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The amount you can claim back at Members’ Choice providers, up to annual limits. Fixed amounts apply at non-Members’ Choice providers, up to annual limits.
The amount you pay before Medibank contributes to your hospital costs.
Your cover also includes
Hospital cover
- One of our highest levels of cover, including services you may need to support your health as you get older, such as cataracts and joint replacements.
- The only services this cover does not include are assisted reproductive services, weight loss surgery and pregnancy and birth, with restrictions to hospital psychiatric services.
- Want more options during an emergency? This cover includes a $400 Private Emergency Department Benefit per membership each year.>
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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Nil | |
1 day | |
Nil | |
2 months | |
2 months | |
2 months | |
2 months
(12 months for pre-existing) |
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2 months
(12 months for pre-existing) |
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2 months
(12 months for pre-existing) |
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2 months
(12 months for pre-existing) |
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2 months
(12 months for pre-existing) |
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2 months
(12 months for pre-existing) |
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2 months
(12 months for pre-existing) |
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2 months
(12 months for pre-existing) |
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2 months
(12 months for pre-existing) |
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2 months
(12 months for pre-existing) |
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2 months
(12 months for pre-existing) |
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2 months
(12 months for pre-existing) |
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2 months
(12 months for pre-existing) |
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2 months
(12 months for pre-existing) |
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2 months
(12 months for pre-existing) |
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2 months
(12 months for pre-existing) |
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2 months
(12 months for pre-existing) |
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2 months
(12 months for pre-existing) |
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2 months
(12 months for pre-existing) |
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2 months
(12 months for pre-existing) |
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2 months
(12 months for pre-existing) |
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2 months
(12 months for pre-existing) |
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2 months
(12 months for pre-existing) |
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2 months
(12 months for pre-existing) |
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2 months
(12 months for pre-existing) |
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2 months
(12 months for pre-existing) |
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2 months
(12 months for pre-existing) |
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2 months
(12 months for pre-existing) |
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2 months
(12 months for pre-existing) |
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2 months
(12 months for pre-existing) |
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2 months
(12 months for pre-existing) |
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2 months
(12 months for pre-existing) |
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Nil | |
Nil | |
2 months |
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 surgically implanted prostheses included on the Australian Government Prostheses List
Depending on your cover you may need to pay an excess or co-payment before we will pay any benefits towards your hospital admission.
- Services not included in your cover or for which you are serving waiting periods
- Some high-cost medications
- Services not covered by Medicare
- Prostheses in excess of approved benefits in the Government’s Prostheses List
- Cosmetic treatments
It's a good idea to call us on 1300 518 089 so we can take you through what we will pay benefits for, and let you know of any potential out-of-pockets for your procedure.
Extras cover
- You choose the cover to suit your budget and lifestyle - 60% or 75% back from Members' Choice Providers.
- Cover for the extras services for day-to-day health and wellbeing.
- 100% back for kids at Members' Choice providers, up to annual limits.##
- 100% back on annual flu vaccinations up to annual limits.^^
Inclusions | Annual limits per person | Waiting period | |
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Claim back percentage: | 60% | 75% | |
Claim back percentage: | |||
N/A | N/A | 1 day | |
$400 | $750 | 2 months | |
$350 | $450 | 12 months | |
$150 combined limit | $200 combined limit | 6 months | |
2 months | |||
$200 combined limit | $400 combined limit | Nil | |
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 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
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.

Canstar awarded ‘Outstanding Value Health Insurance’ 16 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).
No Gap Joint Replacement Program
The No Gap Joint Replacement Program allows eligible members to pay no out-of-pocket costs on a wide range of medical services as part of hospital admission for elective surgery for a joint replacement where clinically appropriate. The program has been designed to provide eligible members with more affordable care options and transparency about out-of-pocket medical costs when undergoing a joint replacement with participating surgeons and hospitals.†
Private Emergency Department Benefit
Want more options during an emergency? With our Private Emergency Department Benefit we’ll pay towards the admission fee charged for attending an Emergency Department at a Private Hospital, up to your product's annual limit, per membership per year. Other fees may apply.>
Hospital Assist
To help you prepare for and recover from hospital admission, eligible members can access support over the phone from our Health Concierge clinicians, or visit the online hub for helpful tips and tools.«

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.
² Two month 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.
± 6 month waiting period applies. Some lens coatings excluded.
†† Must have eligible Hospital cover and meet clinical eligibility criteria. All relevant waiting periods must have been served and treating doctor must consider it clinically appropriate. Out of pocket expenses may apply.
ΩΩ Must have eligible Hospital cover, all relevant waiting periods must have been served and treating doctor must consider it clinically appropriate. Participation is subject to availability. Out of pocket expenses may apply. Chemotherapy, palliative, infusion and dialysis program not available in all areas.
† An eligible member will not have to pay an excess for a no gap procedure on this cover. There may be out-of-pocket expenses associated with outpatient appointments, such as your initial visit with a participating surgeon in their consulting rooms. This program is only available at participating Hospitals with participating Surgeons. Participating Hospitals are not available in all areas. All applicable waiting periods must have been served.
> We'll pay a benefit up to an annual limit per membership towards any admission fee ("facility fee") charged by the Private Hospital for patients attending a Private Accident and Emergency Department. The fee amount varies by Private Hospital and does not include medical and other charges (such as charges for diagnostic imaging or pathology), so out of pocket expenses may still apply. Only available at Private Hospitals with an Accident and Emergency Department. Members will need to submit a claim to receive the benefit and may have to pay upfront. Two month waiting period applies.
« Health Concierge is available to all eligible Medibank members who hold hospital cover. Excludes Overseas Visitor Health Cover, Working Visa Health Cover and Overseas Student Health Cover (OSHC). Some referred services may involve out of pocket costs.
## Waiting periods apply, including 12 months for some dental services. Applies to Child and Student Dependants only, up to annual limits. Members' Choice providers not available in all areas.
^^ Waiting period applies.
# Medibank has Members' Choice providers for these services. Not available in all areas.
~ 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.
^ Tasmania and Queensland have State schemes that cover ambulance services for residents of those States.
+ Covers with Restricted or Excluded services will be treated as Included services where treatment is required for injuries sustained in an Accident that occurs after joining this cover. Treatment must be sought within 7 days of the Accident. Excludes claims covered by third parties such as Workcover and our Private Room Promise. Out of pockets may apply. Refer to your Cover Summary.
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