nib First Choice network

Information for advisers

nib First Choice information for advisers×

What is the nib First Choice network?

The nib First Choice network features nib recognised health service providers that provide our customers with services and treatment within nib’s First Choice price range, meaning your clients will have 100% of their eligible costs covered (up to their benefit limit and in line with their policy).

nib has considered geographical access to health service providers when establishing the nib First Choice network. We want you to have peace of mind knowing that, wherever your clients live, nib will ensure they get access to the quality care they need.


Frequently asked questions

Why is nib introducing the First Choice network? What’s the benefit to customers?

Through independent analysis nib has found that some health service providers charge significantly more than others for providing comparable health services. nib pays for these charges when we pay customer claims. This means there’s increasing claim costs that can result in higher health insurance premiums for customers.

nib First Choice allows us to maintain the value our health insurance covers provide, while better managing claims costs and helping to make premiums more affordable for customers.

It also means some providers can claim on their customers’ behalf – reducing associated costs and making the claims process easier for customers.

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How will providers be selected to join the First Choice network?

nib recognised health service providers will be automatically included within the First Choice network if they charge within our First Choice price range; there is no requirement to be contracted to nib to participate.

Over 90% of specialists in New Zealand are in the nib First Choice network.

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How will customers know if a health service provider is an nib First Choice provider?

Customers, GPs and advisers can find an nib First Choice provider online at the nib First Choice Directory (available from 1 September 2017).

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Which nib policy holders will be affected?

Most nib health insurance policies are affected by nib First Choice network and will receive new policy wording reflecting these changes.

Ultimate Health Max and Major Medical (previously OnePath) policies will not be affected. We will encourage these customers to choose from the nib First Choice network anyway to help nib to make health insurance premiums more affordable.

Customers on subsidised group policies will be affected over time with changes effective at renewal.

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Do customers have to choose an nib First Choice provider?

No. If customers choose not to see an nib First Choice provider, we’ll still pay up to nib’s Efficient Market Price (a set price) for the treatment needed (in line with policy terms) but customers will have to cover any additional costs over and above what nib pays, including policy excess and other out-of-pockets that may apply.

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What is the nib First Choice price range?

The nib First Choice price range is the amount that nib recognised health service providers can charge up to for health services or treatments, before they are no longer eligible to be a First Choice provider. If a recognised provider charges, on average, below this amount for a health service or treatment they will automatically be included within the network and we will cover 100% of their costs, in line with the policy terms and conditions. We will work with those nib recognised health service providers that charge over this amount, with a view to bringing them into the network.

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What is an Efficient Market Price (EMP)?

An EMP is what nib will pay for health services from an nib recognised health service provider that is not in the nib First Choice network.

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If a healthcare provider is an nib First Choice provider for one procedure or treatment, does this mean they are an nib First Choice provider for all procedures or treatments?

A specialist or hospital may be an nib First Choice provider for some treatments / procedures, but not for others. For example a provider may be an nib First Choice provider for a knee related health service, but not for hip related health services.

The nib First Choice Directory will provide a list of all nib recognised health service providers who provide the health services affected by First Choice network, and indicate whether they are a First Choice provider for each service or not.

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What health services are affected by nib First Choice network?

At time of launch the nib First Choice network will apply to some surgical, specialist and diagnostic related services and does not impact on day-to-day costs like GP, dental and physiotherapist visits.

The First Choice network will be reviewed regularly and provider status can change based on charging within the nib First Choice price range for certain services.

It's easy to check what health services are affected using the nib First Choice Directory.

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My client is being admitted to hospital, what providers do they need to check?

If your client is being admitted to hospital, they will need to check both their surgeon and the hospital to ensure they are nib First Choice providers.

For surgical procedures, the claim costs are separated into two components. The hospital charges are one component. The combined costs of the specialist, anaesthetist and any prosthesis are the second component, this component is referred to as the “Surgical Cost Grouping”.

Customers need to understand whether both the hospital they are being admitted to, and the Surgical Cost Grouping are First Choice providers. They can do this by using the First Choice Directory. They do not need to look up the anaesthetist or the prosthesis company. They only need to look up the specialist.

If the specialist is a First Choice provider, this means we will cover 100% of the eligible costs in line with the customer’s policy. For some surgeries, a separate Prosthesis maximum limit will apply – as it does today, as defined by the Prosthesis schedule available through my nib or nib.co.nz

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What happens if the specialist is a First Choice provider, but the hospital is not?

It is possible for a customer to be treated by a specialist who is a First Choice provider, but be admitted to a hospital that is not, and vice versa. In these cases, we will pay 100% of the eligible costs for the First Choice provider, and pay up to the EMP amount for the other provider.

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Sometimes a treatment or procedure requires more than one provider. What happens in cases like this?

Sometimes a hospital treatment requires more than one specialist. In these cases your client should use the nib First Choice Directory to check the network status of their lead specialist (normally the provider they have had a consultation with). If your client has any questions, please refer them to nib and we can help.

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In practice, how do clients choose providers and make claims?

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Does a customer have to get pre-approval?

nib recommends customers request pre-approval before any hospital or surgical treatment, so they know what they’re covered for and what nib will pay.

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What if a customer already has pre-approval or is being treated right now?

At the time of launch (1 September 2017), if your clients have pre-approval for a treatment by an nib recognised health service provider who is not in the nib First Choice network, we will honour the terms of that existing pre-approval, and the EMP will not apply.

For any future pre-approvals, or for treatment customers receive after this date from nib recognised health service providers not in the nib First Choice network that have not been pre-approved, the EMP will apply.

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What happens if a provider ceases to be an nib First Choice provider or their charges change?

Pre-approvals are valid for 90 days. If an nib First Choice provider changes their network status between the date of the pre-approval and the date of the treatment, we will honour the pre-approval for the 90 days it is valid for. If a client has a pre-approval for a treatment by a provider that is not part of the First Choice network, but that provider becomes an nib First Choice provider before the treatment date, nib will pay 100% of approved costs in line with their policy, and the EMP will no longer apply.

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When will the nib First Choice network be launched?

1 September 2017.

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Customer communications

How to claim 150 KB PDF


Product change summaries

Cover4Health 211 KB PDF

Easy Health 185 KB PDF

EasyCare 214 KB PDF

Health Plus 287 KB PDF

HealthAON 133 KB PDF

Parent Plan 202 KB PDF

Premier Health 201 KB PDF

Staywell 221 KB PDF

Ultimate Health 160 KB PDF


Adviser communications