Why do Allianz OSHC tables show both 85% and 100% of the MBS?
The Allianz Care Australia OSHC Standard policy wording effective 1 July 2026 pays 100% of the MBS fee for most GP medical services outside hospital and for medical services to admitted hospital patients, and 85% of the MBS fee for other out-of-hospital medical services, with hospital accommodation treated as a separate benefit category.
The short answer: 85% and 100% of the MBS are not two versions of the same benefit. In the Allianz Care Australia Standard policy wording effective 1 July 2026, the 100% rate applies to most GP medical services outside hospital and to medical services provided to admitted hospital patients, while the 85% rate applies to other out-of-hospital medical services such as specialists, pathology and radiology. Hospital accommodation is not paid at 85% of the MBS — it sits in its own category with its own rule. Verified against the current policy document on 14 October 2026.
This page explains the Allianz Standard wording. It is not a summary of every Allianz OSHC product, and it is not advice about which cover to buy or how your own claim will be settled.
Where the 85% and 100% figures actually come from
The Allianz Care Australia OSHC Standard policy wording effective 1 July 2026 sets out separate benefit categories:
| Benefit category | Benefit stated in the Standard policy wording |
|---|---|
| Most GP medical services outside hospital | 100% of the MBS fee |
| Other out-of-hospital medical services, including specialists, pathology and radiology | 85% of the MBS fee |
| Medical services to admitted hospital patients | 100% of the MBS fee |
| Public hospital, listed categories | The applicable State or Territory non-resident rate |
| Agreement private hospital | 100% of contracted charges for insurable costs, with a minimum of shared ward accommodation |
| Non-agreement private hospital | The applicable minimum benefit under the relevant benefit requirement rules |
Those are different categories with different bases. Nothing in the Standard wording labels hospital accommodation as 85% of the MBS.
What to do when an overview table conflicts with the policy
The overview label on Allianz’s summary material conflicts with the category breakdown in the current Standard policy wording. We cannot tell you why the two differ. Check the wording for the specific product you hold, and ask your insurer to clarify if you rely on the overview label for a decision.
The same compression can happen at the other end. Reading “100% of the MBS” as “100% of the hospital invoice” is also wrong: the percentage is applied to the Medicare Benefits Schedule fee for the item, not to whatever the provider actually charges.
Does a percentage of the MBS cover the actual charge?
Not necessarily. A practitioner may set a fee above the applicable MBS fee or above the contracted amount. In the worked examples below, the gap is what the provider charges minus the benefit actually payable.
- Charge of $100, confirmed benefit of $85 — you pay $15 out of pocket.
- Charge of $100, confirmed benefit of $100 — you pay $0.
- Charge of $120, confirmed benefit of $100 — you pay $20.
These are arithmetic illustrations, not MBS item fees, provider prices, quotations or claims outcomes. The $85 figure is an out-of-hospital example, not a hospital benefit. For the same charge and the same approved benefit, the amount you end up paying is the same whether the provider bills the insurer directly or you claim and are reimbursed; only the timing differs. Each actual charge and approved benefit is different, so your own result can differ.
Hospital accommodation is a separate benefit
This is the part most often misread. In the Standard wording, public hospital cover applies to listed categories of treatment charged at the State or Territory non-resident rate. Agreement private hospital cover applies to contracted charges for insurable costs, with a minimum of shared ward accommodation. A non-agreement private hospital attracts a minimum benefit.
The policy wording also notes that hospital treatment can involve out-of-pocket costs. A 100% MBS medical benefit does not settle the accommodation component, and it does not make every hospital charge payable.
Where the 85% floor comes from nationally
The Deed for the Provision of Overseas Student Health Cover commencing 1 July 2025 sets the minimum framework for OSHC products. It sets the base out-of-hospital medical rate at 85% of the MBS, allows higher benefits, and sets the in-hospital medical rate at 100% of the MBS. Private hospital facility costs depend on whether the hospital has an agreement with the insurer.
That deed is a floor, not a promise that every student’s GP benefit is exactly 85%. Allianz Standard pays more than the floor for most GP services outside hospital. Reading the deed’s 85% as your own GP benefit is a common error in the opposite direction.
What about waiting periods, extras and pharmacy items?
Waiting periods, benefit limits, exclusions and general terms still apply. Rather than repeat figures that change between policy versions, treat the waiting periods that apply to your situation as a matter for the current policy wording you hold. Read your own document, and confirm it with your insurer if the treatment is time-sensitive. The same applies to non-MBS services and pharmacy items: benefits are subject to the limits in the current wording.
Bulk billing is a separate idea. As Services Australia explains, Medicare bulk billing means a practitioner accepts the Medicare benefit as full payment for a service, and it requires Medicare enrolment — OSHC membership is not the same as Medicare eligibility. Many OSHC benefits are expressed as a percentage of MBS without any Medicare bulk billing being involved.
What to do before treatment
- Confirm which Allianz product you hold and read the current policy wording for it.
- Ask the clinic whether they direct bill your exact insurer and product.
- Ask what your benefit is and whether a gap will apply.
- If the clinic will not direct bill, ask for an itemised invoice and keep your proof of payment.
- Check the invoice line by line against the benefit category for each service.
- Submit through your insurer’s stated process with the details they require, and confirm document requirements and claim deadlines with them.
Where direct billing fits
Allianz Care Australia’s OSHC explanation describes direct billing as the provider submitting the covered bill to the insurer and the insurer paying the covered benefit to the provider, with the patient still responsible for any gap. Money is not sent to the insurer for the treatment. Some providers offer gap-free arrangements. Direct billing is not the same as free care; it changes who pays what, and when.
If an amount does not match what you expected, ask the provider for an itemised invoice and the insurer for a written explanation of the benefit applied before assuming an error. Processing times vary, so allow for them rather than expecting an immediate result.
Sources
- AllianzCare OSHC Standard policy wording, effective 1 July 2026 (PDF)
- AllianzCare policy wording and documents index
- Understand your OSHC policy | Allianz Care Australia
- Deed for the Provision of Overseas Student Health Cover, commencing 1 July 2025 (PDF)
- Bulk billing | Services Australia
FAQ
Is hospital accommodation covered at 85% of the MBS?
No. In the Allianz Standard wording effective 1 July 2026, 85% of the MBS relates to other out-of-hospital medical services, such as specialists, pathology and radiology. Hospital accommodation falls under separate categories: the State or Territory non-resident rate for public hospital listed categories, contracted charges at an agreement private hospital, or a minimum benefit at a non-agreement private hospital.
So which services get 100% of the MBS in Standard?
Two categories: most GP medical services outside hospital, and medical services provided to admitted hospital patients.
Does 100% of the MBS mean the whole bill is covered?
No. The percentage applies to the MBS fee for the item. If the provider charges more, the difference can be payable by you as an out-of-pocket cost. Accommodation and non-MBS items are handled under their own categories.
Where does the 85% figure come from if Standard pays more for GPs?
The government OSHC deed sets a base out-of-hospital medical rate of 85% of the MBS as a minimum, with higher benefits permitted. Allianz Standard pays more than that minimum for most GP services outside hospital.
Does the same table apply to other Allianz products?
Not necessarily. This page covers the Standard wording linked from Allianz’s current documents page. Check the wording for the specific product you hold.
Is direct billing free care?
No. Under direct billing the provider bills the insurer, and the insurer pays the covered benefit to the provider; you may still owe a gap. Ask the provider whether they direct bill your exact insurer and product, and what gap applies.
Should I rely on an Allianz webpage table?
No. Allianz describes its overview material as a summary and directs readers to the policy wording for full terms, exclusions, limitations and waiting periods. The current issued wording governs.
General information only, verified 14 October 2026 against the sources listed above. This is not medical, legal or financial advice, and it is not an approval or guarantee of any claim or payment. Check your current policy wording and confirm details with your insurer before relying on any figure.