Information on Medibank Private GapCover Information

Notice Board

Patient Eligibility Checks for the GapCover Scheme

Interactive Voice Response (IVR) is used to interact with health providers through a series of voice commands. Medibank uses the IVR technology on its Medical Enquiry Line to enable prompt patient eligibility checks of private health insurance cover for proposed medical procedures and suitability for the GapCover scheme. As a provider, we know this service is important to you in providing access to timely patient eligibility information.

You can now conduct patient eligibility checks at any time as the Medical Enquiry Line is available 24 hours a day.

Follow these simple steps to use the IVR system
  • Call the Medical Enquiry Line on 1300 130 460
  • Select option 1
  • Enter the GapCover Access Code – 540 300
  • Follow the prompts to enter patient details

Please ensure the admitting hospital has completed a separate check to confirm a member’s eligibility for private health insurance benefits in relation to the proposed hospital admission.

For further information, please refer to ‘Payment of Benefits’ in the GapCover Provider Guide (click here).

The GapCover Schedule of Benefits as at 1 November 2016

The GapCover Schedule of Benefits is indexed in line with the Medicare Benefits Schedule (MBS). The GapCover Schedule has been updated to reflect the indexation of the MBS from 1 July 2014.

The changes that took effect as at 1 November 2016 are listed below:

  • New MBS items 12025, 12026 and 12027 have been added for epicutaneous patch testing services provided by consultant.
  • New MBS item 11219 has been added for optical coherence tomography.

The GapCover Schedule of Benefits as at 1 December 2016

The GapCover Schedule of Benefits is indexed in line with the Medicare Benefits Schedule (MBS). The GapCover Schedule has been updated to reflect the indexation of the MBS from 1 July 2014.

The changes that took effect as at 1 December 2016 are listed below:

  • New item 11220 listed onto the MBS for optical coherence tomography for the assessment of the need for further treatment following PBS-subsidised ocriplasmin.
  • Description for item 11219 was amended to reflect the listing on the Pharmaceutical Benefits Scheme (PBS) of aflibercept to treat branch retinal vein occlusion and ocriplasmin to treat vitreomacular traction.

Medibank members

If you’re interested in obtaining information about GapCover you can read about GapCover or search for a GapCover provider.

Doctors and their staff

Access our most recent notifications on our Notice Board or download useful forms and information (pdf) under GapCover Information.


New GapCover claim processing system

New version of the GapCover Batch Header is available

Informed Financial Consent and Eclipse Claims

GapCover claims to be paid by EFT only

Payment for Online Claiming via ECLIPSE

Known Gap

GapCover Accounts – Medicare and Referring Provider Numbers

Ceasing patient-submitted GapCover claims

Revised Gap Cover Rates effective 1st Jan 2016


GapCover Information


Gap Cover Rates – 1 December 2016 (308 Kb)
Version Date:1 December 2016
Gap Cover Rates – 1 December 2016

Gap Cover Rates – 1 November 2016 (308 Kb)
Version Date:1 November 2016
Gap Cover Rates – 1 November 2016

Gap Cover Application and Change of Details Form (473 Kb)
Version Date:20 January 2017
This form is for Gap Cover applications and Gap Cover changes of details only.

GapCover Batch Header (86 Kb)
Version Date:1 November 2011
.

GapCover Booklet (563 Kb)
Version Date:1 July 2012
.

Revised Gap Cover Rates effective 1 Jan 2016 (1029 Kb)
Version Date:1 January 2016
Revised Gap Cover Rates effective 1 Jan 2016 - PDF Version