Access Gap Cover

At Queensland Country Health, we’re committed to delivering market leading health insurance at an affordable price. That’s why we’ve introduced our Access Gap Cover initiative, which helps our policyholders to minimise or, in some cases, eliminate out-of-pocket expenses.

Under the Access Gap Cover scheme, participating medical practitioners who provide a service in hospital can decide to accept up to the Queensland Country Health fee as full settlement of the account. This means you don’t have to make any additional payments for that particular service.

The doctor can also accept the fee as part of the payment and will inform you of any gap – called the known gap. The known gap is the additional out-of-pocket expenses you will need to pay.

Doctors can participate in the Access Gap Scheme on a patient-by-patient basis.

If your doctor doesn’t participate in access gap, we will only cover the 25% between the 75% Medicare Rebate and the Medicare Benefits Schedule fee for inpatient services.

How the Access Gap scheme works

To make sure you’re fully aware of all fees to be charged prior to treatment, we recommend contacting your treating doctor to find out if they will participate in the Access Gap scheme for your treatment and to discuss fees upfront. That way, you’ll be fully prepared and aware of any out-of-pocket expenses.

You can also find doctors who may participate in the Access Gap Scheme by visiting the AHSA website at https://www.ahsa.com.au/web/doctors/information/doctor_search.