The NDIA has confirmed that gap fees can be covered in NDIS Plans, if the service directly relates to a participant's disability and supports them in reaching their goals.
“NDIA plan budgets are developed to cover the full cost of Allied Health Services where these are considered as reasonable and necessary for the participant. As a result, there should not be a "gap" fee required to be paid.
Where NDIA participants have private health insurance some people have claimed against their health insurance for part of the cost of their services and claim the gap only from their NDIS plan. The gap may only be claimed from the NDIA plan if the service has been provided to support the participant's goals in their plan. If the service has been provided to address health issues then the gap should not be claimed from the plan”.
While this is great news for families, remember to use your extras cover wisely. If you have used your annual limit, and then break an arm for example and need physio, you will not be able to claim the gap on your private health cover or on your NDIS Plan, as it’s not a disability support related to your goals.
Your private health fund may have rules about using NDIS funds, so be sure to check with them, too.
9 Jan 2018