Media releases

June 5, 2001

Medibank Private gap payments on the rise

Medibank Private’s "GapCover" payouts - which are designed to help minimise, even eliminate out-of-pocket medical expenses - have soared almost eight-fold in 12 months.

Australia’s largest health fund paid almost $60.5 million in the year to February - well up on the $7.5 million paid out in the corresponding year prior � with some 308,000 fund member having no gap costs for in-hospital medical procedures.

The medical gap is the difference between the fee patients are charged by their specialists and doctors for in-hospital procedures and the total benefits they receive from Medicare and their private health insurance fund.

These fees are separate from accommodation and other service fees.*

Under GapCover, doctors conducting in-hospital procedures can choose to charge either a "no" or "known" gap and can do so from episode to episode.

The $60.5 million represents 4 per cent of the $1.4 billion in total benefits paid out by Medibank Private between Feb 2000 and Feb 2001.

On a state-by-state basis, the health fund paid over $27.6 million in gap benefits to Victorian members, over $12.7 million to Queensland members, almost $11 million to NSW and between $600,000 and $2.5 million in other states.

$60.5M$27.6M$12.7M$11 M$4.8M$2.6M$1.2M$600,000

Commenting on the latest gap payment figure, Medibank Private chief operating officer, Mike Whelan, says it is a wonderful result for members given that medical gaps remain one of the most vexing issues facing private health insurance holders.

Mr Whelan believes that the success in the reduction and elimination of out of pocket expenses is closely linked to the growing number of doctors that support gap arrangements.

Since the introduction of Medibank Private’s "GapCover" scheme in November 1999 � which was followed by a further enhanced scheme late last year � there has been a huge uptake in the number of doctors who have used the schemes.

Currently, this figure is at over 4,300 doctors nationally.

Says Mr Whelan: "The implementation of our GapCover schemes and other gap arrangements have also seen the number of in-hospital procedures which did not incur out of pocket expenses, increase to 72 per cent.

"We’re hopeful of this figure reaching the 80 per cent mark by the end of the year," he says.

Of the 4,300 doctors who currently charge under Medibank Private’s no and known gap arrangements for hospital procedures, over 90 per cent charge no gaps and less than 10 per cent, a known gap.

Over 90 per cent of known gaps are less than $300.

Medibank Private’s GapCover scheme is automatically available to the majority of fund members, excluding only those who hold Public/Basic Hospital cover, Overseas Visitors Cover and Overseas Student Health Cover.

* Co-payments and excesses (where applicable) only apply to hospital accommodation and other hospital charges and do not apply to in-hospital medical procedures.

Back to top