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Medical Gap Cover

Option 1 - Known Gap

With this option your doctor chooses to use GMHBA’s medical gap cover system - and charge a known patient gap. To participate, your doctor must inform you in writing of the cost of the anticipated services, the Medicare and GMHBA benefits and the patient gap before any treatment commences. And they must bill GMHBA direct for the GMHBA and Medicare benefits. GMHBA will arrange to pay these benefits direct to your doctor and all you need to pay is the known gap.

Option 2 - No Gap

If your doctor chooses to use GMHBA’s medical gap cover and not charge a patient gap, your GMHBA benefit, together with the Medicare benefit will fully cover the doctor’s charges. In these instances, your doctor will bill GMHBA direct, and you’ll have nothing to pay. GMHBA will arrange to pay all benefits direct to your doctor.

If others are involved in your treatment (such as anaesthetists etc.) you should ask GMHBA, your doctor or the other medical professionals if they will be using GMHBA’s medical gap cover system. If they choose not to use our medical gap cover system, you’ll still receive a combined Medicare and GMHBA benefit of up to 100% of the Medicare Schedule Fee.

Ask your doctor before treatment begins if they have chosen to participate in GMHBA’s medical gap cover system. Otherwise, visit a branch or call 1300 4 GMHBA (46422). Obviously in the case of an emergency, it may not be possible for a participating doctor to advise you of their fees in advance. Please note the participation in GMHBA’s medical gap cover by any medical practitioner is not a recommendation or endorsement by GMHBA of that practitioner.