Family Health Insurance

Things you should know

Waiting periods and annual limits may apply.

‡ We pay limited benefits for Restricted services. This means that if you choose to be treated in a private hospital the benefits we pay will not cover all hospital costs and are likely to result in significant out-of-pocket expenses. For Restricted services in a Public hospital we will pay minimum shared room benefits.

⁼ Eligible members on Medibank extras (excluding Healthy Living Extras and Gold Ultra Health) can claim a maximum of two 100% back dental check-ups per member, per year at a Members’ Choice Advantage provider (including bitewing x-rays where clinically required). For members on eligible extras, the first two check-ups do not count towards your annual limit. Members with Healthy Living Extras can get 100% back on one dental check-up each year at a Members’ Choice Advantage provider (including up to two bitewing x-rays, where clinically required) or at a Members’ Choice provider (excluding x-rays). Members with Gold Ultra Health can get 100% back on up to three dental check-ups at a Members’ Choice or Members’ Choice Advantage provider. Members’ Choice and Members’ Choice Advantage providers are not available in all areas. Two month waiting period applies. Some products may have other dental benefits, check your cover summary for details.

^# 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.

⁺ For Accidents that occur in Australia after your cover starts. Must seek medical treatment within 7 days, and receive hospital treatment within 12 months of the Accident occurring. Excludes Private Emergency Department Benefit, hospital bonus, claims covered by third parties and our Private Room Promise. Out-of-pocket costs may apply. For Gold hospital covers, Accident Cover Boost is not required because all clinical categories are Included, regardless of whether or not the treatment is required as a result of an Accident.

^¶ Counsellors must be registered with Australian Counselling Association, Psychotherapy and Counselling Federation of Australia, Australian Traditional Medicine Society. Mental Health Social Workers must hold a mental health accreditation by the Australian Association of Social Workers. Medibank will pay benefits towards pharmacogenetic tests for all conditions. Benefits will only be paid towards pharmacogenetic tests administered in-person, or for approved home kits where supporting documentation from a medical practitioner outlining the clinical purpose is supplied.

^Ω Other out–of–pocket expenses may apply.

^¥¥ Some referred services may involve out of pocket costs and waiting periods may apply.

^ Waiting periods apply. 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. TAS and QLD have state schemes to cover ambulance services for residents of those states.

^> 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.

¹ Waiting periods apply, including 12 months for some dental services. For Child Dependants (up to 21 years) and eligible Student Dependants (up to 31 years). Members’ Choice providers not available in all areas.

² Eligibility requirements apply for Dependants. Only available on eligible policies. Additional costs for the first Adult Dependant. Eligible Student Dependants may be added to most Overseas Visitors Health Cover and all Overseas Workers Health Cover products. Adult Dependants cannot be added to any overseas health covers.

³ To be eligible for the Young Adult Discount, a Young Adult must have their own residential hospital policy or a residential hospital policy with their partner. They cannot be a dependent on their parents' policy. If they are on their own couple or family policy, the discount is calculated by taking an average of the discount applied to the adults on the hospital cover. So, if one person has a 10% discount and their partner has no discount, or 0%, the discount applied is 5% overall.

⁴ 'Income’ and 'dependants' have a specific meaning for Medicare Levy Surcharge purpose. Learn more.

⁵ Australian Taxation Office – Australian Government; Appropriate level of patient hospital cover; retrieved October 2024.

^€ For full Hospital and Extras offer Terms, Conditions and Exclusions, click here.