Nurses & Midwives Health StarterPak

What are the benefits of combined hospital and extras cover with Nurses & Midwives Health?

Nurses & Midwives Health was established in 2016 by Teachers Health in order to provide health cover for these professionals as well as their families.

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The combined cover

Nurses & Midwives Health offers a single combined cover option called the StarterPak. It’s an affordable cover option for younger people, which entitles them to the tax and rebate advantages of private health insurance as well as delivering an important level of cover. As a combined package, it includes extras cover as well as the all-important hospital cover.

The hospital cover

With this cover, you can access a range of private hospitals within the Nurses & Midwives network. However, since it is basic cover, it still includes a range of restrictions and exclusions. Only specified treatments are covered, while others are restricted or excluded.

StarterPak cover
Removal of tonsils and adenoids
  • Yes
Knee and shoulder investigations
  • Yes
Appendicitis treatment
  • Yes
Hernias
  • Yes
Wisdom teeth removal
  • Yes
Pregnancy, fertility and birth-related issues
  • No
Hip, knee, ankle and shoulder replacements
  • No
Coronary care and cardiothoracic surgery
  • No
Dialysis
  • No
Major eye and lens surgery
  • Restricted
Bariatric procedures
  • Restricted
Psychiatric, rehabilitation and palliative care
  • Restricted
Non-Medicare services
  • No

You can access private hospital cover for the specified covered procedures, while the remainder are only covered in shared rooms of public hospitals.

StarterPak features
ExcessNone
Private hospital accommodationFor the five covered procedures only
Public hospital accommodationPrivate rooms for the five covered procedures only Shared rooms for all other procedures
Theatre and intensive care fees (private hospital)For the five covered services only
Theatre and intensive care fees (public hospital)Included in accommodation cover where applicable
Labour ward feesNot covered at all in private or public hospitals
Choice of doctorWhen attending as a private patient at a public or private hospital, you can choose your own doctor
Access Gap CoverEliminates or caps your out-of-pocket expenses when getting treated by a participating provider for covered services
Government-approved prosthesesCovered up to the government-specified limits. Depending on the prosthesis you choose, it might be 100% covered or there might be a gap
Non-emergency ambulance coverWhen medically necessary. No cover for inter-hospital transfers
Emergency ambulance cover
  • Yes

The extras cover

The Nurses & Midwives StarterPak delivers a range of extras cover, with the amount claimable being dependent on the procedure. The cover encompasses important dental, optical and therapeutic services as well as providing an extensive range of other benefits.

Dental

StarterPak general dental cover$500 per person, $1,000 per family annual general dental limit
Oral exams
  • $40
Bitewing x-ray
  • $30
Removal of calculus
  • $70
Remineralising agent application
  • $25
Tooth removal
  • $90
Metallic fillings
  • $63 for a single filling, up to $109 for multiple
Surface adhesive restorations
  • $80 for a single restoration, up to $115 for multiple
StarterPak major dental cover$500 per person, $1,000 per family annual major dental limit
Wisdom teeth removal requiring removal of bone
  • $120
Wisdom teeth removal requiring removal of bone and tooth division
  • $150
Veneered crown
  • No
Upper and lower dentures
  • No
Orthodontics
  • No

Optical

StarterPak optical cover$165 per person, $330 per family annual optical limit
Frames
  • $100
Single vision lens pair
  • $95
Bifocal lens pair
  • $95
Multifocal lens pair
  • $95
Contact lenses
  • $165
Disposable contact lenses
  • $165

Physiology and psychology

ServiceLimits
Chiropractic
  • $300 per person, $600 per family annual limit
Osteopathy
  • $300 per person, $600 per family annual limit
Physiotherapy
  • $300 per person, $600 per family annual limit
Exercise physiology
  • $300 per person, $600 per family annual limit
Speech therapy
  • No
Podiatry
  • No
Psychology
  • No
Dietician
  • No

Pharmaceuticals, health aids and appliances

After paying the required PBS amount, you are covered for non-PBS prescription pharmaceuticals to a maximum of $400 every 12 months (singles) or twice that for families and couples. However, there is no cover for appliances or aids, such as wigs, wheelchairs, hearing aids or blood monitors under the StarterPak.

Healthy lifestyle reimbursements

You can claim a reimbursement for part of the cost of approved health and lifestyle programs, including the following:

  • Disease management subscriptions or memberships
  • Health screening and prevention services
  • National Healthy Eating Activity and Lifestyle (HEAL) program
Programs need to be approved before you can claim them and may need to be recommended as part of a health management program. You can claim 75% of the cost of each, up to a limit of $150 per person or $300 per family, per year.

Natural and complementary therapies

The StarterPak lets you claim up to $32 per session, and up to $200 a year per person or $400 for families, for the following services:

  • Acupuncture
  • Remedial massage
  • Alexander technique
  • Aromatherapy
  • Bowen therapy
  • Chinese herbal medicine (consultations only)
  • Feldenkrais method
  • Homeopathy
  • Kinesiology
  • Myotherapy
  • Naturopathy
  • Reflexology
  • Shiatsu
  • Western herbal medicine (consultations only)

What are the benefits of a Nurses & Midwives StarterPak plan?

This combined cover option is the only package deal that Nurses & Midwives offers. It is affordable and a relatively basic type of cover. It’s also relatively flexible with cover for an extensive range of ancillary health services. The hospital cover focuses on a specific range of important procedures, but also lets you claim a range of others in public hospitals. Some of the other noteworthy features include the following:

  • Emergency and non-emergency ambulance cover. A very useful inclusion that might save you from needing to buy a state ambulance subscription or standalone ambulance cover.
  • Preventative dental cover. Although there is no cover for some of the major dental procedures, this policy pays set benefits for preventative dental services rather than only reimbursing a percentage.
  • Public-hospital-focused cover. Although you are only covered for a few specific procedures at private hospitals, they’re the ones you may be more likely to use. For many of the other procedures, you’ll need to use public hospitals and the Medicare system.

Limitations and waiting periods

Where applicable, the following waiting periods apply to extras services:

  • 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

Waiting periods also apply for the following hospital services:

  • Pre-existing conditions. 12 months
  • Pregnancy. 9 months
  • Psychiatric, rehabilitation and palliative care, even for pre-existing conditions, and all other hospital services. 2 months
  • Ambulance transport. 1 day

How to make a claim

When you attend hospital, the bill will usually be sent directly to Nurses & Midwives Health. You will only need to pay any applicable gap expenses or other charges to the hospital or doctor. To claim extras, it’s often as simple as just swiping the Nurses & Midwives Health fund card. After that, you can just pay any difference as needed. Where providers don’t have electronic claiming facilities, you can also download the member’s app to make claims. This involves photographing and uploading your receipt. You can also complete and send in a claims form to Nurses & Midwives Health to receive a reimbursement directly to your nominated account.

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Picture: Shutterstock

Andrew Munro

Andrew writes for finder.com, comparing products, writing guides and looking for new ways to help people make smart decisions. He's a fan of insurance, business news and cryptocurrency.

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