Benefits are subject to annual and maximum benefit limits on extras covers. An annual limit is the maximum amount we'll pay for included items or services in a calendar year. The benefit we pay for a particular item or service may be less than your annual limit and less than your provider's charge which means you may have out-of-pocket expenses to pay. Benefits will be subject to the maximum price a Members' Choice provider is permitted to charge or the maximum benefit payable set by Medibank at a Non Members' Choice provider.
An excess is an amount you will pay towards the cost of your hospital treatment. Basically, the higher the excess on your cover, the lower your premium. There are excess options available. You can choose to reduce the hospital excess and pay an additional amount in your premium. An excess applies per person for each calendar year and doesn't apply to children on your membership. It's important to note that you may have other out-of-pocket expenses.
A Benefit Replacement Period is a period of time you need to wait after purchasing an item that we paid benefits towards, 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 2011, you can only receive benefits for another one purchased on or after 1 July 2013. Call 1800 RIO RIO (1800 746 746) to see what your replacement periods are.
Depending on your age and income, the Government may pay a certain amount of your health cover premium. This rebate can reduce your health insurance bill if claimed as an upfront premium reduction. Remember that Essentials Silver Plus Hospital cover with a $500 excess (assumes no Lifetime Health Cover loading) is fully subsidised by Rio Tinto so you will only be paying the difference between the subsidised amount and your upgrade to Gold Top Hospital and/or if you add extras cover.
The Medicare Levy Surcharge is a tax that applies if your annual income* is over $90,000 as a single (or $180,000 as a couple/family) and you don't hold an appropriate level of hospital cover. It starts at 1% and increases (up to 1.5%) with income growth.
However, if you take out Essentials Silver Plus Hospital Cover or Gold Top Hospital cover and hold it for the full tax year, you may avoid paying the Medicare Levy Surcharge.
If you have private health insurance and choose to be treated as a private patient, you have choice over which doctors treat you and in which hospitals you’re treated. Depending on your hospital cover, it pays benefits towards some of the costs of in-hospital treatment as a private patient, and generally means reduced waiting times for elective surgery. If you have extras cover, it pays benefits towards health services usually not covered by Medicare.