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).
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). |
---|---|
Nil | |
Nil | |
Nil
(12 month pre-existing conditions) |
|
Nil | |
Nil
(12 month pre-existing conditions) |
|
Nil
(12 month pre-existing conditions) |
|
Nil
(12 month pre-existing conditions) |
|
Nil
(12 month pre-existing conditions) |
|
Nil
(12 month pre-existing conditions) |
|
Nil
(12 month pre-existing conditions) |
|
Nil
(12 month pre-existing conditions) |
|
Nil
(12 month pre-existing conditions) |
|
Nil
(12 month pre-existing conditions) |
|
Nil
(12 month pre-existing conditions) |
|
Nil
(12 month pre-existing conditions) |
|
Nil
(12 month pre-existing conditions) |
|
Nil
(12 month pre-existing conditions) |
|
Nil
(12 month pre-existing conditions) |
|
Nil
(12 month pre-existing conditions) |
|
Nil
(12 month pre-existing conditions) |
|
Nil
(12 month pre-existing conditions) |
|
Nil
(12 month pre-existing conditions) |
|
Nil
(12 month pre-existing conditions) |
|
Nil
(12 month pre-existing conditions) |
|
Nil
(12 month pre-existing conditions) |
|
Nil
(12 month pre-existing conditions) |
|
Nil
(12 month pre-existing conditions) |
|
Nil
(12 month pre-existing conditions) |
|
Nil
(12 month pre-existing conditions) |
|
Nil
(12 month pre-existing conditions) |
|
Nil
(12 month pre-existing conditions) |
|
Nil
(12 month pre-existing conditions) |
|
Nil
(12 month pre-existing conditions) |
|
12 months
(Waived for UTS students on Comprehensive OSHC) |
|
Nil
(12 month pre-existing conditions) |
|
Nil
(12 month pre-existing conditions) |
|
Nil
(12 month pre-existing conditions) |
|
Nil
(12 month pre-existing conditions) |
Exclusions |
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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
Comprehensive OSHC only:
- In-hospital family (boarder fee) benefit (Up to $150 per admission)
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
Comprehensive OSHC only:
- In-hospital family (boarder fee) benefit (Up to $150 per admission)
- 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
Medibank 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 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 an item for a GP consultation is $39.75. You visit a doctor that charges $50. You have Medibank OSHC that pays 100% of the MBS fee for GP consultations. This means you would get back $39.75. Your out-of-pocket cost would be $10.25.
Pharmacy (prescription medicine)
Medibank OSHC provides 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 |
Essentials OSHC | Comprehensive OSHC |
---|---|---|
Member contibution | $30 |
$30 |
Amount we’ll pay (maximum per item) |
$70 |
100% of the cost |
Annual limit - Single membership |
$500* | $1,000* |
Annual limit - Couple/Family membership |
$500 per member / $1,000 per membership* | $1,000 per member / $2,000 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).
Private psychology
Comprehensive OSHC provides benefits towards psychology services received from recognised providers and billed privately (that is, without an MBS item number).
For eligible services | Essentials OSHC | Comprehensive OSHC |
---|---|---|
Amount we’ll pay (maximum per consultation) |
Not Included |
$100 |
Annual limit - Single membership |
Not Included |
$200 |
Annual limit - Couple/Family membership |
Not Included |
$400 |
See 'Medical benefits' above for how we pay towards psychology services billed with an MBS item number (for example, under a mental health management plan).
Repatriation
Comprehensive OSHC can help if you or any person included on your membership sustains a substantial life-altering disability or a serious medical condition, as determined by us, and needs to return to their home country. We can help arrange and pay the reasonable cost of travel with the appropriate medical supervision, up to applicable limits.
Or in the unfortunate event of death, the repatriation of mortal remains of you or anyone else on your membership to their home country, up to applicable limits.
For eligible services | Essentials OSHC | Comprehensive OSHC |
---|---|---|
Medical repatriation | Not Included |
$100,000 |
Repatriation of mortal remains |
Not Included |
$10,000 |
The provision of any repatriation benefit is at our discretion and is payable only once per member per lifetime.
A 12-month waiting period is only applicable for repatriating a sick or injured member for:
• Pre-existing conditions
• Pregnancy and birth.
This will be waived if the medical practitioner certifies, and we agree, that you require Emergency Treatment.
Conditions apply, call us on 134 148 for more information.
Further benefits
Health support services
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), Medibank 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
Membership Guides
Cover Summaries
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.
*Offer available until 31 March 2025. Must take out eligible Medibank Overseas Workers Health covers and commence your policy by 30 April 2025. Offer available via phone, web, messaging and in store. For new members on new memberships residing in Australia on a working visa or Medibank members who are transferring from Medibank OSHC or ahm OSHC. Must be over the age of 18. Must quote promo code 'WORKER8’ when joining. Member must sign up to direct debit. Excludes Overseas Visitors Health Cover, all corporate covers, all Corporate Non-resident covers, all residential hospital and extras covers, Overseas Students Health Cover (OSHC), Ambulance Cover, ahm covers, and other selected covers. Waiting periods may apply to hospital cover. Not available if the policy holder has already taken up this offer, or taken up any other discount offer from Medibank within 12 months from the policy start date. Not available to Medibank employees. Not available with any other offer except the Overseas Extras only offer. Offer cannot be redeemed for cash. Member take up of the offer is deemed acceptance of these Terms and Conditions. Medibank reserves the right to amend these Terms and Conditions without notice from time to time.
8 weeks free terms: Member must maintain direct debit and keep policy premium payments up to date and hold eligible cover for 42 consecutive days from the policy start date to get next 8 weeks free. If you change to an ineligible cover during this period, or you terminate or suspend your cover, 8 weeks free will not be issued.