Gold, Silver and Bronze Hospital
In the event that your doctor chooses to use GMHBA’s medical gap cover and where the actual fee for the anticipated service is greater than the MBS fee, an additional medical gap benefit will be paid equal to 20% of the MBS fee for each service*.
GMHBA's medical gap cover options
If your doctor or specialist is one of more than 14,000 who choose to participate in GMHBA's medical gap cover system, two options are available for our Hospital products:
Option 1 - Known Gap
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. They must bill us direct for the GMHBA and Medicare benefits. We'll arrange to pay these benefits direct to your doctor and all you’ll need to pay is the known gap.
Option 2 - No Gap
If your doctor chooses to use our medical gap cover and not charge a patient gap, your GMHBA benefit and the Medicare benefit will fully cover the doctor's charges. In these instances, your doctor will bill us direct and you'll pay nothing.
If other doctors are involved in your treatment (such as anaesthetists) 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, you will still receive a combined Medicare and GMHBA benefit of up to 100% of the MBS fee and (if applicable) any GMHBA member ‘Connect Rewards Plus’ dollars you may have accrued for medical out of pocket costs that exist. The participation in GMHBA’s medical gap cover by any medical practitioner is not a recommendation or endorsement by GMHBA of that practitioner.