Closing the gap
Access Gap Cover
Should you need specialist care in hospital, and your doctor chooses to use Defence Health's Access Gap Cover you will incur no out-of-pocket expenses, or you will know exactly how much you will have to pay prior to treatment.
If your specialist charges more than the Access Gap Cover fee, then you pay the difference. Co-payments are capped at the Australian Medical Association schedule fee, or $400 per item, whichever is the lesser. Obstetricians may charge a co-payment of up to $800 above the Access Gap Cover amount for Management of Labour and Delivery as defined in the Medicare Benefits Schedule.
To be eligible for Access Gap Cover benefits the doctor's account must be suitably endorsed, show financial consent for any known-gap amounts, and instruct the patient to send the claim directly to their health fund. We will take care of the rest including the Medicare portion.
If sent to Medicare first you may experience significant delays before Access Gap Cover benefits can be paid. Your doctor can bill Defence Health directly, making it even easier for you.
It is your doctor's choice to use Access Gap Cover. Your relationship with your doctor and the treatment you receive will not change - Defence Health however can only pay the lower Default Medical "Gap" Benefits if your doctor chooses not to treat you as an Access Gap Cover patient.
For more information, download the Access Gap Cover brochure.