Medicare Benefit Schedule (MBS)

The Medicare Benefit Schedule (MBS) is a list of fees for medical services issued by the Commonwealth Government. If you have health cover and are admitted to hospital as a private patient, Medicare pays a benefit of 75% of the MBS and the remaining 25% is paid by RBHS.

If a doctor raises a charge that is above the MBS, this amount is known as a ‘medical gap’. RBHS has arrangements with more than 36,000 specialists Australia-wide where additional benefits are payable by the fund to reduce or eliminate ‘medical gaps’ faced by members. This scheme is known as ‘Access Gap’.

Before admission to hospital you should ask your specialists to inform you of all medical fees that may be charged and whether they participate in our ‘Access Gap’ scheme. If the specialists elect not to participate in the ‘Access Gap’ scheme and charge fees above the MBS, this additional amount will need to be paid by you. Before any hospital treatment you should confirm all charges with your specialists.

Find out whether your specialist participates in the ‘Access Gap’ scheme by using our Access Gap search.