Reduce your medical gap

Reduce your medical costs

Your doctor, surgeon, anaesthetist, pathologist or radiologist will all charge for their services separately to your hospital accommodation charge. Their fees are known as medical expenses.

These medical expenses are assessed against the Medicare Benefits Schedule (MBS) fees, which are set by the government. If you are admitted to hospital as a private patient, Medicare will pay 75% of the MBS fee for your medical expenses. Defence Health will pay the remaining 25% of the MBS fee.

Some doctors charge more than the MBS fee. This can result in out-of-pocket expenses. Defence Health hospital cover can help reduce or avoid these extra expenses through no-gap agreements and the Access Gap scheme.

Access Gap

Minimise out-of-pocket medical expenses

If you are about to go to hospital, please ask your doctor to use the Defence Health Access Gap scheme. It is a major feature of our hospital cover that can save you money.

Under this scheme, Defence Health will pay a higher amount to your doctor if he or she agrees to charge a no-gap or known gap fee to you. If your doctor agrees, the most you will be out-of-pocket is $400 for each Medicare item number or $800 for obstetric services. 

Your doctor must inform you of the total of any out-of-pocket expenses you will have to meet before you go to hospital. We strongly encourage you to ask your doctor to use Access Gap.

Search for doctors who participate in Access Gap.

No-gap agreements

Defence Health has negotiated no-gap agreements with a number of diagnostic service providers, such as radiologists and pathologists. If you receive these services in hospital from a provider with whom we have a no-gap agreement, they will send the bill directly to Defence Health for payment.

For more information, check out the Access Gap brochure.