Medibank GapCover Scheme Information

Notice Board

Revised Terms and Conditions for Medibank's GapCover Scheme

We have recently made some changes to our GapCover terms and conditions to help improve the delivery of private healthcare to our customers and strengthen our partnership with GapCover participants.

Click here to view the updated terms and conditions of our GapCover scheme, to take effect from 1 May 2017. Please note, the revised Terms and Conditions do not affect any payment terms (i.e., the timeframe in which claims for benefits are assessed and paid) or the current schedule of GapCover fees.

We have also updated the GapCover Provider Guide which includes useful operational information like registration and claims management processes.

Note, current terms and conditions will continue to be relevant until 30 April 2017.

What do you need to do?

  • The updated GapCover Terms and Conditions will apply in respect of any claims for benefit payments submitted via GapCover processes on and from 1 May 2017. You can continue to submit GapCover claims as you usually do, and you will continue to be recognised and promoted as a GapCover provider.
  • Please refer to the GapCover Information section below and complete the GapCover Application and Change of Details form if you wish to:
    • update your contact information, and/or
    • opt out of being included in the lists we or others publish of Medibank GapCover providers.
  • You can update these details or opt-out of publication at any time. Please note that even if you have previously opted-out prior to 1 Jan 2017, you will need to do so again to continue that exclusion

Note,

  • If you wish at any stage to opt in to being published as a GapCover participant, you will need to complete and submit the GapCover Application and Change of Details Form (even if you are not changing any of your contact or other details) and leave the opt-out from publication un-selected.

More Information

For more information you can contact us on 1300 130 460.

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 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.

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


GapCover Provider Guide - Effective 1 July 2012 (563 Kb)
Version Date:1 July 2012

GapCover Application and Change of Details Form (473 Kb)
Version Date:20 January 2017
This form is for GapCover applications, change of details and opt out of publishing.

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

GapCover Terms and Conditions - Effective 1 May 2017 (345 Kb)
Version Date:21 March 2017

GapCover Provider Guide - Effective 1 May 2017 (695 Kb)
Version Date:1 May 2017

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

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