You may have noticed from your OSHC policy that benefits are mostly listed as a percentage of “MBS”. MBS stands for Medical Benefits Schedule, and it represents the amount that government pays to doctors when they perform the specified procedures in the Schedule on Australian citizens and permanent residents. In many cases doctors charge more than the MBS fee, which is where the Gap Fee concept arises.
How do I find out how much money I will get back? You can find out what you will get back from your insurer by looking up the MBS amounts here at MBS Online.
If you would like to find out how much you will get back for some common procedures, such as visiting the doctor, you can find some common MBS items in this document: medicare_cheat_sheet.
How does it work? Say you need to go to the doctor for a standard appointment. From the cheat sheet, you can see that the MBS Item number for this procedure is 23. You should look up this Item Number on MBS Online as it is always up to date. From MBS Online, you can determine that the MBS Benefit is $36.30. You speak to the doctor’s surgery, and they tell you that they will charge you $60 for a standard consult. Therefore, the gap amount that you will be out of pocket is $60 charged by doctor less $36.30 that your OSHC insurer will reimburse you = $23.70.