Access Gap Cover

How Access Gap Cover works

What is Access Gap Cover?

Access Gap Cover is designed to reduce the medical costs you need to pay for treatment when you're admitted into hospital. Medical costs are the fees your specialist or doctor charges you for your hospital treatment (as opposed to hospital costs such as accommodation and theatre fees).

Access Gap Cover is included with each of our private hospital covers and can also simplify your claims, as most Access Gap doctors send the bill straight to us, and we handle Medicare claims on your behalf. 

How Access Gap Cover works

We pay more, so you pay less.

When you’re admitted into hospital as a member of our health fund, Medicare pays 75% of the Medicare Benefits Schedule (MBS) fee for eligible inpatient services, and we pay the remaining 25%. If your doctor charges more than the MBS schedule fee, you will be out-of-pocket for this additional amount unless billed under Access Gap Cover.

Under Access Gap Cover your doctor agrees to only charge up to a certain fee. We then pay a higher amount than we normally would, so that:

  • You pay nothing; or,
  • You pay no more than $400 out-of-pocket for medical treatment (or $800 for obstetrics), for that doctor. Remember, you may have to see multiple doctors for one procedure.

Prior to treatment, you can request a written estimate of costs from your doctor, so you understand how much you will be out-of-pocket (if at all). See Informed Financial Consent.

Ask your doctor:

  1. Will you treat me under TUH’s Access Gap Scheme?
  2. Can you give me a written estimate of any personal out-of-pocket expenses I might incur?
  3. Will assisting doctors also use Access Gap Cover?
  4. Will you send the bill directly to my fund so they can manage my Medicare claim for me?

For more information please refer to the Ombudsman’s brochure ‘Doctor’s Bills’ which you can download from ombudsman.gov.au.

Find a specialist

Use the search below to find out if your specialist has participated in the Access Gap Scheme.

TUH does not recommend or endorse any doctors. This list has no bearing on skill or experience of any doctors listed. TUH reserves the right to refuse Access Gap Cover benefits to providers who do not adhere to the Business Guidelines.