Access Gap Cover explained

Access Gap Cover is used by participating private health insurers and is administered through the Australian Health Service Alliance (AHSA).

Why the schedule is state based

Access Gap Cover publishes separate schedules by state and territory. When checking the relevant schedule, use the location associated with the provider number and confirm the current AHSA instructions.

Which funds use it?

Participating funds include a number of not-for-profit and restricted-membership insurers. Rather than assuming a fund has its own separate rate file, search the fund name in the DEVZ directory to see whether the AHSA schedule is the relevant starting point.

What the schedule tells you

The schedule provides scheme fee information for medical services. It does not replace eligibility checks, provider participation requirements or the individual fund’s claiming conditions.