Understanding AMA Benefits and Top Cover Gold
What are the AMA benefits?
The AMA publishes a list of Medical Services and Fees to help medical practitioners determine their fees, as well as providing an important point of reference for those in medical practice.
The AMA gap benefit offers the highest level of protection against out-of-pocket costs, paying benefits up to the AMA list of medical services and fees. The AMA gap benefit does not require treating doctors to ‘opt-in’ to a scheme or contract, allowing members the freedom of choice to select the provider that best suits their needs. Importantly, it also ensures treating doctors are adequately remunerated for their services.
What does this mean for me?
The primary benefit of having medical gap cover up to the AMA list of services and fees compared to other medical gap cover schemes is no out-of-pocket expenses when doctors charge up to this list of services and fees.
Medical benefits up to the AMA list of services and fees aren’t new to us. In fact, Doctors’ Health Fund has been offering the best medical gap cover in Australia for many years. This offering is an important part of our foundations, starting as The AMA Health Fund in 1977.
Top Cover Gold $750 Excess
Introduced mid-last year, Top Cover Gold $750 Excess is an extension of our existing Top Cover Gold product. To enhance affordability and improve accessibility of AMA benefits, we added a $750 excess option to Top Cover Gold. Members benefit from lower premiums while maintaining comprehensive coverage, with a $750 excess payable upon hospital admission. The original nil excess option remains available. This product has proved very popular and is growing faster than the nil excess option.
What is a hospital excess?
Like any insurance excess, the excess on a health insurance policy is an upfront payment you are required to pay before being admitted to hospital as a private patient. Importantly, the excess is payable to the hospital, and is not related to the medical fees charged by your doctors.
Having an excess on your hospital policy means you pay a lower premium. For family and couples policies, there is a maximum of two excess payments per calendar year. In addition, an excess is only payable once per calendar year by every person covered on the policy.
Speak with our team to learn more
We welcome all new or existing members to speak to our expert Member Service Team on 1800 226 126 to ensure you are making the right decision when it comes to your policy choice.
Private health insurance products are issued by The Doctors’ Health Fund Pty Limited, ABN 68 001 417 527 (Doctors’ Health Fund), a member of the Avant Mutual Group. Cover is subject to the terms and conditions (including waiting periods, limitations and exclusions) of the individual policy, available at doctorshealthfund.com.au/our-cover.
