What's New?

1st November 2018 - New Access Gap Cover Schedules

The AGC schedules have been updated to incorporate a large number of MBS changes introduced by the Department of Health. 100 new MBS items have been introduced, including 60 new spinal items. 113 items have been deleted. Access Gap Cover fees have changed on the following items: 11820, 11823, 12003, 14106, 30310, 30318, 42705, 45553 & 45641.

Grand United Corporate Health Limited - No longer participates in Access Gap Cover

As at 1st November 2018 Grand United Health Limited (GU Health) will no longer participate in Access Gap Cover as they have been purchased by nib.

HBF Updated Postal Address

Please note that HBF has updated their postal address. The January 2018 Participating Funds Contact List is now available for download.

1st November 2017- New Medicare Rule for Consultations

The Australian Government Department of Human Services has made changes to take effect from 1 November 2017 for T8 procedures and subsequent consultations rendered on the same day by specialists and consultant physicians.

From 1 November 2017, specialists and consultant physicians cannot claim Medicare Benefits Schedule (MBS) for subsequent attendance items, 105, 116, 119, 386, 2806, 2814, 3010, 3014, 6019, 6052 and 16404 if they're claiming any MBS Group T8 (surgical operations) items with a schedule fee of $300 or more performed on the same day. The MBS Group T8 items are those items numbered 30001 to 50952.

For your convenience, we have also supplied a link to the new rules on MBS on-line.

New Medicare Rules for Consultation Items

Medicare Benefits Schedule - Note AN.0.70 

1st May 2017 - Updated Access Gap Cover Schedules & updated benefit for MBS Item 42705

AHSA inadvertently allocated incorrect benefits for item 42705 (originally published on 4th May 2017). AHSA has now reset the Access Gap Cover benefit for item 42705 to the same level as item 42702 (updated 10th May 2017). For further information on the new Schedules please refer to the Schedule of Benefits.

1 January 2017 Changes

Effective from 1 January 2017 Access Gap Cover schedules have been indexed. 

There is also a new version of the Access Gap Cover Billing & Business Guidelines.  The main changes relate to the publication of Doctors information on the AHSA and participating funds' provider searches.

To facilitate the changes to the business rules the Provider Registration (Provider Details and Direct Credit Authority) form has also been updated. All registrations received on or after 1 January 2017 must use this new form. All out dated Provider Registration forms received after this date will automatically be rejected.

16 January 2017 - Nurses & Midwives Health Pty Ltd Joins Access Gap Cover

Please note Nurses & Midwives Health Pty Ltd joins Access Gap Cover as at 16 January 2017. Download a list of AHSA funds that participate in Access Gap Cover.

9 January 2017 - Emergency Services Health Pty Ltd Joins Access Gap Cover

Please note Emergency Services Health Pty Ltd joins Access Gap Cover as at 9 January 2017. Download a list of AHSA funds that participate in Access Gap Cover.

1st Sept 2016 - CBHS Corporate Health Pty Ltd Joins Access Gap Cover

Please note this is a separate entity to CBHS Health Fund Limited. Access Gap Cover will be available to members who have any hospital product. Download a list of AHSA funds that participate in Access Gap Cover.

1st April 2016 - GMHBA Joins Access Gap Cover

Access Gap Cover will be available to members who hold hospital cover with GMHBA Health Insurance from 1st April 2016. Please note that this change does not apply to members who hold hospital cover with Frank Health Insurance or Budget Direct Health Insurance. Download a list of AHSA funds that participate in Access Gap Cover.

The following letter regarding GMHBA joining Access Gap Cover was sent to medical providers.

GMHBA Joins Access Gap Cover