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.
Hospital cover
- A broader range of hospital services than Corporate Silver Hospital, with Sleep studies and Rehabilitation, as well as Heart and vascular system admissions.
- Our Private Room Promise.**
- Emergency Ambulance Australia-wide.^
- Accidental Injury Benefit.⁺
- No hospital excess for kids on a family membership.⁺⁺
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 | |
Nil | |
Nil | |
2 months | |
2 months | |
2 months
(12 month for pre-existing) |
|
2 months
(12 month for pre-existing) |
|
2 months
(12 month for pre-existing) |
|
2 months
(12 month for pre-existing) |
|
2 months
(12 month for pre-existing) |
|
2 months
(12 month for pre-existing) |
|
2 months
(12 month for pre-existing) |
|
2 months
(12 month for pre-existing) |
|
2 months
(12 month for pre-existing) |
|
2 months
(12 month for pre-existing) |
|
2 months
(12 month for pre-existing) |
|
2 months
(12 month for pre-existing) |
|
2 months
(12 month for pre-existing) |
|
2 months
(12 month for pre-existing) |
|
2 months
(12 month for pre-existing) |
|
2 months
(12 month for pre-existing) |
|
2 months
(12 month for pre-existing) |
|
2 months
(12 month for pre-existing) |
|
2 months
(12 month for pre-existing) |
|
2 months
(12 month for pre-existing) |
|
2 months
(12 month for pre-existing) |
|
2 months
(12 month for pre-existing) |
|
2 months
(12 month for pre-existing) |
|
2 months
(12 month for pre-existing) |
|
2 months
(12 month for pre-existing) |
|
2 months
(12 month for pre-existing) |
|
2 months
(12 month for pre-existing) |
|
2 months
(12 month for pre-existing) |
|
2 months
(12 month for pre-existing) |
|
2 months |
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 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 518 089 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
- $1,500 annual limit to use on any included extras treatments (except optical).
- BONUS $300 annual limit to use on optical (with 100% back at any recognised provider up to your limit¹).
- 80% back on included services at Members' Choice providers, up to annual limits.
Inclusions | Annual limits per person | Waiting period |
---|---|---|
Claim back percentage: | 80% | |
Claim back percentage: | ||
No annual limit | 1 day | |
$300 | 6 months | |
Combined annual limit of $1,500 ($3,000 Lifetime limit on orthodontics) | 2 months | |
2 months | ||
2 months | ||
2 months | ||
2 months | ||
2 months | ||
2 months | ||
Nil | ||
2 months | ||
2 months | ||
2 months | ||
12 months | ||
12 months | ||
2 months | ||
12 months | ||
24 months | ||
36 months | ||
2 months | ||
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.
If your extras provider isn't part of our Members' Choice network don't worry. As long as they're a Medibank recognised provider, with Flexi 60, 70 and 80, you can still claim a set percentage back on included extras up to your cover limits. With Flexi 80MC you can claim a fixed amount for each included service or item, up to your cover limits.
With Flexi 60, 70 and 80 covers, you’ll get a set percentage back on included services at any recognised provider, up to your annual limits. If you’re on Flexi 80MC, you’ll get a set percentage back on included services at a Members' Choice provider, up to your annual limits.
Use your extras how you want
Get a combined extras limit to spend how you want at any recognised provider, plus a separate limit for optical (some lens coatings excluded, waiting periods apply).
Claim almost anywhere
With Flexi 60, 70 and 80, claim a set percentage back on included services at any recognised provider nationwide, (up to annual limits and subject to any waiting periods). With Flexi 80MC, claim 80% back on included services at Members' Choice providers and a fixed amount for included services at non-Members' Choice providers (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 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.
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We’re proud to deliver outstanding value health insurance products designed to suit your needs. But don’t just take our word for it.
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^ Tasmania and Queensland have state schemes that cover ambulance services for residents of those States.
++ Other out-of-pocket expenses may apply.
# Medibank has Members' Choice providers for these services. With Flexi 80MC you will receive 80% back on included services at a Members' Choice provider, up to annual limits. For non-Members' Choice providers you'll receive a fixed amount for each service or item, up to your cover limits, as long as they're a Medibank recognised provider. See your Cover Summary for details.
~ 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.