Hospital insurance

Excess
An excess is the amount you pay before Medibank contributes to your hospital costs.
Benefits
  • Broader range of hospital services, such as heart-related admissions, shoulder & knee reconstructions
  • Rest assured you'll receive the benefits of our top level of hospital cover in the event of an Accident
  • Unlimited Emergency Ambulance Australia-wide^
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

To make health insurance easier to understand, we've simplified some our most commonly used jargon. Find out more here.

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^

For ambulance attendance or transportation to a hospital where immediate professional attention is required and your medical condition is such that you couldn't be transported any other way.

1 day

Shoulder and knee reconstruction surgery & investigations

Reconstructions to repair ligament tears, remove loose tissue and to 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

Admission to hospital for a suspected inflamed appendix (appendicitis) and where appendectomy is not required.

2 months
(12 months for pre-existing)

Appendix removal (Appendectomy)

Surgery to remove an inflamed appendix.

2 months
(12 months for pre-existing)

Tonsils & adenoids removal

Surgery to remove tonsils and/or adenoids.

2 months
(12 months for pre-existing)

Surgical removal of wisdom teeth

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.

2 months
(12 months for pre-existing)

Colonoscopy

A procedure to examine the lining of the large bowel (colon) to investigate the cause of abdominal pain, bleeding, irregular bowel habits, to remove polyps or detect cancer.

2 months
(12 months for pre-existing)

Palliative care

Health care that offers support to people with a life-limiting illness. Its aim is to comfort and to relieve pain and distress for people who are dying. Benefits are only payable where admission to a palliative care unit in a hospital occurs.

2 months

Spinal fusion

Surgery to join two or more vertebrae to reduce pain and improve function arising from disorders of the spinal column.
It may include treatment of conditions such as chronic low back pain, spondylolisthesis, spondylosis and degeneration of the spine. It does not include treatment of developmental deformities such as scoliosis or kyphosis.

2 months
(12 months for pre-existing)

Limited

Psychiatric treatment

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.

2 months

Rehabilitation treatment

Therapy which assists in recovery following a major health-related event, such as a joint replacement or heart attack. Treatment needs to be provided at an approved rehabilitation facility and under an approved program.

2 months

Heart-related medical & surgical admissions

Medical and surgical admissions to investigate, diagnose, monitor and/or treat heart-related conditions.
May include services such as open heart and bypass surgery, invasive cardiac investigations and procedures such as angiograms, angioplasties and stent insertions.

2 months
(12 months for pre-existing)

Limited

Obstetrics-related services (pregnancy)

Services and treatment provided to an admitted patient in hospital for care during pregnancy and childbirth. Includes vaginal and caesarean delivery and in-patient diagnostic imaging, as well as treatment of pregnancy-related complications.

12 months

Major gynaecological surgery

Such as hysterectomy, prolapse and ovarian surgery.

2 months
(12 months for pre-existing)

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.

2 months
(12 months for pre-existing)

Other joint replacement surgery

Surgery to replace a shoulder, elbow or ankle joint with a prosthesis. It includes surgery after fracture as well as joint deterioration and revision of previous replacement surgery. Any prosthesis provided must be on the Australian Government Prostheses List for benefits to be payable.

2 months
(12 months for pre-existing)

Nerve treatment

Insertion of a device or injection to manage severe movement disorders or chronic pain.

2 months
(12 months for pre-existing)

Vascular surgery

Surgery of arteries and removal of varicose veins.

2 months
(12 months for pre-existing)

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

The Medicare Benefits Schedule (MBS) lists all the medical services subsidised by the Australian Government through Medicare. This includes thousands of in-hospital services that we pay benefits towards.

2 months
(12 months for pre-existing)

Cover For Accidents

Covers which have services that are normally Limited 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:

  • Fertility treatment
  • Eye Surgery (including cataracts)
  • Hip & knee joint replacement surgery
  • Renal dialysis
  • Weight loss surgery

Cover Summary

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

Extras insurance

Benefits
  • 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 an annual dental check-up & clean at any Members' Choice dentist, on top of your annual limit (excludes x-rays)
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.

N/A

1 day

General dental#~

Includes examinations, preventative treatment, scale and clean, extractions, fillings, x-rays, and surgery to remove wisdom teeth (excludes hospital charges).

$800

2 months (12 months for surgical dental procedures)

Major dental#~

Includes services such as root canal, periodontics, crowns, dentures, bridges and veneers.

$500

12 months

Orthodontics

Procedures to help with the correction & alignment of the teeth and jaw. We pay benefits towards 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#

100% back on eligible items up to annual limits at all recognised providers. Includes prescription glasses and contact lenses. Some items, such as lens coatings, are excluded.

$200

6 months

Remedial massage#

Benefits paid 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 paid towards consultations with a chiropractor or osteopath.

$200

2 months

Podiatry#

Diagnosis, treatment and prevention of conditions affecting the toe, foot and ankle to help with good foot hygiene and posture. We pay benefits towards consultations and approved orthotics.

$200

2 months

Natural therapies

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

Combined limit

- see Remedial massage
2 months

Dietetics

Dietetics involves using nutritional principles to promote good health through proper eating and development of modified diets. We pay benefits towards consultations with a recognised dietitian or nutritionist only.

$200

2 months

Breathing appliances~

Peak flow meters, nebulisers and spacing devices only.

$150

12 months

Blood glucose monitor & blood pressure monitors~

100% back up to your annual limit when you purchase a monitor.

$150

24 months

Speech therapy

Benefits paid towards consultations with a recognised speech therapist.

$200

2 months

Psychology

Diagnosis & treatment of behavioural and mental health conditions such as depression, anxiety and phobias, as well as personality disorders such as Obsessive Compulsive Disorder (OCD) and other behavioural problems. Benefits paid towards consultations with a recognised psychologist only.

$200

2 months

Health appliances & external prostheses~

Includes insulin delivery pens, pressure therapy garments, braces, splints, orthoses, post-mastectomy brassieres and external mammary prostheses/breast forms.

$200

2 months

Hearing aids~

Benefits paid towards the cost of a hearing aid.

$400

36 months

Prescription pharmaceuticals (non-PBS)

Includes most prescription-only items not subsidised by the Government. Benefits will be paid after a set charge has been deducted. It’s important to note that we don’t pay benefits for oral contraceptives or for pharmaceuticals prescribed for cosmetic purposes.

$200

2 months

Occupational therapy

Occupational therapy helps with the development or recovery of core physical, mental and developmental abilities. Benefits are paid towards consultations with a recognised occupational therapist.

$200

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).

$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.
^Tasmania and Queensland have State schemes that cover ambulance services for residents of those States.
~ 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).

Canstar

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