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Bupa Medical Gap Scheme

Bupa believes that the care a patient receives is of utmost importance and that part of that care is reducing or eliminating the financial expenses that may be caused by medical gaps. When the Bupa Medical Gap Scheme is used, Bupa will pay a higher benefit directly to the provider, than would normally be covered.

Providers have the option to register as either No Gap or Known Gap under our Medical Gap Scheme.

As a participating provider, it’s important that you are familiar with your registration status and, the Bupa Medical Gap Scheme Terms and Conditions.

For providers registered under the Medical No Gap Scheme:

  1. Use the Scheme which provides higher Scheme rates, bill Bupa directly for this amount and charge the patient no gap; or
  2. Don’t use the Scheme and bill the patient directly.

For providers registered under the Medical Known Gap Scheme:

  1. Use the Scheme which provides higher Scheme rates, bill Bupa directly for this amount and charge the patient a maximum out of pocket of $500 per episode of care. The known gap must be included in the total fee charged for both manual and electronic claims submitted via ECLIPSE; or
  2. Don’t use the Scheme and bill the patient directly.

It is important to note that if the Scheme is used, no additional charges (for No Gap providers) or no additional charges above the maximum of $500 (for Known Gap providers) can be raised under the guise of other miscellaneous items such as administration fees, booking fees or any item not being a professional service described by a Medicare MBS item. If an additional charge is raised, our Scheme must not be used.

Bupa undertakes regular audits of members to ensure that the Terms and Conditions of the Scheme are adhered to. Repeated misuse of the Scheme has resulted in some providers being de-registered from our Scheme.

For full Terms and Conditions visit

Medical Gap Scheme Terms and Conditions > (PDF 188KB - Opens in new window)

Medical Known Gap Scheme Terms and Conditions > (PDF 80KB - Opens in new window)

If you would like to make any changes to your current registration, please complete a Change of Details form (PDF 88KB - Opens in new window).

Please ensure that you include your Bupa Practice Identification (ID) number on the Change of Details form, as this will assist us to identify your practice.

To view or download the current Bupa Medical Gap Scheme Schedules click here.

For full details about the Bupa Medical Gap Scheme, click here