What is the Medibank No Gap program?
Thanks to a partnership with select surgeons and hospitals, we can deliver a range of Medibank No Gap programs to provide our members with a more affordable care option.
Eligible members who participate in the Medibank No Gap program pay no out-of-pocket costs* for included treatments and services as part of a hospital admission for certain elective procedures at participating hospitals with participating surgeons.
Depending on the member's type of cover, an excess or co-payment may still be payable.
Read on to find out more about each program.
What programs are available?
The Medibank No Gap program includes the following programs for eligible members with hospital cover:
No Gap Joint Replacement Program
Eligible members with hospital cover2 pay no out-of-pocket costs* for included treatments and services as part of hospital admission for elective surgery for a joint replacement at participating hospitals with participating surgeons.3
The doctor-designed model of care has been developed to help patients spend less time in hospital and get back to doing what they love faster.
This program includes:
- Patient education and support, which may include pre-admission joint school or rehabilitation with a physiotherapist or other allied health support, if your treating surgeon considers it to be clinically appropriate.
- Access to the Rehab at Home program to help you recover after hospital in the comfort of your own home. Your surgeon will decide if this program is clinically suitable for you and will help you decide if you require rehabilitation after surgery and if so, what type of rehabilitation is right, all personalised to your needs.
- Typically a 1-4 day hospital stay, provided your treating surgeon considers it to be clinically appropriate for you to return home.4
No Gap Endoscopy program
Eligible members with hospital cover5 pay no out-of-pocket costs* for included treatments and services as part of a hospital admission for endoscopy procedures with participating surgeons at participating hospitals.
What is an endoscopy procedure:
An endoscopy procedure is a procedure using an endoscope (a long tube with a camera at one end and a lens at the other) to allow medical specialists to see inside a patient without the need for major surgery. Endoscopy procedures included in this program are gastroscopy, colonoscopy and sigmoidoscopy.
No Gap ACL Reconstruction program
Eligible members with hospital cover6 pay no out-of-pocket costs* for included treatments and services as part of hospital admission7 for elective surgery for an ACL reconstruction procedure with participating surgeons at participating hospitals.
What is an ACL reconstruction procedure:
The anterior cruciate ligament (ACL) is an important ligament in your knee. A knee injury that tears (ruptures) this ligament can cause your knee to collapse or ‘give way’ when you make twisting or turning movements, this procedure involves a graft replacing the damage ligament.
No Gap General Surgery program
Eligible members with hospital cover8 pay no out-of-pocket costs* for included treatments and services as part of hospital admission9 for hernia and laparoscopic cholecystectomy procedures with participating surgeons at participating hospitals.10
What is a hernia repair procedure?
A hernia procedure repairs a weak muscle or tissue wall that has allowed tissues or organs to protrude.
What is a laparoscopic cholecystectomy procedure?
A laparoscopic cholecystectomy is keyhole surgery to remove a diseased gallbladder.
Hear from our members
Bronwyn and Robert share their experiences with Medibank's No Gap Joint Replacement program.
Extra support at no additional cost
Medibank members with hospital cover can access a whole range of health programs, services and support, at no extra cost.11
Hospital Assist
To help you prepare for and assist in your recovery from a hospital admission, eligible members can access support over the phone from our Health Concierge clinicians, or visit the online hub for helpful tips and tools.12, 13
24/7 Medibank Nurse Support
Medibank members with health insurance can chat to a registered nurse about their health concerns at no extra cost.11 Chat over the phone or online with 24/7 Medibank Nurse Support anytime of the day or night.
24/7 Medibank Mental Health Support
Medibank members with health insurance can talk with a mental health professional at no extra cost.11 Chat online or call 1800 644 325 to discuss mental health or emotional concerns, 24 hours a day, 7 days a week.
Things you should know
* There may be out-of-pocket expenses associated with outpatient appointments, such as your initial visit with a participating surgeon in their consulting rooms. An excess or per day payment may still be payable, depending on the product a member has chosen and whether they are claiming under their hospital cover for the first time in a calendar year.
2 Must have hospital cover that includes joint replacement surgery. Waiting periods apply.
3 Excludes joint replacements resulting from an emergency admission.
4 Medibank No Gap Joint Replacement Program member clinical Indicators average length of stay data taken from October 2023 to March 2024.
5 Must have hospital cover that includes endoscopy procedures. Waiting periods apply.
6 Must have hospital cover that includes ACL reconstruction procedures. Waiting periods apply.
7 Excludes ACL reconstructions resulting from an emergency admission.
8 Must have hospital cover that includes hernia and laparoscopic cholecystectomy procedures. Waiting periods apply.
9 Excludes hernia, and laparoscopic cholecystectomy procedures resulting from an emergency admission.
10 The participating hospital and participating surgeon will work with you to decide if the program is right for you and your health needs. However, if your medical surgeon refers you to a non-participating hospital and/or the program is not otherwise right for your health needs, any such procedure will not be part of the No Gap General Surgery Program and you may incur out-of-pocket costs.
11 Some referred services may involve out of pocket costs and waiting periods may apply.
12 Health Concierge is available to all eligible Medibank members who hold hospital cover. Excludes Overseas Visitor Health Cover, Working Visa Health Cover and Overseas Student Health Cover (OSHC). Some referred services may involve out of pocket costs.
13 OSHC members should call the Student Health and Support Line on 1800 887 283.