HCi Factsheet – Access Gap Cover (AGC)
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HCi’s Access Gap Cover (AGC)
22 April 2024
Your medical team and HCi’s Access Gap Cover (AGC) Scheme could reduce your out-of-pocket costs
Your doctor can improve the value of your private health insurance by participating in HCi’s Access Gap Cover (AGC) scheme. Doing so will reduce or even eliminate out-of-pocket medical expenses (often referred to as a medical “gap”) associated with many specialist hospital admissions.
This gap is usually the difference between the fee charged by your doctor and the amount covered jointly by Medicare and HCi. It includes other doctors who may also be involved in your admission, such as an assistant surgeon or anaesthetist.
Depending on your treatment, this gap can represent a significant out-of-pocket expense that you need to pay… and if you’re going to hospital, the last thing you want to worry about is medical bills.
What is the Access Gap?
If you go to hospital and your specialist uses HCi’s AGC scheme, it usually means no or limited medical gaps – usually not more than $500^ in out of pocket costs for each doctor involved in your episode of care. There are a number of benefits for your doctor to participate in the AGC, and limit your out of pocket gap expenses for a hospital admission. When a doctor participates in HCi’s AGC scheme, we will pay your doctor more, so you pay less.
We encourage HCi members requiring a hospital procedure to ask your doctor to treat you under HCi’s Access Gap scheme to help reduce any out-of-pocket expenses. However, it is not mandatory for doctors to participate in an AGC scheme. Your doctor should inform you of expected out-of-pocket expenses, which may be considerable.
You have the right to select a doctor who will help reduce your out-of-pocket expenses.
NOTE about the HCi Access Gap Scheme
HCi’s AGC scheme is available for HCi members requiring certain hospital treatments listed as “covered” or “restricted” on your hospital cover product summary. Our Access Gap (AGC) scheme does not cover services and treatment not included in your HCi hospital policy. AGC doesn’t apply if waiting periods have not been fully served. Pathology and radiology services, and outside of hospital medical services are not generally included in our AGC scheme.
Always remember to contact HCi prior to a hospital admission to check you are covered. And to discuss any questions related to costs in your informed financial consent letter.
* You can find more information about Informed Financial Consent and doctors’ bills on the Australian Government private health insurance Ombudsman’s website.
^ Up to $800 for participating obstetricians.
HCi used its best endeavours to ensure this information was accurate at the time of publication. From time to time, circumstances relating to the subject matter may change which may impact the accuracy of the information. This information is also general in nature and does not take into account any specific health or financial situation. Before making any decisions in relation to this information, you should consider your own financial and health situation and seek professional advice. Health Care Insurance Ltd ABN 43 009 579 088. A Registered Private Health Insurer.
