Hospital insurance

Excess
An excess is the amount you pay before Medibank contributes to your hospital costs.
Benefits
  • One of our highest levels of hospital cover without obstetrics and IVF services
  • Rest assured we'll help you with some of the more costly procedures, such as cataract surgery
  • 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
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.

2 months

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)

Restricted

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)

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)

Major eye surgery (including cataract & lens-related)

Surgery to treat vision loss caused by cataracts, as well as other eye-related hospital admissions.

2 months
(12 months for pre-existing)

Hip & knee joint replacement surgery

Surgery to replace a hip or knee joint with a prosthesis. It includes surgery after fracture, joint deterioration and revision of previous replacement surgery. Any prosthesis provided needs to be on the Australian Government Prostheses List for benefits to be payable.

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)

Renal dialysis

Treatment to assist or replace the function of the kidneys by ensuring the appropriate balance of chemicals in the blood. It can include both haemodialysis (circulating the blood through a machine) and peritoneal dialysis (infusing and draining a sterile solution into the abdomen).

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 Restricted 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 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:

  • Obstetrics-related services (pregnancy)
  • Fertility treatment
  • Weight loss surgery

Cover Summary

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

Extras insurance

Benefits
  • Look after your day-to-day health & wellbeing with general dental, optical, physio and more
  • 100% back on an annual dental check-up & clean at any Members' Choice dentist, on top of your annual dental limit (excludes x-rays)
  • See better value with 100% back on optical at all recognised providers
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^

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.

N/A

2 months

General dental#~

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

$400

2 months (12 months for surgical dental procedures)

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.

$150

6 months

Remedial massage#

Benefits paid towards remedial massage treatments.

$100

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

combined limit
2 months

Chiropractic# & Osteopathy

Benefits paid towards consultations with a chiropractor or osteopath.

$300

combined limit
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

# 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 Basic 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).

2 & 6 month waiting periods on extras waived

When you join Medibank combined Hospital & Extras by September 30

Canstar-2008-2016

Benefits of being a medibank member

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