Gaps

Mind the Gap...

The Government has a list of fees known as the Medicare Benefits Schedule (MBS). This details what doctors and other medical providers can charge in a hospital, or day surgery. Medicare pays 75% of the cost, and NIB pays the remaining 25% as a benefit towards your doctors' bills, provided the procedure is not excluded on your cover. Some doctors and specialists charge more than the MBS. If this happens, you have to pay the 'gap', which is the difference between the MBS and what the doctors charge.

Can I be treated as an NIB MediGap patient?

The NIB MediGap aims to eliminate the 'gap' for members. We've built up a network of doctors and specialists who charge NIB directly, at no additional cost to you. Medicare still pays 75% of the MBS, and NIB pays the remaining 25% plus an agreed amount set by the NIB MediGap Schedule (but not for excluded procedures).

• Doctors can choose on a case by case basis if they're going to bill you as a MediGap patient (or not)
• Always ask your doctor if they'll treat you as an NIB MediGap patient, and if other providers treating you (e.g. anaesthetist) will be using NIB MediGap as well
• NIB MediGap will only cover services provided during your hospital stay
• Any consultations before and after your hospital stay won't be covered
• Administration and booking fees are not covered by NIB MediGap