nib MediGap aims to eliminate the 'gap' payments for specialist fees in hospital for customers, and can assist in lowering your out of pocket expenses.
When a specialist chooses to participate in MediGap for your procedure they agree not to charge an out of pocket expense. Ask your specialist if they'll MediGap for you.
We do this by building a network of specialists who may agree to 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.
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 fee and if this happens, you will have to pay the difference between the MBS and what the specialist charges. MediGap means that nib agrees to pay an extra amount in addition to the standard 25% of the schedule fee. The service has to be eligible for MediGap benefits and your doctor has to agree to participate in MediGap and bill nib directly for your procedure.
Doctors choose on a case by case basis if they’re going to bill you as a MediGap patient. You can ask your specialist if they will participate in nib MediGap to eliminate your out-of-pocket expenses relating to their fees. If there’s other doctors (such as anaesthetists) that are part of your treatment plan, make sure you ask them if they will also charge only the schedule fee or participate in MediGap.
From time to time the amount paid to specialists under nib MediGap will change. Usually a review of nib MediGap will see the payments increase, however if nib reduces the amounts a specialist will receive for a procedure under nib MediGap we will provide prior notice of the change on our website, as well as give written notice to any customer who has claimed for an affected procedures in the two years before the change occurs. Other changes outside nib’s control, such as changes to the MBS, may mean nib is not able to provide notice in this form.