Understanding private health insurance can be complicated. This section is designed to help make things a little easier for you. It contains some important information about our covers along with explanations of commonly used terms you might not be familiar with. It also gives you an overview of some of our key rules.
It also important you have a good look through the Membership Guide you'll receive after you join. This contains a summary of the rules of your membership with us (known as our Fund Rules) – things like your responsibilities as a member. It's also important to read the Cover Summary you'll receive further details of your cover and entitlements.
Helping you choose the right cover
Am I eligible for Working Visa Health Insurance?
Medibank Working Visa Health Insurance covers are only available to people who are in Australia on certain working-type visas approved by Medibank. We may require proof of eligibility such as a copy of your visa.
Medibank can transfer anyone who is not eligible for our Working Visa Health Insurance covers to an alternative cover. We can backdate this change and require you to pay any additional premiums and/or repay any higher benefits you received on your Working Visa Health Insurance cover. So it's important that you let us know if your visa status changes.
Is Visitors Health Insurance right for you?
Medibank Visitors Health Insurance covers are designed for visitors, temporary residents, residents of Norfolk Island and other residents in Australia who are not eligible for full Medicare entitlements.
Reciprocal Health Care Agreements
Australia has Reciprocal Health Care Agreements with the United Kingdom, New Zealand, Italy, Belgium, Malta, the Netherlands, Sweden, Finland, Norway and the Republic of Ireland. If you're a resident of a country which has a Reciprocal Health Care Agreement with Australia, you may be entitled to restricted access to Medicare, but only for medically necessary treatment. Post-arrival time limits and other restrictions may apply. So be sure to check what you're covered for before relying on a Reciprocal Health Care Agreement.
What if I'm an international student?
If you're an international student with a valid student visa, our Visitors Health Insurance and Working Visa Health Insurance will not meet your student visa requirements. We recommend you purchase Medibank Overseas Student Health Cover (OSHC) which is specifically designed with the needs and budgets of students in mind.
What if I'm on a working visa?
If you're in Australia on a working visa, our Visitors Health Insurance may not meet any visa requirements you might have. We recommend you purchase one of our Working Visa Health Insurance covers which meet the Australian Government 457 visa requirements. You can purchase Working Visa Health Insurance online.
What happens if I become a permanent resident?
If you are granted permanent residency our Visitors Health Insurance or Working Visa Health Insurance may not be the most suitable cover for your needs. When your residency status changes remember to call us on 134 190 to discuss your options.
About your membership with us
Do you have a ‘cooling-off' period?
If you join but then decide you'd like to either cancel your membership or move to another cover, we have what is known as a ‘cooling-off' period. This also applies if you're already a member and have recently changed your cover. As long as you tell us within 30 days of your cover commencing, and no claims have been made against your cover there's no problem. We can either transfer you to a more suitable cover or refund your premium in full. If you close your membership after the cooling-off period we will refund any unused premium less an administration fee.
How often should I review my cover?
You may have different health needs at different stages of your life, so it makes sense to review your health cover regularly. This is especially important if your situation changes. For example, if you are granted permanent residency, if you're planning to start a family, the kids have grown up or either you or someone in your family has developed a health issue. Whatever your situation, it's a good idea to call us to discuss your options on 134 190 or drop into one of our stores.
What's the difference between a member and a policy holder?
There are three terms we use when we're talking about membership: member, membership and policy holder. As a starting point, it's good to be clear on all three. A member is simply any person covered under a Medibank membership.
A membership is made up of one or more members and can consist of:
- Just one person, (single membership)
- A couple membership which covers you (the policy holder) and your partner
- Family membership, which covers you and your partner and
- - any of your child dependants and/or
- - any of your student dependants
The term policy holder refers to the person who ‘owns' the membership. This is the person we contact when we need to communicate important information.
Can my partner manage my membership too?
Although you as the policy holder ‘own' the membership, your partner (if he or she is also covered by the same membership) can automatically manage most aspects of the membership too, including: making claims, adding or removing dependants, changing cover, suspending the membership and changing contact and bank account details. However, as the policy holder you're the only one who can remove yourself from the membership or cancel the membership. It's important to be aware that this means we may disclose registered membership details to both of you. If at any time you want to be the only person who can manage the membership or you require further information about the handling of personal information, please call us on 134 190.
If I transfer to Medibank from another Australian private health insurer, am I covered immediately?
You'll be covered for services on your new cover from the date you join if: those services were also included on your cover with your former health insurer, you join us within two months of leaving your former health insurer and you've already served the applicable waiting periods. So although we'll recognise any waiting periods you've served with your former fund, if you haven't fully served the applicable waiting periods with your former health insurer, you'll need to serve the balance before you're eligible for benefits. Additional waiting periods may also apply if you've switched to a higher level of cover with Medibank or if you wait more than two months after leaving your former fund before you join Medibank. Find out more about waiting periods.
If you transfer to Medibank or to another Medibank cover, any benefits that may have been paid under your previous cover may be taken into account in determining the benefits payable under your new cover.
What if I want to add my partner to my single membership?
It's easy to change from a single to a couple membership, but you should be aware that higher premiums apply to a family membership and waiting periods may apply to your partner. To add your partner to your membership, contact us
Can I add a dependent child to my membership?
If you're on a single membership:
To add a dependent child to your membership you'll need to change from a single to a family membership. If you do this within two months of the date of their birth or date of inclusion in your family unit (for example, through marriage, adoption or fostering) your child won't have to serve any additional waiting periods. And the change will be backdated to the date of birth or inclusion in your family unit. Also, this change of membership means you'll pay higher premiums.
*Only Working Visa Health Insurance covers have the option of a couple membership.
If you're on a family membership:
You can add a dependent child to your membership at any time and they won't need to serve any waiting periods already served on the membership. Your premium doesn't increase when you add a dependent child to your cover.
What if I want more information on adding a dependent child?
Call us on 134 190.
What happens if my newborn baby needs hospital treatment?
When a newborn baby is in hospital with its mother, no accommodation charges apply for the baby unless the baby becomes an admitted patient in their own right.
This happens when the baby requires admission to a neo-natal intensive care unit or it is the second or later child of a multiple birth.
If I have children, how long can they be insured on my cover?
As your children grow older they can still be covered at no additional cost on your family membership until they turn 21 or, if they are full-time students, until they turn 25, provided they're not married or in a de facto relationship. This is because we consider them to be your dependent children.
About benefits for pharmaceuticals
Visitors Health Insurance
Visitors to Australia are generally ineligible for benefits under the Pharmaceutical Benefits Scheme (PBS), so you may have significant out-of-pocket expenses.
Benefits are not payable for oral contraceptives or for pharmaceuticals prescribed for cosmetic purposes.
Working Visa Health Insurance
International visitors to Australia are generally not eligible for subsidised pharmaceuticals under the Pharmaceutical Benefits Scheme (PBS).
With our Working Visa Health Insurance, Medibank will pay some benefits towards PBS listed drugs, prescribed according to PBS-approved indications, that are administered during and form part of your admitted episode of care (including drugs prescribed upon discharge). Your benefit is equal to the PBS government subsidy in excess of your patient contribution.
Pharmaceuticals used in oncology (cancer) and other treatments can be very expensive for people who do not have access to subsidised pharmaceuticals under the PBS. If high cost pharmaceuticals are required for your treatment when in hospital, you may incur significant out-of-pocket expenses.
No benefits are payable for oral contraceptives, or for pharmaceuticals prescribed for cosmetic purposes.
For more information on the PBS, visit health.gov.au
About waiting periods
What is a waiting period?
All health funds have waiting periods. In short, a waiting period is a period of time you need to wait after taking out your cover before you can receive benefits for services or items covered.
You're not able to receive benefits for any items or services you might have obtained while you're serving a waiting period or before you joined Medibank.
How do I know if a waiting period applies to me?
Waiting periods may apply if you're a new member, you're rejoining Medibank after not having health cover for some time or you're changing to a higher level of cover (either within Medibank or transferring from another fund).
If you're changing to a higher level of cover, you'll still be entitled to benefits at the level of your former cover while you're serving any waiting periods on your new cover if:
- those services were included under your old cover; and
- you've already served the waiting periods that applied under your old cover.
How long is the waiting period?
That depends on the types of services or items included on your cover. Have a look at the following table for a guide.
Waiting periods for Young Visitors Health Insurance, Intermediate 70 Visitors Health Insurance and Top 85 Visitors Health Insurance
||All services (including ambulance services) except as specified below:
- Pre-existing conditions
- Obstetrics-related services
- Major dental services
- Orthodontic services
- Surgical dental procedures
- Peak flow meters
- Spacing devices
||Blood glucose monitors and blood pressure monitors
Waiting periods for Working Visa Hospital Insurance, Working Visa Hospital and Medical Insurance and Top 85 Working Visa Health Insurance
- In-hospital psychiatric treatment, rehabilitation treatment and palliative care, regardless of whether or not the condition is pre-existing
- All extras services (including ambulance services) except as specified below:
- Pre-existing conditions
- Obstetrics-related services
- Major dental services
- Orthodontic services
- Endodontic services (eg. root canal)
- Surgical dental procedures
- Peak flow meters
- Spacing devices
||Blood glucose monitors and blood pressure monitors
* If you have an accident after joining us or changing cover and require treatment, we'll waive the 2 month waiting period.
About pre-existing conditions
It's standard practice in the private health insurance industry to apply a waiting period of 12 months before benefits are payable for a pre-existing condition.
What's a pre-existing condition?
By pre-existing condition, we mean an ailment, illness or condition where signs or symptoms existed at any time during the 6 months before you either took out your new cover, or transferred to a higher level of cover.
We'll appoint a medical or health practitioner to determine whether you have a pre-existing condition, based on information provided by the practitioner(s) treating you.
What if I have a pre-existing condition?
If you're a new member, you'll have to wait 12 months before you can receive benefits for items or services related to a pre-existing condition.
If you're changing to a higher level of cover (either within Medibank or from another fund), you may have to wait 12 months to receive the higher benefits, including benefits for services not previously covered.
How do orthodontic benefits work?
About benefit replacement periods
What's a benefit replacement period?
It's a period of time you need to wait after purchasing an item covered by us before you can receive further benefits to replace the item. For example, if you received benefits for an insulin delivery pen, purchased on 1 July 2011, you can only receive benefits for another one purchased on or after 1 July 2013.
How long is a benefit replacement period?
This varies from item to item and generally applies per member unless specified in the following table.
- External mammary prostheses
- Repairs of external prostheses and health appliances
- Hip protectors
- Insulin delivery pens
- Blood glucose monitors and blood pressure monitors
- Breathing appliances
- - nebulisers
- - peak flow meters
- - spacing devices
- Mouthguards (for members up to 18 years of age benefits may be payable for a replacement mouthguard each calendar year)
- Dentures, crowns and bridges
- Other health appliances and external prosthesis
- Hearing aids
- Sleep apnoea – continuous pressure devices and other similar approved appliances under our hospital cover
Other rules for paying benefits
Are there any other rules I need to know about?
Yes, there are some other important rules for you to be aware of:
- We only pay benefits for items and services delivered by Medibank-recognised providers
- Restrictions may apply to the number of services you can claim in a particular period
- Some appliances may need to be ordered by a medical practitioner before benefits are payable eg. nebulisers
- To claim for a sleep apnoea device or similar device approved by Medibank firstly, you'll need Intermediate 70 Visitors Health Insurance, Top 85 Visitors Health Insurance, or Top 85 Working Visa Health Insurance. You'll also need to undergo an overnight investigation for sleep apnoea which is listed in the Medicare Benefits Schedule. Lastly, the device must be requested by a medical practitioner and purchased or hired within 12 months of undergoing the investigation
- Limitations apply to some benefits. For example, for an initial consultation for an extras service, we generally pay the higher benefit (if any) per person, per provider, per calendar year (if any) only once in a course of treatment
- Limited hospital benefits apply to hospital charges for podiatric surgery (performed by an accredited podiatrist) and dental procedures that are performed in a private non Members' Choice hospital
- The benefits we pay toward hospital treatment will be no less than the minimum benefit as set by the Federal Government.
- The benefits we pay towards surgically implanted prostheses, and other items included on the Federal Government Prostheses Schedule, will be no more than the minimum benefits as set by the Federal Government.
- If you no longer need acute care and stay in hospital for more than 35 days, then after 35 days you'll be classified as a nursing home type patient. If this happens, we'll only pay a small portion of the hospital charges and you may need to pay the rest of the cost of your care. If you're in a private hospital, these costs may be substantial. Your doctor and hospital will be aware of this requirement and they can advise you
- We don't pay benefits for services or treatments where you are, or may be, entitled to compensation and/or damages. For example State Government workers' compensation schemes, traffic accident schemes or public liability claims
- We generally don't pay benefits for hospital procedures not recognised for Medicare benefit purposes such as cosmetic surgery. However where eligible, we do pay benefits towards hospital charges for dental surgery or podiatric surgery (performed by an accredited podiatrist)
- Benefits are not payable for treatment not considered medically necessary (eg. health screening services as required for employment or visa renewal purposes)
- Benefits are not payable for treatment arranged prior to arrival in Australia
- Benefits are not payable for services provided outside Australia.
It's important you call us on 134 190 for information on recognised providers and the benefits you're entitled to before commencing treatment.
About out-of-pocket expenses
What's an out-of-pocket expense?
It's any expense for a hospital, medical or extras service or item for which you won't be reimbursed by us.
What out-of-pocket expenses can I expect if I receive an extras service and how can I reduce them?
The out-of-pocket expense will be the difference between the provider's charge and the benefit we pay. To help reduce your out-of-pocket expenses, visit a Members' Choice extras provider where you can access capped charges and/or discounts and generally receive higher benefits than you would with a non Members' Choice provider.
What kinds of out-of-pocket expenses can I expect if I go to a hospital?
Although hospital cover helps reduce the cost of your hospital visit, you'll still have out-of-pocket expenses for things like your excess and any difference between what the hospital charges and the benefit we pay for the hospital services.
You can also expect to pay the difference between the charge for in-hospital medical services (eg. doctors' services, pathology and radiology) and what you receive from us. To explain it further, the benefits you're entitled to for the medical services you receive while you're in an overnight hospital or day hospital facility are based on the Medicare Benefits Schedule (MBS) fee. The MBS is a list of all the services Medicare pays benefits for and the rules that apply to payment of those benefits.
If you visit a doctor and they charge you more than the MBS fee, you may have out-of-pocket expenses. These can vary and may be significant, especially for doctors' visits when you're in hospital.
How can I reduce my private hospital out-of-pockets?
If possible, go to a Members' Choice hospital where our agreement with the hospital limits what you can be charged. This means your out-of-pockets for hospital charges should be limited to things like:
- Any excess you may have with your cover
- Any difference between your doctors' charges (including pathology and radiology fees) and the benefits we pay you
- Any difference between the amounts you are charged for pharmaceuticals (including drugs issued on discharge from hospital) that are not covered by our agreement with the hospital and the benefits available to you under the extras component of your cover for pharmaceutical prescriptions (if your cover includes extras except for Young Visitors)
- Any gap for surgically implanted prostheses and other items on the Federal Government's Prostheses Schedule
- Costs for services not covered, or not fully covered, by our agreement with the hospital or under your cover
- Costs for treatment in an emergency department in a private hospital.
If you go to a non Members' Choice private hospital, you're likely to have significant out-of-pocket expenses.
Going to hospital
Call us first on 134 190 so we can help you understand what's involved and the types of questions you need to ask your doctor or specialist.
Medically necessary ambulance services – am I covered?
Benefits for medically necessary ambulance services are included in all Visitors Health Insurance covers and Working Visa Health Insurance covers except in the following circumstances where you're entitled to benefits from another source, such as ambulance subscription or a state ambulance transport scheme. For more information on this, call us on 134 190.
About my premiums
If I cancel my membership, will I get a refund?
If you need to cancel your membership you may apply to claim a refund of premiums paid in advance and we may apply an administration fee.
Are pre-paid premiums protected from rate increases?
Where premiums have been paid in advance of the rate increase, the new rates will apply from your next payment. However, if you change the level of your cover or membership category, the new rates will apply from the date of the change.
About the Medicare Levy Surcharge
If you're an Australian resident for taxation purposes you may be required to pay the Medicare Levy and the Medicare Levy Surcharge (MLS).
None of the Visitors Health Insurance covers or Working Visa Health Insurance covers will exempt you from the Medicare Levy Surcharge.
For more information on the MLS, please contact the Australian Taxation Office on 132 861, or visit ato.gov.au
About Goods and Services Tax (GST)
Our Visitors Health Insurance and Working Visa Health Insurance are subject to a Goods and Services Tax (GST), which is included in the premium you pay. Under Medibank's Fund Rules, if you're on any of our Visitors Health Insurance covers or Working Visa Health Insurance covers it is assumed you have no entitlement to claim any part of the GST as an input tax credit. If you're eligible and intend to claim back part or all of the GST you must notify us in writing.
Other important information
What's the best way for me to give feedback?
If you have any feedback on our products and services, or you'd like further explanation on anything to do with your membership, please contact us
What if I have a complaint?
We'll try to resolve any complaint you may have the first time you raise it with us – please contact us with any issues. If you believe your complaint has not been satisfactorily dealt with, let us know and we'll escalate your complaint.
You can also write to our Customer Resolutions team at Medibank, GPO Box 9999, Melbourne, VIC 3000.
Free, independent advice is also available from the Private Health Insurance Ombudsman on 1800 640 695.
Medibank Private encourages providers to offer high-quality products and services at competitive prices to its members.
Where Medibank Private recognises a provider, advertises on behalf of a provider, or appears by reference of logo or otherwise in an advertisement of any provider, to the fullest extent allowed by the law, such advertising or reference should not be construed as:
- an endorsement by Medibank Private;
- an acknowledgment or representation by Medibank Private as to fitness for purpose; or
- a recommendation or warranty by Medibank Private, of, for, or in relation to, the product and/or service of the provider. Accordingly, Medibank Private neither takes nor assumes any responsibility for the product and/or service provided.
Members should make and rely on their own enquiries and seek any assurance or warranties directly from the provider of the service or product.