+ For Accidents that occur in Australia after your cover starts. Must seek medical treatment within 7 days, and receive hospital treatment within 12 months of the Accident occurring. Excludes Private Emergency Department Benefit, hospital bonus, claims covered by third parties and our Private Room Promise. Out-of-pocket costs may apply.
The amount you can claim back at Members’ Choice providers, up to annual limits. Fixed amounts apply at non-Members’ Choice providers, up to annual limits.
The amount you pay before Medibank contributes to your hospital costs.
Your cover also includes
Hospital cover
- Benefits towards a range of hospital services including dental surgery if you need wisdom teeth removed in hospital.
- Earn over $97k as a single or $194k as a couple/family? You could save money on tax by holding an appropriate level of hospital cover. Find out more about the Medicare Levy Surcharge.
- Benefits towards hospital treatment for gynaecology, including investigations for conditions such as endometriosis.
What is a waiting period?
The time you need to wait before you can receive benefits for services or items listed in your cover.
When do they apply?
To new members, or when switching to a higher level of cover.
Switching funds?
If you're switching from another health fund, on similar cover, we'll recognise waiting periods already served.
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).
Inclusions | Waiting period
What is a waiting period? The time you need to wait before you can receive benefits for services or items listed in your cover. When do they apply? To new members, or when switching to a higher level of cover. Switching funds? If you're switching from another health fund, on similar cover, we'll recognise waiting periods already served. 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 | |
1 day | |
Nil | |
2 months | |
2 months | |
2 months | |
2 months
(12 months for pre-existing) |
|
2 months
(12 months for pre-existing) |
|
2 months
(12 months for pre-existing) |
|
2 months
(12 months for pre-existing) |
|
2 months
(12 months for pre-existing) |
|
2 months
(12 months for pre-existing) |
|
2 months
(12 months for pre-existing) |
|
2 months
(12 months for pre-existing) |
|
2 months
(12 months for pre-existing) |
|
2 months
(12 months for pre-existing) |
|
2 months
(12 months for pre-existing) |
|
2 months
(12 months for pre-existing) |
|
2 months
(12 months for pre-existing) |
|
2 months
(12 months for pre-existing) |
|
2 months
(12 months for pre-existing) |
|
2 months
(12 months for pre-existing) |
|
2 months
(12 months for pre-existing) |
|
2 months
(12 months for pre-existing) |
|
2 months
(12 months for pre-existing) |
|
2 months
(12 months for pre-existing) |
|
2 months
(12 months for pre-existing) |
|
2 months
(12 months for pre-existing) |
|
2 months
(12 months for pre-existing) |
|
Nil |
Exclusions |
---|
Hospital costs explained
Hospital cover helps with the cost of treatments you receive in hospital as a private patient. Of course, everyone is different, and so our Hospital covers come in all shapes and sizes to suit different priorities and stages in life.
For services included under each of our Hospital covers, we’ll pay benefits towards:
- Eligible ambulance services
- In-hospital medical services
- Overnight accommodation in a private hospital, or a shared room in a public hospital as a private patient
- Same-day admission
- Intensive care
- Theatre fees
- The minimum benefit for medical devices and human tissue products as set out in the government's Prescribed List of Medical Devices and Human Tissue Products
Depending on your cover you may need to pay an excess or co-payment before we will pay any benefits towards your hospital admission. Other out-of-pocket expenses may apply.
- Services not included in your cover or for which you are serving waiting periods
- Some high-cost medications
- Services not covered by Medicare
- Medical devices and human tissue products in excess of approved benefits in the Government’s Prescribed List
- Cosmetic treatments
- Certain other items (e.g. streaming services and parking), depending on the hospital you're admitted to. The hospital should discuss any charges with you.
It's a good idea to call us on 132 331 so we can take you through what we will pay benefits for, and let you know of any potential out-of-pockets you might expect for your procedure.
Your cover also includes
Extras cover
- You choose the cover to suit your budget and lifestyle - 60%, 75% or 90% back from Members' Choice providers
- Cover for a wide range of services, including more costly ones, like major dental, orthodontics and hearing aids
- 100% back on up to two dental check-ups every year (including bitewing x-rays) at any Members’ Choice Advantage dentist1, OR
- 100% back on an annual dental check-up & clean at any Members' Choice dentist, on top of your annual limit (excludes x-rays)1
Inclusions | Annual limits per person | Waiting period | ||
---|---|---|---|---|
Claim back percentage: | 60% | 75% | 90% | |
Claim back percentage: | ||||
N/A | N/A | N/A | 1 day | |
N/A | N/A | N/A | 2 months | |
$800 | No annual limit | No annual limit | 2 months | |
$500 | $1,000 | $1,200 | 12 months | |
$400 | $800 | $1,000 | 12 months | |
$200 | $225 | $250 | 6 months | |
$200 combined limit | $300 combined limit | $400 combined limit | 2 months | |
$300 | $600 | $700 | 2 months | |
$200 | $400 | $500 | 2 months | |
$200 | $400 | $500 | Nil | |
$200 | $400 | $500 | 2 months | |
Combined limit | Combined limit | Combined limit | 2 months | |
$200 | $400 | $500 | 2 months | |
$150 combined limit | $200 combined limit | $250 combined limit | 12 months | |
24 months | ||||
$200 | $400 | $500 | 2 months | |
$200 | $400 | $500 | 2 months | |
$400 | $800 | $1,200 | 36 months | |
$200 | $400 | $600 | 2 months | |
$200 | $400 | $500 | 2 months | |
$200 | $400 | $500 | 2 months |
What are annual limits?
The maximum amount of benefits payable towards services, items or groups of services and/or items in a calendar year.
Switching health funds?
Benefits paid under your previous cover will be taken into account in determining the benefits payable under your Medibank cover.
What is a waiting period?
The time you need to wait before you can receive benefits for services or items listed in your cover.
When do they apply?
To new members, or when switching to a higher level of cover.
Switching funds?
If you're switching from another health fund, on similar cover, we'll recognise waiting periods already served.
Extras costs explained
Extras cover gives you money back for non-hospital services such as dental, physio, optical and more.
The amount of money you can claim back depends on the level of cover you have. Generally speaking, the higher the level of cover, the higher your annual limit and higher the percentage you can claim back. Which means more money back in your pocket.
- 100% back on at least one dental check-up and clean each year at a Members’ Choice or Members’ Choice Advantage provider.1
- 100% back on optical items at all recognised providers up to annual limits. Excludes Healthy Living Extras.±
- Access to Members’ Choice, one of the largest health provider networks in Australia, covering more than 12,000 providers. We’ve set maximum prices that these providers can charge, so you’ll avoid any surprises when the bill arrives
With a Members' Choice provider, you'll receive a fixed % back on services, up to your annual limits.
If your extras provider isn't part of our Members' Choice network don't worry. As long as they're a Medibank recognised provider, we'll still pay a fixed amount for each service or item, up to your annual limits.
Why choose Medibank?
30 day cooling off period
If you're not completely happy with your cover in the first 30 days of joining, let us know and we'll transfer you to a more suitable cover or refund your premiums (as long as no claims have been made).
Medibank member perks
Explore an abundance of rewards, discounts, offers, services, and health programs that can help you live better.
Access to Live Better rewards
Live Better rewards is a health and wellbeing program inspiring, supporting and rewarding you to eat, move, and feel better, all while enjoying the things you do every day.
Medibank members with eligible Hospital or Extras cover could earn up to $400 a year in rewards% by redeeming the points earned for taking healthy actions. Plus, if you shop with our partner brands, you could earn even more points.≈
Want to discuss your options?
Leave your details and a Medibank expert will be in touch to take you through your options. In providing your telephone number, you consent to Medibank contacting you about health insurance.
Things you should know
^ Waiting period applies. For ambulance attendance or transportation to a hospital where immediate medical attention is required and your condition is such that you couldn't be transported any other way. TAS and QLD have State schemes that provide ambulance services for residents of those States.
1 Eligible members on Medibank extras (excluding Healthy Living Extras and Gold Ultra Health) can claim a maximum of two 100% back dental check-ups per member, per year at a Members’ Choice Advantage provider (including bitewing x-rays where clinically required). For members on eligible extras, the first two check-ups do not count towards your annual limit. Members with Healthy Living Extras can get 100% back on one dental check-up each year at a Members’ Choice Advantage provider (including up to two bitewing x-rays, where clinically required) or at a Members’ Choice provider (excluding x-rays). Members with Gold Ultra Health can get 100% back on up to three dental check-ups at a Members’ Choice or Members’ Choice Advantage provider. Members’ Choice and Members’ Choice Advantage providers are not available in all areas. Two month waiting period applies. Some products may have other dental benefits, check your cover summary for details.
± Excludes Healthy Living Extras and select products that are no longer available for sale (for more information check your cover summary or check this page). Applies to prescription glasses and select contact lenses. Some glasses lens coatings and contact lenses are excluded. To find which specific items are included or excluded, call us on 132 331. 6 month waiting period applies.
= Eligible members on Medibank extras (excluding Healthy Living Extras and Gold Ultra Health) can claim a maximum of two 100% back dental check-ups per member, per year at a Members’ Choice Advantage provider (including bitewing x-rays where clinically required). For members on eligible extras, the first two check-ups do not count towards your annual limit. Members with Healthy Living Extras can get 100% back on one dental check-up each year at a Members’ Choice Advantage provider (including up to two bitewing x-rays, where clinically required) or at a Members’ Choice provider (excluding x-rays). Members with Gold Ultra Health can get 100% back on up to three dental check-ups at a Members’ Choice or Members’ Choice Advantage provider. Members’ Choice and Members’ Choice Advantage providers are not available in all areas. Two month waiting period applies. Some products may have other dental benefits, check your cover summary for details.
# Medibank has Members' Choice providers for these services. Not available in all areas.
~ Some items and services may require a Referral Letter and may have a benefit replacement period. Please see the Cover Summary or Member Guide for more information.
% Live Better rewards members could earn up to 40,000 Live Better rewards points each calendar year for successfully completing select Live Better rewards points-earning activities. These activities include, but are not limited to, health and wellbeing challenges, the Weekly Goal, onboarding actions, partner activity earn and the daily auto-tracking bonus. This does not include points earned by shopping with Live Better rewards partners or visiting Members' Choice Advantage providers. 40,000 Live Better points could be redeemed for up to $400 worth of rewards from the Live Better rewards store.
≈ Must be 16 years or over to register for Medibank Live Better rewards. Must be a Medibank member with hospital cover, extras cover, or hospital and extras cover, be up-to-date with premium payments and have signed up to Medibank Live Better rewards with My Medibank to earn Live Better points for eligible purchases and redeem rewards. Excludes Overseas Student Health Cover (OSHC), Ambulance only cover, ahm covers and other selected covers. Live Better Management Pty Ltd, ACN 003 457 289 has entered into commercial arrangements with Medibank Live Better rewards program partners and may receive commissions. Additional terms and conditions may apply to points earning activities and rewards. Points earning activities and rewards are subject to change and may be subject to availability. Wherever possible, we will give you notice of these changes. Some program partners and earning activities require a person to be at least 18 years of age to be eligible to earn and/or redeem a reward. See full Medibank Live Better rewards terms.
€ For new members on new memberships who join and start eligible combined Bronze hospital and extras cover or above from 16 January and who have not held Medibank health cover in previous 60 days (unless they are dependents coming off their parent’s cover). Must quote promo code 8WEEKSPLUS and set up direct debit when joining. Excludes Basic cover, Corporate covers, Hospital only cover, Extras only cover, Accident Cover, Overseas Visitors Health Cover, Overseas Workers Health Cover, Overseas Students Health Cover (OSHC), Ambulance Cover, ahm covers, and other selected covers. Not available to Medibank employees. Not available with any other offer. Medibank reserves the right to amend these Terms and Conditions from time to time.
Weeks free terms: Must set up direct debit when joining and hold eligible cover for 42 consecutive days from the policy start date to get initial 6 weeks free, and for 14 consecutive months to receive subsequent 2 weeks free. The initial 6 weeks free will be applied at the next billing cycle after you have held eligible cover for 42 consecutive days. The subsequent 2 weeks free will be applied at the next billing cycle after you have held eligible cover for 14 months. The initial 6 weeks free and/or the subsequent 2 weeks free will not be issued if you change to an ineligible cover, terminate your cover or suspend your cover during this period. Discounted amount to reflect level of eligible cover at time of discount.
2&6 month waits waived on extras terms: 2&6 month waiting periods on extras waived. Other waiting periods apply (including 12 months on some dental services). Annual limits apply. If you're switching from another fund and you’ve used any of your current limits (at that fund), that will count towards your annual limits with us. If you've reached your limits at your previous fund you may not be able to claim straight away on extras.
Live Better rewards points terms: Must maintain direct debit and hold eligible product for 42 consecutive days from the policy start date to receive Live Better rewards points. The points will not be issued if you change to an ineligible cover, terminate your cover or suspend your cover during this period. Policyholder will require access to a smartphone and will need to download the My Medibank app. Policyholder will need to have registered a My Medibank account, sign up to Live Better via the My Medibank app and track a Live Better activity within 42 consecutive days from the policy start date. Must be 16 years or over to register for Medibank Live Better. Live Better rewards points could take up to 10 weeks from the policy start date to be loaded to the policyholder’s Live Better account. Singles and single parents will receive 25,000 Live Better rewards points, and families and couples will receive 50,000 Live Better rewards points.
Live Better rewards terms: Must be a Medibank member with eligible hospital cover, extras cover, or hospital and extras cover, be up-to-date with premium payments and have signed up to Live Better via the My Medibank app to redeem rewards. Additional terms and conditions may apply to the redemption of a reward depending on the type of reward chosen. Read full Medibank Live Better terms here: https://www.medibank.com.au/livebetter/rewards/terms/