GapCover can help reduce or remove the medical gap.
If your doctor chooses to participate in GapCover for 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 claiming provider (i.e. doctor’s account). Use our Find a doctor search to find doctors who’ve previously registered to participate in GapCover. Please note this doesn’t mean they’ll do so for your procedure, so you should always check with your doctor before agreeing to treatment.
How it works
Doctors can choose to participate in GapCover on a patient-by-patient and treatment-by-treatment 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 treatment.
GapCover doesn’t apply to pathology and radiology services (although these might be covered by one of our partner hospitals), and it doesn’t apply to your excess, daily charge (co-payments), out-of-hospital consultations or any services not included in your policy.
If your doctor/s choose not to participate in 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.
If your doctor bills you directly, it’s important that you do not pay this bill. If you do, you cannot claim under GapCover and will not receive your full GapCover benefit. Contact us for advice on what to do if this happens.
For more information check the member guide.