MediGap - nib

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Table of Contents 2 Rules and General Information Item Numbers 7 1 to 11713 8 11715 to 15257 9 15260 to 20143 10 20144 to 21234 11 21260 to 23082 12 23083 to 30078 13 30081 to 30484 14 30485 to 31346 15 31350 to 32769 16 33050 to 35533 17 35536 to 36836 18 36840 to 38415 19 38418 to 39658 20 39660 to 41776 21 41779 to 42802 22 42805 to 45462 23 45464 to 45819 24 45821 to 47348 25 47351 to 47982 26 48200 to 49803 27 49806 to 52030 28 52033 to 53400 29 53403 to 61316 30 61317 to 75854 30 Consultations - Derived* Fees per patient
Rules for participation in nib’s MediGap Scheme General Information nib’s MediGap Scheme 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 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; and • nib’s Fund Rules, as amended from time to time. Eligible Practitioners Generally, medical practitioners who are registered and hold a current HIC provider number 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 • the practitioner is a Radiologist or Pathologist • 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 • 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. 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 Department of Health approval.
Page 1: MediGap Rules, General Information
Page 5 and 6: Making Claims for MediGap Benefits
Page 7 and 8: Disclosure of Financial Interests P
Page 9 and 10: Item No Benefit Item No Benefit Ite

MediGap - nib

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