Out-of-pocket expenses (gaps)
A 'gap' is the amount you pay for medical charges, over and above what you get back from Medicare and your health fund. While all health funds have gaps, we work with hospitals and doctors to keep your out-of-pocket expenses as low as possible.
Before you go to hospital, you should ask your doctor for an estimate of their costs for your in-hospital treatment, if there will be other doctors involved in your care (for example anaesthetist, assistant surgeon) and what their charges will be. They need to provide you with the item numbers for your treatment so when you phone us, we can provide you with a benefits quote.
Many hospitals have arrangements with health funds to fully or partially cover costs relating to hospital accommodation. If you go to a hospital that does not have an agreement with your health fund, you may face significant out-of-pocket expenses for your treatment.
If your health insurance policy has an excess or co-payment, you will have to pay the agreed amount of excess or co-payment towards the cost of hospital treatment out of your own pocket, even if your hospital has an agreement with HBF.
The good news for HBF members is they are fully covered for 82% of medical treatments in WA hospitals – that’s higher than the industry average.
Where there are unavoidable gaps, we have GapSaver. A unique and fantastic way for you to build up benefits to cover both Hospital and Extras out-of-pocket expenses.
You can pay an additional premium for GapSaver cover, which accrues quarterly and accumulates year after year until you use it. The benefit continues to roll over if you don’t use it, and you can use your GapSaver benefits for as long as you have HBF health cover (they don’t expire each year). GapSaver helps cover things such as hospital co-payments, hospital excess and out-of-pocket expenses for dental, optical and physio.
GapSaver can be added to most Hospital, Packages or Extras policies and there are four levels to choose from. Singles can choose to build $100, $200, $400 or $600 in GapSaver benefits each year. Couples and families can build $200, $400, $800 or $1200.
If you’re eligible for the Australian Government Rebate on private health insurance, you could build more benefits than you pay in premiums. This makes GapSaver a great way to reduce your healthcare costs.
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