The maximum amount of benefits payable for particular items or services, or a group of services and/or items within a calendar year. In most cases the limit will apply per member, but it can apply per membership
Admission to hospital for an inflamed appendix (appendicitis). The purpose is to remove pain and discomfort associated with an inflamed appendix. It includes admission to hospital with suspected appendicitis and may include surgery to remove the appendix (appendectomy)
A rebate provided by the Australian Government to help Australians reduce the cost of their health insurance premiums. The rebate is means tested, and applies only to the base premium of a residential cover. Click here for more information on determining and applying for your eligible rebate
The amount of money we contribute towards the cost of an item or service included under a member's cover. The benefit we pay for services or items is likely to be less than your annual limit and less than your provider’s charge, which means you may have out-of-pocket expenses to pay
Surgery for conditions affecting the small and/or large bowel. Bowel surgery may be required to treat conditions such as inflammatory bowel disease, bowel cancer, perforation of the bowel and bowel obstruction. It includes removal or repair of damaged segments of the bowel and is often undertaken to remove a cancerous growth
Surgery to treat conditions involving the brain and the skull. It may be used to treat brain tumours, meningiomas, aneurysms, alteration to the blood vessels, bleeding and raised intracranial pressureand includes neurosurgery to the brain, stereotactic surgery and craniotomy
Chiropractic treatment involves the manipulation or adjustment of the spine and the diagnosis and management of spinal health related problems and is intended to treat conditions such as back or neck pain and injuries, headaches/migraines and joint problems to promote mobility.
It includes consultations and x-rays. Benefits are payable for one-on-one sessions only. Where x-rays are provided under a person’s cover, the practitioner must be licensed to provide them.
A daily amount that a member contributes towards their accommodation costs when admitted to hospital, separate to any excess applicable. The amount payable is determined by the cover held and is payable directly to the hospital
A procedure to examine the lining of the large bowel (colon). It is used to investigate the cause of abdominal pain, bleeding, irregular bowel habit, remove polyps or detect cancer. Where a colonoscopy procedure is included under a cover, it must be performed in-hospital for benefits to be payable
An actual or perceived stated of health for which treatment is sought. It includes but is not limited to states variously described as; abnormality, ailment, disability, disease, disorder, health problem, illness, impairment, impediment, infirmity, injury, malady, sickness or unwellness
The 30 day period from the date a member joins Medibank or changes their cover, to review and make sure they are happy with it. If a member changes their mind during this period, Medibank will either provide a full premium refund or transfer them to a more appropriate cover from the cover start date, provided no claims have been made
Dietetics applies nutritional principles to the planning and preparation of food to maintain health and treat disease. It's purpose is to promote good health through proper eating and development of modified diets. It includes consultations with a registered dietician where they have a Medicare provider number. Any consumables are not claimable. The peak body for Dietitians is the Dietitians Association of Australia (DAA)
An arrangement between a person and Medibank where the person authorises Medibank to automatically debit money from their nominated bank account or credit card subject to agreed terms, governed by Medibank’s direct debit agreement
An amount that a member must contribute towards their same day or overnight hospital treatment. It is deducted from the benefits we pay and is separate to any co-payment applicable. Some hospitals may require the excess to be paid at the time of admission. The amount payable is determined by the cover held
Exercise physiology involves the design, implementation and supervision of exercise programs for the prevention and management of illness and injury and aims to assist the body’s recovery from illness or injury.
One-on-one consultations are payable under Natural Therapies, while group consultations are only payable through a cover with a PackageBonus, MembershipBonus or Flexi-Bonus. The peak body for Exercise physiologist is the Clinical Exercise Physiology Association (CEPA)
Is the study and treatment of vision problems resulting from defects in the eye muscles (such as squint and lazy eye) or faulty visual habits. It is used to treat eye strain, visually-induced headaches and people who are cross-eyed or experience double vision. Therapy involves eye exercises and treatment designed to correct the alignment of the eyes. It includes consultations only. Also known as Orthoptics
Treatment in hospital to facilitate the implantation of a viable embryo in order to achieve pregnancy. It includes retrieval and implantation of eggs and collection of semen. In Vitro Fertilisation (IVF) treatment and Gamete Intra Fallopian Transfer (GIFT) are two of the most common procedures. Benefits are only payable for parts of the treatment where a member is admitted to hospital
A set amount of money that is payable for a particular service or item. The amount of the fixed benefit will depend on the cover held and the type of service or item received. A fixed benefit amount will not exceed the annual limit or the provider's charge
The rules that set out the arrangement for membership of, and the payment of benefits by the Fund in respect of Medibank health insurance products. All members of the Fund, are bound by the Fund Rules and any supplementary Fund Policies as amended from time to time
An arrangement a medical practitioner can participate in to reduce or eliminate a member's out-of-pocket medical expenses. Medical practitioners may choose to participate in GapCover on a case-by-case basis
An external device fitted to the ear. The device must operate independently of any other audio equipment and improve hearing ability. It includes the purchase of In the ear (ITE), In the canal (ITC) and Behind the ear (BTE) hearing aids as well as the repair of hearing aids.
Where a government subsidy is available, it must be claimed prior to any health insurance benefit and the account must be paid in full. It does not include benefits for batteries
Medical and surgical admissions intended to investigate, diagnose, monitor and/or treat heart-related conditions. It includes medical admissions for heart-related conditions, angiograms, insertion of stents, pacemakers and defibrillators, open heart surgery, valve replacement or repair and other invasive cardiac procedures
Services provided in the member's home by a registered nurse who is employed by a nursing service to provide medical treatment in the home. This includes wound care and injections where the nursing service is approved by Medibank
A cover that helps with the cost of a member's hospital stay as a private patient including:
- hospital accommodation on the ward,
- in-patient medical treatment; and
- associated appliances provided during the admission e.g. approved internal prostheses
The provision of cost information to patients in writing, including notification of likely out-of-pocketexpenses, by all relevant service providers. Where possible, this is provided prior to admission to hospital or provision of treatment
Surgery to investigate and repair damage to a joint in order to restore function to a joint that has been damaged by injury or illness. This includes an arthroscopy, repair of ligaments and tendons, removal of loose bodies, repair of the joint surface, meniscus or other joint structures
Surgery to replace a joint with a prosthesis with the aim of relieving pain or increasing function by replacing all or part of the joint or joint resurface. 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
Surgery to the eye which uses laser beams to correct refractive vision problems by reshaping the cornea (front of the eye) in order to reduce or eliminate the need for glasses or contact lenses. This can includes LASIK, LASEK and PRK treatment.
Laser eye surgery is only included under Ultra Health Cover and subject to waiting periods and lifetime limits
Surgery to treat conditions and disorders associated with the eye. This includes cataract surgery as well as surgery to the cornea, retina, eyelid, tear duct and muscles of the eye, however does NOT include laser eyesurgery for the correction or improvement of vision instead of wearing glasses or contact lens
Surgery or treatment that if not performed, could adversely affect the patient’s condition and is undertaken in accordance with accepted standards of medical practice, appropriate to the treatment, diagnosis and care required for the particular condition, illness or injury
The basis of Australia's public health care system that provides free or subsidised medical treatment to eligible persons, including as a public patient in a public hospital. More information on the Medicare services can be found on their website
A list of medical services for which Medicare pays a benefit and the rules that apply to the payment of those benefits. Each service has a fee that has been set by the Australian Government for the purpose of calculating the Medicare benefit payable for that service. Also known as the Commonwealth Medicare Benefits Schedule (CMBS)
The level of coverage a person is entitled to receive under Medicare. It determines the type of health insurance cover most appropriate to supplement any existing entitlements. Levels of Medicare eligibility are:
• Full Medicare (Green card)
• Interim Medicare (Blue card)
• Reciprocal Medicare (Yellow card); or
• No Medicare
An additional surcharge, on top of the Medicare levy, which Australian taxpayers are charged if they earn above a certain income threshold and do not hold residential hospital cover. For more information or to see if this applies to you visit the ATO's website
A feature included on some covers which can be used for:
- benefits for approved health related items,
- a top up towards extras benefits where the member has an out-of-pocketexpense, or
- towards a hospital excess
One of the following:
a) an extras provider Medibank has negotiated with so you won’t be charged more than the maximum agreed price, or
b) a hospital Medibank has an agreement with to help minimise members' out-of-pocketexpenses
Members’ Choice hospitals/extras providers are subject to change. Search for a current Members' Choice provider online
An amount set by the Australian Government as the minimum amount that a health fund must contribute towards hospital accomodation charges for an Included or Restricted service or treatment. Also known as a default benefit. Where a minimum benefit applies a member may have significant out-of-pocketexpenses
Medication that is prescribed by a medical practitioner, but which is not subsidised by the Pharmaceutical Benefits Scheme (PBS) and which is not otherwise available over the counter which aims to prevent or manage a medical condition. It includes contraceptives for specified medical conditions, allergen extracts, travel and other vaccinations and hormonal implants. Any items available without a prescription including over the counter, off the shelf, herbal medicines and vitamins can't be claimed
Services and treatment provided in hospital that deal with the care of women during pregnancy, childbirth and following delivery. It includes delivery of the baby and complications of pregnancy. This does not include any treatment that the baby may require.
Occupational therapy helps people develop, recover, or maintain their daily living and work skills where they have a physical, mental or developmental condition. Its purpose is to enable people to participate more fully in the activities of everyday life.
Benefits are payable for consultations only and providers must have a Medicare provider number. The peak body for occupational therapist is Occupational Therapy Australia
The dental specialty concerned with the diagnosis, prevention and treatment of any abnormalities associated with the developing dentofacial structures. It aims to assist with the correction and alignment of the teeth and jaw. It generally involves the use of braces, removable appliances, functional appliances or headgear.
A type of cover which is only available to people who hold an eligible student visa. OSHC covers are designed to meet the criteria set by a Deed issued by the Australian Government’s Department of Health. For more information visit the Department of Health website
A feature included on some covers which can be used for:
- benefits for approved health related items;
- a top up towards extras benefits where the member has an out-of-pocket expense; or
- towards a hospital excess
A type of health care that provides support to people with a life-limiting illness. Its aim is to comfort, not cure; to relieve pain and distress for people who are dying. Benefits will only be payable where included under a member's cover and an admission to a palliative care unit in a hospital occurs
Physiotherapy assesses, diagnoses, treats, and works to prevent disease and disability through physical means in order to help a person recover from injury, reduce pain and stiffness, and increase mobility.
It includes one-on-one and group physiotherapy consultations, clinical Pilates, hydrotherapy (group sessions only).
Surgery which is medically necessary to treat a physical deformity that is either acquired (through an accident, an infection or 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
The diagnosis, treatment and prevention of conditions affecting the toe, foot and ankle in order to help members maintain good foot hygiene and posture. It may include the treatment of toe nail conditions, calluses and ulcers of the feet and assessment of gait to correct poor posture. The provider must be an AHPRA registered health practitioner
An ailment, illness or condition that in the opinion of a medical practitioner appointed by Medibank, the signs or symptoms of that ailment, illness or condition existed at any time in the period of 6 months prior to the day on which the person became insured under the policy or changed their cover
Psychiatric treatment involves prevention, diagnosis and treatment of a wide range of mental health conditions in order to improve a person’s social functioning. It includes treatment with medications and/or psychotherapy for disorders such as: depression, anxiety, personality disorders, eating disorders and addiction. Where included under a person's cover, treatment must be provided at an approved psychiatric facility for benefits to be payable. Conditions such as dementia and Alzheimers are not generally considered psychiatric conditions
Psychology focuses on the diagnosis and treatment of behavioural and mental health conditions such as depression, anxiety, phobias, personality disorder such as obsessive compulsive disorder (OCD) and other behavioural problems.
It includes one on one and family/couple consultations where no Medicare benefit is payable. Benefits are not payable for telephone consultations. The provider must be an AHPRA registered health practitioner.The peak body for psychologist is the Australian Psychological Society (APS)
An agreement between the Australian Government and certain overseas countries to provide visitors with access to subsidised health services for essential medical treatment. These arrangements vary from country to country. Additional information and confirmation of entitlements can be checked with Medicare. Holders of reciprocal Medicare entitlements are generally eligible to receive the AGR if they hold a Resident cover
Therapy which assists in recovery following a major health event. It aims to assist people to manage activities of daily living without the assistance of another person. If this is not possible, the goal is to minimize the need for external assistance through the use of adaptive techniques and equipment
It may include physical therapy and exercise programs to assist in the recovery from stroke, after a joint replacement or following a heart attack. These services can consist of overnight or day therapy programs. Where included under a cover, rehabilitation must be provided at an approved rehabilitation facility and under an approved program for benefits to be payable. It does not include treatment for substance addictions
Surgery to remove an inflamed appendix with the purpose of removing pain and discomfort associated with an inflamed appendix (appendicitis). Also known as a appendectomy, the appendix must be removed for benefits to be payable where included under a persons cover
Treatment aimed at assisting or replacing 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). Where included under a persons cover, treatment must be provided in hospital for benefits to be payable
Speech therapy diagnoses, manages and treats individuals who are unable to communicate effectively or who have difficulty with feeding or swallowing. It's purpose is to assist people who have communication disabilities. Speech pathologists also assist with a variety of conditions associated with feeding, swallowing or breathing problems Benefits are only payable for consultations and providers must have a Medicare provider number. Speech Pathology Australia (SPA) is the peak body
Surgery to join two or more vertebrae in the spinal column. Spinal fusion often involves a bone graft and may involve the insertion of screws, rods or cages to hold the fused joints in place. It aims 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, but does not include the treatment of developmental deformities such as scoliosis or kyphosis. Spinal fusion can be undertaken from the back or through the abdomen, chest or neck. Spinal fusion can sometimes be undertaken through a laparoscope
The surgical removal of wisdom teeth in hospital in order to alleviate symptoms such as pain and infection associated with wisdom teeth. It includes the hospital and anaesthetic charges associated with surgical removal of wisdom teeth, but does not pay for charges raised by a dentist (these charges are normally covered through the dental component of an extras cover)
A period of time where a membership is temporarily 'discontinued'. During this time a member is not required to pay premiums for their membership, cannot make any claims and is not exempt from the MLS. Refer our Medibank Member Guide for more information
A period of time a Member must serve after taking out their cover before benefits are payable towards included services or items. Benefits are not payable for items and services obtained during a waiting period or prior to joining Medibank
Surgery to the stomach which aims to help people lose weight in order to reduce a person’s health risk arising from obesity. Surgery may involve reducing the size of the stomach (gastric banding or stapling), removing a portion of the stomach (sleeve gastrectomy) or bypassing the stomach (gastric bypass). It also includes subsequent surgery such as reversal or adjustment
A type ofcover which is designed to comply with the conditions of the 457 Working Visa and similar visa types including ‘visa condition 8501’ regarding the holding of a minimum level of insurance. They are only available to those who are in Australia on certain working-type visas, as determined by Medibank. More information on these covers can be found here