So, you’re eligible for Medicare and have the added peace of mind and flexibility of HIF Hospital Cover. But what happens when you need medical treatment? What’s covered? Will there be any out-of-pocket expenses? Before receiving any hospital treatment, we strongly recommend you contact us for a benefit estimate, so you know exactly what your gap (if any) might be.
How to confirm which services are included on your Hospital Cover and the amount we’ll pay:
Ask your doctor or specialist for an itemised medical estimate as soon as your procedure is confirmed.
Then, send us the details using our Medical Estimate form or give us a call on 1300 134 060.
You’ll need to provide the following details for each service involved in your procedure:
How your medical estimate is calculated:
The Medicare Benefit Schedule (MBS) guides how much a health fund can pay for medical services in Australia.
For inpatient services that are covered by Medicare and your Hospital Cover, Medicare covers 75% of the MBS fee and we cover the remaining 25%.
Learn more: What is the Medicare Benefits Schedule (MBS)?
How an out-of-pocket (gap) cost can apply to a procedure you have cover for:
While regulations limit how much Australian funds can pay towards medical services (the 25% we mentioned), providers can charge their own fees.
If your provider’s fee is higher than the MBS fee for your service, you will incur an out-of-pocket expense (that isn’t covered by Medicare or your insurance) for the difference between the fee charged and the MBS.
Learn more: Why do I have an out of pocket expense?
Access Gap: Can I avoid out-of-pocket costs?
Yes! As an HIF member, you can reduce or even eliminate out-of-pocket costs by asking providers to treat you under Access Gap.
With thousands of participating doctors and specialists across Australia, our gap cover arrangement helps you access the treatment you need at a reduced cost.
Learn more: Find Access Gap Cover Doctors & Specialists | HIF Gap Scheme
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