No Gap Joint Replacement Program

Eligible members could pay no out-of-pocket costs* for a knee or hip joint replacement.

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How Medibank's No Gap Joint Replacement Program works

The No Gap Joint Replacement Program allows eligible members to pay no out-of-pocket costs* on a wide range of services as part of hospital admission for elective surgery for a joint replacement1. That means they will only pay their excess if they participate in the program.

The program has been designed to provide members with more affordable care options and transparency about out-of-pocket costs* when undergoing a joint replacement with participating surgeons and hospitals.

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Doctor-led and designed

The doctor-designed model of care has been developed to help patients spend less time in hospital and get back to doing what they love faster. The typical joint replacement experience may have people in hospital for 5 days.2 The No Gap Joint Replacement Program typically has people in hospital between 1-3 days.This means we can pass on no out-of-pockets to our members.

Through this model of care people may return to mobility faster, aiding an improved range of movement and outcome.

 

 doctor checking a patient's knee

Patient education and support

With the No Gap Joint Replacement Program, members may spend less time in hospital but that doesn’t mean they get less support. The program is designed to provide eligible members access to personalised support before and after their surgery.

This may include: pre-admission joint school, rehabilitation with a physiotherapist, other allied health support if their treating doctors consider it to be clinically appropriate.

 

patient sitting on a bed while a physio checks the patient's leg

Personalised recovery    

The program provides a new model of care that may reduce the amount of time in hospital, where clinically appropriate. This means members can recover in the comfort of their own home with the right support.

The surgeon will decide if this program is clinically suitable for members and will work with them to decide if they need rehabilitation after their surgery and if so, what type of rehabilitation is right.

 

What costs are covered in the No Gap Joint Replacement Program?

Usually, there are several out-of-pocket costs* associated with an elective joint replacement surgery: surgeon fees, bills for scans and blood tests, the anaesthetist’s bill and more – it adds up.

That’s why we've partnered with a range of surgeons and participating hospitals to deliver no gap knee or hip joint replacement surgeries. 

 

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Pre-admission joint school

 

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Joint replacement surgery with a participating surgeon, including your prosthesis (artificial joint)

 

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Anaesthetist costs

 

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Assistant surgeon costs

 

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Hospital accommodation, including all theatre costs

 

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Diagnostic tests (scans and blood tests)

 

patient sitting on a chair using an exercise band to perform knee exercises with a physio

What about rehabilitation?

There isn’t a one-size-fits-all approach to rehabilitation because everyone is different. A surgeon will decide whether rehabilitation is required as part of a joint surgery recovery plan. If rehabilitation is required there is two ways: in hospital or at home.

If clinically appropriate, and there is a rehabilitation at home provider in the area, eligible Medibank members can receive rehabilitation in the comfort of their own home at no additional cost.

Please note: excess and any per-day payments under the policy are still payable.

Extra support, no extra cost

Medibank members with hospital cover can access a whole range of health programs, services and support, at no extra cost.

 

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Hospital Assist

To help you prepare for and recover from hospital admission, eligible members can access support over the phone from our Health Concierge clinicians, or visit the online hub for helpful tips and tools.5 

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Health advice that never sleeps

Members with hospital cover can call our 24/7 Medibank Nurse Phone Service to speak to a qualified nurse about their health concerns at any time of the day or night.6

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Mental health support around the clock

Members with hospital cover can chat to experienced and qualified mental health professionals over the phone to discuss any mental health questions or issues and get advice on what to do next via our 24/7 Medibank Mental Health Phone Support.6

Questions to ask your health professionals

These questions have been developed as a guide to help you feel better informed, prepared and confident with your health care options. 

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FAQs

Things you should know

* There may be out-of-pocket expenses associated with outpatient appointments, such as your initial visit with a participating surgeon in their consulting rooms. If a member has chosen an excess or per-day payment on their cover to lower their monthly premium, this will still be payable (for example, if you’re claiming for the first time that calendar year, you may need to pay an excess). 

Excludes joint replacements resulting from an emergency admission.

2 Schilling C, Keating C, Barker A, Wilson S, Petrie D. ‘Predictors of inpatient rehabilitation after total knee replacement: an analysis of private hospital claims data’, Med J Aust 2018; 209(5):222-227.  

3 Medibank No Gap Joint Replacement Program member clinical Indicators average length of stay data taken from July 2020 to November 2021.

4 Soffin E, YaDeau J. ‘Enhanced recovery after surgery for primary hip and knee arthroplasty: A review of the evidence’, Br J Anaesth 2016; 117(3):iii62-iii72.

5 Health Concierge is available to all eligible Medibank members who hold hospital cover. Excludes Overseas Visitor Health Cover, Working Visa Health Cover and Overseas Student Health Cover (OSHC). Some referred services may involve out of pocket costs.

6 OSHC members should call the Student Health and Support Line on 1800 887 283.

Offered only by participating orthopaedic surgeons and only at participating hospitals. The surgeon and hospital will work with you to decide if the pilot is right for you and your health needs. However, if the surgeon refers you to a non-participating hospital and/or the pilot is not otherwise right for your health needs, any such procedure will not be part of the no gap joint replacement program and you may incur out-of-pocket costs.

The listing of a provider does not comprise any sort of representation or recommendation by Medibank regarding the provider. To the fullest extent allowed by law, such reference should not be construed as:

  • an endorsement by Medibank; or
  • commendation for the status of the provider’s registration with their registration bodies like the Australian Health Practitioner Regulation Agency (AHPRA); or
  • a recommendation or warranty by Medibank of, for or in relation to the provider’s services.

Accordingly, Medibank neither takes nor assumes any responsibility for the services provided. Members should rely on their own enquiries and seek any assurance or warranties directly from the provider in relation to the service or with the registration bodies (e.g. AHPRA) regarding any conditions or restrictions to the provider’s registration.

Information presented is refreshed regularly. Information is accurate at time of publishing.

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