Document ID: chunk:federal_register_of_legislation:C2004A00666:clause:1_73bdda
Version: federal_register_of_legislation:C2004A00666
Segment Type: clause
Provision Reference: sch 1 cl 73BDDA
Character Range: 4653–5469

73BDDA  Purpose of gap cover schemes

  The purpose of a gap cover scheme is to enable a registered organization to offer insurance coverage for the cost of particular hospital treatment and associated professional attention for the person or persons insured where:
 (a) the cost of the treatment or attention is greater than the Schedule fee (within the meaning of Part II of the Health Insurance Act 1973) for the treatment or attention; and
 (b) there is not a hospital purchaser-provider agreement, a medical purchaser-provider agreement or a practitioner agreement between the registered organization and the service provider concerned; and
 (c) the person insured pays a specified amount or percentage under a known gap policy or the full cost of the treatment or attention is covered under a no gap policy.