An important change to your medical benefits from 15 July 2019.
On 15 July 2019, we changed the benefits payable for medical services included in your cover to make it easier for you to understand.
Before we outline the specific changes to your cover, it’s helpful to understand the following:
Your cover allows you to claim benefits towards in-hospital and out-of-hospital medical services (e.g. surgeon and anaesthetist fees, general practitioner (GP) and specialist consultations). Each service has an item number and a ‘recommended’ fee that’s been set by the Australian government, called the Medicare Benefits Schedule (MBS) fee.
Depending on the service, the maximum amount we previously paid towards medical services included in your cover ranged between 100% and 272% of the MBS fee.
So what's changing for you?
From 15 July 2019, the maximum benefit we'll pay towards medical services included in your cover is set to 125% of the MBS fee.
This means there was a reduction in the maximum benefit we will pay for approximately 60% of the medical services included in your cover, such as those related to pregnancy and birth, joint replacements and assisted reproductive services. If your doctor charges more than 125% of the MBS fee for these services, you'll pay the difference as an increased out-of-pocket expense.
The good news is, this change also means the maximum benefit payable has increased for around 40% of other included medical services, such as common radiology and pathology services, which may help to reduce your out-of-pocket expenses for these services.
For more information about the new maximum benefits for specific MBS items you may require, take a look at the table below.
We’re here to help
Of course, if you’d like to review your cover, we’d be happy to guide you through your options and find one that better suits your personal circumstances, give us a call on 132 331.
^ Current as of 15 July 2019.
Note: Items listed in the MBS without an pre-set MBS fee (i.e. derived fees) are not included in this look up as the maximum benefit payable is variable and are unchanged. See mbs.gov.au for more information on MBS fees.