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A ‘medical gap’ is any out-of-pocket expense incurred by a patient for their medical treatment during their stay in hospital. This reflects the difference between the total fee charged by the doctor and any Medicare rebate plus health fund benefit. Our surgeons have a gap cover arrangement with the following health funds in place which will cover all of your surgeon’s charge*, you will not have to contribute towards the surgeon’s bill out of your own pocket.

Unfortunately Latrobe Health services does not have a No Gap scheme. As such there will be a gap charged to equalise the amount to that paid by Most  other health funds.

Unfortunately HCF has chosen to significantly CUT their payments made for item numbers 30648 30651 30652 30655 (inguinal and ventral hernias) which replaced item numbers 30614 30609 and 30403, as such from November 1 2021 they are NO LONGER A NO GAP FUND. There will be an out of pocket cost for procedures. 

Please see the list below which provides more details on gap cover by each health fund

Fund Link
ACA Health Benefits Fund
ahm Health Insurance
Australian Unity Health Limited
Bupa Australia Pty Ltd
CBHS Health Fund Limited
CDH Benefits Fund
Central West Health Cover
CUA Health Limited
Defence Health Limited
Doctors’ Health Fund
GMF Health
GMHBA Limited
Grand United Corporate Health
HBF Health Limited
Health Care Insurance Limited
Health Insurance Fund of Australia Limited
Health Partners
Latrobe Health Services
Medibank Private Limited
Mildura District Hospital Fund Ltd
National Health Benefits Australia Pty Ltd (onemedifund)
Navy Health Ltd
NIB Health Funds Ltd.
Peoplecare Health Insurance
Phoenix Health Fund Limited
Police Health
Queensland Country Health Fund Ltd
Railway and Transport Health Fund Limited
Reserve Bank Health Society Ltd
St.Lukes Health
Teachers Health Fund
Transport Health Pty Ltd
Westfund Limited

Terms and conditions:

*Some anaesthetists do charge a gap.
*Australian Unity Has no gap cover scheme for Members on Basic Hospital (B1, YB2), Smart Start (LB), Care ‘N Share (BA), Budget Hospital (B2), Basic Starter (YCA) and Basic Saver (YCB)
*Frank Health insurance without extra gap cover will have a gap payment charged.
*Combined Cases (involving multiple surgeons eg plastic surgeons) may incur a co-payment. This will be discussed with you and full financial consent obtained before your procedure.
*You may have a health fund excess depending on your policy.
*Some anaesthetists do charge a gap.
*From 1 July 2021 there may be a gap payment required for incisional, ventral, umbilical or recurrent hernias. (Not including inguinal)