Medical providers

Information for medical providers on all things HBF medical gap.

Medical gap arrangements

HBF’s medical gap cover arrangements are designed to make life easier for you and your patients. They apply to services provided in a licensed 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 payments 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.

What’s in it for you?

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

Arrangement types

Full cover

The full cover arrangement is a ‘no gap’ arrangement.

As a full cover provider, you are agreeing to charge all eligible HBF members fees which do not exceed the fee specified in the HBF Full Cover Schedule. HBF will pay you an additional benefit above the MBS, fully covering the difference between your fee and the Medicare Benefits Schedule fee resulting in a no gap experience for the member.

When providing services under the fully covered options, the total fee for the service(s) includes all fees associated with or otherwise relevant to the service(s) such as administration or booking fees.

Specialist anaesthetist

The specialist anaesthetist arrangement is a ‘no gap’ arrangement.

As a specialist anaesthetist provider, you are agreeing to charge all eligible HBF members fees which do not exceed the fee specified in the HBF Specialist Anaesthetist Schedule. HBF will pay you an additional benefit above the MBS, fully covering the difference between your fee and the Medicare Benefits Schedule fee resulting in a no gap experience for the member.

To be eligible to register on the specialist anaesthetist arrangement you must hold an 051 anaesthesia specialty code with Medicare.

When providing services under the fully covered options, the total fee for the service(s) includes all fees associated with or otherwise relevant to the service(s) such as administration or booking fees.

Known gap opt in & out

The known gap opt in/opt out cover arrangement allows you flexibility to adjust the fee you charge for each individual patient.

As a known gap provider, you can elect to bill in one of three ways on an episodic basis:

  1. Opt-in – no gap

  2. You elect 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 have no out of pocket expense.

  3. Opt-in – known gap

  4. You elect to charge fees that do not exceed the fee specified in the Full Cover Schedule, the account will be paid up to the fee specified in the Known Gap Schedule. The difference between the Known Gap Schedule fee and the Full Cover Schedule fee is the out of pocket expense the member pays.

  5. Opt-out

  6. You elect to charge a fee that exceeds the fee specified in the Full Cover Schedule, the account will be paid up to the MBS fee. The member is required to pay the difference between the MBS fee and your fee.

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 that obtaining prompt payment for the services you provide is important. HBF’s express pay is designed to make this process easier for you. Using express pay will provide you with a number of advantages, including:

  • Prompt payment
  • Improved cash flow
  • Dedicated medical claims query helpline.

As an HBF Medical Gap provider, you will be registered as a direct billing provider under HBF’s simplified billing system (express pay). Alternatively, you may submit claims electronically through Eclipse.

Express pay

Express pay is easy to use, all you need to do is forward all fully unpaid accounts for private hospital services provided to eligible HBF members directly to HBF.

HBF will process the account and forward it to Medicare. We will arrange for the combined HBF and Medicare benefits to be paid directly to you by Electronic Funds Transfer within approximately 21 business days of receiving the claim.

HBF will forward a detailed statement to you for your records.

Eclipse

If you have Eclipse software installed and are registered with HBF, you can use Eclipse straight away. To claim through Eclipse simply send your claims to HBF using Fund ID ‘HBF’ and claim type ‘AG’.

For claims submitted electronically via Eclipse, the Eclipse remittance advice (ERA) will match your Eclipse claim to the deposits made into your bank account allowing for automated reconciliation.

How to:

HBF Medical Gap Schedules

HBF schedules may be amended from time to time to accommodate changes as a result of MBS updates and to ensure our arrangements are delivering the best value for both members and providers.

HBF participates 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.

Common medical FAQs

Who is eligible for HBF medical gap cover?

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.

If I register for the full cover arrangement, do I need to adhere to the arrangement with all HBF patients?

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.

Who can register for an HBF medical gap arrangement?

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

What arrangement can I register on if I am practising outside of Western Australia (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.

I already have an arrangement with HBF. How do I register a new provider number?

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.

I am no longer practising at a location, how can I cease my provider number?

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.

Can I have my arrangement backdated?

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. 

Can I change the type of arrangement I’m currently on?

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.

Why does it take 90 days to change arrangements?

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.

How can I update my bank account or contact details?

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

Can I be listed as a provider on the HBF website?

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.

I don’t want my details to be advertised on the HBF website, how can I have them removed?

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.

What are the benefits of being listed on the website?

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.

I am having some trouble understanding the arrangements who can I contact for help?

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 08 9265 6378 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

(08) 9265 6378 8am-4pm AWST*
medicalgap@hbf.com.au

*Monday – Friday – Closed public holidays