Medibank Pacific Workers Advanced Hospital and Medical

Comprehensive hospital and medical cover for PALM workers that meets visa health insurance requirements (condition 8501) and pays benefits towards the cost of everyday medical care and hospital treatment, including pregnancy and birth services. With higher benefits on included medical services to help reduce out-of-pocket costs, it offers greater peace of mind while living and working in Australia.

This product is only available through PALM Approved Employers. If you are an Approved Employer, email palm@medibank.com.au to discuss a suitable, visa compliant health cover offering for your PALM workforce.

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Approved Employers

PALM Members

Hospital cover

Helps towards the accommodation costs and doctors, specialists, surgeons and anaesthetists fees for the Included services below.

Inclusions	Waiting Period What is a waiting period? A set period of time you need to wait before you can receive benefits for services or items included in your cover. You can’t receive benefits for any items or services you obtained while you’re serving a waiting period. This means you will have to pay the full cost of the service. What is a pre-existing condition? An ailment, illness or condition that, in the opinion of a Medical Practitioner appointed by Medibank, the signs or symptoms existed at any time during the six months before you either took out your new cover, or transferred to a higher level of cover (12 month waiting period applies).
Ambulance services	Nil
Public hospital accident and emergency departments	Nil
No Excess for kids on a family membership	Nil
Rehabilitation	2 months
Hospital psychiatric services	2 months
Palliative care	2 months
Brain and nervous system 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. Waiting Period Nil (12 months for pre-existing conditions)	Nil (12 months for pre-existing conditions)
Eye (not cataracts) 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. Waiting Period Nil (12 months for pre-existing conditions)	Nil (12 months for pre-existing conditions)
Ear, nose and throat 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. Waiting Period Nil (12 months for pre-existing conditions)	Nil (12 months for pre-existing conditions)
Tonsils, adenoids and grommets	Nil (12 months for pre-existing conditions)
Bone, joint and muscle 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). Waiting Period Nil (12 months for pre-existing conditions)	Nil (12 months for pre-existing conditions)
Joint reconstructions 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). Waiting Period Nil (12 months for pre-existing conditions)	Nil (12 months for pre-existing conditions)
Kidney and bladder	Nil (12 months for pre-existing conditions)
Male reproductive system	Nil (12 months for pre-existing conditions)
Digestive system 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. Waiting Period Nil (12 months for pre-existing conditions)	Nil (12 months for pre-existing conditions)
Hernia and appendix	Nil (12 months for pre-existing conditions)
Gastrointestinal endoscopy 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. Waiting Period Nil (12 months for pre-existing conditions)	Nil (12 months for pre-existing conditions)
Gynaecology 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. Waiting Period Nil (12 months for pre-existing conditions)	Nil (12 months for pre-existing conditions)
Miscarriage and termination of pregnancy	Nil (12 months for pre-existing conditions)
Chemotherapy, radiotherapy and immunotherapy for cancer 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.} Waiting Period Nil (12 months for pre-existing conditions)	Nil (12 months for pre-existing conditions)
Pain management 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. Waiting Period Nil (12 months for pre-existing conditions)	Nil (12 months for pre-existing conditions)
Skin 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. Waiting Period Nil (12 months for pre-existing conditions)	Nil (12 months for pre-existing conditions)
Breast surgery (medically necessary) 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. Waiting Period Nil (12 months for pre-existing conditions)	Nil (12 months for pre-existing conditions)
Diabetes management (excluding insulin pumps) 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. Waiting Period Nil (12 months for pre-existing conditions)	Nil (12 months for pre-existing conditions)
Heart and vascular system 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. Waiting Period Nil (12 months for pre-existing conditions)	Nil (12 months for pre-existing conditions)
Lung and chest 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. Waiting Period Nil (12 months for pre-existing conditions)	Nil (12 months for pre-existing conditions)
Blood	Nil (12 months for pre-existing conditions)
Back, neck and spine 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. Waiting Period Nil (12 months for pre-existing conditions)	Nil (12 months for pre-existing conditions)
Plastic and reconstructive surgery (medically necessary) 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. Waiting Period Nil (12 months for pre-existing conditions)	Nil (12 months for pre-existing conditions)
Dental surgery 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.} Waiting Period Nil (12 months for pre-existing conditions)	Nil (12 months for pre-existing conditions)
Podiatric surgery (provided by a registered podiatric surgeon) 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.} Waiting Period Nil (12 months for pre-existing conditions)	Nil (12 months for pre-existing conditions)
Implantation of hearing devices	Nil (12 months for pre-existing conditions)
Cataracts	Nil (12 months for pre-existing conditions)
Joint replacements 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). Waiting Period Nil (12 months for pre-existing conditions)	Nil (12 months for pre-existing conditions)
Dialysis for chronic kidney failure	Nil (12 months for pre-existing conditions)
Pregnancy and birth 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. Waiting Period 12 months	12 months
Assisted reproductive services 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. Waiting Period Nil (12 months for pre-existing conditions)	Nil (12 months for pre-existing conditions)
Weight loss surgery	Nil (12 months for pre-existing conditions)
Insulin pumps	Nil (12 months for pre-existing conditions)
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. Waiting Period Nil (12 months for pre-existing conditions)	Nil (12 months for pre-existing conditions)
Sleep studies	Nil (12 months for pre-existing conditions)

_{Please note: Medibank does not pay any benefits towards the cost of cosmetic surgery/procedures e.g. surgery that isn’t clinically necessary and which an MBS item is not billable.}

Hospital cover explained

For the services listed as Inclusions in the table above, we pay benefits towards:

Other hospital items we pay benefits towards:

Doctors' fees for Included in-hospital medical services (as set out in Medical benefits below).
Surgically implanted prostheses (such as an artificial body part like a limb) and other items on the Australian Government’s Prescribed List of Medical Devices and Human Tissue Products ^{^^}.
Pharmaceutical Benefits Scheme (PBS)** listed medication given to you as part of your admitted treatment for most medical conditions, including medication prescribed for after you leave hospital.

Private Hospital

Overnight accommodation in a private or shared room
Same-day admissions
Intensive care

Other benefits as set out in 'Hospital benefits' below.

Public Hospital (as a private patient)

Overnight accommodation in a private or shared room
Same-day admissions
Intensive care
Operating theatre fees
Outpatient and emergency department charges

Hospital benefits

Members’ Choice hospitals

Medibank has agreements with most private hospitals and day surgeries in Australia. We call this our Members’ Choice network. When you visit a Members’ Choice hospital you will generally get better value for money compared to a non-Members’ Choice private hospital, provided the service is included under our agreement with the hospital and not Excluded under your cover.

To find your nearest Members’ Choice hospital, visit medibank.com.au/memberschoice. Members’ Choice hospitals are subject to change from time to time and are not available in all areas.

Hospital excess

No excess is payable on Medibank Pacific Workers Advanced Hospital and Medical.

Medical benefits

Medibank Pacific Workers Advanced Hospital and Medical includes benefits towards medical services provided by a doctor, that are listed in the government’s Medicare Benefits Schedule (MBS). The MBS is a list of medical services and corresponding fees.

Medibank Pacific Workers Advanced Hospital and Medical pays 125% of the MBS fee for:

general practitioner (GP) consultations
other medical services provided out-of-hospital (for example, specialists, pathology and x-rays).
in-hospital medical services provided as part of an Included service (for example, surgeon and anaesthetist fees)
allied health services billed with an MBS item number (for example, eye checks and services related to chronic disease and mental health management plans).

If your doctor chooses to charge above the amount we pay you will have to pay an out-of-pocket expense to cover the difference.

Further benefits

24/7 Medibank Nurse Support

Medibank health insurance members can talk to a registered nurse or mental health professional at no extra cost.# Call 1800 644 325 or chat online using My Medibank. Anytime day or night, 7 days a week.

Repatriation

If you or any person on Medibank Pacific Worker Advanced Hospital and Medical sustains a substantial life-altering disability or a serious medical condition, as determined by us, and needs to return to their home country, we may arrange and pay the reasonable cost of travel with the appropriate medical supervision.

In the unfortunate event of death, we’ll pay the reasonable cost for the repatriation of mortal remains of you or anyone else on your membership to their home country.

The provision of any repatriation benefit is at our discretion. Conditions apply, including waiting periods. Contact us or refer to the Overseas Workers Member Guide for more information.

If your situation changes

If at any time you gain access to full Medicare entitlements or your visa status changes (e.g. you are granted permanent residency), Medibank Pacific Workers Advanced Hospital and Medical may no longer be suitable. In these instances, you should notify us of the change in your circumstances. Medibank can still remain an important part of your private health insurance plans as we offer a large range of other covers.

Supporting documents

Membership Guide (PDF - 512 KB)

Cover Summary (PDF - 381 KB)

Cover Summary - Bislama (PDF - 114 KB)

Cover Summary - Fijian (PDF - 103 KB)

Cover Summary - Pijin (PDF - 111 KB)

Cover Summary - Samoan (PDF - 124 KB)

Cover Summary - Tetum (PDF - 129 KB)

Cover Summary - Tok Pisin (PDF - 101 KB)

Cover Summary - Tongan (PDF - 105 KB)

Cover Summary - Tuvaluan (PDF - 111 KB)

Cover Summary - Vietnamese (PDF - 145 KB)

Things worth knowing

Find out more about things like waiting periods and pre-existing conditions or check our list of definitions if you don't know the meaning of a word or phrase

Find out more

^~ The fee may not include all medical services provided and out-of-pocket expenses may apply such as for x-rays, blood tests and any charges raised by the doctor above the benefit we pay.

^{^^} If you need to be hospitalised for a procedure requiring a surgically implanted prosthesis (for example: a pacemaker or cardiac stent), we’ll pay the minimum benefit for the thousands of items set out in the Australian Government’s Prescribed List of Medical Devices and Human Tissue Products.

^** The PBS provides subsidised prescription drugs to residents of Australia, as well as certain foreign visitors covered by a Reciprocal Health Care Agreement.

^# Some referred services may involve out of pocket costs and waiting periods may apply.