GapCover

Simply complete the GapCover form.  Note that when you register for GapCover, you will be registered with both Medibank and ahm.

Please contact us through web messaging or via our provider line on 1300 130 460 to complete this process and access the form.

View step-by-step instructions and further information on making a claim here: 

How to make a GapCover claim

The Department of Health makes regular changes to items and fees on the Medicare Benefits Schedule, so we recommend you review the rates regularly.

You can access both current and previous rates below: 

Current GapCover rates

Previous GapCover rates

You can check whether a Medibank or ahm member is eligible for GapCover easily with our interactive voice response enquiry service (IVR). 

To make the check, you will need your patient’s membership number and their date of birth.

1. Call our Medical Enquiry Line on 1300 130 460
2. Select 1 to be connected to IVR
3. Enter the GapCover access code: 540 300
4. Enter the patient’s membership number and date of birth. The IVR instructions will guide you through the process and if necessary, transfer you to one of our staff.

Please make sure that the admitting hospital has completed a separate eligibility check to confirm private health insurance benefits for the hospital admission.

The maximum member out of pocket on GapCover claims is $500 per account.  This is irrespective of the number of items or claim lines in the account for the relevant episode of care.

You may not bill a customer for any additional charges such as administration fees, booking fees, fees for arranging the member’s admission to hospital, etc., that have no Medicare rebate. 

Informed Financial Consent 

You need to provide our members with a written estimate of fees for each hospital admission and they must give their agreement to any out-of-pocket costs. For scheduled admissions, this should happen at the earliest opportunity before the admission. For all other admissions, this should happen as soon after the admission as circumstances reasonably allow. 

For more information on Informed Financial Consent, click here.

Please contact us through web messaging or via our provider line on 1300 130 460 to complete this process and access the relevant application form.

Please note that if you seek to update bank account details, we will ask you to confirm your current bank account details as part of the validation process.

GapCover batch header

GapCover provider guide

Terms and Conditions of using the Medibank GapCover scheme