Core Hospital and Top Extras

You know hospital is important, but you want more than just a safety net with your Extras. Perhaps major dental work is on the cards? If this is you, this is your cover.

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Hospital excess

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Core Hospital and Top Extras

Hospital excess

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Hospital excess

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Hospital cover

Rest assured you'll receive the benefits of our top level of hospital cover in the event of an Accident
Be covered for some of the more common hospital procedures, such as colonoscopies, tonsils & knee reco
Better value for families with no hospital excess for kids on a family membership

Inclusions	Waiting period What is a waiting period? The time you need to wait before you can receive benefits for services or items listed in your cover. When do they apply? To new members, or when switching to a higher level of cover. Switching funds? If you're switching from another health fund, on similar cover, we'll recognise waiting periods already served. What is a pre-existing condition? An ailment, illness or condition that, in the opinion of a Medical Practitioner appointed by Medibank, the signs or symptoms existed at any time during the six months before you either took out your new cover, or transferred to a higher level of cover (12 month waiting period applies).
No Excess for kids on a family membership We pay limited benefits for restricted services. This means that if you choose to be treated in a private hospital the benefits we pay will not cover all hospital costs and are likely to result in significant out-of-pocket expenses. For restricted services in a Public hospital we will pay minimum shared room benefits.	2 months (12 months for pre-existing)
Ambulance services^ We pay limited benefits for restricted services. This means that if you choose to be treated in a private hospital the benefits we pay will not cover all hospital costs and are likely to result in significant out-of-pocket expenses. For restricted services in a Public hospital we will pay minimum shared room benefits.	1 day
Shoulder and knee reconstruction surgery & investigations We pay limited benefits for restricted services. This means that if you choose to be treated in a private hospital the benefits we pay will not cover all hospital costs and are likely to result in significant out-of-pocket expenses. For restricted services in a Public hospital we will pay minimum shared room benefits.	2 months (12 months for pre-existing)
Minor Gynaecological Surgery We pay limited benefits for restricted services. This means that if you choose to be treated in a private hospital the benefits we pay will not cover all hospital costs and are likely to result in significant out-of-pocket expenses. For restricted services in a Public hospital we will pay minimum shared room benefits.	2 months (12 months for pre-existing)
Repair of Hernia We pay limited benefits for restricted services. This means that if you choose to be treated in a private hospital the benefits we pay will not cover all hospital costs and are likely to result in significant out-of-pocket expenses. For restricted services in a Public hospital we will pay minimum shared room benefits.	2 months (12 months for pre-existing)
Appendicitis treatment We pay limited benefits for restricted services. This means that if you choose to be treated in a private hospital the benefits we pay will not cover all hospital costs and are likely to result in significant out-of-pocket expenses. For restricted services in a Public hospital we will pay minimum shared room benefits.	2 months (12 months for pre-existing)
Appendix removal (Appendectomy) We pay limited benefits for restricted services. This means that if you choose to be treated in a private hospital the benefits we pay will not cover all hospital costs and are likely to result in significant out-of-pocket expenses. For restricted services in a Public hospital we will pay minimum shared room benefits.	2 months (12 months for pre-existing)
Tonsils & adenoids removal We pay limited benefits for restricted services. This means that if you choose to be treated in a private hospital the benefits we pay will not cover all hospital costs and are likely to result in significant out-of-pocket expenses. For restricted services in a Public hospital we will pay minimum shared room benefits.	2 months (12 months for pre-existing)
Surgical removal of wisdom teeth We pay limited benefits for restricted services. This means that if you choose to be treated in a private hospital the benefits we pay will not cover all hospital costs and are likely to result in significant out-of-pocket expenses. For restricted services in a Public hospital we will pay minimum shared room benefits. The surgical removal of wisdom teeth in hospital in order to alleviate symptoms such as pain and infection associated with wisdom teeth. Includes benefits towards hospital accommodation and medical charges raised by doctors (e.g. anaesthetics) only where a Medicare benefit is payable. No benefits are payable under Hospital covers towards charges raised by dentists. Waiting period 2 months (12 months for pre-existing)	2 months (12 months for pre-existing)
Colonoscopy We pay limited benefits for restricted services. This means that if you choose to be treated in a private hospital the benefits we pay will not cover all hospital costs and are likely to result in significant out-of-pocket expenses. For restricted services in a Public hospital we will pay minimum shared room benefits.	2 months (12 months for pre-existing)
Palliative care We pay limited benefits for restricted services. This means that if you choose to be treated in a private hospital the benefits we pay will not cover all hospital costs and are likely to result in significant out-of-pocket expenses. For restricted services in a Public hospital we will pay minimum shared room benefits.	2 months
Psychiatric treatment Limited Service We pay limited benefits for restricted services. This means that if you choose to be treated in a private hospital the benefits we pay will not cover all hospital costs and are likely to result in significant out-of-pocket expenses. For restricted services in a Public hospital we will pay minimum shared room benefits. The diagnosis and treatment of a wide range of mental health conditions, including addiction. For benefits to be payable, treatment needs to be provided at a Medibank-approved psychiatric facility. Members that have served the 2 month waiting period for Limited Psychiatric treatment may be eligible to use the once-per-lifetime Mental Health Waiver when upgrading (without a break of more than 2 months) to a cover with Included Psychiatric treatment. Waiting period 2 months	2 months
Rehabilitation treatment Limited Service We pay limited benefits for restricted services. This means that if you choose to be treated in a private hospital the benefits we pay will not cover all hospital costs and are likely to result in significant out-of-pocket expenses. For restricted services in a Public hospital we will pay minimum shared room benefits.	2 months
All other in-hospital services where a Medicare benefit is payable unless they are Limited or Excluded. We pay limited benefits for restricted services. This means that if you choose to be treated in a private hospital the benefits we pay will not cover all hospital costs and are likely to result in significant out-of-pocket expenses. For restricted services in a Public hospital we will pay minimum shared room benefits.	2 months (12 months for pre-existing)
Cover For Accidents We pay limited benefits for restricted services. This means that if you choose to be treated in a private hospital the benefits we pay will not cover all hospital costs and are likely to result in significant out-of-pocket expenses. For restricted services in a Public hospital we will pay minimum shared room benefits.	Nil

Exclusions
Spinal fusion
Weight loss surgery
Heart-related medical & surgical admissions
Obstetrics-related services
Fertility treatment
Major gynaecological surgery
Plastic & reconstructive surgery Surgery which is medically necessary to treat a physical deformity that is either acquired (through an accident, infection, changes in body shape) or congenital (present from birth). It may include the removal of excess fat or tissue (breast reduction, abdominoplasty), correction of nose deformities, or removal of a scar - where these conditions lead to a medical condition that requires treatment. Medibank does not pay for cosmetic treatment.
Eye Surgery (including cataracts)
Hip & knee joint replacement surgery
All other joint replacement surgery
Renal dialysis
Vascular surgery
Nerve treatment

Hospital costs explained

Hospital cover helps with the cost of treatments you receive in hospital as a private patient. Of course, everyone is different, and so our hospital covers come in all shapes and sizes to suit different priorities and stages in life.

Before your hospital admission..

It's a good idea to call us on 1300 518 089 so we can take you through what you're covered for, and let you know of any potential out-of-pockets for your procedure.

What we won't pay towards

Services not included in your cover or for which you are serving waiting periods
Some high-cost medications
Services not covered by Medicare
Prosthesis in excess of approved benefits in the Government’s Prosthesis List
Cosmetic treatments

What we'll pay towards

For services included under each of our Hospital covers, we’ll pay benefits towards:

Eligible ambulance services
In-hospital medical services
Overnight accommodation in a private hospital, or a shared room in a public hospital as a private patient
Same-day admission
Intensive care
Theatre fees
The minimum benefit for surgically implanted prostheses included on the Australian Government Prostheses List

Depending on your cover you may need to pay an excess or co-payments before we will pay any benefits toward your hospital admission.

Extras cover

You choose the cover to suit your budget and lifestyle - 55%, 70% or 85% back from Members' Choice providers.
Cover for a wide range of services, including more costly ones, like major dental, orthodontics and hearing aids
100% back on up to two dental check-ups every year (including x-rays) at any Members’ Choice Advantage dentist¹, OR
100% back on an annual dental check-up & clean at any Members' Choice dentist, on top of your annual limit (excludes x-rays)²

From 1st April, some natural therapy services will be removed from all Medibank products. Click here to find out more.

Inclusions	Annual limits per person			Waiting period
Claim back percentage:	55%	70%	85%
Claim back percentage:
Ambulance services^{^}	N/A	N/A	N/A	1 day
General dental^#~	$800	No annual limit	No annual limit	2 months
Major dental^#~	$500	$1,000	$1,200	12 months
Orthodontics	$400	$800	$1,000	12 months
Optical^#	$200	$225	$250	6 months
Remedial massage^#	$200 combined limit	$300 combined limit	$400 combined limit	2 months
Physiotherapy^#	$300	$600	$700	2 months
Chiropractic^# & Osteopathy	$200	$400	$500	2 months
Psychology	$200	$400	$500	Nil
Podiatry^#	$200	$400	$500	2 months
Natural therapies	Combined limit	Combined limit	Combined limit	2 months
Dietetics	$200	$400	$500	2 months
Breathing appliances^~	$150 combined limit	$200 combined limit	$250 combined limit	12 months
Blood glucose monitor & blood pressure monitors^~	$150 combined limit	$200 combined limit	$250 combined limit	24 months
Speech therapy	$200	$400	$500	2 months
Health appliances & external prostheses^~	$200	$400	$500	2 months
Hearing aids^~	$400	$800	$1,200	36 months
Prescription pharmaceuticals (non-PBS)	$200	$400	$600	2 months
Occupational therapy	$200	$400	$500	2 months
Eye therapy Study and treatment of vision problems due to defects in the eye muscles (such as a squint or a lazy eye) or harmful visual habits. Used to treat eye strain, vision-induced headaches, cross-eyes or double vision. Therapy involves eye exercises and treatment to correct the alignment of the eyes. Benefits are paid towards consultations with a recognised orthoptist (eye therapist). Annual limits per person : $200 $400 $500 Waiting period : 2 months	$200	$400	$500	2 months

Extras costs explained

Extras cover gives you money back for non-hospital services such as dental, physio, optical and more.

The amount of money you can claim back depends on the level of cover you have. Generally speaking, the higher the level of cover, the higher your annual limit and higher the percentage you can claim back. Which means more money back in your pocket.

Using a non-Members' Choice provider?

If your extras provider isn't part of our Members' Choice network don't worry. As long as they're a Medibank recognised provider, we'll still pay a fixed amount for each service or item, up to your cover's limits.

Using a Members' Choice provider?

With a Member’s Choice provider, you’re guaranteed a fixed % back on services, up to your annual limits. We’ve also negotiated a capped price with Members’ Choice providers, so you won’t be charged more than the agreed price.

Benefits of Medibank Extras

100% back at all recognised optical retailers (some items excluded, up to your annual limit, waiting periods apply)
100% back on at least one dental check-up & clean at any Members’ Choice dentist (excludes x-rays, waiting periods apply)
Access to Members’ Choice, one of the largest health provider networks in Australia, covering more than 12,000 providers. We’ve set maximum prices that these providers can charge, so you’ll avoid any surprises when the bill arrives

Supporting documents

Membership Guide (PDF - 339 KB)

Core Hospital summary (PDF - 71 KB)

Top Extras 55 summary (PDF - 79 KB)

Top Extras 70 summary (PDF - 79 KB)

Top Extras 85 summary (PDF - 79 KB)

Canstar awarded ‘Outstanding Value Insurance’ 11 years in a row

We’re proud to deliver outstanding value health insurance products designed to suit your needs. But don’t just take our word for it.

Why choose Medibank?

30 day cooling off period

If you're not completely happy with your cover in the first 30 days of joining, let us know and we'll transfer you to a more suitable cover or refund your premiums (as long as no claims have been made).

Better health begins with better teeth

Medibank members with extras cover for 2 months or more can get 100% back on up to two dental check-ups every year, including x-rays, at any Members’ Choice Advantage dentist.*

Request a call back

Leave your details and a Medibank expert will be in touch to take you through your options. In providing your telephone number, you consent to Medibank contacting you about health insurance.

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^ Tasmania and Queensland have state schemes that cover ambulance services for residents of those States
# Medibank has Members' Choice providers for these services only. By choosing a Members' Choice provider you are guaranteed to receive the percentage back shown on the cover, up to annual limits.
~ Some items and services may require a Referral Letter and may have a benefit replacement period. Please see the Cover Summary or Member Guide for more information.
¹ Members can claim a maximum of two 100% back dental check-ups per member, per year—either two check-ups at a Members’ Choice Advantage dentist (including up to two bitewing x-rays per check-up where required), or a first check-up at a Members’ Choice dentist (excluding x-rays) and a second check-up at a Members’ Choice Advantage dentist. These check-ups do not count towards annual limits. Waiting periods apply. Not available in all areas.
² Waiting period applies.
* Limited to two dental check-ups on all extras annually. Maximum two bitewing x-rays per check-up, where clinically needed. Not available in all areas.

³ For new members on new memberships who have not held Medibank cover in the last 60 days and who join and start Medibank combined hospital and extras cover during the promo period (from Jan 1, 2019 – Feb 28, 2019). Must quote promo code ADIDAS and set up direct debit when joining. Not available on Accident Cover, Visitors Health Insurance, Working Visa Health Insurance, OSHC, Ambulance Cover, ahm covers, some Corporate covers and other selected covers. Not available with any other offer. E- gift card terms: Must maintain eligible cover for 40 consecutive days after the policy start date. E-gift card could take up to 8 weeks from the policy start date to arrive by email. Singles and single parents will receive a $200 adidas e-gift card, and families and couples will receive 2 x $200 adidas e-gift cards. E-gift card can only be redeemed at adidas’s online store, is not transferrable and is valid 12 months from date of issue. E-gift card must be activated within 3 months from date of issue. E-gift card cannot be redeemed on outlet items, on limited edition products, or on super exclusive products. For full list of exclusions see https://adidas.com.au/promotion-medibank-live-betterprogram.html. E-gift card can only be used in a single transaction and any unused balance in that transaction will be forfeited. E-gift card is subject to the adidas standard terms and conditions. For full terms and conditions on activating and using your card see www.medibankrewards.com.au. 2 & 6 waiver terms: 2 and 6 month waiting periods on extras waived. Other waiting periods apply. If you’ve reached your limits from a previous fund you may not be able to claim straight away.

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Core Hospital and Top Extras

Core Hospital and Top Extras

Hospital cover

Hospital costs explained

Extras cover

Extras costs explained

Supporting documents

Canstar awarded ‘Outstanding Value Insurance’ 11 years in a row

Why choose Medibank?

30 day cooling off period

Better health begins with better teeth

Request a call back

Refine your details

Core Hospital and Top Extras

Core Hospital and Top Extras

Want an adidas e-gift card worth up to $400?

Hospital cover

Hospital costs explained

Extras cover

Extras costs explained

Supporting documents

Canstar awarded ‘Outstanding Value Insurance’ 11 years in a row

Why choose Medibank?

30 day cooling off period

Better health begins with better teeth

Request a call back