Hospital insurance

Excess
An excess is the amount you pay before Medibank contributes to your hospital costs.
Benefits
  • Colonoscopies
  • Tonsils & adenoids
  • No hospital excess for kids on a family membership
Excess An excess is the amount you pay before Medibank contributes to your hospital costs.

Choosing a higher excess will lower your premium. An excess will apply to each adult member admitted to hospital per calendar year.

Hospital inclusions
Services we pay benefits for Treatments & Features Waiting periods Waiting periods explained Waiting periods are a length of time you need to wait after taking out your cover before you can claim or receive benefits covered by your policy. Waiting periods apply to new members or for new services, including if you're changing to a higher level of cover. If you're switching you will not need to re-serve waiting periods if you have already served your waiting periods and you change to a comparable or lower level of cover. If you change to a higher level of cover, we will recognise any waiting periods you have already served and pay benefits at your former lower level of cover until you serve the waiting periods for your higher level of cover. If you have only partially served your waiting periods on your former level of cover, you will need to serve the balance before you can claim at your former level of cover. A 12 month waiting period applies for all pre-existing conditions. Pre-existing condition A pre-existing condition is an ailment, illness or condition where 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. A 12-month waiting period applies for all pre-existing conditions. Call 134 190 to find out more.

No Excess for kids on a family membership

No matter what hospital excess you pay, the excess will not apply if kids on your membership are admitted to hospital

2 months
(12 months for pre-existing)

Ambulance services

100% cover for immediate professional attention. Includes ambulance transportation to hospital when your medical condition means you can't be transported in any other way. Tasmania and Queensland have State schemes that cover ambulance services for residents of those States.

2 months

Shoulder and knee reconstruction surgery & investigations

Reconstructions to repair ligament tears, remove loose tissue or treat other damage

2 months
(12 months for pre-existing)

Minor Gynaecological Surgery

Surgery to treat conditions of the female reproductive system e.g. endometriosis. Excludes IVF

2 months
(12 months for pre-existing)

Repair of Hernia

Surgical repair and treatment of a hernia

2 months
(12 months for pre-existing)

Appendicitis treatment

Hospitalisation for appendicitis

2 months
(12 months for pre-existing)

Removal of appendix

The surgical removal of your appendix

2 months
(12 months for pre-existing)

Removal of tonsils & adenoids

Surgery to remove tonsils and/or adenoids

2 months
(12 months for pre-existing)

Surgical removal of wisdom teeth (for hospital charges only)

Accommodation and theatre charges for wisdom tooth removal in hospital (does not include doctor/dentist fees)

2 months
(12 months for pre-existing)

Colonoscopies & endoscopies

Procedure to examine the large bowel

2 months
(12 months for pre-existing)

Palliative care

Health care that provides support to people with a life-limiting illness

2 months

Restricted

Psychiatric treatment

Including diagnosed disorders or addiction requiring immediate hospital-based intervention

2 months

Restricted

Rehabilitation treatment

Approved physical therapy and exercise programs, generally following an inpatient admission

2 months

All other in-hospital services where a Medicare benefit is payable unless they are Restricted or Excluded.

The Medicare Benefits Schedule sets out treatment and services which the Commonwealth Government subsidies via the Medicare system.

2 months
(12 months for pre-existing)

Cover For Accidents

Covers which have services that are normally Restricted or Excluded will be treated as an Included service where treatment is required for injuries sustained in an Accident that occurs after joining this cover, provided that the treatment is on the Medicare Benefits Schedule. Refer Cover Summary for full details.

nil

Services not covered by this product:

  • Spinal Fusion
  • Heart-related medical and surgical admissions
  • Obstetrics-related services (eg. pregnancy)
  • Fertility treatment (eg. IVF & GIFT programs)
  • Major gynaecological surgery
  • Plastic & reconstructive surgery
  • Major eye surgery - including cataract & lens-related services
  • Hip & knee joint replacement surgery
  • Other joint replacement surgery
  • Renal dialysis
  • Nerve treatment
  • Vascular surgery
  • Weight Loss Surgery (e.g Bariatrics)

Cover Summary

For further information on Core Hospital, please see the cover summary.

Extras insurance

Benefits
  • You choose 55%, 70% or 85% back on extras
  • 100% back on a yearly check-up at a Members' Choice dentist (excludes x-rays). And this doesn't count towards annual limits
  • Dental, major dental & orthodontics
  • Podiatry, speech therapy & hearing aids
  • 100% back on optical at all optical providers up to annual limits
55% Claim Back at Members' Choice

The information shown below is the Extras services you claim benefits for as well as any annual limits and waiting periods that may apply. If you use a Members' Choice provider you will be able to claim 55% back on the cost, up to annual limits, on the costs of services that are included in your cover. We've negotiated a capped price with Members' Choice providers, so you won't be charged more than the agreed price. Services available through our Members' Choice provider network are indicated in the table with a #.

If your provider is not part of our Members' Choice network, we still pay benefits up to a fixed benefit at any recognised provider. This benefit may be less than the provider charges.

Extras inclusions
Services we pay benefits for Treatments & Features Annual limits per person An annual limit is the maximum amount of benefits Medibank will pay for particular treatments each calendar year. Generally, the more comprehensive your cover, the higher the annual limits. If you are switching, benefits that have been paid under your previous cover will be taken into account in determining the benefits payable under your Medibank cover. Waiting periods Waiting periods explained Waiting periods are the length of time you need to wait after taking out your cover before you can claim or receive benefits covered by your policy. Waiting periods apply to new members or for new services, including if you're changing to a higher level of cover. If you're switching you will not need to re-serve waiting periods if you have already served your waiting periods and you change to a comparable or lower level of cover. If you change to a higher level of cover, we will recognise any waiting periods you have already served and pay benefits at your former lower level of cover until you serve the waiting periods for your higher level of cover. If you have only partially served your waiting periods on your former level of cover, you will need to serve the balance before you can claim at your former level of cover.

Ambulance services

100% cover for immediate professional attention. Includes ambulance transportation when your medical condition means you can't be transported in any other way. Tasmania and Queensland have State schemes that cover ambulance services for residents of those States.

N/A

2 months

General dental#~

Includes examinations, preventative treatment, scale and clean, extractions, fillings and x-rays and surgical removal of wisdom teeth (excluding hospital charges).

$800

2 months (12 months for surgical dental procedures)

Major dental#~

Includes services such as endodontic services (e.g. root canal); periodontics (e.g. treatment of gum disease); crowns, dentures and bridges; and major restorative fillings (e.g. veneers)

$500

12 months

Orthodontics

Includes braces

$400

Opening balance top up of $200 per full calendar year after waiting periods have been served up to a $1,200 lifetime limit. Please refer to cover summary for full details.
12 months

Optical items#

100% back up to annual limits at any recognised provider. Includes frames, prescription lenses and repairs. Excludes some lens coatings.

$200

6 months

Remedial massage#

Benefits towards remedial massage treatments

$200

combined limit for Remedial massage and Natural therapies.
2 months

Physiotherapy#

Includes one-on-one and group consultations, Clinical Pilates, antenatal and hydrotherapy sessions

$300

2 months

Chiropractic# & Osteopathy

Benefits towards consultations with an osteopath or chiropractor

$200

2 months

Podiatry#

Benefits towards consultations, biomechanical assessments and custom orthotics

$200

2 months

Natural therapies

Consultations for naturopathy# and acupuncture#.
Consultations for reflexology, kinesiology, Chinese & Western herbalism, exercise physiology, shiatsu, aromatherapy, homeopathy, Bowen therapy, Alexander technique & Feldenkrais.

$200

Combined limit - see Remedial massage
2 months

Dietetics

Benefits towards dietitian and nutritionist consultations

$200

2 months

Breathing appliances~

Peak flow meters, nebulisers & spacing devices

$150

12 months

Blood glucose monitors & blood pressure monitors~

100% back up to your annual limit

$150

24 months

Speech Therapy

Benefits are paid towards consultations with a speech therapist

$200

2 months

Psychology

Cover for consultations only

$200

2 months

Health appliances & external prostheses~

Including insulin delivery pens

$200

2 months

Hearing aids~

Benefits are paid towards the cost of hearing aids and hearing aid repairs

$400

36 months

Prescription pharmaceuticals (non PBS)

For certain prescribed items not subsidised by the Government

$200

2 months

Occupational therapy

Benefits are paid towards consultations with an Occupational Therapist

$200

2 months

Eye therapy

Benefits are paid towards consultations with an orthoptist

$200

2 months

# 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.
~ 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.

Cover Summary

For further information on Top Extras 55, please see the cover summary.

icon-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).

Get one month free plus 2&6 month waiting periods waived on extras

When you join Medibank combined Hospital & Extras by March 31*

Canstar-2008-2016

Benefits of being a medibank member

Medibank nurse 24/7
Fast online claims
Wide range of extras
Advice for better health