HBF's Medical Gap Cover-in-hospital services

What is the medical gap?

The Medical Gap is the difference between the Medicare Benefit Schedule (MBS) set by the Federal Government, and the amount Medical Practitioners charge for services provided to private patients admitted to a hospital or day hospital facility.

Medicare covers 75% of the MBS fee for private in-hospital medical services and, if you have HBF Hospital cover (except HBF Basic Hospital cover), HBF pays the remaining 25%.

This means that there is no Medical Gap to pay when your Medical Practitioner charges no more than the MBS fee.

However, many Medical Practitioners do charge more than the MBS fee. It is this amount above the MBS fee that is known as the Medical Gap. Having HBF Hospital cover (except Basic Hospital), means you can substantially reduce the gap or avoid having to pay the gap at all.

When will HBF cover the Medical Gap?

All HBF Hospital policies, except Basic Hospital cover, include HBF's Medical Gap cover. This cover could either eliminate or substantially reduce your medical out of pocket expenses for in-hospital treatment provided by a wide range of Medical Practitioners in Western Australia.

HBF's Medical Gap cover applies for treatment provided when you are admitted to a hospital or day hospital. However, limitations and exclusions do apply for some plastic and reconstructive surgery items, and for treatment that is specifically excluded from your level of cover.

It is important to note that HBF is unable to pay benefits for medical fees charged for services provided out of hospital, such as consultations in a Medical Practitioner's rooms.

In certain cases such as maternity, you may have substantial out of pocket expenses for visits to your Medical Practitioner, both before and after hospitalisation. These out of pocket expenses arise when the Medical Practitioner charges fees that are higher than the benefit that Medicare will pay for out of hospital services (The amount Medicare will pay for out of hospital services is 85% of the fee listed in the MBS).

How do I find out if I'm covered by HBF's Medical Gap?

We can tell you if your Medical Practitioner is Fully Covered or Known Gap Covered by HBF. Simply call us on 133 423 or visit an HBF Service Centre BEFORE your hospital stay. Or, search HBF Fully Covered Medical Practitioners.

To find out more about HBF's Medical Gap cover, how to save on out of pocket hospital expenses, or for information to help you prepare for your hospital stay please refer to the following:

• Explaining the Medical Gap
• Preparing for your hospital stay
• HBF's GapSaver