What is it?
When you go to hospital, or attend day surgery, there’s often a gap between what Medicare will pay and what the doctor charges.
This is because many doctors choose to charge more than the Medicare Benefit Schedule fee.
This means after Medicare and your health fund contribute, there’s still a difference. This is often called the “gap” or “out-of-pocket” costs.
Whilst a health fund pays a benefit towards it, that ‘gap’ can leave you with large out-of-pocket expenses to pay.
Access Gap Cover helps reduce or in some cases even eliminate that gap. It’s a scheme, approved by the Australian Government, that allows Emergency Services Health to make up the difference.
When do I use it?
The best way to ensure you have no, or lower, out-of-pocket medical costs is to choose a doctor who participates in our Access Gap Scheme.
You will need to ask your GP to either refer you to a doctor who may participate in the program, or for a non-specific referral so you can get quotes from different doctors.
Ask your specialist rooms when booking your initial appointment if they’ll participate in our Access Gap scheme.
If they don’t, and they’re unwilling to, you can look for a doctor who does.
What happens if they agree?
If they agree, the maximum you’ll pay is as a known gap of up to $500 per doctor per hospital episode ($800 for obstetrics), or agree to no gap at all.
Specialists aren’t obliged to participate in the scheme, so if one specialist won’t, you can keep looking.
How do I find doctors who participate in Access Gap Cover?
Simple, go to our Find an Access Gap Doctor search.
If you have any questions, please call us on 1300 703 703.