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Things you should know
Medibank recommends that you should carefully read our fund Rules, the information on the website and any brochures or Standard information Statement available to you, and you should retain this information for future reference
About your membership with us
A member is simply any person included on a Medibank membership.
A membership is made up of one or more members and can consist of:
- just one person (single membership)
- a couple membership which includes you (the policy holder) and your partner
- single parent family* membership, which includes you and
- any of your Child Dependants and/or
- any Student Dependants
- family membership*, which includes you and your partner and
- any of your Child Dependants and/or
- any of your Student Dependants
- family with adult children membership option, which can, for an additional cost, extend a single parent or family membership to include any of your children who:
- have reached the age of 21 but are under 31,
- are not classified as a Student Dependant, and
- are neither married nor living in a de facto relationship
*Not all membership categories are available on all our products.
The term policy holder refers to the person who is responsible for the membership. This is the person we contact when we need to communicate important information.
For a more detailed explanation of Child Dependants, Student Dependants, and Adult Dependants, check the glossary.
Although you as the policy holder ‘are responsible' for the membership, your partner (if he or she is also included on the same membership) can (unless you otherwise advise) manage most aspects of the membership too, including (but not limited to): making claims, adding or removing dependants, changing cover and suspending the membership.
However, as the policy holder you're the only one who can remove yourself from the membership or cancel the membership. It's important to be aware that this means we may disclose registered membership details to both of you. If at any time you want to be the only person who can manage the membership or you require further information about the handling of personal information, please call us on 1300 531 726.
In some cases yes, in other cases no. We’ll pay towards services included on your new cover from the date you join if: (i) those services were also included on your cover with your former fund, and (ii) you join us within two months of leaving your former fund, and (iii) you've already served the applicable waiting periods. So, although we'll recognise any waiting periods you've served with your former fund, if you haven't fully served the applicable waiting periods, you'll need to serve the balance with us before you're eligible for benefits.
Additional waiting periods will also apply for any increased benefits, where you have chosen a lower excess, or if you wait more than two months after leaving your former fund before you join Medibank.
Any loyalty bonus or other similar entitlements built up with your former fund (for example, orthodontic entitlements) will not transfer to Medibank. If you transfer to Medibank or to another Medibank cover, any benefits that may have been paid under your previous cover will be taken into account in determining the benefits payable under your new cover.
If you're on a single membership:
To add a dependant child to your membership you'll need to change from a single to a family or single parent family membership. If you do this within two months from the date of their birth or inclusion in your family unit (e.g. through marriage, adoption or fostering) your child won't have to serve any waiting periods the policy holder has already served. The change must be backdated to the date of birth or the date of inclusion in your family unit and will affect the premiums you’ll need to pay. Where a child is added outside two months, they’ll have to serve all waiting periods applicable to the cover.
If you're on a couple or family membership:
You can add a dependant child to your membership within 12 months of their birth or inclusion into the family unit and they generally won't need to serve any waiting periods the policy holder already served on the membership. This change can be backdated or commence from the date of application or any future date you choose. Where a child is added outside of 12 months, they will be subject to the regular waiting periods.
Adding a dependant child may affect the premiums you’ll need to pay.
Call us on 1300 531 726.
As your children grow older they may still remain on your family policy until they turn 21 or, if they are classified as a Student Dependant or Adult Dependant, until they turn 31, provided they're not married or in a de facto relationship. Adult Dependants may be able to be added to your policy for an additional cost.
About Lifetime Health Cover (LHC)
If you switch to us from another fund we recommend you keep your cover with your old fund until the date you transfer to us. This way you will have continuous cover which if you hold hospital cover, means you can avoid paying the Medicare Levy Surcharge and also avoid using up any of the 1,094 permitted days you can be without hospital cover during your lifetime. Also, if you already have an LHC loading, it will move with you.
No, the LHC loading doesn't apply to people born on or before 1 July 1934. There are also special rules that apply to people who fall under a LHC exemption category. For more information please refer to the Department of Health and Ageing website.
The loading generally applies if you don’t have hospital cover on the 1 July following your 31st birthday. This means for every year you don’t have hospital cover, you’ll pay a 2% loading on top of a base rate on your premium (or on your share of a couple or family premium) up to a maximum loading of 70%. The loading applies only to hospital cover or the hospital component of your cover – not to extras covers. Any loading that applies to your premium will be removed after you’ve held hospital cover continuously for 10 years. However, the loading may be reapplied if you then cease to hold a hospital cover and subsequently take it up again.
About waiting periods
That depends on the types of services or items included on your cover.
|2 months*||All included services - except those set out below
Ultra bonus for out of pocket expenses
Pre-existing conditions. However, the 12 month pre-existing condition waiting period does not apply to hospital or hospital substitute treatment for psychiatric treatment, rehabilitation treatment or palliative care
Dental Treatment and Major dental services including surgical extractions
CPAP type devices
|24 months||Blood glucose monitors|
Laser eye surgery
* If you have an accident after joining us or changing cover and require treatment, we'll waive the 2 month waiting period.
Waiting periods will apply if you're a new member, you're rejoining Medibank after not having health cover for some time or you're changing to a higher level of cover (either within Medibank or transferring from another registered Australian health fund). If you're changing to a higher level of cover, you'll still be entitled to benefits at the level of your former cover while you're serving any waiting periods on your new cover if:
- those services were included under your old cover; and
- you've already served the waiting periods that applied under your old cover.
Waiting periods may apply to some of our betterhealth programs.
All health funds have waiting periods. In short, a waiting period is a period of time you need to wait after taking out your cover before you can receive benefits for services or items covered.
You’re not able to receive benefits for any items or services you might have obtained while you’re serving a waiting period or before you joined Medibank.
About pre-existing conditions
It's standard practice in the private health insurance industry to apply a waiting period of 12 months before benefits are payable for a pre-existing condition.
If you're a new member, you'll have to wait 12 months before you can receive benefits for items or services related to a pre-existing condition.
If you're changing to a higher level of cover (either within Medibank or from another fund), you may have to wait 12 months to receive the higher benefits, including benefits for services not previously covered.
By pre-existing condition, we mean 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.
We'll appoint a medical or health practitioner to determine whether you have a pre-existing condition, based on information provided by the practitioner(s) treating you.
About benefit replacement periods
This varies from item to item and generally applies per member unless specified in the following table.
|12 months||Repairs of external prosthesis and health appliances|
Insulin delivery pens
Pregnancy compression garments
Blood glucose monitors
Dentures, crowns and bridges
Other health appliances and external prosthesis
Sleep Apnoea - continuous pressure devices and other similar approved appliances under our hospital cover (excluding Young Hospital)
It's a period of time you need to wait after purchasing an item included under your cover before you can receive further benefits to replace the item. For example, if you received benefits for an insulin delivery pen, purchased on 1 July 2021, you can only receive benefits for another one purchased on or after 1 July 2023.
Other rules for paying benefits
About out-of-pocket expenses
Other important information
We're proud to be a signatory to the Private Health Insurance Code of Conduct. The code was developed by the private health insurance industry and aims to promote the standards of service to be applied throughout the industry. The code is designed to help you by ensuring that:
Information which we provide to you is written in plain language
Our employees are competently trained to deal with your enquiries
We protect the privacy of your information in line with the privacy legislation
You have access to a reliable and free system of addressing complaints with us.
A copy of the code is available online at privatehealth.com.au/codeofconduct
How do orthodontic benefits work?
On most Medibank covers (check your cover summary), your orthodontic entitlement starts with an opening balance, which you can access once your 12 month waiting period is served. The balance is then topped up with an additional amount each 1 January (following the completion of your waiting period) up to a maximum lifetime limit.
The benefit you can claim (after waiting period) = Opening Balance + Any top ups - Any benefits ever claimed.
Benefits will only be paid towards dental and orthodontic treatments that are administered in person (not via phone or online), by a recognised provider.
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