What is the Medicare Benefits Schedule (MBS)?

The Medicare Benefits Schedule (MBS) is the schedule of fees set by the government for standard medical services. In a nutshell, it determines the amounts that Medicare defines to be a fair charge by a doctor or specialist. If a doctor charges within the MBS, Medicare will pay 75% of the doctor's fee up to the pre-defined limit, and your hospital insurance policy will cover the remaining 25%. 

It's important to note though, that whilst some doctors do charge within the MBS, some can charge more and if they do, patients will incur an out of pocket expense for the difference between the fee charged and the MBS. This is why most health insurers have a "gap cover" arrangement in place, to help encourage medical providers to limit their fees so they don’t exceed what Medicare thinks is a reasonable charge.

Does HIF have a gap cover arrangement?

Absolutely! It's called AccessGap, and when providers do participate, we will happily pay for part or all of the gap on behalf of our members. In some circumstances though, some providers opt to charge well above the AccessGap limit and in those cases the patient must unfortunately cover the gap themselves. This is why we always encourage our members to contact us before undertaking a medical service, so we'll be able to confirm exactly what we'll cover and any gap payment that may apply. 

If you'd like to request a medical estimate, please complete this form. Alternatively, if you'd like to search for a list of registered participating specialists, visit our AccessGap webpage

Useful tip: If you hold private hospital cover, it’s always advisable to ask EACH doctor, obstetrician or specialist if they will treat you under the AccessGap arrangement in order to reduce any potential medical gaps. To search for a list of registered participating specialists, please visit our AccessGap Specialists page.
Category: Hospital Cover
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