GapCover can help reduce or remove the medical gap.
If your doctor chooses to participate in GapCover for the claim forming part of your treatment, we’ll provide benefits up to an agreed fee and then you’ll have to pay the difference. Under GapCover, the maximum gap that you’ll have to pay is $500 per provider (i.e. each doctor’s account). Use our Find a doctor search to find doctors who’ve previously registered to participate in GapCover. This doesn’t mean they’ll do so for each claim forming part of your treatment, You should always check upfront with your doctor before agreeing to each claim forming part of your treatment.
How it works
Doctors can choose to participate in GapCover on a patient by per claim, per treatment and per patient basis. If you are being treated by more than one doctor (e.g. surgeon and anaesthetist), participation is at each individual doctor’s discretion. So it is important to ask your doctor(s) if they’ll do so prior to each claim forming part of your treatment.
GapCover doesn’t apply to diagnostic services such as blood tests, x-rays and ultrasounds, out-of-hospital medical services and services not included on your policy. GapCover doesn’t apply to things such as excess payments and co-payments. You may still have out-of-pocket costs.
If your doctor/s choose not to participate in ahm's GapCover, the amount we pay will be limited to 25% of the MBS fee. This means that where the doctor elects to charge more than the MBS fee you will need to pay the gap yourself.
For more information about GapCover, check the Member Guide.