Medibank GapCover Scheme Information

Important information

Medibank are working towards moving away from accepting provider refunds via cheque and from issuing cheques to providers for claim benefits. Instead, we’ll use Electronic Funds Transfer (EFT) to get payments to you faster – 2 to 3 business days.

What happens next?

You’ll need to provide your EFT details, which can be done in 3 simple steps:

  1. Go to GapCover Application and Change of Details Form
  2. Complete the registration form
  3. Save and send the completed form to


The GapCover Rates for 1 March 2022 is now available. The Department of Health has made changes to items and fees on the Medicare Benefits Schedule. To align with these changes, Medibank has also updated their GapCover benefits. To view and download the GapCover rates 1 March 2022, please see the ‘Current GapCover Rates’ section below. If you have any questions about the changes to the Medicare Benefits Schedule, please go to MBS online. for further information. If you have any questions about changes to Medibank`s GapCover Schedule please, contact us on 1300 130 460.

Changes to Information Published for GapCover Providers 

We know that our customers are concerned about the cost of their hospital admission and we are supporting them to have better conversations with their treating doctor about out-of-pocket costs.

We are including additional information about GapCover participation for most doctors and specialists that have not opted out to being published on the Medibank Find a Provider website. Customers will be able to find out the percentage of hospital claims the doctor or specialist charged no out-of-pocket, charged an out-of-pocket of up to $500 or charged an out-of-pocket of more than $500.

This information is published in accordance with the GapCover Terms and Conditions

The information on GapCover participation will support our customers to make the best decisions about their health and about what, if any, out-of-pocket costs they might face when admitted to the hospital.

Please contact us for further information about GapCover on 1300 130 460.

Changes to In-patient Medical Claims (IMC) submitted as a GapCover claim

The Department of Human Services (the Department) will implement changes to the way they pay Private Health Insurers. Learn more

GapCover Application and Change of Details form

For GapCover registrations and any other change of details you want to make, simply fill out the GapCover Application and Change of Details forms and email to our dedicated mailbox

What do you need to do?

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 that took effect on 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.

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.

GapCover Schedule of Benefits

The GapCover Schedule of Benefits is indexed in line with the Medicare Benefits Schedule (MBS).

Please refer to the Department of Human Services website for further information on the MBS -

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 the relevant option on IVR

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).

Doctors and their staff

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

GapCover Information

GapCover Application and Change of Details Form (785KB)

Version Date: 01 April 2021

This form is for GapCover applications, change of details and opt-out of publishing.

GapCover Batch Header (86KB)

Version Date: 1 November 2011

GapCover Terms and Conditions - Effective 1 May 2017 (345KB)

Version Date: 1 May 2017

GapCover Provider Guide - Effective 14 May 2018 (695KB)

Version Date: 14 May 2018

Current GapCover Rates

GapCover Rates - 1 March 2022 (525KB)

Version Date: 1 March 2022

Previous GapCover Rates

GapCover Rates - 1 November 2021 (520KB)

Version Date: 1 November 2021

GapCover Rates - 16 August 2021 (522KB)

Version Date: 16 August 2021

GapCover Rates - 1 July 2021 (522KB)

Version Date: 1 July 2021

GapCover Rates - 1 March 2021 (492KB)

Version Date: 1 March 2021

GapCover Rates - 1 November 2020 (154KB)

Version Date: 1 November 2020

GapCover Rates - 1 August 2020 (152KB)

Version Date: 1 August 2020

GapCover Rates - 1 July 2020 (151KB)

Version Date: 1 July 2020

GapCover Rates - 1 May 2020 (147KB)

Version Date: 1 May 2020

GapCover Rates - 1 March 2020 (147KB)

Version Date: 1 March 2020

GapCover Rates - 17 January 2020 (144KB)

Version Date: 17 January 2020

GapCover Rates - 1 November 2019 (144KB)

Version Date: 1 November 2019

GapCover Rates - 1 July 2019 (144KB)

Version Date: 1 July 2019

GapCover Rates - 1 May 2019 (144KB)

Version Date: 1 May 2019 

GapCover Rates - 1 April 2019 (144KB)

Version Date: 1 Apr 2019

GapCover Rates - 8 March 2019 (144KB)

Version Date: 8 Mar 2019 

GapCover Rates - 1 March 2019 (144KB)

Version Date: 1 Mar 2019 

GapCover Rates - 1 January 2019 (143KB)

Version Date: 1 Jan 2019

GapCover Rates - 1 November 2018 (143.7KB)

Version Date: 1 Nov 2018

GapCover Rates - 1 October 2018 (200KB)

Version Date: 1 Oct 2018

GapCover Rates - 1 July 2018 (203KB)

Version Date: 1 July 2018

GapCover Rates - 1 May 2018 (152KB)

Version Date: 1 May 2018

GapCover Rates - 1 April 2018 (148KB)

Version Date: 1 April 2018

GapCover Rates - 1 December 2017 (166KB)

Version Date: 1 December 2017

GapCover Rates - 1 November 2017 (166KB)

Version Date: 1 November 2017

GapCover Rates - 1 May 2017 (166KB)

Version Date: 1 May 2017

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