MediGap aims to eliminate the gap payments for specialist fees in hospital for Australian resident nib members.
When a specialist chooses to participate in MediGap for your procedure they agree not to charge a gap fee (also known as an ‘out of pocket expense’) for their services. Our network of MediGap specialists may agree to receive a higher benefit from nib than they would ordinarily receive in exchange for their agreement not to charge nib members an out of pocket expense.
Ask your specialist if they'll participate in MediGap for you. If other doctors (such as anaesthetists) are part of your treatment plan, ask them if they'll also agree to participate in MediGap.
How does MediGap work?
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 included on your cover. Some specialists charge more than the MBS fee, meaning you'll have to pay an additional cost that isn't covered by Medicare or your health insurance (an out of pocket or gap fee). MediGap means that nib agrees to pay an extra amount in addition to the standard 25% MBS fee. The service must be eligible for MediGap and your doctor must agree to participate in MediGap and bill nib directly for your procedure.
MediGap is not applicable to overseas nib members, as your OSHC or OVHC will cover your treatment instead of Medicare.
How can I access MediGap?
Doctors choose on a case by case basis if they will bill you as a MediGap patient. Ask your specialist if they will participate in MediGap to eliminate your out of pocket expenses for their fees. If other doctors (such as anaesthetists) are part of your treatment plan, ask them if they'll agree to only charge the MBS fee, or participate in MediGap as well.
What happens if we change MediGap?
From time to time the amount paid to specialists under nib MediGap will change. Usually a review will see the payments increase, however if nib reduces the amount a specialist will receive for a procedure under MediGap, we'll provide prior notice of the change on our website, as well as written notice to any member who has claimed for an affected procedure 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.