Access Gap Cover

In the past, large out-of-pocket expenses were often part of any hospital stay for people with private health insurance. To help improve this, ACA Health offers you the Access Gap Cover Scheme.

How benefits for doctors' fees work

Medical (doctor/specialist) services provided to hospital in-patients are charged separately from hospital accommodation/theatre fee charges. Medicare pays 75% of the Medicare Schedule Fee and ACA Health pays the remaining 25%.

Some doctors charge an amount above the Medicare Schedule Fee. These costs are generally referred to as out-of-pocket expenses, and in the past, health funds were unable to pay benefits on these amounts.

Now, out-of-pocket doctor/specialist expenses for hospital inpatients can be eliminated completely or dramatically reduced with our "Access Gap Cover" payment and billing scheme.

How "Access Gap Cover" cover can work for you

Doctors/specialists who choose to participate in the "Access Gap Cover" scheme agree to charge for services with either no out-of-pocket expenses or a predetermined amount, which is capped. In return, ACA Health can pay the doctor above the Medicare Schedule Fee.

Already a significant and growing number of doctors/specialists are utilising "Access Gap Cover" to bill patients. So if you or a family member requires treatment in a hospital or same-day surgery, discuss "Access Gap Cover" with your doctor or referring doctor. It could save you paying more than you have to.

ACA Health has "Access Gap Cover" arrangements with over 11,000 Doctors Australia wide, established on our members' behalf by the Australian Health Service Alliance (AHSA). You can find out which doctors are using the scheme by clicking on the link above. Not all doctors in the scheme have agreed to have their names listed, so keep this in mind when you are looking.

All our hospital products include "Access Gap Cover" automatically, so you don't have to pay any more for this extra benefit.

Finally, the doctor will usually lodge your claim for you - making the whole process even easier.

Please note: ACA Health is unable to provide recommendations on health care providers, and thus the search function is not intended as a list of "preferred providers".