This is the amount you pay towards your hospital treatment before we pay any benefits. It's paid once per person, per calendar year. It does not apply to children on a family policy.
Hospital cover
Helps towards the accommodation costs and doctors, specialists, surgeons and anaesthetists fees for the Included services below.
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).
| Services that are Included | 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). |
|---|---|
| Nil | |
| Nil | |
| Nil
(12 months for pre-existing conditions) |
|
| Nil | |
| Nil
(12 months for pre-existing conditions) |
|
| Nil
(12 months for pre-existing conditions) |
|
| Nil
(12 months for pre-existing conditions) |
|
| Nil
(12 months for pre-existing conditions) |
|
| Nil
(12 months for pre-existing conditions) |
|
| Nil
(12 months for pre-existing conditions) |
|
| Nil
(12 months for pre-existing conditions) |
|
| Nil
(12 months for pre-existing conditions) |
|
| Nil
(12 months for pre-existing conditions) |
|
| Nil
(12 months for pre-existing conditions) |
|
| Nil
(12 months for pre-existing conditions) |
|
| Nil
(12 months for pre-existing conditions) |
|
| Nil
(12 months for pre-existing conditions) |
|
| Nil
(12 months for pre-existing conditions) |
|
| Nil
(12 months for pre-existing conditions) |
|
| Nil
(12 months for pre-existing conditions) |
|
| Nil
(12 months for pre-existing conditions) |
|
| Nil
(12 months for pre-existing conditions) |
|
| Nil
(12 months for pre-existing conditions) |
|
| Nil
(12 months for pre-existing conditions) |
|
| Nil
(12 months for pre-existing conditions) |
|
| Nil
(12 months for pre-existing conditions) |
|
| Nil
(12 months for pre-existing conditions) |
|
| Nil
(12 months for pre-existing conditions) |
|
| Nil
(12 months for pre-existing conditions) |
|
| Nil
(12 months for pre-existing conditions) |
|
| Nil
(12 months for pre-existing conditions) |
|
| Nil
(12 months for pre-existing conditions) |
|
| Nil
(12 months for pre-existing conditions) |
|
| Nil
(12 months for pre-existing conditions) |
|
| 12 months | |
| Nil
(12 months for pre-existing conditions) |
|
| Nil
(12 months for pre-existing conditions) |
|
| Nil
(12 months for pre-existing conditions) |
|
| Nil
(12 months for pre-existing conditions) |
| Services that are Excluded |
|---|
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:
- Overnight accommodation in a private or shared room
- Same-day admissions
- Intensive care
- Operating theatre fees
- Emergency department facility fees
Other benefits as set out in Hospital benefits below.
- Overnight accommodation in a private or shared room
- Same-day admissions
- Intensive care
- Operating theatre fees
- Outpatient and emergency department charges
- Doctors' fees for Included in-hospital medical services (as set out in Medical benefits below).
- Surgically implanted prostheses (such as an artificial joint for a shoulder replacement) and other items on the Federal Government's Prostheses List^^
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.
Medical benefits
Essentials OSHC 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.
| For Included services |
|
|---|---|
| We pay 100% of the MBS fee for: | In-hospital medical services provided as part of an Included service (for example, surgeon and anaesthetist fees) |
| General practitioner (GP) consultations |
|
| We pay at least 85% of the MBS fee for: |
Other medical services provided out-of-hospital (for example, specialists, pathology and x-rays), except for Assisted reproductive services. |
| Allied health services billed with an MBS item number (for example, eye checks and services related to chronic disease and mental health management plans). |
You must pay any difference between the benefit we pay and the actual fee charged by the doctor, known as an out-of-pocket expense.
For example:
If the MBS fee for item number for a GP consultation is $41.40. You visit a doctor that charges $50. You have Essentials OSHC that pays 100% of the MBS fee for GP consultations. This means you would get back $41.40. Your out-of-pocket cost would be $8.60.
Pharmacy (prescription medicine)
Essentials OSHC includes benefits towards the cost of eligible prescription medicines. You will be required to pay a contribution towards the cost of each eligible prescription medicine before we pay any benefits.
| For eligible prescription medicines |
|
|---|---|
| Member contribution | $30 |
| Amount we’ll pay (maximum per item) |
$70 |
| Annual limit - Single membership |
$500* |
| Annual limit - Couple/Family membership |
$500 per member / $1,000 per membership* |
*Annual limit effective from 1 May 2023. If you are an existing member, any claims for prescription medicines purchased prior to 1 May 2023 will be payable up to the previous annual limits applicable. Contact us for more information.
- If the cost of the prescription medicine is higher than the benefit we pay, you must pay the difference.
- Benefits are payable only for prescription-only medicines prescribed by a doctor (GP or specialist) to treat an illness, injury or condition.
- We don’t pay benefits towards medicines prescribed for a contraceptive or cosmetic purpose or for prescription medicines that relate to a service that is an Excluded service.
It’s important to note that you may have large out-of-pocket expenses if you need treatment that uses high-cost pharmaceuticals (for example, cancer treatment).
Further benefits
24/7 Student Health and Support Line
Medibank OSHC members can call 1800 887 283 for:
• Medical assistance from a registered nurse
• Counselling services
• Emergency legal advice
• Travel document assistance
• Health system guide
• Family and friends message service
• Living in Australia support
• Interpreter service.
Direct Billing
Direct billing means the doctor will bill Medibank directly for your consultation. Please note, there may be some costs that are not covered by Medibank, which you will have to pay out of your own pocket.
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), Essentials OSHC 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
Need some help?
We’re here to help you choose the health cover that matches your needs while you’re in Australia. Contact Medibank how it suits you; online 24/7, WeChat, in-store or by phone.
Need a little extra help?
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
~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 Prostheses List.