†† Medibank health programs: 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.
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The amount you pay before Medibank contributes to your hospital costs.
The amount you can claimback at all recognised providers, up to annual limits.
Your cover also includes
Understand your cover
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). |
|---|---|
| Nil | |
| 1 day | |
| Nil | |
| 2 months | |
| 2 months | |
| 2 months | |
| 2 months
(12 months for pre-existing) |
|
| 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) |
|
| 2 months
(12 months for pre-existing) |
|
| Nil | |
| Nil | |
| 2 months |
| Exclusions |
|---|
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
- You choose the cover to suit your budget and lifestyle - 60%, 75% or 90% 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 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 limit (excludes x-rays)=
| Inclusions | Annual limits per person | Waiting period | ||
|---|---|---|---|---|
| Claim back percentage: | 60% | 75% | 90% | |
| Claim back percentage: | ||||
| N/A | N/A | N/A | 1 day | |
| N/A | N/A | N/A | 2 months | |
| $800 | No annual limit | No annual limit | 2 months | |
| $500 | $1,000 | $1,200 | 12 months | |
| $400 | $800 | $1,000 | 12 months | |
| $200 | $225 | $250 | 6 months | |
| $200 combined limit | $300 combined limit | $400 combined limit | 2 months | |
| 2 months | ||||
| $300 | $600 | $700 | 2 months | |
| $200 | $400 | $500 | 2 months | |
| $200 | $400 | $500 | Nil | |
| $200 | $400 | $500 | 2 months | |
| $200 | $400 | $500 | 2 months | |
| $150 combined limit | $200 combined limit | $250 combined limit | 12 months | |
| 24 months | ||||
| $200 | $400 | $500 | 2 months | |
| $200 | $400 | $500 | 2 months | |
| $400 | $800 | $1,200 | 36 months | |
| $200 | $400 | $600 | 2 months | |
| $200 | $400 | $500 | 2 months | |
| $200 | $400 | $500 | 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.
More than health insurance
Your rewards, discounts, offers and health programs are here to help you live better.
Medibank at Home
With your doctor's support, eligible members can choose whether a treatment is delivered in the Hospital or home, with a range of services, such as rehabilitation and chemotherapy.ΩΩ
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.>
Awarded Outstanding Value Health Insurance 18 years running
We're proud to deliver award-winning health insurance products, but don't just take our word for it. Canstar have awarded Medibank an outstanding value award for health insurance in Australia for the 18th year in a row.
Live Better and get rewarded
Earn up to $400 of rewards a year
Live Better Rewards is our health and wellbeing program that rewards you for healthy actions. Walking, sleeping, eating healthy and more – everything counts! Eligible Medibank members with hospital and/or extras cover could earn up to $400 worth of rewards.≈ π
Want to save $200 on your premium?
Eligible Medibank members with hospital and/or extras cover≈ who have signed up to Live Better Rewards, could save $200 on their premium by completing everyday healthy actions and redeeming 25,000 Rewards points.π
Sports gear, shoes and more!
Put your best foot forward and exchange your Live Better points with our partner brands like THE ICONIC and Apple, for sporting gear, footwear, AirPods Pro, and more.
Earn points for shopping
Shop with our partners including The ICONIC, Amcal, Brooks or HelloFresh, and earn points on eligible purchases.