nib is implementing changes to its MediGap network, offering members enhanced flexibility in managing out-of-pocket expenses for in-patient treatments.
As of Oct. 1, over 40,000 specialists registered with MediGap have the option to offer patients a maximum out-of-pocket cost of $500, referred to as Known Gap, for a wide range of hospital services, including anaesthesia, surgery, obstetrics, psychiatry, and more.
The introduction of the Known Gap option represents a shift from the current arrangement, where specialists could only offer No Gap, meaning patients had to cover the remaining gap after the government co-payment.
With the new plan, providers will be able to charge either a No Gap or a Known Gap up to $500, creating more flexibility for specialists and patients.
nib expects this adjustment to encourage more specialists to participate in MediGap, potentially lowering overall out-of-pocket expenses for members. The insurer estimates that these changes could reduce total member expenses by up to $8.1 million annually, particularly benefiting those receiving fixed-price treatments that were previously excluded from MediGap.
Ed Close, chief executive of nib’s Australian Residents Health Insurance (arhi), noted that the changes were made in response to feedback from specialists and to address rising costs for members.
“We believe this change will provide greater cost certainty to members and better support specialists in managing the needs of their practices and patients,” he said.
nib plans to enhance its Find a Provider tool to assist members in identifying specialists participating in the MediGap network.
The upgraded tool will display how frequently specialists offer No Gap and Known Gap treatments and detail typical out-of-pocket costs.
In the last financial year, the tool was used in over 369,000 searches by more than 168,000 unique visitors.
Honeysuckle Health, a joint venture between nib Group and Cigna, manages the MediGap network on behalf of nib members. The changes will apply to nib members with hospital cover, as well as to members of some partner brands.
Aside from reducing out-of-pocket treatment costs, nib also aims to reduce hospital readmissions.
In May, nib launched a collaborative initiative with cardiology provider Advara HeartCare, aimed at reducing hospital readmissions for heart disease patients.
The partnership targets the roughly 17% of heart disease patients who are readmitted to the hospital within 30 days of their initial treatment.
According to nib, managing heart failure-related hospital admissions costs the Australian healthcare system $1.8 billion annually, with another $900 million going toward community care. A significant portion of these costs is linked to preventable readmissions.
Under the partnership, eligible nib members who have recently been hospitalised for chronic heart failure will gain access to Advara HeartCare clinics in Victoria. These services will be provided at no additional cost to members who meet the eligibility criteria.
Additionally, nib’s GapSure Cardiology network offers qualifying members no-gap coverage for certain in-patient cardiology treatments.
Advara HeartCare’s Heart Failure Program, led by Dr Leighton Kearney, aims to reduce readmissions through a multidisciplinary approach that involves cardiologists, nurses, GPs, and other allied health providers.
