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MediGap

Medical gap cover for our customers. Please note: Our MediGap Terms and Conditions have been updated. See below to view the latest Terms and Conditions.

MediGap Terms & Conditions have been updated

Ongoing stakeholder engagement has highlighted the opportunity for us to improve the wording in the MediGap Terms and Conditions; particularly around Section 7: Auditing.

Based on this feedback this clause has been simplified to more accurately reflect the way we may conduct an audit.

Additionally, changes have been made to Section 8: Collection and Publication of Provider Information, namely to clarify how we collect, use and where we may publish this information.

At nib we think it’s important to help our members and consumers make informed choices about their healthcare. Therefore, we’ll soon start publishing some information about the practitioners who participate in MediGap to help our members and consumers find a practitioner who suits their needs, including who is more likely to participate in MediGap.

We have also taken this opportunity to rework the look, language and layout of the document to make it clearer.

Please review the updated MediGap Terms and Conditions here.

What is MediGap

nib MediGap aims to eliminate the out of pocket costs nib customers pay for inpatient medical and surgical fees. The MediGap benefit is higher than the Medicare Benefits Schedule (MBS) benefit, as outlined in more detail in the MediGap Schedule of Benefits.

As a registered MediGap practitioner you have the right to decide on a case-by-case basis if you wish to participate. When you participate in MediGap for a patient, you agree not to charge the nib customer any out of pocket costs for their inpatient service. The benefits to you as a provider include receiving faster payment from nib, not having to chase your patients for payment of their invoice, and being listed in our MediGap specialist search directory.

To claim MediGap benefits you must first be registered for MediGap and you, the patient, and the claim must meet the eligibility criteria set out in the MediGap Terms and Conditions.

Innovative digital tools

Customers can search for a specialist who is registered to participate in MediGap in three ways:

  • Use our Going to Hospital tool in Online Services
  • Check out the find a provider tool search tool on the nib website
  • Or search for a provider within the nib App

MediGap FAQs

Practitioners employed by public hospitals, pathologists or radiologists are not eligible to participate in MediGap. These practitioners can, however, register with nib to claim the 25% portion of the MBS fee. Other eligibility criteria apply so please see the Terms and Conditions.

The fastest and easiest way to claim is by registering with the Department of Human Services for ECLIPSE which is Medicare's system for simplified billing. When submitting a claim for MediGap using ECLIPSE simply select 'SC' for scheme.

Alternatively, you can post your account along with a Batch Header Form to us at:

nib Claims and Policy Administration
Reply Paid 62208
Newcastle NSW 2300

To change your bank details, or set up a new account, you will need to use our online form. It's our preferred payment method for MediGap as payments so you can be processed more quickly and securely.

With the customer's permission, you can confirm their eligibility for MediGap by calling MediGap on 1300 853 530 (Option 1). Simply quote the customer's name, their nib customer number, and the MBS item numbers expected to be performed.

More than 1 million Aussies trust nib with their health insurance.

Register to participate in MediGap and we'll introduce you to our customers through our innovative online specialist search tools.

Did you know?

nib underwrites APIA Health Insurance, Qantas Health Insurance, Suncorp, AAMI and United Healthcare Global for Medicare eligible residents in Australia.

The MediGap Schedule of Benefits for nib patients also applies for these customers.

Contact us

Registrations and updating details

For MediGap claim enquiries