Gap Cover

A Choice of Cover for Doctors' Bills


One of the most important components of hospital insurance is the cover for medical services expenses during hospital treatment.

The cover provided by different funds delivers different outcomes for patients. Most Australian health insurers pay full benefits on between 75% - 91% medical services delivered to patients. The remainder of patients are paid only the Medicare schedule benefit. 

Whether your priority is

  • financial protection when there is a healthcare incident in your life, or 
  • cover at a price that fits your perceived risk, or 
  • looking after your health well

you'll find The Doctors' Health Fund is unique among Australian health insurers as it offers two types of gap cover for medical services during hospital treatment. This allows you to choose which will best suit your needs and expectations of hospital insurance.

The Doctors' Health Fund gap schemes

Real Top Cover for hospital - Unique, with benefits based on AMA List fees

Our premium hospital cover, Top Cover,  includes medical gap cover which pays benefits on every medical services bill. This gives you complete choice of doctor. Medical benefits for covered services may be paid under the Access Gap Cover Scheme for the first 12 months if you are upgrading your cover. Benefits are thereafter based on AMA List fees. More Information

  • You will have no out-of-pocket expenses when the doctor charges the AMA List fee or less
  • If the doctor charges above the AMA List fee you will need to pay the doctor the amount above the AMA List fee
Access Gap Cover - High performance, widely accepted gap cover

Our Prime Choice and Smart Starter hospital insurance products include the Access Gap Cover scheme. Full benefits are paid when your doctor participates in the scheme. A participating doctor simply agrees to bill for their services according to the scheme's schedule for each medical service item and the rules regarding co-payments which can be charged directly to the patient. Co-payments by patients are not allowed to exceed $400 per service or $800 on a confinement.

The Access Gap Cover scheme has above average benefit payment performance. The Access Gap scheme has a record of paying benefits on over 92% of medical services, with almost 88% of services having no out-of-pocket expenses for the patient. Among large private health insurers the record of providing benefits on medical services ranges from 77%, to 89% of services*.

For further information click through to our product descriptions, call 1800 226 126 or email


 * data source: Private Health Insurance Administration Council

Looking for Extras Cover as well?

You can add Extras cover to your Hospital Cover

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