Designated Service Provider (DSP)

Cover for non-network providers

If a GP or specialist that is not a Designated Service Provider sees you in hospital, we will cover you up to 100% of the Scheme Rate.

If you are treated Out-of-Hospital by a non-network provider, we will cover you up to 80% of the Scheme Rate on TFG Health plus and up to 100% of the scheme rate on TFG Health.

You may have a co-payment if your provider charges above these rates.

In certain instances you will not have to pay co-payments or deductibles 

The Scheme will still pay the Prescribed Minimum Benefit claims in full if you have involuntarily obtained the services from a provider other than a Designated Service Provider, if:

  • it was an emergency, for hospital admissions
  • the service was not available from the Designated Service Provider or would not have been provided without unreasonable delay;
  • or there was no Designated Service Provider within a reasonable distance from your place of business or residence.

Where the Scheme has appointed a Designated Service Provider (such as these listed above), non PMBs will only be paid in full if the services are obtained at the DSP.