Nurses & Midwives Hospital Cover Health Insurance

Choose from three Hospital Cover policies from Nurse & Midwives Health, an industry fund for the nursing community.

As a fund for the nursing community and their families, Nurse & Midwives Health seek to provide services that specifically work for registered and enrolled nurses, midwives, nursing practitioners and nursing students.

finder.com.au does not currently have access to this health insurance brand. You may wish to compare options available on the health insurance homepage.
Top 3 features
  1. Good for nurses and midwives.
  2. Good for those starting a family.
  3. Beware if you're after a mid-level policy.

What Nurses & Midwives Hospital Cover policies are available?

The three levels of hospital only cover available from Nurses & Midwives Health are:

  • Basic Hospital (Basic Plus): Designed for the young and healthy, this includes cover for a range of treatments that might be needed at any age, such as tonsil removal.
  • Mid Hospital (Basic Plus): This option balances affordability with a wide range of services covered. Except for the specifically restricted treatments, it covers all Medicare services in private hospitals.
  • Top Hospital (Gold): Comprehensive cover for all Medicare services without any treatments being excluded or restricted.

Covered treatment for each plan include:

Standard Clinical CategoriesBasic Hospital (Basic Plus)Mid Hospital (Basic Plus)Top Hospital (Gold)
Assisted reproductive servicesRestrictedRestricted
Back, neck and spineRestricted
BloodRestricted
Bone, joint and muscleRestricted
Brain and nervous systemRestricted
Breast surgery (medically necessary)Restricted
CataractsRestrictedRestricted
Chemotherapy, radiotherapy and immunotherapy for cancerRestricted
Dental surgery
Diabetes management (excluding insulin pump)Restricted
Dialysis for chronic kidney failureRestrictedRestricted
Digestive systemRestricted
Ear, nose and throatRestricted
Eye (not cataracts)Restricted
Gastrointestinal endoscopyRestricted
GynaecologyRestricted
Heart and vascular systemRestrictedRestricted
Hernia and appendix
Hospital psychiatric servicesRestrictedRestricted
Implantation of hearing devicesRestricted
Insulin pumps
Joint reconstructions
Joint replacementsRestrictedRestricted
Kidney and bladderRestricted
Lung and chestRestrictedRestricted
Male reproductive systemRestricted
Miscarriage and termination of pregnancyRestricted
Pain managementRestricted
Pain management with deviceRestricted
Palliative careRestrictedRestricted
Plastic and reconstructive surgery (medically needed)Restricted
Podiatric surgery (provided by a register podiatric surgeon - limited benefits)
Pregnancy and birthRestrictedRestricted
RehabilitationRestrictedRestricted
SkinRestricted
Sleep studiesRestricted
Weight loss surgeryRestrictedRestricted
Tonsils, adenoids and grommets

Other benefits of Nurses & Midwives Hospital Cover

As a member of Nurses & Midwives Health you can access the Member Wellbeing Network, which provides substantial discounts on eyewear and optometry procedures, as well as other benefits, when attending a Teachers Health Centre located in Victoria or NSW.

Nurses & Midwives also 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.

Members receive:

  • Platinum membership to Nourish Learning Hub, an online portal where you can learn from expert midwives, lactation consultants, sleep consultants and more.
  • A package of AROMABABY skincare products for mum and bub.

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.

How do the costs work?

As a patient, you may experience some out-of-pocket costs, but Nurses & Midwives' Access Gap Cover (AGC) is designed to reduce or eliminate these expenses for medical services received in hospital. Before treatment, you should contact your doctor to discuss if they are willing to treat you under this arrangement. If your doctor or specialist agrees, you will experience either reduced or nil out-of-pocket expenses for inpatient medical charges.

AGC allows Nurses & Midwives Health to pay above the scheduled fee for doctors' services provided to you as an inpatient, covering entire doctors' fees or leaving you with significantly reduced out-of-pocket expenses. If your doctor charges the AGC fee, you might not need to pay anything for your treatment. Just make sure your doctor provides you with an Informed Financial Consent document so you have an estimate of fees and out-of-pocket expenses.

Waiting periods and limitations

Waiting periods apply whenever you join a health fund, or switch to one after not having cover for that service previously. You have to wait until the waiting period has elapsed before you can claim for a service.

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

An excess will also apply to all plans and there are no $0 excess options available the way there are with some other providers. With the Mid and Top level plans you can choose either a $300 or $500 excess, while you can only get $300 with Basic cover. Picking a higher excess will reduce your premiums.

The excess is payable per hospital admission, directly to the hospital. The excess is payable only up to once per year per person, or up to twice per year overall with family cover.

Certain other hospital services are not covered and you will need to pay out of pocket for things like telephone charges, TV hire or certain pharmaceuticals that you take home with you.

How to make a claim

When you attend hospital you will generally need to pay the excess upon admission or discharge. The bill will usually be sent directly to Nurses & Midwives Health and you only need to pay any applicable gap or additional charges.

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