Hospital eligibility check support

There are a number of reasons why you may have to pay out-of-pocket costs when you go to hospital. However, one of the most common causes of out-of-pocket expenses is how much your specialist charges.

Specialists and providers are not restricted to charging the Medicare Benefits Schedule (MBS) fee (that is, the fee set by the government for each treatment) and may choose to charge more for a particular service. If they charge more than the MBS fee, you’ll have an out-of-pocket expense unless:

• your specialist participates in Medibank’s GapCover; and
• the service provided is eligible for GapCover.

Hospital eligibility checks provide you with guidance on if a service is included in your cover or not. They do not provide dollar figures for your procedure. If you would like to understand the fees associated with your admission, please speak with your surgeon and hospital. 

If any of the details change with your admission, it’s good to let us know. You can simply request another hospital eligibility check through My Medibank or contact our friendly teams. 

Financial status refers to your premium payments being up to date. One of the many factors on being eligible to claim a hospital admission is being up to date with your premium payments.  If your admission date is in the future and you are currently not paid up to that date, you may notice your Hospital Eligibility Check refers to ‘unfinancial’ status. As long as your payments are up to date when you are admitted in hospital, this status will revert back to financial.  

Eligible coverage means you have a service included on your health insurance policy and are eligible to claim for it. 

Restricted coverage means we will only partially cover you for a service, leaving you with potentially significant out-of-pocket expenses. If you have Restricted coverage for a service, please get in touch with our team to discuss further. 

Ineligible/excluded coverage means you do not have a service included on your level of cover. This means your admission will not be claimable through Medibank. If you have ineligible/excluded coverage for a service, please get in touch with our team to discuss further.  

Medibank does not pay a benefit for the additional robotic technology fee if one is charged. This means there would be a larger than normal out-of-pocket expense. You should check with your surgeon if Robotic-assisted surgery will be used. 

If you would like to discuss the details on your hospital eligibility check, please contact our friendly teams via messaging, in store or by calling 132 331. 

We understand there’s a lot to think about when going to hospital, and it can sometimes be overwhelming. 

You can speak to a registered nurse over the phone or online to discuss any health questions or concerns and get professional support on what to do next. 

You can reach out to our friendlyt team on 1800 644 325 or message them online.

We offer a range of support services when going to hospital. You can speak to our Health Concierge Clinicians on 1800 789 414 between 9am-5pm AEST/AEDT.

You will need to contact us within 2 months after your baby is born to add them to your policy. Depending on the scale of your policy (Single, Family, etc) it may include an increase in your premiums. 

Please make contact with us once your baby is born and we can discuss this with you. 

Generally, a healthy newborn isn't separately admitted to hospital as an inpatient because the baby comes under the mother's admission. Usually they will only be an inpatient if they need to be admitted to the special care nursery. 

What this means is for any doctors who visit them in hospital, they will be charged as an outpatient service and you will only receive a benefit from Medicare.

However, if the paediatrician's visit is billed as inpatient service for an Included item, Medibank will pay benefits towards the visit, in-line with your cover.

You should speak with your doctor prior to going to hospital to check for any out of pocket expenses which may apply. 

Medibank has a great hub called Better Families which has useful information about how the health system works. There's also some great discounts for members. You can find this at medibank.com.au/livebetter/families/

If you are having a total or partial hip or knee replacement or any other hospital admission where follow up re-conditioning is required, Medibank is offering rehabilitation at home when it is clinically appropriate. 

You can contact the team on 1300 733 338 if you would like to discuss this more.

When a person requires palliative care, their needs, as well as those of their carers and family, often increase. Additional services and support are then required to ensure the person receives quality, coordinated care and the family has the support they need. Visit our Palliative Care at Home page to find out more about the program.

Many people have a preference to die at home. This means the patient can receive the care and support needed while surrounded by their family, friends and pets, all in the comfort and privacy of their home. For customers who are eligible and where it is clinically appropriate to participate in Palliative Care at Home, we bring a team of palliative care specialists into the home. The team may include doctors, nurses, social workers, counsellors, pastoral care workers and trained volunteers who’ll look after the physical, emotional, spiritual and social needs of the person, and provide practical and emotional support for their family.

If you’d like to speak to someone about Palliative Care at home for your loved one, please contact our team on 1300 936 114.