Unfortunately, out of pocket (gap) expenses can occur. You’re likely to have an out of pocket expense when:
- The treatment, service or item fee is greater than the maximum item benefit payable as per the policy benefit schedule
- The sum of benefits claimed for the calendar year to date are in excess of the applicable limit or sub-limit for that service
- Where a provider performs more than one consultation or treatment less than two hours after an identical service on the same day
- Where a benefit has already been paid for that service by another insurer or where the sum of benefits paid by HIF and other insurers that calendar year has exceeded the applicable sub or annual limit.
We always recommend that prior to any hospital, medical or dental treatment or procedure you get in touch with us to get a benefit estimate. Simply ask your doctor, specialist or dentist to provide you with their provider number, an item list including the fees that you’ll be billed for and then complete either our medical or dental estimate online form for a benefit estimate. Alternatively, you’re welcome to call us on 1300 134 060 and we can provide a benefit estimate over the phone.
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