Using Your Cover

Answers to some common questions about your health cover

Confused by private health insurance? Don’t worry, you aren’t alone! Let’s clear things up by answering some of the more commonly asked questions people have.

Written by Medibank
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What are out-of-pocket expenses?

The term ‘out-of-pocket expense’ is used to describe the remaining sum that you may have to pay after making a claim for accessing a health service. It is sometimes also known as the ‘gap’.

For Extras services, out-of-pocket expenses exist where there is a difference between what the provider charges you, and the amount Medibank pays towards that cost.

In the hospital system, out-of-pocket expenses typically arise where your treating doctor (like your specialist or anaesthetist) charges you more than the Medicare Benefits Schedule fee (i.e. the government set fee). Out-of-pocket expenses may also arise for costs associated with your hospital accommodation as well.

Hospitals and specialists are required to provide you with an overview of the costs involved in your treatment prior to your admission where practicable (known as Informed Financial Consent) – this will give you an opportunity to review their charging structure, help identify any out-of-pocket expenses, and ask them questions like ‘do you participate in GapCover?’ and ‘can you provide treatment in a Members’ Choice hospital?’.

You should also contact Medibank prior to admission to help understand any potential out-of-pocket expenses.

You can read more about out-of-pocket expenses and what you can do to reduce them here.

What’s GapCover?

Doctors aren’t duty-bound to charge only the Medicare Benefits Schedule (MBS) fee for their services – if they decide to charge an amount above the MBS fee, you may be left with an out-of-pocket expense for their medical services (or ‘gap’).

The good news is Medibank has a scheme to help cover some or all of this ‘gap’ amount, aptly named ‘GapCover’.

Doctors don’t have to participate in GapCover, but it’s always worth asking the question. By choosing a specialist that participates in GapCover (and one who will treat you at a Medibank Members’ Choice hospital) your out-of-pocket expenses can be significantly reduced.*

*Excludes public hospital covers. Out-of-pocket expenses may still apply. GapCover does not apply to diagnostic services.

What are Extras?

Extras refer to the range of health services or items that are generally not covered by Medicare. This includes services like dental, optical, physiotherapy, remedial massage and more.

Extras services aren’t just handy for when you have a health issue that needs attention; they can be used to help you stay at the top of your health game.

Depending on your level of cover, the services included and benefits paid can vary.

You can read more about Extras cover here.

How do I make a claim?

There are a few different ways to make a claim with Medibank:

Claiming on-the-spot is the quickest and easiest way – just be aware that not all healthcare providers allow for this option. If available, it’s just a matter of presenting your Medibank membership card and the provider will process the claim immediately, so all that’s left to pay is any out-of-pocket expense.

For most Extras services, you can also submit your claims online via My Medibank or via the Medibank Mobile App. Simply login and follow the prompts, keying the item numbers provided on your receipt.

You also have the option of mailing in your claim. You can download and print a claim form from My Medibank or the Medibank Mobile App. Post your completed form to us for processing:

Medibank Claims
GPO Box 2984
Melbourne VIC 3001

How do I check my annual Extras limits?

You can view your Extras limits by logging in to My Medibank or by using the Medibank Mobile App.

What are waiting periods?

A waiting period is the amount of time you might have to wait after taking out health cover before Medibank will start paying benefits towards specific services or items.

You can view your waiting periods by logging in to My Medibank or by using the Medibank Mobile App.

If switching to Medibank from another insurer, in some instances you will not have to re-serve waiting periods for equivalent services. You can call us on 132 331 to confirm what your waiting periods are.

Why does my health cover premium change every year?

Premium changes vary from member to member and are influenced by factors such as the state you live in, the type of cover you’re on, and even the general claiming pattern of our members.

Premium changes are also a reflection of the state of the health sector. Increasing use and cost of healthcare services, our ageing population, new medical technologies and a rise in the incidence of chronic conditions all contribute to health insurance premiums rising.

Medibank’s premiums need to keep pace with these costs to maintain the quality of cover and continue to meet our members' healthcare needs.

You can read more about why costs change each year and what Medibank is doing to keep costs in check here.

How can I get extra value from my Medibank membership?

Did you know that your Medibank membership unlocks a wide range of exclusive offers and discounts? Check these out:

GymBetter® – enjoy pay-as-you-go access to participating gyms across Australia from as little as $8.50 a visit.^

Special offers and discounts – we have a range of special offers from some of your favourite brands including Palace Cinemas, and Sunglass Hut®.

Discounts on other types of covers – when you have Medibank health insurance, you can enjoy discounts on pet, travel and life insurance too.

^ Excludes ahm covers and Ambulance covers.

Written by Medibank

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