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.
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.
|Removal of tonsils and adenoids|
|Knee and shoulder investigations|
|Wisdom teeth removal|
|Pregnancy, fertility and birth-related issues|
|Hip, knee, ankle and shoulder replacements|
|Coronary care and cardiothoracic surgery|
|Major eye and lens surgery|
|Psychiatric, rehabilitation and palliative care|
You can access private hospital cover for the specified covered procedures, while the remainder are only covered in shared rooms of public hospitals.
|Private hospital accommodation||For the five covered procedures only|
|Public hospital accommodation||Private 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 fees||Not covered at all in private or public hospitals|
|Choice of doctor||When attending as a private patient at a public or private hospital, you can choose your own doctor|
|Access Gap Cover||Eliminates or caps your out-of-pocket expenses when getting treated by a participating provider for covered services|
|Government-approved prostheses||Covered 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 cover||When medically necessary. No cover for inter-hospital transfers|
|Emergency ambulance cover|
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.
|StarterPak general dental cover||$500 per person, $1,000 per family annual general dental limit|
|Removal of calculus|
|Remineralising agent application|
|Surface adhesive restorations|
|StarterPak major dental cover||$500 per person, $1,000 per family annual major dental limit|
|Wisdom teeth removal requiring removal of bone|
|Wisdom teeth removal requiring removal of bone and tooth division|
|Upper and lower dentures|
|StarterPak optical cover||$165 per person, $330 per family annual optical limit|
|Single vision lens pair|
|Bifocal lens pair|
|Multifocal lens pair|
|Disposable contact lenses|
Physiology and psychology
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:
- Weight management programs
- Gym memberships
- Disease management subscriptions or memberships
- Health screening and prevention services
- National Healthy Eating Activity and Lifestyle (HEAL) program
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:
- Remedial massage
- Alexander technique
- Bowen therapy
- Chinese herbal medicine (consultations only)
- Feldenkrais method
- 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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