The amount you pay before Medibank contributes to your hospital costs.
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.
Hospital cover
- Emergency Ambulance Australia-wide.
- No hospital excess for kids on a family membership.⁺⁺
- Health screeningᶲ and home nursing.ᵟ
- Benefits up to 100% of the provider's charge for eligible medical services listed in the Medicare Benefit Schedule (MBS).^
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 | |
Nil | |
Nil | |
2 months | |
2 months | |
2 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) |
|
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) |
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 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
- The minimum benefit for surgically implanted prostheses included on the Australian Government Prostheses List
Depending on your cover you may need to pay an excess or co-payment before we will pay any benefits towards your hospital admission.
- Services not included in your cover or for which you are serving waiting periods
- Some high-cost medications
- Services not covered by Medicare
- Prostheses in excess of approved benefits in the Government’s Prostheses List
- Cosmetic treatments
It's a good idea to call us on 1300 763 422 so we can take you through what we will pay benefits for, and let you know of any potential out-of-pockets for your procedure.
Extras cover
- $1,900 annual limit to use on General dental, Major dental and Orthodontics.
- $300 to use on optical every year (with 100% back at any recognised provider up to your limit¹).
- $700 annual limit on Physiotherapy and a separate $700 limit to use on Chiropractic, Osteopathy and Podiatry every year.
- 90% back on any Included extras up to annual limits.
- Claim at ANY recognised extras provider, anywhere in Australia.
Inclusions | Annual limits per person | Waiting period |
---|---|---|
Claim back percentage: | 90% | |
Claim back percentage: | ||
$300 | 6 months | |
$1,900 | 2 months | |
12 months | ||
12 months | ||
$700 | 2 months | |
$700 | 2 months | |
2 months | ||
$400 | 2 months | |
$1,000 | 2 months | |
2 months | ||
2 months | ||
Nil | ||
2 months | ||
2 months | ||
2 months | ||
$600 | 24 months | |
2 months | ||
2 months | ||
12 months | ||
36 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.
If your extras provider isn't part of our Members' Choice network don't worry. As long as they're a Medibank recognised provider, you can still claim a set percentage back on included extras up to your cover limits.
Claim a set percentage back on included services at any recognised provider, up to your annual limits.
Use your extras how you want
Use your extras limit at any recognised provider, plus get a separate limit for optical (some lens coatings excluded, waiting periods apply).
Claim almost anywhere
Claim a set percentage back on Included services at any recognised provider nationwide, (up to annual limits and subject to any waiting periods).
100% back on Optical items
We'll reimburse you for 100% of the cost of your optical items at recognised providers, up to your annual limit (some lens coatings excluded, waiting periods apply).
100% on up to two dental check ups
100% back on up to two dental check-ups every year, including bitewing x-rays, at any Members’ Choice Advantage dentist. That’s on top of your annual limit, so you can get your check-up no matter how much dental you’ve already claimed. Two month waiting period applies. Limited to two dental check-ups on all extras annually. Maximum two bitewing x-rays per check-up, where clinically needed. Not available in all areas.
Supporting documents
The following supporting documents relate to the Overseas Visitors Hospital cover and the Resident Extras cover.

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++ Other out-of-pocket expenses may apply.
ᶲ Benefits for Health screening tests are payable towards health screening services approved by Medibank for the detection of an illness or condition and performed by a Medicare registered provider, and where no Medicare benefits are payable for that service. Conditions apply, refer to your Cover Summary for details.
ᵟ Home nursing benefits are payable toward the cost of private nursing services which do not involve a hospital intervention, and must be provided by a registered home nursing provider. Medibank currently has no Recognised Home Nursing providers in NT and TAS. Conditions apply, refer to your Cover Summary for details.
^ Eligible medical services include: general practitioner (GP) consultations, other medical services provided out-of-hospital (for example specialists, pathology and x-rays), in-hospital medical services provided as part of an Included service (for example surgeon and anaesthetist fees), and allied health services billed with an MBS item number (for example eye checks and services related to chronic disease and mental health management plans).
** 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.
# 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.
ΦΦ Counsellors must be registered with Australian Counselling Association, Psychotherapy and Counselling Federation of Australia, Australian Traditional Medicine Society. Mental Health Social Workers must hold a mental health accreditation by the Australian Association of Social Workers. Medibank will pay benefits towards pharmacogenetic tests for all conditions. Benefits will only be paid towards pharmacogenetic tests administered in-person, or for approved home kits where supporting documentation from a medical practitioner outlining the clinical purpose is supplied.
1 Waiting periods apply. Some lens coatings excluded.