Australian private health fund fee schedules & gap rates
Find official medical fee schedules, GapCover, MediGap, Medicover and Access Gap Cover resources in one place. Search by health fund, choose the relevant state where required, then open the official source to check the applicable schedule and MBS item number.
Latest verified schedule updates
AHSA Access Gap Cover schedules updated.
Medibank and ahm GapCover rates updated.
Use each insurer or scheme administrator’s current provider resource before billing; effective dates and participation rules can change.
Official fee schedule directory
| Health fund / scheme | Arrangement | State | Official schedule |
|---|---|---|---|
| Bupa Bupa Australia Medical Gap Scheme | Direct insurer | Australia | Open official schedule |
| Medibank GapCover | Direct insurer | Australia | Open current rates |
| ahm GapCover schedule of benefits | Direct insurer | Australia | Open schedule / Excel links |
| HCF Medicover | Direct insurer | Australia | View fee schedule Provider login |
| nib MediGap | Direct insurer | Australia | Open current schedule |
| GU Health Medical Gap Network | Direct insurer | State-based | Open provider resources |
| AHSA participating funds Access Gap Cover — includes many participating not-for-profit funds | Shared scheme | State-based | Open Access Gap schedules |
| CBHS Access Gap Cover via AHSA | AHSA | State-based | Open AHSA schedule |
| Defence Health Access Gap Cover via AHSA | AHSA | State-based | Open AHSA schedule |
| Teachers Health / Doctors’ Health Fund Access Gap Cover via AHSA | AHSA | State-based | Open AHSA schedule |
| Australian Unity Access Gap Cover resources | AHSA | State-based | Open AHSA schedule |
| HBF Provider arrangements vary by location; check HBF for WA arrangements and the applicable scheme for other locations | Mixed | State-dependent | Open HBF provider page |
| RT Health Medicover | Direct insurer | State-based | Open provider resources |
Find official schedules for an MBS item number
Enter an MBS item number to open the official fund schedule sources where you can verify that item. This directory does not perform an item-specific benefit lookup or calculate a payable benefit because schedules, eligibility and provider participation can change.
How to use a health fund schedule safely
How to read a private health fund fee schedule →
Check effective date, state, item number and provider participation.
MBS fee vs health fund gap fee →
Understand why the MBS fee and a fund’s scheme rate are not the same thing.
No Gap vs Known Gap billing →
A practical overview for specialists and practice teams.
Access Gap Cover explained →
How AHSA schedules work and why provider-number location matters.
Need help billing a health fund?
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