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We’re committed to delivering market leading health insurance at an affordable price. Your doctor, surgeon and anaesthetist all charge for their services separately. For most hospital services, Medicare sets an amount known as the Medicare Benefit Schedule fee (MBS), services are assessed against this. When you go into hospital, this is the amount you’re guaranteed will be covered - Medicare covers 75% of the MBS fee, and we cover the other 25%.
Some doctors, however, charge more than the MBS fee. We try and make treatment more affordable by offering Access Gap Cover.
What is Access Gap Cover?
Access Gap Cover is a major feature of our hospital cover. If your doctor particpates in the Access Gap scheme, it can help minimise or, in some cases, eliminate out-of-pocket expenses when you go to hospital for an inpatient procedure, service or treatment.
The Access Gap Benefit is an agreed maximum amount we’ll pay up to for your doctor’s services if they’re part of the scheme. Your doctor may choose to accept this amount as full payment for your treatment, which means no out-of-pockets for you. But, if your doctor’s fee is higher than the Access Gap Benefit, you'll unfortunately have out of pocket expenses to pay.
Some doctors don’t participate in the Access Gap scheme at all, and some participate on a patient-by-patient basis. If your doctor doesn’t participate, we’ll only cover the 25% between the Medicare rebate and MBS fee. 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 before you go to hospital.
We have agreements in place with certain providers under our Premier Provider Network to provide you with great discounts, so you get even more value for money when visiting the dentist or optometrist.