Hospital claims |
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Making hospital claims
Your hospital benefits from Medicare (for treatment provided in hospital)
Making claims for medical services (for treatment provided in hospital)
What is the "Medical Gap"?
What is Access Gap Cover?
Making hospital claims
If you're hospitalised, just present your GU Health Member Card, so the hospital will
be able to bill GU Health directly. If your cover has an excess, the hospital may ask
you to pay your excess upfront. GU Health pays benefits for all eligible hospital costs
in accordance with your chosen level of cover.
Claims relating to pre‑existing conditions may be referred to GU Health's consulting
doctor prior to being approved for payment. We recommend that you contact GU Health
before any hospital treatment if there is any doubt as to whether a condition is pre‑existing.
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Your hospital benefits from Medicare (for treatment provided in hospital)
If you choose to go to a public hospital and receive treatment from a hospital‑appointed
doctor, you won't be charged for either the treatment or the accommodation. However, if
you choose to be a private patient in a public or private hospital and receive treatment
from a doctor of your own choice, Medicare won't pay any of the accommodation charges,
and will only pay 75% of the Medicare Schedule Fee for the doctor's services.
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Making claims for medical services (for treatment provided in hospital)
There are two ways to claim your medical expenses when you're in hospital:
- First, complete your claim with Medicare and obtain a Medicare Statement of
Benefit Advice. Then, complete your GU Health claim form, attach your Medicare
Statement of Benefit Advice, and mail both to GU Health in one of the postage‑paid
envelopes provided, or FreeFax to 1800 656 778,
- If your doctor participates in Access Gap Cover, their bills may be sent directly
to GU Health or to you for forwarding on to us.
Please note: Health funds are not permitted to pay for medical services provided for
out‑of‑hospital treatments. Services for out‑of‑hospital treatments are covered by Medicare.
If you're going into hospital you can download a hospital checklist.
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What is the "Medical Gap"?
With GU Health Hospital cover, you are covered for 100% of the difference between the Medicare
benefit and the Medicare Schedule Fee for services performed while you're in hospital. However,
some doctors and specialists may charge more than the scheduled fee. This difference is known as
the Medical Gap, and is where out‑of‑pocket expenses can arise.
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What is Access Gap Cover?
GU Health Access Gap Cover can reduce or eliminate out‑of‑pocket expenses.
If your doctor or specialist has agreed to use the Access Gap Cover scheme, GU Health can help
pay some or all of the gap.
Participating doctors will tell you in advance what the cost of service will be ‑ and, if applicable,
any payment you'll need to make to cover the difference between the Access Gap Cover benefit and
their fee. You should always ask your doctor if they'll be participating in the GU Health Access
Gap Cover scheme.
For more information you can download an Access Gap Cover brochure.
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