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Gap Cover |
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Australian Unity now offers Gap Cover for most hospital covers, Gap Cover
has been designed to eliminate or reduce the out-of-pocket costs associated
with hospital treatment.
When you are treated by your doctor in a hospital or day surgery, Medicare
covers 75% of the Government schedule fee and Australian Unity pays the
remaining 25%. However, some doctors charge above the Government schedule
fee and you are usually required to pay this difference. This out-of-pocket
cost is referred to as ‘the gap’.
Australian Unity Gap Cover seeks to reduce or eliminate the gap, resulting
in less out-of-pocket costs to you. Just as importantly, it maintains freedom
of choice in your selection of doctor, hospital and treatment. It also recognises
the right of medical practitioners to exercise their own clinical judgement.
Australian Unity has set its own schedule of fees which is generally higher
than the current Government schedule of fees. If your doctor chooses to
charge using our schedule of fees, there will be no out-of-pocket cost for
you. Alternatively, your doctor may choose to charge a co-payment, which
is the amount charged above the fee set out in our schedule. This co-payment
will be an out-of-pocket cost for you. When a doctor charges a co-payment,
they must inform you in writing of the charge prior to treatment.
Participating doctors will generally send their accounts directly to Australian
Unity, so not only does it cost you less, it's easier too. However, if your
doctor chooses to use our schedule and gives the account to you, you must
submit it directly to Australian Unity and not to Medicare.
Gap Cover applies to all Australian Unity hospital tables with the exception
of the Basic Hospital and Healthy Travel tables.
Gap Cover can be applied to all treatments provided by doctors in a hospital
or day surgery, that have a Medical Benefits Schedule item number. It does
not apply to services for illnesses or conditions that are specifically
excluded from some health insurance tables.
Participation in Gap Cover is open to all doctors who treat patients in
hospitals or day surgeries. Doctors are free to choose whether or not they
want to participate. Australian Unity will be working hard to encourage
doctors to participate and provide widespread benefits for our members.
Use the
Gap Cover search
to find a doctor in your area.
You should ask your doctor whether he/she is using Gap Cover. You should
also raise the issue with your GP prior to obtaining a referral to a specialist.
Download and print this brochure
and give it to your doctor at your first appointment. (You will require
Adobe Acrobat to view the brochure - install Adobe Acrobat.
If your doctor hasn’t previously heard of Gap Cover they can contact Australian
Unity and we will provide them with the details.
If you have any questions about our Gap Cover, please telephone Australian
Unity on 13 29 39 8:30am-8:30pm Australian Eastern Standard Time, Monday-Saturday Australia-wide.
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