nib Prosthesis Schedule

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:

  • Major Medical covers (Assurance Extra, Medical Extra and Mortgage Extra)
  • Basic and Mid EveryDay
  • Standard and Premium Everyday

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:

  • health service delivery;
  • market demand; and
  • nib's own claims experience

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.

nib First Choice network

The First Choice network was introduced on 1 September 2017 and affects the amount payable for some prostheses. ‘FCN’ 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 September 2017. Figures shown are the maximum amount payable, inclusive of GST.


* Only available for Health AON Hospital Plus policies

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