Medibank's contracts with hospitals

As Australia’s largest private health insurer, Medibank has a role to play in helping improve our 3.8 million members’ health outcomes, healthcare experience, and the affordability of their healthcare.

To help achieve these healthcare goals, which we refer to as the triple aim of healthcare*, Medibank is working with hospitals on a range of initiatives including reducing hospital acquired complications and re-admissions.

To date, Medibank has entered into agreements with more than 120 leading private hospitals, representing around 70 per cent of Australia’s major private hospitals, to implement these important changes.

What changes is Medibank introducing?

Medibank is asking participating hospitals to cover any additional costs that result from certain types of hospital complication or associated re-admissions where there is good evidence that these types of complication could be reduced or avoided.

Why are these changes important?

These changes are good for all our members. They can improve health outcomes and help ensure that private health insurance doesn’t become unaffordable.

Hospital acquired complications and readmissions as a result of a hospital acquired complication have an adverse impact on the health of our members, make health insurance less affordable, and challenge the sustainability of Australia’s world-class health system.

In 2014, Medibank funded over one million interventions.  Of these, we identified over 11,000 hospital acquired complications, with one in 10 resulting in Medibank paying a claim on behalf of our members that was more expensive than would have been the case if the complication had not occurred.

What do these changes mean for our members?

The treatment a member is covered for will not change. Medibank still funds the original cost of the treatment on behalf of members, in line with the terms of their policy.

Members will not be charged extra by participating hospitals for the cost of a hospital acquired complication or re-admission as a consequence of a complication and our members’ access to high quality treatment in their hospital of choice will remain unchanged.

Will the changes affect payments to doctors?

Medibank’s payments to medical specialists, including the surgeon, physician, anaesthetist or assistant surgeon, for our members’ care remain unchanged. 

Who can I speak to for more information?

Your health and wellbeing are important to us. If you have any concerns or would like to discuss your individual needs, our team is available to help:

Medibank members - 8.00am to 8.00pm AET weekdays on 1300 756 959

ahm members - 8.00am to 6.00pm AET weekdays on 134 246.

*Informed by the work of the Institute of Healthcare Improvement, Cambridge, MA, USA



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