Hospital treatment for physical rehabilitation for a patient related to surgery or illness.

For example: inpatient and admitted day patient rehabilitation, stroke recovery, cardiac rehabilitation.

Hospital treatment for the treatment and care of patients with psychiatric, mental, addiction or behavioural disorders.

For example: psychoses such as schizophrenia, mood disorders such as depression, eating disorders and addiction therapy.

Hospital treatment for care where the intent is primarily providing quality of life for a patient with a terminal illness, including treatment to alleviate and manage pain.

Hospital treatment for fertility treatments or procedures.

For example: retrieval of eggs or sperm, In vitro Fertilisation (IVF), and Gamete Intra-fallopian Transfer (GIFT).

 

Treatment of the female reproductive system is listed separately under Gynaecology.

 

Pregnancy and birth-related services are listed separately under Pregnancy and birth.

 

 

 

 

 

Hospital treatment for the investigation and treatment of the back, neck and spinal column, including spinal fusion.

For example: sciatica, prolapsed or herniated disc, and spine curvature disorders such as scoliosis, kyphosis and lordosis.

Joint fusions are listed separately under Bone, joint and muscle.

Spinal cord conditions are listed separately under Brain and nervous system.

Management of back pain is listed separately under Pain management. Pain management that requires a device is listed separately under Pain management with device.

Hospital treatment for the investigation and treatment of blood and blood-related conditions.

For example: blood clotting disorders and bone marrow transplants.

Treatment for cancers of the blood is listed separately under Chemotherapy, radiotherapy and immunotherapy for cancer.

Hospital treatment for the investigation and treatment of diseases, disorders and injuries of the musculoskeletal system.

For example: carpal tunnel, fractures, hand surgery, joint fusion, bone spurs, osteomyelitis and bone cancer.

Chest surgery is listed separately under Lung and chest.

Spinal cord conditions are listed separately under Brain and nervous system.

Spinal column conditions are listed separately under Back, neck and spine.

Joint reconstructions are listed separately under Joint reconstructions.

Joint replacements are listed separately under Joint replacements.

Podiatric surgery performed by a registered podiatric surgeon is listed separately under Podiatric surgery (provided by a registered podiatric surgeon).

Hospital treatment for the investigation and treatment of the brain, brain-related conditions, spinal cord and peripheral nervous system.

For example: stroke, brain or spinal cord tumours, head injuries, epilepsy and Parkinson’s disease.

Treatment of spinal column (back bone) conditions is listed separately under Back, neck and spine.

Chemotherapy and radiotherapy for cancer is listed separately under Chemotherapy, radiotherapy and immunotherapy for cancer.

Hospital treatment for the investigation and treatment of breast disorders and associated lymph nodes, and reconstruction and/or reduction following breast surgery or a preventative mastectomy.

For example: breast lesions, breast tumours, asymmetry due to breast cancer surgery, and gynecomastia.

This clinical category does not require benefits to be paid for cosmetic breast surgery that is not medically necessary.

Hospital treatment for surgery to remove a cataract and replace with an artificial lens.

Hospital treatment for chemotherapy, radiotherapy and immunotherapy for the treatment of cancer or benign tumours.

Surgical treatment of cancer is listed separately under each body system.

^{We will only pay towards cancer-related surgery related to an Included service under your cover.}

Hospital treatment for surgery to the teeth and gums.

 

 

 

For example: surgery to remove wisdom teeth and dental implant surgery.

^{For Dental surgery performed by a dentist rather than a medical practitioner we only pay benefits towards hospital charges. If the surgery is performed by a medical practitioner and an MBS item number is billed, we will pay benefits towards the hospital and medical charges.}

 

 

 

Hospital treatment for the investigation and management of diabetes.

For example: stabilisation of hypo- or hyper- glycaemia, contour problems due to insulin injections.

Treatment for diabetes-related conditions is listed separately under each body system affected. For example, treatment for diabetes-related eye conditions is listed separately under Eye.

Treatment for ulcers is listed separately under Skin.

Provision and replacement of insulin pumps is listed separately under Insulin pumps.

Hospital treatment for dialysis treatment for chronic kidney failure.

For example: peritoneal dialysis and haemodialysis.

Hospital treatment for the investigation and treatment of the digestive system, including the oesophagus, stomach, gall bladder, pancreas, spleen, liver and bowel.

For example: oesophageal cancer, irritable bowel syndrome, gall stones and haemorrhoids.

Endoscopy is listed separately under Gastrointestinal endoscopy.

Hernia and appendicectomy procedures are listed separately under Hernia and appendix.

Bariatric surgery is listed separately under Weight loss surgery.

Hospital treatment for the investigation and treatment of the ear, nose, throat, middle ear, thyroid, parathyroid, larynx, lymph nodes and related areas of the head and neck.

 

For example: damaged ear drum, sinus surgery, removal of foreign bodies, stapedectomy and throat cancer.

Tonsils, adenoids and grommets are listed separately under Tonsils, adenoids and grommets.

The implantation of a hearing device is listed separately under Implantation of hearing devices.

Orthopaedic neck conditions are listed separately under Back, neck and spine.

Sleep studies are listed separately under Sleep studies.

 

 

Hospital treatment for the investigation and treatment of the eye and the contents of the eye socket.

 

For example: retinal detachment, tear duct conditions, eye infections and medically managed trauma to the eye.

Cataract procedures are listed separately under Cataracts.

Eyelid procedures are listed separately under Plastic and reconstructive surgery.

 

 

Hospital treatment for the diagnosis, investigation and treatment of the internal parts of the gastrointestinal system using an endoscope.

 

For example: colonoscopy, gastroscopy, endoscopic retrograde cholangiopancreatography (ERCP)

Non-endoscopic procedures for the digestive system are listed separately under Digestive system..

 

Hospital treatment for the investigation and treatment of the female reproductive system.

 

For example: endometriosis, polycystic ovaries, female sterilisation and cervical cancer.

Fertility treatments are listed separately under Assisted reproductive services.

Pregnancy and birth-related conditions are listed separately under Pregnancy and birth.

Miscarriage or termination of pregnancy is listed separately under Miscarriage and termination of pregnancy.

 

 

Hospital treatment for the investigation and treatment of the heart, heart-related conditions and vascular system.

 

For example: heart failure and heart attack, monitoring of heart conditions, varicose veins and removal of plaque from arterial walls.

Chemotherapy and radiotherapy for cancer is listed separately under Chemotherapy, radiotherapy and immunotherapy for cancer.

 

Hospital treatment for the investigation and treatment of a hernia or appendicitis.

Digestive conditions are listed separately under Digestive system.

Hospital treatment to correct hearing loss, including implantation of a prosthetic hearing device.

Stapedectomy is listed separately under Ear, nose and throat.

Hospital treatment for the provision and replacement of insulin pumps for treatment of diabetes.

Hospital treatment for surgery for joint reconstructions.

For example: torn tendons, rotator cuff tears and damaged ligaments.

Joint replacements are listed separately under Joint replacements.

Bone fractures are listed separately under Bone, joint and muscle.

Procedures to the spinal column are listed separately under Back, neck and spine.

Podiatric surgery performed by a registered podiatric surgeon is listed separately under Podiatric surgery (provided by a registered podiatric surgeon).

Hospital treatment for surgery for joint replacements, including revisions, resurfacing, partial replacements and removal of prostheses.

 

For example: replacement of shoulder, wrist, finger, hip, knee, ankle, or toe joint.

Joint fusions are listed separately under Bone, joint and muscle.

Spinal fusions are listed separately under Back, neck and spine.

Joint reconstructions are listed separately under Joint reconstructions.

Podiatric surgery performed by a registered podiatric surgeon is listed separately under Podiatric surgery (provided by a registered podiatric surgeon).

 

Hospital treatment for the investigation and treatment of the kidney, adrenal gland and bladder.

For example: kidney stones, adrenal gland tumour and incontinence.

Dialysis is listed separately under Dialysis for chronic kidney failure.

Hospital treatment for the investigation and treatment of the lungs, lung-related conditions, mediastinum and chest.

For example: lung cancer, respiratory disorders such as asthma, pneumonia, and treatment of trauma to the chest.

Chemotherapy and radiotherapy for cancer is listed separately under Chemotherapy, radiotherapy and immunotherapy for cancer.

Hospital treatment for the investigation and treatment of the male reproductive system including the prostate.

For example: male sterilisation, circumcision and prostate cancer.

Chemotherapy and radiotherapy for cancer is listed separately under Chemotherapy, radiotherapy and immunotherapy for cancer.

Hospital treatment for the investigation and treatment of a miscarriage or for termination of pregnancy.

Hospital treatment for pain management that does not require the insertion or surgical management of a device.

For example: treatment of nerve pain and chest pain due to cancer by injection of a nerve block.

Pain management using a device (for example an infusion pump or neurostimulator) is listed separately under Pain management with device.

Hospital treatment for the implantation, replacement or other surgical management of a device required for the treatment of pain.

For example: treatment of nerve pain, back pain, and pain caused by coronary heart disease with a device (for example an infusion pump or neurostimulator).

Treatment of pain that does not require a device is listed separately under Pain management.

Hospital treatment which is medically necessary for the investigation and treatment of any physical deformity, whether acquired as a result of illness or accident, or congenital.

For example: burns requiring a graft, cleft palate, club foot and angioma.

Plastic surgery that is medically necessary relating to the treatment of a skin-related condition is listed separately under Skin.

Hospital treatment for the investigation and treatment of conditions affecting the foot and/or ankle, provided by a registered podiatric surgeon, but limited to benefits towards:
• accommodation; and
• the cost of a prosthesis as listed in the prostheses list set out in the Private Health Insurance (Prostheses) Rules, as in force from time to time.

^{For Podiatric surgery we only pay benefits towards hospital charges. There are no MBS items for podiatric surgery. This means we also don’t pay any benefits towards the podiatric surgeon’s fees under Hospital cover and you could incur significant out-of-pocket expenses.}

Hospital treatment for investigation and treatment of conditions associated with pregnancy and child birth. 

Treatment for the baby is included under the clinical category relevant to their condition.

Female reproductive conditions are listed separately under Gynaecology.

Fertility treatments are listed separately under Assisted reproductive services.

Miscarriage and termination of pregnancy is listed separately under Miscarriage and termination of pregnancy.

Hospital treatment for the investigation and treatment of skin, skin-related conditions and nails. The removal of foreign bodies is also included. Plastic surgery that is medically necessary and relating to the treatment of a skin-related condition is also included.

For example: melanoma, minor wound repair and abscesses.

Removal of excess skin due to weight loss is listed separately under Weight loss surgery.

Hospital treatment for the investigation of sleep patterns and anomalies.

For example: sleep apnoea and snoring.

Hospital treatment of the tonsils, adenoids and insertion or removal of grommets.

Hospital treatment for surgery that is designed to reduce a person’s weight, remove excess skin due to weight loss and reversal of a bariatric procedure.

For example: gastric banding, gastric bypass and sleeve gastrectomy.

Unlimited emergency ambulance services Australia-wide. For ambulance attendance or transportation to a hospital where immediate professional attention is required and your medical condition is such that you couldn’t be transported any other way.

No matter what hospital excess you choose on your cover, the excess will not apply if your kids on a family membership are admitted to hospital

Services which are normally Excluded will be treated as Included services where Treatment is required due to injuries sustained in an Accident that occurred after joining this Cover (‘Accidental Injury Benefit’).

The following conditions apply to Accidental Injury Benefit:

·       The Accident must have occurred in Australia.

·       Immediate treatment by a medical practitioner must be sought within seven (7) days of the Accident occurring.

·       The Membership must not have been suspended when the Accident occurred.

·       The member must complete Medibank’s Accident Claim form.

·       Benefits are payable only for Hospital Treatment received within twelve (12) months of the Accident.

If you need to attend an accident and emergency department, we’ll pay 100% of any ‘facility fee’ charged by the hospital for attending their accident and emergency department.^~

 

If you need to attend a Public hospital accident and emergency department, we’ll pay 100% of any ‘facility fee’ charged by the hospital for attending their accident and emergency department.~

Includes examinations, preventative treatment, scale and clean, extractions, fillings, x-rays, and surgery to remove wisdom teeth (excludes hospital charges).

Includes services such as root canal, periodontics, crowns, dentures, bridges and veneers.

Procedures to help with the correction & alignment of the teeth and jaw. We pay benefits towards braces.

100% back on eligible items up to annual limits at all recognised providers. Includes prescription glasses and contact lenses. Some items, such as lens coatings, are excluded.

Benefits paid towards remedial massage treatments.

Includes one-on-one and group consultations, clinical pilates, antenatal and hydrotherapy sessions.

Benefits paid towards consultations with a chiropractor or osteopath.

Diagnosis & treatment of behavioural and mental health conditions such as depression, anxiety and phobias, as well as personality disorders such as Obsessive Compulsive Disorder (OCD) and other behavioural problems. Benefits paid towards consultations with a recognised psychologist only.

Diagnosis, treatment and prevention of conditions affecting the toe, foot and ankle to help with good foot hygiene and posture. We pay benefits towards consultations and approved orthotics.

Consultations for Acupuncture^#, Chinese medicine and Exercise Physiology

Dietetics involves using nutritional principles to promote good health through proper eating and development of modified diets. We pay benefits towards consultations with a recognised dietitian or nutritionist only.

Peak flow meters, nebulisers and spacing devices only.

100% back up to your annual limit when you purchase a monitor.

Benefits paid towards consultations with a recognised speech therapist.

Includes insulin delivery pens, pressure therapy garments, braces, splints, orthoses, post-mastectomy bras and external mammary prostheses/breast forms.

Benefits paid towards the cost of a hearing aid.

Includes most prescription-only items not subsidised by the Government. Benefits will be paid after a member contribution has been deducted. It's important to note that we don't pay benefits for pharmaceuticals prescribed for contraceptive or cosmetic purposes.

Occupational therapy helps with the development or recovery of core physical, mental and developmental abilities. Benefits are paid towards consultations with a recognised occupational therapist.

Study and treatment of vision problems due to defects in the eye muscles (such as a squint or a lazy eye) or harmful visual habits. Used to treat eye strain, vision-induced headaches, cross-eyes or double vision. Therapy involves eye exercises and treatment to correct the alignment of the eyes.
Benefits are paid towards consultations with a recognised orthoptist (eye therapist).

Consultations for Psychology and Counselling.
Benefits paid towards consultations with a recognised psychologist or recognised counsellor only.