Save on medical bills

Choose an HBF Member Plus hospital

We partner with a large network of HBF Member Plus hospitals across Australia, to help keep your out-of-pocket costs to a minimum.

With HBF Member Plus hospitals, you’ll be covered for accommodation and theatre fees for all agreed services on your policy, less any co-payment or policy excess.

Find an HBF Member Plus hospital

Choose an HBF Member Plus provider

In addition to HBF Member Plus hospitals, we also have agreements with thousands of specialists.

Outside of Western Australia, HBF participates in the Australian Health Service Alliance (AHSA) Access Gap Cover (AGC) arrangement.

If your specialist participates in the AGC arrangement, they have the option to opt-in or opt-out of the arrangement on a case by case basis. They have the option of billing one of three ways:

1. No Gap
   Your specialist will charge up to the AGC schedule fee and HBF will pay an additional amount above the Medicare Benefit Schedule (MBS), leaving you with no out-of-pocket expense for your inpatient services.
2. Known Gap
   If your specialist chooses to charge a “known gap” under the AGC agreement, you will charge up to the maximum agreed fee. HBF will pay an additional amount above the MBS, leaving you with a maximum out-of-pocket expense of $500 (or $800 for obstetric services).
3. Opt-out or no agreement
   If your specialist chooses to opt-out of the arrangement or are not registered to participate in an arrangement, their in-patient services will be covered up to the MBS fee. You will need to pay the difference between the MBS fee and the specialist’ fees (this is your out-of-pocket expense).

Find an HBF Member Plus provider

Medical gap

You might have heard of the Medicare Benefit Schedule (MBS). This is a list of the medical procedures Medicare covers, as well as what they’ll pay towards treatment.

When you are admitted to hospital as a private patient, your specialist’s bills will be covered up to the MBS fee. Medicare will cover 75% of the MBS fee, while we will cover the remaining 25%. An out-of-pocket cost occurs when there is a difference between your specialist’s fees and the combined benefit provided by Medicare and HBF.

To help eliminate or reduce these out-of-pocket costs for you, HBF participates in the Australian Health Service Alliance (AHSA) Access Gap Cover (AGC) arrangement for all states outside of Western Australia.

If your specialist participates in the AGC arrangement, they have the option to opt-in or opt-out of the arrangement on a case by case basis. When your specialist chooses to opt-in to AGC they have the option of billing one of two ways:

 

Please note: Even if you’re booked into an HBF Member Plus hospital, it doesn’t mean your specialist, anaesthetist, hospital or pharmacy fees will automatically be fully covered. Call us on 133 423 before you book to make sure you know what you’re covered for.

Talk to us before your treatment

We know your cover inside out, so be sure to contact us before you book a hospital stay or significant medical treatment and we’ll do everything we can to help you reduce your out-of-pocket costs, and ensure you have all the information you need to make the best choice for you.

Don’t forget to ask for a quote from your specialist and discuss how they can help reduce your out-of-pocket costs, too.