nib MediGap

Medicare and specialists' fees

The Government has a list of fees for services (such as surgical procedures) known as the Medicare Benefits Schedule (MBS). If you are treated by a specialist, Medicare pays 75% of the MBS fee, and nib pays the remaining 25%, provided the procedure is not excluded on your cover. Some specialists charge more than the MBS. If this happens, you have to pay the difference between the MBS and what the specialist charges.

nib MediGap Scheme

Our MediGap Scheme means that we will agree to pay an extra amount to your specialist in addition to the standard 25% for services covered under our MediGap Scheme. We've built up a network of doctors and specialists who may charge us directly, at no additional cost to you.

Specialists who are registered for MediGap decide on a case-by-case basis if they are going to participate in the Scheme and charge no out-of-pockets for your procedure. For this reason, it's important to ask if your specialist is willing to participate in the MediGap Scheme for you.

How does MediGap work?

When a specialist participates in MediGap they receive a higher benefit from nib than they would ordinarily receive in exchange for their agreement not to charge nib customers an out-of-pocket expense.

This higher benefit is paid if the services being claimed are covered by the nib MediGap schedule, your health cover includes the hospital service being claimed and the specialist agrees to participate in the MediGap Scheme for your procedure.

If you need to go to hospital, please call us on 13 16 42 first and we can help you understand what you'll need to know about the nib MediGap Scheme.

More information is also available in the Policy Booklet.

What happens if we change the MediGap Schedule?

If nib reduces amounts paid to specialists under the MediGap Scheme, then nib will provide 60 days' written notice of the reduction on this website and will also write to those members who have claimed under their insurance policies for any of the affected procedures in the previous 2 years where that procedure was part of an ongoing course of treatment (for example, dialysis) providing 60 days' written notice of the change.

Important changes to nib MediGap After a review we've made changes to the amounts paid to specialists under nib's MediGap Scheme. Read more about these changes.