- Coronavirus FAQ's
- How we're supporting you during coronavirus
- The value of private health insurance in a pandemic
- Adding or removing people from your account
- Authorising another person on your cover
- Cover review
- How do I check my limits?
- Pre-existing conditions
- Suspending your cover
- Updating your details
- What am I covered for?
- Waiting periods explained
- Private health insurance reforms
- Gap in cover
- Ambulance explained
- Ante/Post Natal Services
- Dental Explained
- Extras limits explained
- Health Appliances
- Health Screening
- HICAPS & HealthPoint explained
- How does extras cover work?
- Natural Therapies
- Non PBS prescriptions
- Optical explained
- Set Benefits FAQ
- Telehealth Benefits
- Travel vaccines
- What is health maintenance?
- Emergency Department Fees
- Going to Hospital
- Hospital Added Costs
- Insulin Pumps
- IVF & assisted reproductive services
- LHC exemptions
- Public vs. Private
- Restrictions & Exclusions
- Understanding out of pockets
- What is an excess?
- What is LHC?
- What is the MBS?
- Where does Medicare fit in?
- Transcranial Magnetic Stimulation (TMS) Pilot
- Mental Health Waiver
- Entry Hospital
- Annual premium review
- Can I lock in my premium?
- I can’t use my cover like I used to...
- What if my cover is currently suspended?
- Where do my premiums go?
- Why does my premium change every year?
- Why does my premium change, if I rarely make claims?
- Why is my price change different to the national average percentage?
- 3 ways to save money on your health insurance.
Understanding out of pockets
Understanding how your cover works and the fees involved isn’t as easy we’d like it to be. Here at health.com.au, we try our best to be simply helpful by giving you a step by step way of understanding how it works.
We try to help reduce or eliminate your out of pocket expenses by participating in the Access Gap Cover Scheme.
The Access Gap Cover Scheme is administered by the Australian Health Services Alliance to help reduce your out of pocket expenses. However, doctors can decide on a case-by-case basis whether or not they choose to participate in the scheme.
In the instance that your doctor decides to not participate in the Scheme, Medicare will pay 75% of the fee set in the Medicare Benefits Scheme (MBS) and health.com.au will pay the other 25% of the scheduled amount. Because doctors can set their own fees, if your invoice is more than the MBS fee you'll need to pay the difference. This is classified as your out of pocket expense.
Remember to ask your main doctor/surgeon, anaesthetist and assistant doctor for “informed financial consent” - which is the doctor’s quote. This will give you more detail on the following points:
Things to ask your doctor:
- What are your fees?
- What is the MBS number for my treatments/s?
- Can you tell me how much out of pocket I will be, if at all?
- If I cannot afford to pay immediately, can I set up a payment plan?
- Will I receive one bill or will you bill my health fund directly?
Things to ask your hospital:
- Do you have an agreement with my insurer, health.com.au?
- Am I required to pay extra for my hospital accommodation?
- Are there any out of pocket expenses I should know about?