Private Health Insurance

A Medical Gap Cover Scheme is when a health insurer has a Gap Cover Agreement with a particular doctor or healthcare provider. The agreement allows health insurers to cover all or some of the gap fees for your treatment in hospital. The idea is to reduce or eliminate out-of-pocket costs for you as the patient....

A Hospital Gap is the difference between what a hospital charges you as a private patient for accommodation, meals, time in theatre, labour ward and other fees and what your health insurer pays for those services. It applies to private patients in a public or private hospital. It does not apply to the difference between...

A Medical Gap is the difference between what your doctor charges to treat you as a private patient, the amount Medicare gives you for the service your doctor provided and the amount your health insurer contributes. It applies to private patients in a public or private hospital. How a Medical Gap works If Medicare covers...

Even if you have private health insurance, you will probably have to pay part of the cost of your treatment. Informed financial consent is a process that involves your doctor, healthcare provider, health insurer and hospital so you understand how much you have to pay out of your own pocket before your treatment. Before you...

How to make a claim on your private health insurance policy depends on your health insurer and the type of claim you are making. Making a Hospital Cover claim If you are making a claim under your Hospital Cover, your health insurer usually pays the hospital directly. On admission to hospital, you need to show...

You can avoid unexpected out-of-pocket medical costs by asking your doctor about fees in advance. Do this when consulting with them before a hospital admission or as soon as possible if you need to be admitted to hospital urgently. Here is a checklist of questions to ask your doctor and/or health insurer before agreeing to...

An out-of-pocket cost is the amount you have to pay for a medical appointment or treatment. It is sometimes called a ‘gap payment’ or ‘patient payment’. Your out-of-pocket cost is the difference between what your doctor, allied health professional or hospital charges for a service and what Medicare or your private health insurer pays for...

A co-payment is the amount you agree to pay if you have Hospital Cover and are admitted to hospital. It means you have to make a contribution each time the health insurer pays hospital benefits for you. Usually, you pay a co-payment for each day of hospitalisation up to an annual amount or admission amount....