Medibank GapCover Scheme Information

Notice Board

We have recently made some changes to our GapCover terms and conditions to help improve the delivery of private healthcare to our 3.8 million 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.

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 you need to do

By continuing to participate in GapCover by making claims under the scheme, you consent to the revised Terms and Conditions, and no further action is required. You will be recognised as a GapCover provider and promoted as such.

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 in or out of your practice’s information being published as a GapCover participant.


  • If you had previously opted out prior to 1 Jan 2017, you will need to do so again for the revised Terms and Conditions, by completing the GapCover Application and Change of Details form

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