Useful definitions

Access Gap Cover
Ambulance Cover
Excess
Excess Year
Family Membership
Membership Year
Medical Gap
Medicare
Policyholder
Registered GU Health Provider
Student Dependant

Access Gap Cover

Access Gap Cover reduces or eliminates all out‑of‑pocket expenses for specialist care you receive in hospital, and is automatically included with all GU Health Hospital covers. If your treating doctor or specialist participates in our Access Gap Cover scheme, you'll have either no out‑of‑pocket expenses or you'll know before treatment starts exactly how much you'll have to pay. Participating doctors bill GU Health direct.

More information on Access Gap Cover

Ambulance Cover

All GU Health Hospital covers include full cover for ambulance transport and treatment for residents of NSW and the ACT, and emergency cover for residents of other States who aren't covered by a State Government Ambulance Scheme.

Excess

An excess is an agreed amount that you must pay before benefits can be claimed for certain healthcare treatments each excess year.

If your cover includes an Overall Excess (if applicable this would be outlined in your GU Health membership book), your excess is payable on any Hospital and/or Ancillary claim.

Unless otherwise stated in your membership book, an excess is payable once per membership, per excess year. The excess is deducted from the benefit payable, until the excess has been reached. Where an excess is applicable to an ancillary claim, annual limits are reduced by the benefit amount which goes towards excess.

Excess Year

Your excess year begins on the date you first joined a cover with an applicable excess. A new excess year will begin when a change is made to your excess level.

Family Membership

A Family Membership can include the member (policyholder), the policyholder's spouse / de facto spouse / partner, and all dependant children up to the age of 21 or, if registered as a Student Dependant, up to the age of 24 years (inclusive).

Membership Year

Your membership year begins on the date you first joined GU Health. A new membership year will begin whenever you make a change to the scale of your membership, or either you or your employer makes a product change.

The maximum limit refers to any benefit (in $ terms) that can be claimed within a membership year. Maximum limits are reset each time you start a new membership year.

Medical Gap

Medicare covers you for 75% of the Medicare Schedule Fee for treatments provided by doctors in hospital. Your GU Health Hospital cover pays the remaining 25% difference between the Medicare benefits and the Medicare Schedule Fee. If your doctor chooses to charge more than the Medicare Schedule Fee for services, you may have to pay any difference between the Medicare Schedule Fee and your doctor's fee, which is known as the Medical Gap.

GU Health Access Gap Cover can help you avoid these costs, or at least know what they'll be in advance. Find out about Access Gap Cover.

Medicare

Medicare is the national health scheme operated by the Federal Government that provides automatic protection against the costs of essential medical and hospital care. All permanent Australian residents, regardless of age or personal circumstances, are eligible to participate in Medicare. Medicare is funded by a standard 1.5% levy on taxable income.

Policyholder

Ownership of the membership remains solely with the policyholder, who is the person who has legal responsibility for the membership.

Registered GU Health Provider

Benefits are only payable for services rendered by registered providers. Registered providers are those practitioners accredited by the GU Health‑recognised accreditation process. Call your GU Health Member Relations Team to check if your provider is registered.

Student Dependant

A student dependant is an unmarried student aged from 21 to 24 inclusive, studying full time at an approved school, college or university, who is dependent on you. Student dependants may be covered under a Family membership. Once they turn 21, the policyholder needs to register student dependants each year.

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