When admitted as a private patient of a hospital Medicare pays 75% of the Medicare Benefits Schedule Fee for medical services provided by your treating doctors, such as your surgeon, assistant surgeon and anesthetist and for radiology and pathology services. Police Health will pay up to 25% of the Medicare Benefits Schedule Fee.
Where services are billed higher than the Medicare Benefits Schedule Fee, Police Health's Access Gap Cover scheme will, in many cases, allow us to cover the fee in full or at least to pay a higher benefit and thus reducing your out-of-pocket cost. It is up to the doctor or service provider to participate in Access Gap Cover. Where a doctor or service provider chooses not to participate in the Access Gap Cover scheme, Police Health is only permitted to pay up to 25% of the Medicare Benefits Schedule Fee, after the Medicare benefit.
Enrolled for Medicare Benefits?
For Police Health to pay you up to 25% of the Medicare Benefits Schedule Fee and to pay you benefits under the Access Gap Cover scheme for medical services, you will need to be enrolled with Medicare and hold (or appear on) a valid "green" or "blue" Medicare card. If you are a holder of a "yellow" Medicare card, you are not covered under Medicare for treatment as a private patient in a public or private hospital and Police Health will not pay you benefits for medical services.
Note: Police Health does not pay benefits for medical services where Medicare does not pay a benefit, including services provided to persons who are not enrolled with Medicare or who hold a "yellow" Medicare card.
When not admitted as a patient in a hospital
Medicare pays up to 85% of the Medicare Benefits Schedule Fee and no further benefit is available through health insurance. Please note that charges for medical services provided in a private hospital Accident and Emergency fall in this category.