Out of Pocket expenses is referred to as “GAP” and is one of the main reasons often cited by many people as to the their reason to not use their cover. Medicare does not cover Extras Health and the amount of cover offered is arbitrary and varies between various private health extras insurance providers.

Gap or out of pocket expense is an additional amount of money that you need to come up with to pay for your extras cover over and above what you have paid as premiums to have extras health cover. Irrespective of how long you have been with your private health extras cover provider you may have a “GAP” to pay.

At XHP, we aim to make that a thing of the past by enabling you to accumulate your money which over time has the potential to “eliminate the GAP”. Your gap is dependant on your account balance. Used wisely you may be able to eliminate your GAP totally as your account balance will be greater than the spend.

Private Health Insurance Extras Cover (PHIe)

Mind the GAP

Gap with your extras cover can arise due to

  1. Limits to your Claimable Benefit
  2. Arbitrary limits set for each service type by private health extras provider. eg amount covered for physio sessions required.
  3. Fund rules - where each fund has it own way of calculating the benefit or how much it will cover.
As a general rule the more you pay and higher the type of cover you have with your extras health provider, the higher the benefits you will receive per service. So the catch being you need to pay more to get more. Question though, is it better value?

Some health funds have preferred provider's where their members are able to access some basic services at no gap. This too is limited to the type of cover that you have with the private health extras health provider coupled with limitations on what is covered under the no gap arrangement.

Private Health Extras providers who operate such a scheme, have contracted health providers at a fixed fee schedule. But if you ever had the misfortune of needinf more than just the basics covered by the extras cover provider you will soon find out that you have to pay a gap despite the fixed fee agreement. This is because you have either reached your annual limit or the service has a fixed benefit that is paid.

Data from APRA, shows the average gap across all health funds to be 46.84% calculated from service fees claimed to benefits paid out by private health extras providers.

The GAP translates to increased costs to you as a member as the gap is payable by you over and above the premium you have already paid for the extras health insurance to be a member.

Do yourself a favour, if you would like to save money join XHP

Xtras Health Plan Savings Scheme (XHP)

Mind the GAP

Often the two main reasons a lot of people mention as to why the purchase extras health cover, is for peace of mind and the other to reduce out of pocket expenses or “GAP” to pay when the need arises.

Our research and countless research has shown that many people just simply drop their cover as they are not able to afford the cover with the amount of gap paid on top. For some this has meant putting up with discomfort which over time has an effect on the individuals health and wellbeing. At XHP, we get you and for that very reason we have designed XHP to make

  1. Healthcare affordable, and for peace of mind of knowing that unused funds accumulate in a dedicated account and earns interest as well for you.
  2. “NO GAP”, unless you have spent all the balance in your account. If your account balance is greater than the invoice amount you will never have a GAP.
  3. Quite simply you are in control of your health decision and health expenses on which services that you need to use and how much you wish to spend. Assuming you are careful on how the funds are spent it is very likely you may have adequate funds in the account to cover the big ticket item that you did not foresee coming.
  4. With preferred providers you will have the comfort of knowing the fee schedule is fixed in relation to the maximum fee that can be charged enabling you to quickly make informed decisions.

You are in the driving seat with XHP and can start to take advantage of the dedicated health savings scheme. To become a member, click here


With XHP as your unused money, rolls over each year you will build a nest egg over time to cover most of your extras health needs.

Let’s explore ”the dreaded GAP“ using Betty who wants to have a dental implant for her missing tooth as she is sick of the removable plates which is not attractive.

Betty has had

  1. Health cover for 10 years and has been paying $1825 per year,
  2. pends on an average of $1000 per year on extras health needs
  3. Gap payable is 46.84%
  4. Cost of the dental implant procedure is $5000

Private Health Extras Cover (Numbered List for SEO)

Premiums Paid over 10 years = $18,250

Total of services used of 10 years = $10,000

GAP paid on services over 10 years = $4,684

Cost of dental implant = $5,000

Gap payable on implant = $2,342

Net benefit for implant = $2,650

Net cost over 10 years = ($18,250+$4,700+$2,350) = $25,276

Net benefits over 10 years = $10,000+$2,658 = $12,658

Net GAP over 10 years = $12,650

Xtras Health Plan Savings Scheme (Numbered List for SEO)

Premiums Paid over 10 years = $18,250

Net balance after XHP Fees = $17,069.75

Total of services used of 10 years = $10,000

GAP paid on services over 10 years = $0

Cost of dental implant = $5,000

Gap payable on implant = $0

Net benefit for implant = $5,000

Net cost over 10 years =1180.25

Net benefits over 10 years = $10,000+$5000 = $15,000

Net Balance over 10 years = $2,069.75

You are better off with XHP. Stop adding unnecessary financial pressure. Join XHP and save the smarter way. You and your family will be glad you did.

Information provided is General Information only. Your personal circumstances have not been considered and does not constitute financial, legal, accounting or tax advice. Past performance is not indicative of future performance. Information used here is based on assumptions as above and as having occurred in the past, is not a future forecast. Account balance calculation is based on no spend for health with either PHI or XHP. The return for health insurance assumes no claim on a health insurance policy over the relevant period. No value has been attributed to holding a health insurance policy in the relevant period however it may be desirable to hold health insurance based on your personal circumstances.