Access Gap Cover

Access Gap Cover (AGC) is the AHSA Member Fund gap cover arrangement. It has been approved by the Minister, under the Health Legislation Amendment (Gap Cover Schemes) Act 2000. It is designed to minimise or eliminate out-of-pocket expenses for medical services in hospital.

What are the advantages of Access Gap Cover?

  • Enables Health Funds to cover the medical gap without the need for a contract with Doctors.
  • Facilitates payment of the medical gap above the Medicare Schedule fee in a simple manner that benefits Patients and Doctors.
  • Includes Simplified Billing, which means a better service and a simple system for patients.
  • Allows for written informed consent where there will be a patient co-payment.
  • Is open to all Doctors nationwide, on a patient by patient basis.

What are the advantages for Doctors?

  • No contract.
  • Facilitates payment of the medical gap above the Medicare Schedule fee in a simple manner that benefits Doctors.
  • Simpler billing systems.
  • Allows Doctors to utilise one product for AHSA Funds across Australia who participate in Access Gap Cover.
  • Doctors provide details only once for all participating AHSA funds.
  • Improved cash flow for doctors - 21 day turnaround on claims.
  • Reduces bad debts for doctors.
  • Co-Payment Rule Change - 1 July 2020

  • Schedule of Benefits

    This section contains the Schedules of Benefits in PDF and Excel format.
  • Billing and Business Guidelines

    The Billing and Business Guidelines provides an overview of Access Gap Cover (AGC) and provides information to doctors on how to participate in AGC and information on the claims submission processes and rules.
  • FAQs

    A list of frequently asked questions received from doctors about Access Gap Cover, medical claiming, billing etc.
  • Participating Fund Contact List

    This contact list contains Health Fund information including: the current postal address (for claims), contact numbers and email addresses, Fund Identification Codes and Eclipse Participant ID's. Important Notices or exclusions for all AHSA Funds who participate in Access Gap Cover are listed. General information in relation to Health Fund name changes, mergers and Funds who are no longer a part of AHSA can be found at the bottom of page 3. Funds who are not on this list DO NOT participate in Access Gap Cover.