HCi Factsheet

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HCi’s Access Gap Cover (AGC)

22 April 2024

Your medical team and HCi’s Access Gap 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, which 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 (including other doctors who may also be involved in your admission, such as an assistant surgeon or anaesthetist) and the amount covered jointly by Medicare and HCi.

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.

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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, in return for agreeing to limit your out of pocket gap expenses when you are admitted to hospital.  If your 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 AGC scheme to help reduce any out-of-pocket expenses.  However, it is not mandatory for doctors to participate in HCi’s AGC scheme and your doctor should inform you of expected out-of-pocket expenses, which can otherwise be considerable.

You have the right to select a doctor who will help reduce your out-of-pocket expenses.  The tool˜ below will help you find details of thousands of doctors who have previously used our AGC scheme.  Your doctor must provide us with a copy of your Informed Financial Consent* form, once signed by you, to participate in our AGC scheme for your hospital admission.

NOTE: HCi’s AGC scheme is available for HCi members requiring certain hospital treatments that are listed as “covered” or “restricted” on your hospital cover product summary.  Our AGC scheme does not cover services and treatment not included by your HCi hospital policy, or where 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 find out more about whether your doctor may have access to the Access Gap scheme for your procedure.


* You can find more information about Informed Financial Consent and doctors’ bills on the Australian Government private health insurance Ombudsman’s website.

˜ The information in this tool does not represent a recommendation to use any of these doctors.

^ Up to $800 for participating obstetricians.

Find a AGC provider
Use the HCi provider search to search for registered participating doctors and health providers.

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.

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