We’re committed to delivering market leading health insurance at an affordable price. Your doctor, surgeon and anaesthetist all charge for their services separately. For most hospital services, Medicare sets an amount known as the Medicare Benefit Schedule fee (MBS), services are assessed against this. When you go into hospital, this is the amount you’re guaranteed will be covered - Medicare covers 75% of the MBS fee, and we cover the other 25%.

Some doctors, however, charge more than the MBS fee. We try and make treatment more affordable by offering Access Gap Cover. 

What is Access Gap Cover?

Access Gap Cover is a major feature of our hospital cover. If your doctor particpates in the Access Gap scheme, it can help minimise or, in some cases, eliminate out-of-pocket expenses when you go to hospital for an inpatient procedure, service or treatment.

The Access Gap Benefit is an agreed maximum amount we’ll pay up to for your doctor’s services if they’re part of the scheme. Your doctor may choose to accept this amount as full payment for your treatment, which means no out-of-pockets for you. But, if your doctor’s fee is higher than the Access Gap Benefit, you'll unfortunately have out of pocket expenses to pay.

Some doctors don’t participate in the Access Gap scheme at all, and some participate on a patient-by-patient basis. If your doctor doesn’t participate, we’ll only cover the 25% between the Medicare rebate and MBS fee. To make sure you’re fully aware of all fees to be charged prior to treatment, we recommend contacting your treating doctor to find out if they will participate in the Access Gap scheme for your treatment and to discuss fees upfront. That way, you’ll be fully prepared and aware of any out-of-pocket expenses before you go to hospital.

Effective 1 July 2024, the Australian Health Service Alliance (AHSA), which oversees the scheme for Queensland Country Health Fund and other Australian health insurers, will be amending certain items on the Access Gap Cover (AGC) schedules. Find out more

You can also find doctors who may participate in the Access Gap scheme by visiting the AHSA website.

Medical Costs Finder

The Medical Costs Finder is an initiative of the Australian Federal Government that helps you understand the cost of common medical procedures by specialist in Australia.

The online tool covers common medical services in and out of hospital that patients want to know more about. The tool’s results are based on the most recent publicly available Government data about what people have paid for medical services.

Benefits of Medical Costs Finder

You can use the tool to:

  • see how much people have paid out of pocket for a medical service
  • compare the costs estimated by your specialists and other health providers for a service with the typical costs for the same service

The tool helps you better understand what is typically paid and whether your likely out of pocket costs are high or low, compared with what others have paid for the same service.

You will also see the Medicare and any private health insurance payments, which could affect the out of pocket costs you may pay.

Getting Started

Follow the instructions on each page to step through the tool and see what a procedure typically costs

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