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 replacement.1 Depending on the member's type of cover, an excess or co-payment may still be payable.
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.
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.3 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.4
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.
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.
Hear from participating surgeons
Dr Scott Tulloch and Dr Cameron Cooke discuss how we can offer no gap procedures, spending less time in hospital, and the support patients can expect to receive before and after their surgery.
How we can offer no gap procedures for our eligible members
You may spend less time in hospital but with the same quality of care
Receive personalised support before and after surgery
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.
Pre-admission joint school
Joint replacement surgery with a participating surgeon, including your prosthesis (artificial joint)
Anaesthetist costs
Assistant surgeon costs
Hospital accommodation, including all theatre costs
Diagnostic tests (scans and blood tests)
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.
An excess or per day payment may still be payable, depending on the product a member has chosen.
Hear from program participants
Bronwyn and Robert share their experiences with Medibank's No Gap Joint Replacement program.
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.
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
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
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.
FAQs
If there are complications during your hospital admission that require additional care or services beyond what is included in the No Gap Joint Replacement Program, fees may apply. An example of this includes needing to be transferred to another hospital. Please speak with the Participating Medical Provider to confirm and ensure a valid Informed Financial Consent is given.
Eligible Members participating in this program will not incur out of pocket costs for the following services as part of your hospital admission at participating hospitals:
- pre-admission joint school
- hospital accommodation and theatre costs
- surgeon
- anaesthetist
- surgical assistant
- diagnostic tests.
An excess or per day payment may still be payable, depending on the type of cover you have and whether you are claiming under your hospital cover for the first time in a calendar year. Please contact us on 132 331 to check your product eligibility and level of cover.
If a Member seeks additional services beyond what is included in the No Gap Joint Replacement Program, fees may apply. You may incur fees if medication is prescribed during your hospital stay that is not included on the Pharmaceutical Benefits Scheme or for services that are for your comfort or convenience, such as if you wish to be transported by ambulance to a hospital closer to where you live and dry-cleaning of non-hospital items. Please speak with the Participating Medical Provider to confirm and ensure a valid Informed Financial Consent is given.
If rehabilitation care in an inpatient setting is required, we will pay benefits towards your hospital accommodation at a Members Choice Hospital and you will incur no out-of-pocket costs except for any per-day payment under your policy or any associated hospital costs like parking. There may be a cost associated if you are treated by a Rehabilitation Physician or require diagnostic tests, however the doctor will need to provide you with informed financial consent.
There may be out-of-pocket expenses associated with outpatient appointments, such as your initial visit with a participating surgeon in their consulting rooms. Please speak with your participating surgeon to find out more.
Members who wish to participate in the program must be both clinically suitable to participate as well as have the right level of cover.
Medibank members must have hospital cover with joint replacement included in their product and have served all applicable waiting periods. The program must be clinically appropriate. Please contact us on 132 331 to check your product eligibility and level of cover.
Your participating surgeon will determine if the program is clinically appropriate for you and your health needs.
If you have chronic knee osteoarthritis and your health care team determine that the No Gap program is not right for you, you may want to look into our Better Knee, Better Me preventative health program developed for members with chronic knee osteoarthritis. Find out more here.
The No Gap Joint Replacement Program is only available at participating hospitals with participating surgeons.
Hospitals participating in the no-gap joint replacement program offer patients the opportunity to attend a pre-admission joint school.
The pre-admission joint school is run by participating hospitals and surgeons, and may include things such as:
- A hospital tour and the opportunity to meet the team of staff that will be looking after you during your hospital admission
- Information on exercises to perform both before and after your surgery
- Education on mobility aids such as crutches or anything else you may need when returning home
It’s best to contact your participating hospital or surgeon to find out what services are included in the pre-admission joint school offered by your participating hospital.
Your participating surgeon will work with you to decide if you need rehabilitation after your surgery and if so, what type of rehabilitation is right for you.
If clinically appropriate, your surgeon may refer you to a provider who can deliver rehabilitation in the comfort of your home. Participation in a rehabilitation at home program is subject to the availability of a rehabilitation at home provider.
An excess or per day payment may still be payable, depending on the product a member has chosen.
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. An excess or per day payment may still be payable, depending on the product a member has chosen and whether they are claiming under their hospital cover for the first time in a calendar year.
1 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 program is right for you and your health needs. However, if the surgeon refers you to a non-participating hospital and/or the program 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.