Please DO NOT DELETE this page.

Blog //
  • Membership

Access Gap Cover: What you need to know

20 March, 2020
Access Gap Cover

What is Access Gap Cover?

Access Gap Cover (AGC) is a way to reduce your out-of-pocket expenses for medical services in hospital. Out-of-pocket expenses or the ‘gap’ is the amount you pay for medical or hospital charges, over and above what you get back from Medicare and your private health insurer. Without AGC, you’ll need to pay some of your medical costs for procedures at day surgery or hospital.

AGC is the Australian Health Service Alliance (AHSA) Member Fund gap cover arrangement.

How it works

If you’re an in-patient in a hospital as a private patient, your medical services will be charged separately from hospital accommodation and theatre fees. Medicare pays 75% of the Medicare Schedule Fee and your private health fund pays the remaining 25%. The Medicare Schedule Fee is set by the Department of Health Australia.

Some doctors charge an amount above the Medicare Schedule Fee. This amount is known as out-of-pocket expenses or the gap amount. With AGC, you can reduce this gap amount or not have to pay at all.

If a doctor treats you under the AGC Scheme, they’ll usually process the claim for you. This includes any Medicare benefit claims.

How can you find a doctor who participates in Access Gap Cover?

Not all doctors take part in the AGC scheme, and those that do may not list it on their website. Each doctor can decide on a case-by-case basis.

You can try our Access Gap Search to find a doctor that generally participates or who has agreed to alternative ‘no gap’ arrangements. You’ll still need to ask the doctor if they’ll treat you under CBHS Access Gap Cover arrangement.

Your doctor may have never used AGC before but may still consider it if you ask them.  

Questions to ask your doctor

  • Will you treat me under CBHS Access Gap Cover arrangement?
  • Will I need to pay any out-of-pocket expenses for my treatment? If so, can you give me a written estimate of how much I’ll need to pay?
  • Will any of the doctors assisting with my treatment also participate in Access Gap Cover?
  • Will you send the bill to CBHS directly so that they can claim my Medicare Benefit on my behalf?

Doctors who do use the scheme will usually bill CBHS directly. This includes anaesthetists, surgeons and pathologists.

How to get Access Gap Cover

If you have any questions about Access Gap Cover, you can find out more on our website or email CBHS Member Care at


All information contained in this article is intended for general information purposes only. The information provided should not be relied upon as medical advice and does not supersede or replace a consultation with a suitably qualified health care professional.


Suggested Articles

  • An image of nutrient-rich vegetarian Mexican bow

    Mexican in a bowl

    If you can’t go out for Mexican, make it at home! This nutrient-rich vegetarian Mexican bowl is a quick and easy dinner.
    • Nutrition
    19 May 2020
  • Private Hospital Benefits at Healthscope Group Hospitals

    Private Hospital Benefits at Healthscope Group Hospitals

    CBHS has agreements with over 500 private hospitals across Australia including the Healthscope Group of Hospitals (Healthscope).
    • Membership
    18 May 2020
  • 2003_COVID19_Blog-08

    Financial assistance to members who hold Extras cover

    Here is what we are doing to support our members from both a health and financial perspective through the COVID-19 pandemic.
    • News
    • Membership
    6 May 2020
  • 2003_COVID19_Blog-08

    CBHS COVID-19 Health and Financial Assistance Program

    Here is what we are doing to support our members from both a health and financial perspective through the COVID-19 pandemic.
    • News
    • Membership
    27 April 2020

What Our Members Think

I joined as a CBHS member in 1978. Through many health events and challenges CBHS has always been there for me and my family. Their exceptional service over this time has always been appreciated.

- Jenny J

What Our Members Think

I've not long joined CBHS from another fund, but so far I've been impressed by the super helpful and friendly staff, the higher claim limits and rebates at a very competitive premium, and how easy it is to lodge manual claims through the app. Thanks CBHS - you've won me over! 😃

- Jessica B

What Our Members Think

What I love about CBHS is their customer service - friendly staff and always ready to help and email you the information you ask about. Keep up the great work!!!

- Linda S

What Our Members Think

I love CBHS as its so so easy to lodge a claim and whenever i need a question answered friendly consultant is one phone call away. The phone back option instead of waiting is brilliant!

- Rachel N

What Our Members Think

I have been with CBHS since I began at CBA 15 years ago...Now I have three beautiful children, one who has a disability. Our top extras cover has been really essential for his early intervention. I do love the ease of claiming online.

- Annette E

What Our Members Think

I am relatively new to CBHS and am loving it already. I worked for a CBA subsidiary a long time ago but was still eligible to join. So much better that the for-profit funds - our premium is only a little more and we pay a lower co-contribution and get great benefits. I am loving the massage rebate for my partner and gym rebate for me!

- David G

What Our Members Think

I'm extremely happy with CBHS! I have been a customer for about six years. I think the price is reasonable. And i would refer you to my family and friends any day. Thank you CBHS!!!

- Karen W

What Our Members Think

Love CBHS as I never have to doubt that they've got my back when I need it. Been through other insurers who have limited options or limits, yet cost the same or more.

- Mark F