The amount you pay before Medibank contributes to your hospital costs.
The amount you can claim back when you visit a Medibank preferred provider, up to annual limits. Fixed amounts apply at other providers, up to annual limits.
Hospital cover
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).
| 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). |
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| Exclusions |
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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.
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 medical devices and human tissue products as set out in the government's Prescribed List of Medical Devices and Human Tissue Products
Depending on your cover you may need to pay an excess or co-payment before we will pay any benefits towards your hospital admission. Other out-of-pocket expenses may apply.
- Services not included in your cover or for which you are serving waiting periods
- Some high-cost medications
- Services not covered by Medicare
- Medical devices and human tissue products in excess of approved benefits in the Government’s Prescribed List
- Cosmetic treatments
- Certain other items (e.g. streaming services and parking), depending on the hospital you're admitted to. The hospital should discuss any charges with you.
It's a good idea to call us on 132 331 so we can take you through what we will pay benefits for, and let you know of any potential out-of-pockets you might expect for your procedure.
Extras cover
- Look after your day-to-day health & wellbeing with general dental, optical, physio and more
- See better value with 100% back on optical at all recognised providers±
- 100% back on up to two dental check-ups every year (including bitewing x-rays) at any Members’ Choice Advantage dentist=, OR
- 100% back on an annual dental check-up & clean at any Members' Choice dentist, on top of your annual dental limit (excludes x-rays)=
No waiting periods again
If you are switching to Medibank from another health fund, you won't need to re-serve waiting periods you’ve already served with your previous fund.
| Inclusions | Annual limits per person | Waiting period | |
|---|---|---|---|
| Claim back percentages at Members' Choice Providers where available: | 60% | 75% | |
| Claim back percentages at Members' Choice Providers where available: | |||
| No annual limit | No annual limit | 1 day | |
| 100% back on up to 2 dental check-ups | 100% back on up to 2 dental check-ups | 2 months | |
| $400 | $750 | 2 months | |
| $150 | $200 | 6 months | |
| $100 combined limit | $100 combined limit | 2 months | |
| 2 months | |||
| $300 combined limit | $450 combined limit | 2 months | |
| 2 months | |||
What are annual limits?
The maximum amount of benefits payable towards services, items or groups of services and/or items in a calendar year.
Switching health funds?
Benefits paid under your previous cover will be taken into account in determining the benefits payable under your Medibank cover.
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.
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.
- 100% back on at least one dental check-up and clean each year at a Members’ Choice or Members’ Choice Advantage provider.=
- 100% back on optical items at all recognised providers up to annual limits. Excludes Healthy Living Extras.±
- 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.
With a Members' Choice provider, you'll receive a fixed % back on services, up to your annual limits.
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 annual limits.