nib health insurance can cover some, but not all, possible ambulance expenses
Ambulance cover is an important part of your health insurance that shouldn't be overlooked. Depending on your state, you might not need to worry about it, but for most Australians, it’s a potentially enormous out of pocket expense that isn’t always covered by your health insurance.
About nib ambulance cover
Generally, all nib hospital and extras policies include cover for emergency ambulance services, however this doesn’t mean you’re 100% covered for all ambulance expenses.
Emergency ambulance transport specifically refers to urgent life or death-type situations, whether it’s riding in an ambulance as a patient or having paramedics rush to you in order to perform life-saving treatment. This also includes related services, such as Flying Doctors.
Generally speaking, if an ambulance has its sirens on it’s presumed to be an emergency situation. However, not every situation will ultimately be emergency, even if you thought it was when you made the call.
For example, if you call an ambulance to be on the safe side, or because you’re unable to transport yourself, such as in the event of a broken leg, it may not qualify as an emergency. Here, you will not be covered by any nib health insurance policies.
Similarly, patient transfers between hospitals will not qualify as emergencies.
With an nib health insurance policy that covers emergency ambulances, you are not covered for:
- Private ambulance services
- Claims that are not medically necessary
- Transport from hospital to your home
- Transport between hospitals, unless required as a result of the first hospital not specialising in the treatment required
How to get cover for non-emergency ambulance
In Queensland and Tasmania you’re covered by state schemes and don’t need to worry about ambulance cover. Every resident of QLD and Tasmania is covered for all ambulance services while in these states.
- NSW and the ACT: Pensioners are automatically covered for all ambulance services. For everyone else, you may be eligible for complete ambulance cover if you hold hospital cover which pays for ambulances through a state levy scheme. If you don’t have hospital cover here it may be worth looking into ambulance cover options.
- VIC: Eligible concession card holders and pensioners get free ambulance cover in Victoria. Others may need an Ambulance Victoria membership for complete cover otherwise.
- SA: A South Australia Ambulance Services (SAAS) membership might be required to get full ambulance cover in SA.
- WA: Veterans and aged pensioners are automatically covered for ambulance services. In country areas you can purchase country ambulance membership with St John’s, while an ambulance subscription for your area may be able to cover it elsewhere.
- NT: You may need a St John Ambulance membership for complete cover in the NT.
If you are covered for ambulance transport in another way, such as by being a resident of Tasmania, or a pensioner in Victoria, you cannot claim ambulance expenses.
For complete ambulance cover, you may want to look into a subscription to a state ambulance service. Although nib doesn’t do so, some health insurance funds include cover for these ambulance subscription costs in their extras policies, or might otherwise cover non-emergency ambulance transport up to specified policy limits.