Medical providers

Information for medical providers on all things HBF Medical Gap.

HBF Medical Gap Schedules 1 July

Medical Gap Arrangements explained

HBF’s Medical Gap Arrangements are designed to make life easier for you and your patients. They apply to services provided in a licenced private hospital or day hospital facility (Private Hospital) only.

The arrangements allow you to choose the level of cover you want for your HBF patients. HBF offers two types of arrangements – Fully Covered (Full Cover or Specialist Anaesthetist*) and Opt In/Opt Out Known Gap.

Our Fully Covered arrangements allow your HBF patients to have no gap for your eligible Private Hospital services.

On the other hand, you may prefer our Opt In/opt Out Known Gap option which gives you flexibility around the fee charged to your HBF patients for your eligible Private Hospital services on a case by case basis.

Better patient experience, with reduced or eliminated gaps

Access to WA’s largest member base

Claiming is made easy with payment within 21 days

Help reduce bad debts

Claim electronically via Eclipse to reduce paperwork

Email your invoices for easy billing

Arrangement types

Full Cover

We will pay you an additional benefit above the MBS because you have agreed to charge no more than the rate set out in the HBF Full Cover Schedule.

You and your HBF eligible patients will benefit from the Full Cover arrangement by enjoying a 'no gap' experience for the service(s) you provide.

A ‘no gap’ experience incudes not passing on any other fees to eligible members, such as administrative fees or booking fees.

Specialist Anaesthetist

We will pay you an additional benefit above the MBS because you have agreed to charge no more than the rate set out in the HBF Special Anaesthetist Schedule.

You and your HBF eligible patients will benefit from the Special Anaesthetist arrangement by enjoying a 'no gap' experience for the service(s) you provide.

A ‘no gap’ experience incudes not passing on any other fees to eligible members, such as administrative fees or booking fees.

To be eligible to register for this arrangement you must hold an 051 anaesthesia code with Medicare.

Known Gap opt in & out

The Known Gap opt in/opt out cover arrangement gives you the flexibility to tailor your fee to each patient on an episodic basis.

You can bill as a Known Gap provider in one of three ways:

Opt-in – no gap

If you choose to charge fees that do not exceed the fee specified in the Known Gap Schedule, the account will be paid in full and the member will incur no out of pocket expenses.

Opt-in – known gap

If you choose to charge fees that do not exceed the Full Cover Schedule fee, the account will be paid up to the Known Gap Schedule fee. The out-of-pocket expense paid by the member is the difference between the Known Gap Schedule and the Full Cover Schedule.

Opt-out

If you choose to charge a fee that is greater than the Full Cover Schedule, the account will be paid up to the MBS fee. The difference between the MBS fee and your fee will be paid by the member.

For more member focused information on medical out of pockets and other hospital stay costs, visit: Understand your hospital cover

HBF Limited Surgical Items List

Item numbers on the HBF Limited Surgical Items List are excluded from all Medical Gap Arrangements and will only ever attract benefits up to the MBS scheduled fee.

Benefits for anaesthetic services associated with item numbers on the HBF Limited Surgical Items List are also excluded from the Medical Gap cover Arrangement.

HBF Limited Surgical Items List

Terms and conditions

To participate in HBFs Medical Gap Arrangements you will be required to adhere to terms and conditions, which are subject to change from time to time.

To view the latest terms and conditions that apply to you when you participate in HBFs Medical Gap Arrangements click here:

Terms and conditions

Claiming under the Medical Gap Arrangements

We understand how important it is to receive prompt payment for the medical services you provide. HBF’s direct billing options are intended to make this process as simple as possible for you.

You will benefit from using these options in a variety of ways, including:

Prompt payment
Improved cash flow
A dedicated medical claims query helpline

You can now email your accounts

Simply email your account to medicalinvoices@hbf.com.au in one of the following formats: PDF, JPG, TIF, PNG, DOC, XLS, or CSV. Make sure the account is not password or print-protected. If the account is received in a different format or protected we will be unable to process it for you.

You can use Eclipse right away if you have Eclipse software installed and are registered with HBF. Simply send your claims to HBF using fund id ‘HBF’ and claim type ‘AG’ to make a claim.

The Eclipse remittance advice (ERA) will match your Eclipse claim to the deposits made into your bank account, allowing for automated reconciliation of claims submitted this way.

Express pay is easy to use, simply send all fully unpaid accounts for private hospital services provided to eligible members directly to HBF.

The account will be processed by us and forwarded to Medicare. Within approximately 21 days of receiving the claim, we will arrange for the combined HBF and Medicare benefits to be paid directly to you via Electronic Funds Transfer.

Once completed, HBF will send you a remittance statement to your registered postal address.

How to:

HBF Medical Gap Schedules

HBF schedules may be amended from time to time to accommodate changes brought about by MBS updates and to ensure our arrangements provide the best value for both members and providers.

HBF participate with AHSA in all states except WA. If you are a registered doctor practicing outside of WA, you can find the relevant AHSA Access Gap Cover Schedule here.

Full cover & known gap Specialist anaesthetist

Download Medical Benefits Schedule 1 July 2021 (PDF) Download Medical Benefits Schedule 1 July 2021 (Excel)

Download Specialist Anaesthetists Schedule 1 July 2021 (PDF) Download Specialist Anaesthetists Schedule 1 July 2021 (Excel)

*For any earlier schedules please contact medicalgap@hbf.com.au

Common medical FAQs

You can access the arrangements for any HBF member with HBF Hospital cover (including Overseas Visitors cover) provided:

They are up to date with their premiums at the time of service/treatment.
They have served any necessary waiting periods.
The service/treatment received is covered under their policy.
They are admitted to and the service/ treatment is provided at a licensed private hospital or day hospital facility.

Yes, our full cover arrangement does not allow for you to opt in/out on a patient by patient basis. You will be required to adhere to the arrangement for all eligible members.

Eligible member means any HBF member with HBF hospital cover (including overseas visitor cover) who:

is up to date with their premiums at the time a service is provided;
has served all required waiting periods;
receives a service that is covered under their policy; and
is admitted.

All medical specialists that are licensed and accredited, that is registered with Medicare and is practicing within WA.

HBF currently participates in the AHSA (Australian Health Service Alliance) Access Gap Cover (AGC) for all other states outside of WA. For more information please visit the AHSA website to read more about the AGC Agreement.

You can add a new provider number by completing the provider registration form and sending it to medicalgap@hbf.com.au

Remember to select the same agreement type as what you already have with your other provider numbers.

If you need to cease any old provider numbers/locations, you will need to complete a change of details form, which has a section for ceasing numbers/locations.

Please make sure all forms are filled out in full and have been signed and dated by the provider.

HBF registers you for our medical gap arrangements (including additional provider locations) from the date we receive your application form. However, in extenuating circumstances, we may authorise a backdate to a maximum of 30 days.

To request a backdate, please email medicalgap@hbf.com.au outlining your reason for requesting a backdate including the date you wish your registration to start from.

Once reviewed you will be advised of the outcome.

Yes, you can. You can change your arrangement type by completing a change of agreement form listed above and emailing to medicalgap@hbf.com.au

You will be required to serve a 90 day termination period before the new arrangement comes into effect.

Changing arrangements requires 90 days’ notice to ensure your patients and our members are informed financially about any out of pocket expenses they may have and can plan accordingly.

You can change your banking or contact details by completing a change of agreement form listed above and then emailing to medicalgap@hbf.com.au

To be listed on the HBF website you will firstly need to be on our full cover or specialist anaesthetist arrangement.

Once registered as a full cover or specialist anaesthetist provider you will be automatically advertised on our medical provider search.

If you are a full cover or specialist anaesthetist and no longer wish to be listed on our website please email medicalgap@hbf.com.au and request to be removed.

You will receive confirmation once your request is actioned.

Please note: to be added or removed from the HBF website can take up to 24 hours.

Being listed on the website helps our members or their referring GPs to find your contact information easier. This ensures they can make an informed decision to choose a provider who won’t charge any out of pocket costs and is at a location that is easy for them to access.

Our medical relations team are a dedicated provider support team who are available to assist you with understanding how to bill a patient or how to choose the correct arrangement for you and your patients.

You can reach the medical relations team by emailing your query to medicalgap@hbf.com.au or contacting us on 1300 810 475 between 8am - 4pm WST, excluding public holidays.

Contact details

Our medical relations team is here to help, we are a dedicated team specifically here to assist you with your HBF medical gap queries.

Medical relations

1300 810 475 8am-4pm AWST*
medicalgap@hbf.com.au

*Monday – Friday – Closed public holidays

General Support

1300 810 475
8am-4pm AWST*

*Monday – Friday – Closed public holidays

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Medical Gap Arrangements explained

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