What is the 'gap' in private health insurance?

• A. The gap between appointment times
• B. The gap in PBS coverage
• C. The gap between what insurance covers and the whole fee
• D. The gap between private and public hospital care

Answer: (C)

In private health insurance, the gap is the difference between the total charge for a hospital service and the amount your private insurer pays. It’s the extra you may have to cover out of pocket. For example, if a hospital bill is $5,000 and your fund pays $3,000, the gap is $2,000. Some providers offer no-gap arrangements, meaning they don’t charge more than the insurer’s payment, reducing or eliminating the out-of-pocket cost. The gap applies to hospital-related fees (the hospital, surgeon, and anaesthetist) and reflects what your policy doesn’t cover.