What is the Medibank No Gap program?
Thanks to a partnership with select surgeons and hospitals, we can deliver a range of Medibank No Gap programs to provide our members with a more affordable care option.
Eligible members who participate in the Medibank No Gap program pay no out-of-pocket costs* for included treatments and services as part of a hospital admission for certain elective procedures at participating hospitals with participating surgeons.
Depending on the member's type of cover, an excess or co-payment may still be payable.
Read on to find out more about each program.
What programs are available?
The Medibank No Gap program includes the following programs for eligible members with hospital cover:
No Gap Joint Replacement program
Eligible members with hospital cover2 pay no out-of-pocket costs* for included treatments and services as part of hospital admission3 for elective surgery for a joint replacement at participating hospitals with participating surgeons.
No Gap Endoscopy program
Eligible members with hospital cover4 pay no out-of-pocket costs* for included treatments and services as part of a hospital admission5 for endoscopy procedures with participating surgeons at participating hospitals.
No Gap ACL Reconstruction program
Eligible members with hospital cover6 pay no out-of-pocket costs* for included treatments and services as part of hospital admission7 for elective surgery for an ACL reconstruction procedure with participating surgeons at participating hospitals.
No Gap General Surgery program
Eligible members with hospital cover8 pay no out-of-pocket costs* for included treatments and services as part of hospital admission9 for hernia and laparoscopic cholecystectomy procedures with participating surgeons at participating hospitals.
Adeney Private Hospital - A participating No Gap hospital
Adeney Private Hospital is a new hospital located in the Inner East Melbourne suburb of Kew.
Members with eligible hospital cover could pay no out-of-pocket costs* for included treatments and services10 as part of hospital admission with all surgeons at Adeney Private Hospital. The key advantage for eligible members is they will now have access to a wider range of procedure types via a No Gap pathway.
Waiting periods may apply and depending on the member's type of cover, an excess or co-payment may still be payable.
For more information, including understanding whether you’re eligible for a No Gap experience at Adeney Private Hospital, contact our Customer Health Support Team on 1300 733 338, or find a participating specialist at Adeney Private Hospital by visiting their website below and searching by specialty or service.
Extra support at no additional cost
Medibank members with hospital cover can access a whole range of health programs, services and support, at no extra cost.11
Hospital Assist
To help you prepare for and assist in your recovery from a 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.12, 13
24/7 Medibank Nurse Support
Medibank health insurance members can chat to a registered nurse over the phone or online and get guidance on what they can do next, at no extra cost.11 Chat online with 24/7 Medibank Nurse Support or call 1800 644 325 anytime of the day or night, 7 days a week.
24/7 Medibank Mental Health Support
Medibank health insurance members can chat to a mental health professional over the phone or online about how they feel and get guidance on what they can do next, at no extra cost.11 Chat online or call 1800 644 325 anytime of the day or night, 7 days a week.
Frequently asked questions
Things you should know
* An excess or co-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. The Medibank Member Guide and Fund Rules sets out hospital benefit exclusions, which apply to all hospital admissions for Medibank members. There may be out-of-pocket expenses associated with outpatient appointments, such as your initial visit with a participating surgeon in their consulting rooms.
2 Must have hospital cover that includes joint replacement surgery. Waiting periods apply.
3 Excludes joint replacements resulting from an emergency admission.
4 Must have hospital cover that includes endoscopy procedures. Waiting periods apply.
5 Excludes endoscopy procedures resulting from an emergency admission.
6 Must have hospital cover that includes ACL reconstruction procedures. Waiting periods apply.
7 Excludes ACL reconstructions resulting from an emergency admission.
8 Must have hospital cover that includes hernia and laparoscopic cholecystectomy procedures. Waiting periods apply.
9 Excludes hernia, and laparoscopic cholecystectomy procedures resulting from an emergency admission.
10 An included treatment / service is a treatment / service: (a) that is performed at Adeney Private Hospital; and (b) for which benefits are payable under a member’s policy. Waiting periods may apply.
11 Some referred services may involve out of pocket costs and waiting periods may apply.
12 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.
13 OSHC members should call the Student Health and Support Line on 1800 887 283.