In Australia, by law, health insurance funds insuring Australian residents are only allowed to reimburse up to a set amount. The amount is set by the Government and is found in the Medicare Benefit Schedule. In certain cases, funds are able to reduce the 'gap' by entering into contracts with 'participating hospitals'. The actual amount billed will vary depending on the type of treatment. Doctors sometimes charge up to twice the Medicare Benefit Schedule amount, and many top specialists and surgeons will charge up to three or four times that fee, hence the expression "the gap" that is used to explain the problem.

But there is good news! Temporary Residents and Overseas Visitors are exempted from these frustrating conditions on their health insurance, as AHI pays "the gap" for our Members. When we say 100%, we actually mean 100%! Most other funds simply do not. So, if a top surgeon charges you $1600 for a procedure but the Medicare Scheduled Fee is only $589, we pay the whole $1600.