Fund Gap

Fund Gap claiming allows Medibank to pay the 25% of the MBS (Medicare Benefit Schedule) fee for inpatient medical services provider to eligible Medibank Members. The beneficiary receives separate payments from Medicare (75% of MBS) and Medibank (25% of MBS). 

Medibank can pay benefits for approved inpatient hospital services approved for members who meet the eligibility criteria (level of cover, waiting periods, financial status). Fund Gap claims do go through Medicare before Medibank can assess the claims.

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