This 'prosthesis schedule' details the maximum costs that we will pay for any individual prosthesis or other type of implant under some nib hospital cover policies. The schedule does not apply to the following policies:
All items listed on this schedule are defined by nib as a prosthesis or other type of implant and are subject to the listed benefit maximums, unless the First Choice network applies.
These costs are reviewed each year in relation to:
Please note: we will only pay for those prostheses that are covered by your policy wording and acceptance certificate or renewal certificate (whichever is the latest document). If you have any questions about what you are covered for, please contact us.
The First Choice network was introduced on 1 September 2017 and affects the amount payable for some prostheses. ‘FCN’ mentioned in the chart below, means we will cover 100% of the prosthesis cost if treatment is provided by a specialist who is a First Choice provider. If you choose to be treated by a specialist who is not a First Choice provider, the maximum amount payable for your prosthesis is included in the Efficient Market Price (EMP) payment we will make. In all other cases the specified limit applies.
The First Choice network does not apply to Ultimate Health Max or Major Medical covers. If your policy is part of a group (corporate) scheme, we will advise you when the First Choice network applies to your cover.
If you are unsure as to whether the First Choice network applies to you, please refer to your policy document which you can view within my nib.
This schedule is effective from 1 July 2019. Figures shown are the maximum amount payable, inclusive of GST.
|Basic Private Hospital Cover||Mid Private Hospital Cover / Mid Private Hospital Cover Plus||Priority Health / Priority Health Business||All other hospital covers with First Choice network terms||All other hospital covers without First Choice network terms (Ultimate Health Max, some Group policies and ex-Warehouse Money Health policies)|
|Base Cover: Major Surgical Module||Module 1: Other Surgical Cover|
|Joints||Hip joint – partial (hemi) replacement||-||-||FCN||-||FCN||$6,866|
|Hip joint – total replacement||-||-||FCN||-||FCN||$10,790|
|Hip joint – total replacement revision||-||-||FCN||-||FCN||$14,700|
|Hip joint - resurfacing||-||-||FCN||-||FCN||$9,701|
|Knee joint – partial (hemi) replacement||-||-||FCN||-||FCN||$7,018|
|Knee joint – total replacement||-||-||FCN||-||FCN||$11,165|
|Knee joint – total replacement revision||-||-||FCN||-||FCN||$18,879|
|Ankle joint - total replacement||$10,928||$10,928||$10,928||-||$10,928||$10,928|
|Shoulder joint - total replacement||-||$11,332||$11,332||-||$11,332||$11,332|
|Reverse shoulder joint - total replacement||-||-||$14,211||-||$14,211||$14,211|
|Screws and plates – reconstructive or reparative surgery||$4,292||$4,292||$4,292||$4,292||$4,292||$4,292|
|Anchors to the maximum for shoulder and hip||-||$4,002||$4,002||-||$4,002||$4,002|
|Head||Screws and plates – oral surgery (where covered by the policy)||-||-||-||-||$3,248||$3,248|
|TMJ (jaw joint) - total replacement||-||-||-||-||$10,716||$10,716|
|General||Internal anal sphincter||-||$4,771||-||-||$4,771||$4,771|
|External anal or urinary sphincter||-||$14,170||-||-||$14,170||$14,170|
|Male health||Sling – for pelvic floor||-||$5,473||$5,473||-||$5,473||$5,473|
|Testicular implant single||-||$1,300||$1,300||-||$1,300||$1,300|
|Female health||Tissue expander||-||$2,904||$2,904||-||$2,904||$2,904|
|Breast implant – mammary single||-||$3,700||$3,700||-||$3,700||$3,700|
|TVT, SPARC, monarch||-||$2,100||$2,100||-||$2,100||$2,100|
|Vaginal mesh (total cost)||-||$4,300||$4,300||-||$4,300||$4,300|
|Stent (other than drug eluting stent)||-||-||FCN||FCN||FCN||$2,860|
|Drug eluting stent||-||-||FCN||-||FCN||$5,705|
|Pacemaker (single or dual)*||-||-||-||-||$8,323*||$8,323|
|Vascular||Peripheral stents / stent grafts / Pelvic Vein Coils||-||-||-||-||$6,238||$6,238|
|Eyes||Lacrimal plugs (per eye)||-||-||-||$533||$533||$533|
|Lens implant (per eye)||-||-||-||FCN||FCN||$337|
|Corneal ring implants (per eye)||-||-||-||$850||$850||$850|
|Assorted||Other prostheses not on this list (where covered by the policy)||-||$3,221||$3,221||$3,221||$3,221||$3,221|
* Only available for Health AON Hospital Plus policies