SCHEDULE OF BENEFITS - nib

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Changes to MediGap Rules nib reserves the right to change all or any of the Rules of the MediGap Scheme (including the MediGap Schedule of Benefits) at its discretion at any time. From time to time nib may request a participating provider complete a new application form to participate, confirming their current details. Acceptance of MediGap Rules A practitioner who lodges a Claim under the MediGap Scheme is deemed to have accepted the Rules of the MediGap Scheme at the time the Claim is lodged. Privacy nib is committed to complying with its obligations under the Privacy Act 1988, which regulates how personal information should be used. Refer to nib’s Privacy Policy at www.nib.com.au. Publishing Medical Practitioners Details nib will publish the participating practitioners details on its website and internal intranet unless the practitioner indicates on the MediGap application form that such details are not to be published. Prostheses Participating practitioners must obtain full informed financial consent from nib customers when prosthetic items requiring Gap payments are to be used by the practitioner in providing the services. More information about Prostheses arrangements is available at www.health.gov.au Glossary of Terms In these Rules: Benefit: means the dollar amount that nib pays when a nib customer or an Eligible practitioner makes a claim for an item or service covered by a nib customer’s nib health cover. Claim: means a claim by a participating practitioner for payment of a MediGap benefit for an Eligible service provided to an Eligible customer. Eligible customer: means a nib customer who meets the eligibility requirements set out in these Rules. Eligible practitioner: means a medical practitioner who meets the eligibility requirements set out in these Rules. Eligible service: means a chargeable in-patient hospital service provided to an Eligible customer in respect of which a Medicare benefit is payable. Gap: means when a practitioner charges more than the MediGap schedule fee leaving the customer with an out of pocket expense. MBS: means the Medicare Benefits Schedule. Medicare benefit: means the Benefit payable by Medicare for a particular service as set out in the MBS. MediGap benefit: means the total Benefit payable by nib for a particular Eligible service as set out in the MediGap Schedule of Benefits attached to these Rules as updated from time to time. nib: means nib health funds limited ACN 000 124 381 and all related bodies corporate No Gap: means when a practitioner charges the MediGap schedule fee leaving the customer with no out of pocket expense. Participating practitioner: means an Eligible practitioner whose application for registration in the MediGap Scheme has been approved by nib. | MediGap 2010 8
Item No Benefit Item No Benefit Item No Benefit Item No Benefit 4 DERIVED 599 $171.50 3005 $160.30 11237 $92.80 24 DERIVED 600 $132.65 3010 $80.20 11240 $92.80 37 DERIVED 721 $156.15 3014 $45.65 11241 $118.00 47 DERIVED 723 $123.70 3032 $147.70 11242 $91.20 58 DERIVED 729 $76.15 3040 $221.70 11243 $91.20 59 DERIVED 731 $76.15 3044 $295.45 11300 $223.40 60 DERIVED 732 $78.00 3051 $106.15 11303 $223.40 65 DERIVED 735 $76.45 3055 $169.25 11304 $367.95 104 $97.45 739 $131.00 3062 $232.35 11306 $25.45 105 $49.40 743 $218.40 3069 $147.70 11309 $30.50 106 $80.90 747 $56.20 3074 $221.70 11312 $43.10 109 $146.40 750 $96.30 3078 $295.45 11315 $57.10 110 $166.90 758 $160.50 3083 $106.15 11318 $70.50 116 $83.50 825 $110.35 3088 $169.25 11321 $133.90 119 $47.50 826 $175.95 3093 $232.35 11324 $38.10 132 $292.35 828 $241.55 6007 $148.60 11327 $22.90 133 $146.35 830 $153.55 6009 $49.65 11330 $9.15 135 $292.35 832 $230.50 6011 $98.90 11332 $67.90 141 $501.50 834 $307.15 6013 $137.00 11333 $51.75 143 $313.45 835 $110.35 6015 $174.50 11336 $51.75 160 $243.85 837 $175.95 11000 $140.90 11339 $51.75 161 $406.45 838 $241.55 11003 $372.85 11500 $196.15 162 $568.80 855 $153.55 11006 $191.15 11503 $162.85 163 $731.65 857 $230.50 11009 $260.65 11506 $24.10 164 $812.95 858 $307.15 11012 $128.20 11509 $41.85 170 $131.50 861 $153.55 11015 $171.55 11512 $72.50 171 $138.50 864 $230.50 11018 $256.30 11600 $83.40 172 $168.60 866 $307.15 11021 $171.55 11612 $135.45 173 $26.65 880 $53.70 11024 $130.30 11615 $91.50 195 DERIVED 2801 $160.30 11027 $193.30 11627 $275.65 289 $292.80 2806 $80.20 11200 $46.45 11700 $36.05 297 $288.80 2814 $45.65 11203 $78.45 11701 $17.90 320 $48.00 2946 $147.70 11204 $123.25 11702 $17.90 322 $95.80 2949 $221.70 11205 $123.25 11708 $147.70 324 $147.45 2954 $295.45 11210 $123.25 11709 $193.45 326 $203.45 2958 $106.15 11211 $123.25 11710 $59.95 328 $236.20 2972 $169.25 11212 $79.85 11711 $32.65 342 $54.55 2974 $232.35 11215 $140.10 11712 $175.65 344 $72.45 2978 $147.70 11218 $173.05 11713 $80.55 346 $107.15 2984 $221.70 11221 $77.15 11715 $139.45 385 $94.90 2988 $295.45 11222 $77.15 11718 $40.15 386 $47.65 2992 $106.15 11224 $46.50 11721 $80.55 597 $130.50 2996 $169.25 11225 $46.50 11724 $195.05 598 $111.55 3000 $232.35 11235 $139.80 11727 $109.45 4 to 11727 | MediGap 2010 9
Page 1 and 2: SCHEDULE OF BENEFITS RULES AND GENE
Page 3 and 4: RULES FOR PARTICIPATION IN nib’s
Page 5 and 6: Making Claims for MediGap Benefits
Page 7: for any of the reasons set out abov
Page 11 and 12: Item No Benefit Item No Benefit Ite
Page 33: 1300 853 530 nib.com.au nib health

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