Your benefits: a user’s guide

A benefit is the amount of money we contribute towards the cost of an item or service included under your policy. To get the best value from your private health insurance, you want to make sure you’re claiming your benefits.

Whether you’ve chosen to have hospital cover, extras cover or a packaged option for both, to make the most of your policy, it’s important to understand the factors that go into your benefit claim.

Understanding the MBS

The Medicare Benefits Schedule (MBS) is a list of the services Medicare will pay benefits towards. When you get treatment in hospital as a private patient, Medicare will pay 75% of the fee for MBS-listed items that are part of your treatment. Then, if you are eligible for benefits on those items under your health insurance policy, we will pay the remaining 25%.

Minding the gap

In Australia, doctors decide how much they will charge. So, their fees will vary. Often they will decide to charge more than the MBS fee. This is where a ‘gap’ occurs, and you will have to pay this amount as an out-of-pocket expense.

Using your extras

When you make an extras claim, the amount that we will contribute depends on the level of extras cover you hold.

Your Member Guide is your best mate

Your Member Guide sets out everything you need to know about using your policy. You’ll be given a copy when you join Medibank but you can also access a copy online here.

Once you’ve got familiar with your Member Guide, you should have a clear idea of what benefits you can claim under your policy. If there’s anything that’s not clear or you don’t feel sure about, now’s the time to get in touch and chat to a member of the Medibank team.

It’s time to think ahead

It’s also really important to do some planning and think about what might be coming up for you and your family. Maybe you’re thinking about having children in the next year or two? Well, it’s time to consider a policy with Obstetrics, because most services related to having a baby have a waiting period of 12 months.

A little planning in advance can really pay off when it comes to using your benefits. Similarly, when it comes to claiming your extras, you need to really be across your annual limits, and any sub-limits that apply.

Know your limits

A sub-limit is the maximum amount you can claim for a service within twelve months. Your extras policy might allow $500 across three different services, but have a sub-limit of $250, which means that the most you’ll be able to claim for any one of those services is $250.

Some items also have a lifetime limit, which means that the amount you can claim on a particular service in your lifetime is capped. This will generally carry across if you move to a different insurer too.

It’s time to make a claim

Ready to go? Great. It's really easy to make a claim online - just login to My Medibank or download the Medibank App.

Oh, and don’t forget you can claim 100% back on your yearly check-up with any of our 6,700 Members’ Choice dentists, excluding x-rays, with any of our extras covers.