital features the choice of a $300 or $500 excess
- Basic Hospital features a $300 excess
What are the features and benefits of the extras plans?
Both plans cover a wide range of the most important general and major dental procedures. The Essential plan is an effective way of getting affordable cover for major dental work as you can often only find this type of benefit with mid- and top-level extras plans.
However, the low limits of the basic extras plan means it might not be suitable for someone who specifically intends to use it for major dentistry.
A single dental crown, for example, might cost more than $300 which would take up your full major dental limit for the year and also leave you paying much of the cost out of pocket. By contrast, the Top level extras plan can pay up to $750 for that single procedure, taken out of an annual limit of $2,800 (with a loyalty bonus).
As such, the Essential level plan may be largely focused towards those who want affordable “just in case” extras, while Top extras with its higher limits might deliver good value for people who know they can make use of it.
The basic “just in case” cover still has a range of things you’ll be able to claim regularly to help get more consistent value. The Healthy Lifestyle benefits are available with both levels of cover, including up to 75% back on the cost of the following programs:
- Weight management
- Gym membership
- Pilates
- Yoga
- Disease management subscriptions
- Health screening services
- National Healthy Eating and Lifestyle program
You can also get very similar cover for complementary therapies with an identical range of treatments covered and $32 back per consultation. Here, the only difference between the Essential and Top extras plans is a $400 per year vs $600 per year limit.
If you’re looking for affordable and effective cover of complementary therapies, this Essential plan may be worth adding to your shortlist.
You can get similarly optical cover with both plans. When considering the annual limits, and reimbursement amounts of your optical cover, you might also want to factor in the following eyewear discounts you can get as a Nurses & Midwives Health member:
- Teachers Health centres. You can get no-gap frame and lens packages, 50% off frames, 25% off sunglasses and contact lenses, and free retinal photo and OCT scans at Teachers Health medical centres (located in NSW and VIC only).
- OPSM. You can get 20% off the normal retail price for all lenses and lens add-ons, 10% off retail prices on contact lenses and 15% off prescription sunglasses purchased at OPSM stores. You can get an additional 5% off the online price and free delivery within Australia for all contact lenses purchased from OPSM On-Line.
- Laubman & Pank. You can get 20% off lenses and lens add-ons, 10% off contact lenses and 15% off prescription sunglasses based on normal retail prices when purchased at retail stores.
- VPS Vision Care. VPS Vision Care offers a free second pair of glasses if a Nurses & Midwives Health member spends $300 or more, 15% off all in-store contact lenses, 20% off all lens add-ons, one complete pair of no-gap glasses including extras and multi-lenses as needed.
- Clearly. You can get 20% off as well as free shipping for all online purchases over $99.
- Specsavers. You can get a free contact lens fitting and trial, services bulk billed to Medicare, free digital retinal photography, 25% off select glasses, a 20% discount on all glasses extras like Suntint, transition lenses or UV Filter.
What are the limitations and waiting periods?
Limits and sub-limits apply to much of the extras cover. Limits are the total amounts you can claim per year, per person. The limits specified here are for one person. For example, a single person with Essential cover could claim $300 per year for physiotherapy, while a couple with family cover would be able to claim up to $300 each or $600 together.
It’s also important to be aware of the amount you’ll be reimbursed for certain services. Depending on the service, you may be reimbursed a set amount, such as up to $32 for an acupuncture consultation or a percentage, such as 75%, of a gym membership.
The following waiting periods also apply:
- Orthodontics. 24 months
- Wheelchair purchase (under medical appliances and artificial aids). 24 months
- Major dental and other medical appliances. 12 months
- Optical and healthy lifestyle. 6 months
- Everything else. 2 months
- Emergency ambulance. 1 day
