SCHEDULE OF BENEFITS - nib

RULES FOR PARTICIPATION
IN nib’s MediGap SCHEME
General Information
nib’s MediGap Scheme (MediGap) is a No Gap scheme that aims to eliminate medical gap payments for eligible in-patient
services for Eligible nib customers.
The MediGap benefit must be accepted as full payment of the service and no other charge can be raised. Services where
additional charges, fees or similar are raised are ineligible for MediGap benefits and must be forwarded to the patient for claiming
through Medicare and nib.
nib’s MediGap Scheme is governed by:
• the Rules set out below;
• The MediGap schedule; and
• nib’s Fund Rules,
as amended from time to time.
Eligible Practitioners
Generally, medical practitioners who are registered and hold a current Medicare/healthcare provider identifier are eligible to apply
to participate in nib’s MediGap Scheme.
A medical practitioner is not eligible to participate in the MediGap Scheme if:
• the practitioner is a Salaried Staff Officer of a public hospital; or
• the practitioner is a Radiologist or Pathologist; or
• nib is of the opinion the medical practitioner has failed to comply with the Rules of the MediGap Scheme and gives the
medical practitioner written notice of the non-compliance; or
• the medical practitioner is, or becomes, unregistered or has his or her registration suspended under the laws of the relevant
state within Australia. The practitioner must immediately notify nib if this occurs; or
• the medical practitioner no longer carries medical indemnity insurance with a recognised indemnity provider. The
practitioner must immediately notify nib if this occurs.
If a practitioner is registered as a participating practitioner and one of the events listed above occurs, the registration of the
practitioner will be immediately revoked.
Registering to Participate
Practitioners who wish to participate in the MediGap Scheme must register with nib by completing an application form and
returning it to nib. Application forms can be found at www.providers.nib.com.au
Or via hyperlink http://www.nib.com.au/home/providers/MediGap/Documents/MediGap_Registration.pdf.
nib reserves the right to refuse applications to participate in the MediGap Scheme at its discretion.
Withdrawal of Registration
A practitioner may withdraw registration in the MediGap Scheme at any time by providing written notification to nib.
nib may terminate a practitioner’s registration in the MediGap Scheme at any time by providing written notification to the practitioner.
nib may at any time and at its discretion:
• withdraw the MediGap Scheme; or
• withdraw the MediGap Scheme for a group of practitioners.
nib’s MediGap Scheme is conditional on continued Commonwealth Department of Health and Ageing approval.
| MediGap 2010
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