GapCover
The Medibank GapCover scheme is a medical gap scheme offered by Medibank and ahm.
GapCover aims to reduce or eliminate our members’ out-of-pocket medical expenses for a hospital stay. In return, we pay providers higher rates for most MBS item numbers.
Simply complete the GapCover form. Note that when you register for GapCover, you will be registered with both Medibank and ahm.
Please contact us through web messaging or via our provider line on 1300 130 460 to complete this process and access the form.
View step-by-step instructions and further information on making a claim here:
The Department of Health makes regular changes to items and fees on the Medicare Benefits Schedule, so we recommend you review the rates regularly.
You can access both current and previous rates below:
You can check whether a Medibank or ahm member is eligible for GapCover easily with our interactive voice response enquiry service (IVR).
To make the check, you will need your patient’s membership number and their date of birth.
- Call our Medical Enquiry Line on 1300 130 460
- Select 1 to be connected to IVR
- Enter the GapCover access code: 540 300
- Enter the patient’s membership number and date of birth. The IVR instructions will guide you through the process and if necessary, transfer you to one of our staff.
Please make sure that the admitting hospital has completed a separate eligibility check to confirm private health insurance benefits for the hospital admission.
The maximum member out of pocket on GapCover claims is $500 per account. This is irrespective of the number of items or claim lines in the account for the relevant episode of care.
You may not bill a customer for any additional charges such as administration fees, booking fees, fees for arranging the member’s admission to hospital, etc., that have no Medicare rebate.
Informed Financial Consent
You need to provide our members with a written estimate of fees for each hospital admission and they must give their agreement to any out-of-pocket costs. For scheduled admissions, this should happen at the earliest opportunity before the admission. For all other admissions, this should happen as soon after the admission as circumstances reasonably allow.
For more information on Informed Financial Consent, click here.
Please contact us through web messaging or via our provider line on 1300 130 460 to complete this process and access the relevant application form.
Please note that if you seek to update bank account details, we will ask you to confirm your current bank account details as part of the validation process.
Terms and Conditions of using the Medibank GapCover scheme
ECLIPSE is the in-patient claiming system developed by Medicare Australia. It enables providers, health insurers and Medicare to exchange and pay claims electronically.
To register for ECLIPSE or find out more, contact the Medicare Australia eBusiness Service Centre on 1800 700 199 or email co.eclipse@medicareaustralia.gov.au.
Contact us through web messaging or via our provider line on 1300 130 460 to access the relevant form.
No. Our GapCover rates are the same for both.
You can find a list of the common Medicare rejection codes in our GapCover provider guide.
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COVID-19 Health Assist - Expression of interest
Complete this form to express your interest in one of our programs. If you're eligible, a member of our team will call you within 2-3 business days.
What program are you interested in?
Sorry, only members with current Hospital cover are eligible to participate in these programs
Eligible Medibank members with Extras cover are able to access a range of telehealth services included on their cover - you can find out more here. Alternatively, if you would like to talk to one of our team about your cover, we're here on 132 331.
Your membership details
Please provide your details so we can know how to contact you.
Your contact details
By clicking Submit, I understand that Medibank or its subsidiaries may contact me to discuss my eligibility for the Covid-19 Heath Assist program(s), and will disclose my personal information within the Medibank Group of companies and to third party service providers. Please see Medibank’s privacy policy for further information about how Medibank will handle my personal information, and how to contact Medibank: https://www.medibank.com.au/privacy/
Thank you for expressing your interest in one of our COVID-19 Health Assist programs.
If you are eligible, one of our health professionals will call you in 2-3 business days to discuss your situation and help to enrol you in the relevant program.
There is no cost to participate, however some referred services may incur an out of pocket cost.