Out-of-pocket expenses

Understanding our terms

The difference between the cost of

a hospital or extras service and any
benefit received from us or Medicare
is an out-of-pocket expense. Heres
some info that may help reduce some
of those expenses.

Not familiar with some words or

phrases or want to know the definition
of specific terms? Find a list of
frequently used words, terms and
phrases at medibank.com.au/glossary

How much do you pay for extras?

While you may have to pay an out-ofpocket expense on extras, you may save
money by visiting a Members Choice
extras provider. You benefit from capped
charges and/or discounts, which means
youll generally have lower out-of-pocket
expenses than you would at a non
Members Choice provider.
How much do you pay if you go to hospital?
Hospital cover helps pay for your hospital
visit but doesnt always cover all the costs.
You may be able to reduce your
out-of-pocket hospital expenses by
choosing a Members Choice hospital
and by asking your doctor or specialist
to participate in Medibanks GapCover.
For more information about GapCover,
please refer to the Membership Guide
at medibank.com.au
However, you may still have some
out-of-pocket hospital expenses, such
as the difference between the hospitals
charges and the benefit we pay and an
excess (if you choose to have one).
But remember, by choosing a hospital
cover that has an excess, youll pay a
lower premium.
Before your admission you should
confirm all likely out-of-pocket expenses
with your doctor and/or hospital.

Other things you should know

If theres anything else you want to know
thats not covered here such as benefit
replacement periods or our rules on
paying benefits, you should be able to find
what youre looking for by reading our
Membership Guide at medibank.com.au

What is an accident?
We define an accident as an unforeseen
event occurring by chance and caused
by an external force or object resulting
in involuntary injuries to the body which
requires immediate treatment. This
doesnt include conditions brought on
by medical causes such as asthma
attacks and appendicitis.

call 132 331

131 680 for Corporate enquiries
visit medibank.com.au
or ask in store
connect with us on

Well help you be

your best at every
stage in life

Unhappy?
What if you have a complaint?
We try to resolve all enquiries and
concerns the first time you contact us.
If you still need help with your concern
or any aspect of your membership, our
Customer Resolutions team will provide
courteous and respectful service.
Youll just need to provide sufficient
information regarding your enquiry so
we can investigate it for you. You can
do this by:
calling 132 331
emailing the secure form available
in Online Member Services at
medibank.com.au
writing to Medibank Private Customer
Resolutions, GPO Box 9999,
Melbourne, VIC 3000.
If for some reason we are not able to
satisfy your enquiry, you can also get
free, independent advice from the Private
Health Insurance Ombudsman by:
calling 1800 640 695
visiting phio.org.au

Why Medibank?
Medibank is more than just about insuring your health. We have the people, services
and resources to be your personal health partner, helping you to be your best at
every stage in life. Were committed to making health insurance as straightforward
as possible. For a start, we make it easier for you to choose cover thats right for you.
We have an extensive network of stores across Australia where you can drop in for
advice and assistance. And when it comes to claiming, we do everything we can to
make the process how it should be clear, simple, and certain.

Medibank Private is a signatory to the Private Health Insurance Code of Conduct.

The Private Health Insurance Code of Conduct logo is a trademark of, and is used
under authorisation from, Private Healthcare Australia.
In order to provide you with a range of health insurance and health related services, Medibank Private and its
related companies may share your personal (including sensitive) information. Our Privacy Policy sets out how
your personal (including sensitive) information is handled. You can view a copy of our Fund rules and Privacy
Policy at any Medibank store, or online at medibank.com.au
Medibank Private Limited ABN 47 080 890 259

Effective April 2014. MPL34590414

Important
information

Did you know?

Out-of-pocket expenses

Understanding our terms

The difference between the cost of

a hospital or extras service and any
benefit received from us or Medicare
is an out-of-pocket expense. Heres
some info that may help reduce some
of those expenses.

Not familiar with some words or

phrases or want to know the definition
of specific terms? Find a list of
frequently used words, terms and
phrases at medibank.com.au/glossary

How much do you pay for extras?

While you may have to pay an out-ofpocket expense on extras, you may save
money by visiting a Members Choice
extras provider. You benefit from capped
charges and/or discounts, which means
youll generally have lower out-of-pocket
expenses than you would at a non
Members Choice provider.
How much do you pay if you go to hospital?
Hospital cover helps pay for your hospital
visit but doesnt always cover all the costs.
You may be able to reduce your
out-of-pocket hospital expenses by
choosing a Members Choice hospital
and by asking your doctor or specialist
to participate in Medibanks GapCover.
For more information about GapCover,
please refer to the Membership Guide
at medibank.com.au
However, you may still have some
out-of-pocket hospital expenses, such
as the difference between the hospitals
charges and the benefit we pay and an
excess (if you choose to have one).
But remember, by choosing a hospital
cover that has an excess, youll pay a
lower premium.
Before your admission you should
confirm all likely out-of-pocket expenses
with your doctor and/or hospital.

Other things you should know

If theres anything else you want to know
thats not covered here such as benefit
replacement periods or our rules on
paying benefits, you should be able to find
what youre looking for by reading our
Membership Guide at medibank.com.au

What is an accident?
We define an accident as an unforeseen
event occurring by chance and caused
by an external force or object resulting
in involuntary injuries to the body which
requires immediate treatment. This
doesnt include conditions brought on
by medical causes such as asthma
attacks and appendicitis.

call 132 331

131 680 for Corporate enquiries
visit medibank.com.au
or ask in store
connect with us on

Well help you be

your best at every
stage in life

Unhappy?
What if you have a complaint?
We try to resolve all enquiries and
concerns the first time you contact us.
If you still need help with your concern
or any aspect of your membership, our
Customer Resolutions team will provide
courteous and respectful service.
Youll just need to provide sufficient
information regarding your enquiry so
we can investigate it for you. You can
do this by:
calling 132 331
emailing the secure form available
in Online Member Services at
medibank.com.au
writing to Medibank Private Customer
Resolutions, GPO Box 9999,
Melbourne, VIC 3000.
If for some reason we are not able to
satisfy your enquiry, you can also get
free, independent advice from the Private
Health Insurance Ombudsman by:
calling 1800 640 695
visiting phio.org.au

Why Medibank?
Medibank is more than just about insuring your health. We have the people, services
and resources to be your personal health partner, helping you to be your best at
every stage in life. Were committed to making health insurance as straightforward
as possible. For a start, we make it easier for you to choose cover thats right for you.
We have an extensive network of stores across Australia where you can drop in for
advice and assistance. And when it comes to claiming, we do everything we can to
make the process how it should be clear, simple, and certain.

Medibank Private is a signatory to the Private Health Insurance Code of Conduct.

The Private Health Insurance Code of Conduct logo is a trademark of, and is used
under authorisation from, Private Healthcare Australia.
In order to provide you with a range of health insurance and health related services, Medibank Private and its
related companies may share your personal (including sensitive) information. Our Privacy Policy sets out how
your personal (including sensitive) information is handled. You can view a copy of our Fund rules and Privacy
Policy at any Medibank store, or online at medibank.com.au
Medibank Private Limited ABN 47 080 890 259

Effective April 2014. MPL34590414

Important
information

Did you know?

It pays to understand
your Medibank
health insurance
The more you understand about your Medibank cover the easier
it is to make the most of it.
From rebates and levies, to pre-existing
conditions and cooling off periods, youll
find it explained simply within these
few pages. We know reading about the
ins and outs of private health insurance
isnt everyones idea of a good time, but
its certainly time well spent.

The AGR is applied to the base premium

rate only, not to any Lifetime Health
Cover loading that may be applicable.

For more information on Medibanks

policies and Fund rules, read our
Membership Guide at medibank.com.au

From 1 April 2014, the Federal Government

will reduced the rebate percentages
annually for all health insurers, based
on a calculation that takes in to account
the annual industry average rate increase
on health insurance premiums and the
cost of living.

Rebates, Levies and Loadings

The Medicare Levy Surcharge
The Australian Government encourages
all adults to take out private health
insurance, with the aim of easing the
strain on the public hospital system.
The Medicare Levy Surcharge (MLS) is an
additional tax ranging from 1% to 1.5%
depending on your annual income, on top
of the existing Medicare Levy. If applicable,
it is deducted from your earnings when
you lodge your tax return. You can avoid or
minimise the MLS by having a Medibank
hospital cover. To learn more about the
MLS, go to ato.gov.au
Australian Government Rebate
The Australian Government Rebate
(AGR) on private health insurance helps
make health insurance more affordable
by giving you a rebate on your premiums.

The level of rebate percentage youre

entitled to is determined by the age of
the oldest person covered under the
membership and your income.

If youre a Medibank member you should

nominate your rebate tier by logging into
Online Member Services at medibank.
com.au or by visiting a Medibank store.
Lifetime Health Cover loading
The Australian Government is incentivising
people to take out their own private health
cover through taxes and rebates. And
because they want us to do it sooner rather
than later, they also apply a Lifetime Health
Cover loading (LHC) to people who havent
taken out hospital cover by 1 July following
their 31st birthday. For every year you dont
have hospital cover after your 31st birthday,
youll pay a 2% loading on top of the base
rate of your hospital cover premium up to
a maximum of 70%.

The loading will be removed once youve had

hospital cover continuously for 10 years.
Whos exempt?
People born before 1 July 1934 dont
have to pay a LHC loading. You can learn
more about other exemption categories
at www.health.gov.au
What if you drop your hospital cover?
Lifes unpredictable and you may be
forced to cancel or suspend your hospital
cover for a period of time. The good news
is you can drop your hospital cover for
up to three years (1,094 permitted days)
during your lifetime without impacting
your LHC loading status. Any longer than
this and youll have to pay the loading
once you take out hospital cover again.
There are some circumstances when
your days without hospital cover wont
count towards your 1,094 permitted days
without hospital cover, such as:
if youve been overseas continuously
for more than one year (this includes
visits back to Australia of less than 90
days at a time), and/or
if your health insurer has agreed to a
period of suspension of your cover.
Switching from another health insurer?
If you switch to us from another health
insurer its best to keep your existing cover
until the day you become a Medibank
member. This way you can avoid using up
any of the 1,094 permitted days you can be
without hospital cover during your lifetime.
Any period of time youve had the loading
applied by another health insurer will
be transferred to your Medibank cover
and counted towards the 10 year loading
period. Remember the loading will
be removed after having 10 years of
continuous hospital cover.

Joining Medibank
Cooling off period
Its okay to change your mind. You can
cancel your membership within 30 days

of joining as long as you havent made

a claim, and your premium will be
fully refunded.
Transfers
Coming to us from another health insurer?
Well make the transition as smooth and
painless as possible, and youll be covered
from the date you join if:
those services are also included on the
Medibank cover we consider to be most
similar to the cover you had with your
former health insurer, and

Period

Item/Service

No waiting
period
2 months*

Mi Health support services

(available with hospital covers only)

6 months

Optical items
Ultra bonus
Membership Bonus

12 months

Pre-existing conditions
Obstetrics-related services
Major dental services
Orthodontics
Surgical dental procedures
and extractions
Breathing appliances, including
nebulisers, peak flow meters and
spacing devices^
betterhealth programs
Oral appliances for sleep apnoea^

you join us within two months of leaving

that former insurer, and
youve served applicable waiting periods.
Well credit you with waiting periods youve
already served, so youll only need to
serve the balance with us before you can
claim. Also, benefits that have been paid
under your previous cover may be taken
into account in determining the benefits
payable under your Medibank cover.
Any loyalty bonus or similar entitlements
built up with your former health insurer
wont transfer to Medibank.
Waiting periods
All health insurers have waiting periods
that everyone serves before they can
receive benefits.
If you havent had health insurance before
or its been over two months since you
had health insurance, youll need to serve
waiting periods.
What if youre changing to a higher level?
Whether youre upgrading within Medibank
or from another health insurer, additional
waiting periods may apply. In the meantime
you can still receive a benefit for services
that are covered in both your old and new
cover and where youve already served
relevant waiting periods.
Waiting periods vary for different services
and items. The following table is a guide.

All services (including ambulance

services) except those set out below

24 months

Blood glucose monitors^

Blood pressure monitors^

36 months

Hearing aids^
Laser eye surgery

higher levels of hospital covers (either

from Medibank or from another health
insurer), youll need to wait 12 months
to receive the higher benefits.
For more information about pre-existing
conditions please refer to the Membership
Guide at medibank.com.au

Added benefits of some packaged covers

With some of our packaged covers youll
benefit from an annual Membership
Bonus (per membership) as well as
increasing annual limits on selected
extras services. These benefits are
exclusive to the covers below and arent
available on other Medibank covers.
For New Families Essentials
For New Families Comprehensive
For Settled Families Essentials

*If you have an accident after joining us or changing

cover and require treatment, well waive the 2
month waiting period. Please note that if you have
our stand-alone Ambulance cover, the 7 day waiting
period for accidents still applies.

For Settled Families Comprehensive

The 12 month pre-existing condition waiting period

does not apply to hospital or hospital substitute
treatment for psychiatric treatment, rehabilitation
treatment or palliative care, but a 2 month waiting
period still applies.

With For Everyday Essentials and For

Security Essentials cover, you receive
increasing annual limits on selected
extras services.

^Benefit replacement periods apply. Please refer to

the Membership Guide at medibank.com.au

Pre-existing conditions
All private health insurers have a waiting
period of 12 months before you can claim
for a pre-existing condition. This is an
ailment, illness or condition with signs
or symptoms that existed as determined
by one of our doctors in the six months
before starting your membership or
changing cover and applies only to
hospital cover. If you go to hospital within
the first 12 months of joining, we may
check whether youre being treated for
a pre-existing condition.
What if you have a pre-existing condition?
If youve never had private hospital cover
or if your cover has lapsed, youll need
to wait 12 months before you can claim
for treatment of a pre-existing condition.
If you have upgraded to one of our

For Everyday Comprehensive

For Security Comprehensive.

Membership Bonus
A separate amount that you can put
towards the cost of approved membership
and health related expenses. This annual
bonus is in addition to benefits you
receive towards the hospital and extras
services of this product. Any unused
Membership Bonus will be added to the
following years entitlement which can
accrue up to the maximum limit.* Theres
a 6 month waiting period before you can
use your Membership Bonus. Then on
1 January every year you will receive your
Membership Bonus entitlement until you
reach your limit.
The bonus can be used for a range of
things like topping up your benefits to
reduce your out-of-pocket expenses
such as using on your extras and paying
towards your hospital excess. You can

also use this bonus for other health

related expenses, to find out more call
us on 132 331.
There are some things you cant use
your Membership Bonus towards which
include your premium, any contributions
towards Pharmaceutical Benefits
Scheme (PBS) prescriptions, out-ofhospital medical expenses covered by
Medicare, other non-approved expenses,
or expenses and costs precluded by law
from being paid.
The expenses you can use your
Membership Bonus towards are subject
to change. For more information,
call us on 132 331.
Increasing annual limits on selected
extras services
For a range of extras services*, your
annual limits increase by $50 per
member, per calendar year (up to the
maximum amount*), starting from
1 January only after a full calendar year
of membership has been completed.
The following table is an example of
a member who takes out For New
Families Essentials cover on 30 June
2013 and how their annual limit will
increase for major dental.
Date

Annual Limit

30 June 2013

$400

1 January 2014

$400 (no increase as

membership still within
1st calendar year)

1 January 2015

$450 (annual limit

increases as full calendar
year of membership has
been completed).

1 January 2016

$500

1 January 2017

$550

1 January 2018

$600

1 January 2019

$650 (maximum)

*Refer to Extras product tables in the Family packages

and Singles and Couples packages brochures for more
details, or visit medibank.com.au

Ambulance services
Ambulance services provide peace of
mind by covering the cost to take you
to hospital if youre injured or too sick
to get there another way. Youre also
covered when an ambulance is called
for immediate medical attention, even
if transport by ambulance isnt needed.
Whats covered?
Ambulance services include:
ambulance transport to hospital
to receive immediate professional
attention
when an ambulance is called to
provide immediate professional
attention even if you dont need
ambulance transport
when, as an admitted patient, youre
transferred between private hospitals
transport by air ambulance, where preapproval is obtained from Medibank
by the air ambulance provider.
Whats not covered?
Ambulance services exclude:
when immediate professional attention
is not required, for example general
patient transport
transfers between public hospitals
any ambulance costs that are fully
covered by a third party arrangement,
such as an ambulance subscription
or a federal/state/territory transport
scheme, WorkCover or the Transport
Accident Commission
any air ambulance services that are
fully subsidised, such as South Care
or NRMA Care Flight.
State schemes
Some states and territories, such as
QLD and TAS, have their own state
ambulance schemes which affect how
youre covered by Medibank. We dont
provide Ambulance Cover for QLD and
TAS residents. You can find out more at
medibank.com.au/ambulance

It pays to understand
your Medibank
health insurance
The more you understand about your Medibank cover the easier
it is to make the most of it.
From rebates and levies, to pre-existing
conditions and cooling off periods, youll
find it explained simply within these
few pages. We know reading about the
ins and outs of private health insurance
isnt everyones idea of a good time, but
its certainly time well spent.

The AGR is applied to the base premium

rate only, not to any Lifetime Health
Cover loading that may be applicable.

For more information on Medibanks

policies and Fund rules, read our
Membership Guide at medibank.com.au

From 1 April 2014, the Federal Government

will reduced the rebate percentages
annually for all health insurers, based
on a calculation that takes in to account
the annual industry average rate increase
on health insurance premiums and the
cost of living.

Rebates, Levies and Loadings

The Medicare Levy Surcharge
The Australian Government encourages
all adults to take out private health
insurance, with the aim of easing the
strain on the public hospital system.
The Medicare Levy Surcharge (MLS) is an
additional tax ranging from 1% to 1.5%
depending on your annual income, on top
of the existing Medicare Levy. If applicable,
it is deducted from your earnings when
you lodge your tax return. You can avoid or
minimise the MLS by having a Medibank
hospital cover. To learn more about the
MLS, go to ato.gov.au
Australian Government Rebate
The Australian Government Rebate
(AGR) on private health insurance helps
make health insurance more affordable
by giving you a rebate on your premiums.

The level of rebate percentage youre

entitled to is determined by the age of
the oldest person covered under the
membership and your income.

If youre a Medibank member you should

nominate your rebate tier by logging into
Online Member Services at medibank.
com.au or by visiting a Medibank store.
Lifetime Health Cover loading
The Australian Government is incentivising
people to take out their own private health
cover through taxes and rebates. And
because they want us to do it sooner rather
than later, they also apply a Lifetime Health
Cover loading (LHC) to people who havent
taken out hospital cover by 1 July following
their 31st birthday. For every year you dont
have hospital cover after your 31st birthday,
youll pay a 2% loading on top of the base
rate of your hospital cover premium up to
a maximum of 70%.

The loading will be removed once youve had

hospital cover continuously for 10 years.
Whos exempt?
People born before 1 July 1934 dont
have to pay a LHC loading. You can learn
more about other exemption categories
at www.health.gov.au
What if you drop your hospital cover?
Lifes unpredictable and you may be
forced to cancel or suspend your hospital
cover for a period of time. The good news
is you can drop your hospital cover for
up to three years (1,094 permitted days)
during your lifetime without impacting
your LHC loading status. Any longer than
this and youll have to pay the loading
once you take out hospital cover again.
There are some circumstances when
your days without hospital cover wont
count towards your 1,094 permitted days
without hospital cover, such as:
if youve been overseas continuously
for more than one year (this includes
visits back to Australia of less than 90
days at a time), and/or
if your health insurer has agreed to a
period of suspension of your cover.
Switching from another health insurer?
If you switch to us from another health
insurer its best to keep your existing cover
until the day you become a Medibank
member. This way you can avoid using up
any of the 1,094 permitted days you can be
without hospital cover during your lifetime.
Any period of time youve had the loading
applied by another health insurer will
be transferred to your Medibank cover
and counted towards the 10 year loading
period. Remember the loading will
be removed after having 10 years of
continuous hospital cover.

Joining Medibank
Cooling off period
Its okay to change your mind. You can
cancel your membership within 30 days

of joining as long as you havent made

a claim, and your premium will be
fully refunded.
Transfers
Coming to us from another health insurer?
Well make the transition as smooth and
painless as possible, and youll be covered
from the date you join if:
those services are also included on the
Medibank cover we consider to be most
similar to the cover you had with your
former health insurer, and

Period

Item/Service

No waiting
period
2 months*

Mi Health support services

(available with hospital covers only)

6 months

Optical items
Ultra bonus
Membership Bonus

12 months

Pre-existing conditions
Obstetrics-related services
Major dental services
Orthodontics
Surgical dental procedures
and extractions
Breathing appliances, including
nebulisers, peak flow meters and
spacing devices^
betterhealth programs
Oral appliances for sleep apnoea^

you join us within two months of leaving

that former insurer, and
youve served applicable waiting periods.
Well credit you with waiting periods youve
already served, so youll only need to
serve the balance with us before you can
claim. Also, benefits that have been paid
under your previous cover may be taken
into account in determining the benefits
payable under your Medibank cover.
Any loyalty bonus or similar entitlements
built up with your former health insurer
wont transfer to Medibank.
Waiting periods
All health insurers have waiting periods
that everyone serves before they can
receive benefits.
If you havent had health insurance before
or its been over two months since you
had health insurance, youll need to serve
waiting periods.
What if youre changing to a higher level?
Whether youre upgrading within Medibank
or from another health insurer, additional
waiting periods may apply. In the meantime
you can still receive a benefit for services
that are covered in both your old and new
cover and where youve already served
relevant waiting periods.
Waiting periods vary for different services
and items. The following table is a guide.

All services (including ambulance

services) except those set out below

24 months

Blood glucose monitors^

Blood pressure monitors^

36 months

Hearing aids^
Laser eye surgery

higher levels of hospital covers (either

from Medibank or from another health
insurer), youll need to wait 12 months
to receive the higher benefits.
For more information about pre-existing
conditions please refer to the Membership
Guide at medibank.com.au

Added benefits of some packaged covers

With some of our packaged covers youll
benefit from an annual Membership
Bonus (per membership) as well as
increasing annual limits on selected
extras services. These benefits are
exclusive to the covers below and arent
available on other Medibank covers.
For New Families Essentials
For New Families Comprehensive
For Settled Families Essentials

*If you have an accident after joining us or changing

cover and require treatment, well waive the 2
month waiting period. Please note that if you have
our stand-alone Ambulance cover, the 7 day waiting
period for accidents still applies.

For Settled Families Comprehensive

The 12 month pre-existing condition waiting period

does not apply to hospital or hospital substitute
treatment for psychiatric treatment, rehabilitation
treatment or palliative care, but a 2 month waiting
period still applies.

With For Everyday Essentials and For

Security Essentials cover, you receive
increasing annual limits on selected
extras services.

^Benefit replacement periods apply. Please refer to

the Membership Guide at medibank.com.au

Pre-existing conditions
All private health insurers have a waiting
period of 12 months before you can claim
for a pre-existing condition. This is an
ailment, illness or condition with signs
or symptoms that existed as determined
by one of our doctors in the six months
before starting your membership or
changing cover and applies only to
hospital cover. If you go to hospital within
the first 12 months of joining, we may
check whether youre being treated for
a pre-existing condition.
What if you have a pre-existing condition?
If youve never had private hospital cover
or if your cover has lapsed, youll need
to wait 12 months before you can claim
for treatment of a pre-existing condition.
If you have upgraded to one of our

For Everyday Comprehensive

For Security Comprehensive.

Membership Bonus
A separate amount that you can put
towards the cost of approved membership
and health related expenses. This annual
bonus is in addition to benefits you
receive towards the hospital and extras
services of this product. Any unused
Membership Bonus will be added to the
following years entitlement which can
accrue up to the maximum limit.* Theres
a 6 month waiting period before you can
use your Membership Bonus. Then on
1 January every year you will receive your
Membership Bonus entitlement until you
reach your limit.
The bonus can be used for a range of
things like topping up your benefits to
reduce your out-of-pocket expenses
such as using on your extras and paying
towards your hospital excess. You can

also use this bonus for other health

related expenses, to find out more call
us on 132 331.
There are some things you cant use
your Membership Bonus towards which
include your premium, any contributions
towards Pharmaceutical Benefits
Scheme (PBS) prescriptions, out-ofhospital medical expenses covered by
Medicare, other non-approved expenses,
or expenses and costs precluded by law
from being paid.
The expenses you can use your
Membership Bonus towards are subject
to change. For more information,
call us on 132 331.
Increasing annual limits on selected
extras services
For a range of extras services*, your
annual limits increase by $50 per
member, per calendar year (up to the
maximum amount*), starting from
1 January only after a full calendar year
of membership has been completed.
The following table is an example of
a member who takes out For New
Families Essentials cover on 30 June
2013 and how their annual limit will
increase for major dental.
Date

Annual Limit

30 June 2013

$400

1 January 2014

$400 (no increase as

membership still within
1st calendar year)

1 January 2015

$450 (annual limit

increases as full calendar
year of membership has
been completed).

1 January 2016

$500

1 January 2017

$550

1 January 2018

$600

1 January 2019

$650 (maximum)

*Refer to Extras product tables in the Family packages

and Singles and Couples packages brochures for more
details, or visit medibank.com.au

Ambulance services
Ambulance services provide peace of
mind by covering the cost to take you
to hospital if youre injured or too sick
to get there another way. Youre also
covered when an ambulance is called
for immediate medical attention, even
if transport by ambulance isnt needed.
Whats covered?
Ambulance services include:
ambulance transport to hospital
to receive immediate professional
attention
when an ambulance is called to
provide immediate professional
attention even if you dont need
ambulance transport
when, as an admitted patient, youre
transferred between private hospitals
transport by air ambulance, where preapproval is obtained from Medibank
by the air ambulance provider.
Whats not covered?
Ambulance services exclude:
when immediate professional attention
is not required, for example general
patient transport
transfers between public hospitals
any ambulance costs that are fully
covered by a third party arrangement,
such as an ambulance subscription
or a federal/state/territory transport
scheme, WorkCover or the Transport
Accident Commission
any air ambulance services that are
fully subsidised, such as South Care
or NRMA Care Flight.
State schemes
Some states and territories, such as
QLD and TAS, have their own state
ambulance schemes which affect how
youre covered by Medibank. We dont
provide Ambulance Cover for QLD and
TAS residents. You can find out more at
medibank.com.au/ambulance

It pays to understand
your Medibank
health insurance
The more you understand about your Medibank cover the easier
it is to make the most of it.
From rebates and levies, to pre-existing
conditions and cooling off periods, youll
find it explained simply within these
few pages. We know reading about the
ins and outs of private health insurance
isnt everyones idea of a good time, but
its certainly time well spent.

The AGR is applied to the base premium

rate only, not to any Lifetime Health
Cover loading that may be applicable.

For more information on Medibanks

policies and Fund rules, read our
Membership Guide at medibank.com.au

From 1 April 2014, the Federal Government

will reduced the rebate percentages
annually for all health insurers, based
on a calculation that takes in to account
the annual industry average rate increase
on health insurance premiums and the
cost of living.

Rebates, Levies and Loadings

The Medicare Levy Surcharge
The Australian Government encourages
all adults to take out private health
insurance, with the aim of easing the
strain on the public hospital system.
The Medicare Levy Surcharge (MLS) is an
additional tax ranging from 1% to 1.5%
depending on your annual income, on top
of the existing Medicare Levy. If applicable,
it is deducted from your earnings when
you lodge your tax return. You can avoid or
minimise the MLS by having a Medibank
hospital cover. To learn more about the
MLS, go to ato.gov.au
Australian Government Rebate
The Australian Government Rebate
(AGR) on private health insurance helps
make health insurance more affordable
by giving you a rebate on your premiums.

The level of rebate percentage youre

entitled to is determined by the age of
the oldest person covered under the
membership and your income.

If youre a Medibank member you should

nominate your rebate tier by logging into
Online Member Services at medibank.
com.au or by visiting a Medibank store.
Lifetime Health Cover loading
The Australian Government is incentivising
people to take out their own private health
cover through taxes and rebates. And
because they want us to do it sooner rather
than later, they also apply a Lifetime Health
Cover loading (LHC) to people who havent
taken out hospital cover by 1 July following
their 31st birthday. For every year you dont
have hospital cover after your 31st birthday,
youll pay a 2% loading on top of the base
rate of your hospital cover premium up to
a maximum of 70%.

The loading will be removed once youve had

hospital cover continuously for 10 years.
Whos exempt?
People born before 1 July 1934 dont
have to pay a LHC loading. You can learn
more about other exemption categories
at www.health.gov.au
What if you drop your hospital cover?
Lifes unpredictable and you may be
forced to cancel or suspend your hospital
cover for a period of time. The good news
is you can drop your hospital cover for
up to three years (1,094 permitted days)
during your lifetime without impacting
your LHC loading status. Any longer than
this and youll have to pay the loading
once you take out hospital cover again.
There are some circumstances when
your days without hospital cover wont
count towards your 1,094 permitted days
without hospital cover, such as:
if youve been overseas continuously
for more than one year (this includes
visits back to Australia of less than 90
days at a time), and/or
if your health insurer has agreed to a
period of suspension of your cover.
Switching from another health insurer?
If you switch to us from another health
insurer its best to keep your existing cover
until the day you become a Medibank
member. This way you can avoid using up
any of the 1,094 permitted days you can be
without hospital cover during your lifetime.
Any period of time youve had the loading
applied by another health insurer will
be transferred to your Medibank cover
and counted towards the 10 year loading
period. Remember the loading will
be removed after having 10 years of
continuous hospital cover.

Joining Medibank
Cooling off period
Its okay to change your mind. You can
cancel your membership within 30 days

of joining as long as you havent made

a claim, and your premium will be
fully refunded.
Transfers
Coming to us from another health insurer?
Well make the transition as smooth and
painless as possible, and youll be covered
from the date you join if:
those services are also included on the
Medibank cover we consider to be most
similar to the cover you had with your
former health insurer, and

Period

Item/Service

No waiting
period
2 months*

Mi Health support services

(available with hospital covers only)

6 months

Optical items
Ultra bonus
Membership Bonus

12 months

Pre-existing conditions
Obstetrics-related services
Major dental services
Orthodontics
Surgical dental procedures
and extractions
Breathing appliances, including
nebulisers, peak flow meters and
spacing devices^
betterhealth programs
Oral appliances for sleep apnoea^

you join us within two months of leaving

that former insurer, and
youve served applicable waiting periods.
Well credit you with waiting periods youve
already served, so youll only need to
serve the balance with us before you can
claim. Also, benefits that have been paid
under your previous cover may be taken
into account in determining the benefits
payable under your Medibank cover.
Any loyalty bonus or similar entitlements
built up with your former health insurer
wont transfer to Medibank.
Waiting periods
All health insurers have waiting periods
that everyone serves before they can
receive benefits.
If you havent had health insurance before
or its been over two months since you
had health insurance, youll need to serve
waiting periods.
What if youre changing to a higher level?
Whether youre upgrading within Medibank
or from another health insurer, additional
waiting periods may apply. In the meantime
you can still receive a benefit for services
that are covered in both your old and new
cover and where youve already served
relevant waiting periods.
Waiting periods vary for different services
and items. The following table is a guide.

All services (including ambulance

services) except those set out below

24 months

Blood glucose monitors^

Blood pressure monitors^

36 months

Hearing aids^
Laser eye surgery

higher levels of hospital covers (either

from Medibank or from another health
insurer), youll need to wait 12 months
to receive the higher benefits.
For more information about pre-existing
conditions please refer to the Membership
Guide at medibank.com.au

Added benefits of some packaged covers

With some of our packaged covers youll
benefit from an annual Membership
Bonus (per membership) as well as
increasing annual limits on selected
extras services. These benefits are
exclusive to the covers below and arent
available on other Medibank covers.
For New Families Essentials
For New Families Comprehensive
For Settled Families Essentials

*If you have an accident after joining us or changing

cover and require treatment, well waive the 2
month waiting period. Please note that if you have
our stand-alone Ambulance cover, the 7 day waiting
period for accidents still applies.

For Settled Families Comprehensive

The 12 month pre-existing condition waiting period

does not apply to hospital or hospital substitute
treatment for psychiatric treatment, rehabilitation
treatment or palliative care, but a 2 month waiting
period still applies.

With For Everyday Essentials and For

Security Essentials cover, you receive
increasing annual limits on selected
extras services.

^Benefit replacement periods apply. Please refer to

the Membership Guide at medibank.com.au

Pre-existing conditions
All private health insurers have a waiting
period of 12 months before you can claim
for a pre-existing condition. This is an
ailment, illness or condition with signs
or symptoms that existed as determined
by one of our doctors in the six months
before starting your membership or
changing cover and applies only to
hospital cover. If you go to hospital within
the first 12 months of joining, we may
check whether youre being treated for
a pre-existing condition.
What if you have a pre-existing condition?
If youve never had private hospital cover
or if your cover has lapsed, youll need
to wait 12 months before you can claim
for treatment of a pre-existing condition.
If you have upgraded to one of our

For Everyday Comprehensive

For Security Comprehensive.

Membership Bonus
A separate amount that you can put
towards the cost of approved membership
and health related expenses. This annual
bonus is in addition to benefits you
receive towards the hospital and extras
services of this product. Any unused
Membership Bonus will be added to the
following years entitlement which can
accrue up to the maximum limit.* Theres
a 6 month waiting period before you can
use your Membership Bonus. Then on
1 January every year you will receive your
Membership Bonus entitlement until you
reach your limit.
The bonus can be used for a range of
things like topping up your benefits to
reduce your out-of-pocket expenses
such as using on your extras and paying
towards your hospital excess. You can

also use this bonus for other health

related expenses, to find out more call
us on 132 331.
There are some things you cant use
your Membership Bonus towards which
include your premium, any contributions
towards Pharmaceutical Benefits
Scheme (PBS) prescriptions, out-ofhospital medical expenses covered by
Medicare, other non-approved expenses,
or expenses and costs precluded by law
from being paid.
The expenses you can use your
Membership Bonus towards are subject
to change. For more information,
call us on 132 331.
Increasing annual limits on selected
extras services
For a range of extras services*, your
annual limits increase by $50 per
member, per calendar year (up to the
maximum amount*), starting from
1 January only after a full calendar year
of membership has been completed.
The following table is an example of
a member who takes out For New
Families Essentials cover on 30 June
2013 and how their annual limit will
increase for major dental.
Date

Annual Limit

30 June 2013

$400

1 January 2014

$400 (no increase as

membership still within
1st calendar year)

1 January 2015

$450 (annual limit

increases as full calendar
year of membership has
been completed).

1 January 2016

$500

1 January 2017

$550

1 January 2018

$600

1 January 2019

$650 (maximum)

*Refer to Extras product tables in the Family packages

and Singles and Couples packages brochures for more
details, or visit medibank.com.au

Ambulance services
Ambulance services provide peace of
mind by covering the cost to take you
to hospital if youre injured or too sick
to get there another way. Youre also
covered when an ambulance is called
for immediate medical attention, even
if transport by ambulance isnt needed.
Whats covered?
Ambulance services include:
ambulance transport to hospital
to receive immediate professional
attention
when an ambulance is called to
provide immediate professional
attention even if you dont need
ambulance transport
when, as an admitted patient, youre
transferred between private hospitals
transport by air ambulance, where preapproval is obtained from Medibank
by the air ambulance provider.
Whats not covered?
Ambulance services exclude:
when immediate professional attention
is not required, for example general
patient transport
transfers between public hospitals
any ambulance costs that are fully
covered by a third party arrangement,
such as an ambulance subscription
or a federal/state/territory transport
scheme, WorkCover or the Transport
Accident Commission
any air ambulance services that are
fully subsidised, such as South Care
or NRMA Care Flight.
State schemes
Some states and territories, such as
QLD and TAS, have their own state
ambulance schemes which affect how
youre covered by Medibank. We dont
provide Ambulance Cover for QLD and
TAS residents. You can find out more at
medibank.com.au/ambulance

It pays to understand
your Medibank
health insurance
The more you understand about your Medibank cover the easier
it is to make the most of it.
From rebates and levies, to pre-existing
conditions and cooling off periods, youll
find it explained simply within these
few pages. We know reading about the
ins and outs of private health insurance
isnt everyones idea of a good time, but
its certainly time well spent.

The AGR is applied to the base premium

rate only, not to any Lifetime Health
Cover loading that may be applicable.

For more information on Medibanks

policies and Fund rules, read our
Membership Guide at medibank.com.au

From 1 April 2014, the Federal Government

will reduced the rebate percentages
annually for all health insurers, based
on a calculation that takes in to account
the annual industry average rate increase
on health insurance premiums and the
cost of living.

Rebates, Levies and Loadings

The Medicare Levy Surcharge
The Australian Government encourages
all adults to take out private health
insurance, with the aim of easing the
strain on the public hospital system.
The Medicare Levy Surcharge (MLS) is an
additional tax ranging from 1% to 1.5%
depending on your annual income, on top
of the existing Medicare Levy. If applicable,
it is deducted from your earnings when
you lodge your tax return. You can avoid or
minimise the MLS by having a Medibank
hospital cover. To learn more about the
MLS, go to ato.gov.au
Australian Government Rebate
The Australian Government Rebate
(AGR) on private health insurance helps
make health insurance more affordable
by giving you a rebate on your premiums.

The level of rebate percentage youre

entitled to is determined by the age of
the oldest person covered under the
membership and your income.

If youre a Medibank member you should

nominate your rebate tier by logging into
Online Member Services at medibank.
com.au or by visiting a Medibank store.
Lifetime Health Cover loading
The Australian Government is incentivising
people to take out their own private health
cover through taxes and rebates. And
because they want us to do it sooner rather
than later, they also apply a Lifetime Health
Cover loading (LHC) to people who havent
taken out hospital cover by 1 July following
their 31st birthday. For every year you dont
have hospital cover after your 31st birthday,
youll pay a 2% loading on top of the base
rate of your hospital cover premium up to
a maximum of 70%.

The loading will be removed once youve had

hospital cover continuously for 10 years.
Whos exempt?
People born before 1 July 1934 dont
have to pay a LHC loading. You can learn
more about other exemption categories
at www.health.gov.au
What if you drop your hospital cover?
Lifes unpredictable and you may be
forced to cancel or suspend your hospital
cover for a period of time. The good news
is you can drop your hospital cover for
up to three years (1,094 permitted days)
during your lifetime without impacting
your LHC loading status. Any longer than
this and youll have to pay the loading
once you take out hospital cover again.
There are some circumstances when
your days without hospital cover wont
count towards your 1,094 permitted days
without hospital cover, such as:
if youve been overseas continuously
for more than one year (this includes
visits back to Australia of less than 90
days at a time), and/or
if your health insurer has agreed to a
period of suspension of your cover.
Switching from another health insurer?
If you switch to us from another health
insurer its best to keep your existing cover
until the day you become a Medibank
member. This way you can avoid using up
any of the 1,094 permitted days you can be
without hospital cover during your lifetime.
Any period of time youve had the loading
applied by another health insurer will
be transferred to your Medibank cover
and counted towards the 10 year loading
period. Remember the loading will
be removed after having 10 years of
continuous hospital cover.

Joining Medibank
Cooling off period
Its okay to change your mind. You can
cancel your membership within 30 days

of joining as long as you havent made

a claim, and your premium will be
fully refunded.
Transfers
Coming to us from another health insurer?
Well make the transition as smooth and
painless as possible, and youll be covered
from the date you join if:
those services are also included on the
Medibank cover we consider to be most
similar to the cover you had with your
former health insurer, and

Period

Item/Service

No waiting
period
2 months*

Mi Health support services

(available with hospital covers only)

6 months

Optical items
Ultra bonus
Membership Bonus

12 months

Pre-existing conditions
Obstetrics-related services
Major dental services
Orthodontics
Surgical dental procedures
and extractions
Breathing appliances, including
nebulisers, peak flow meters and
spacing devices^
betterhealth programs
Oral appliances for sleep apnoea^

you join us within two months of leaving

that former insurer, and
youve served applicable waiting periods.
Well credit you with waiting periods youve
already served, so youll only need to
serve the balance with us before you can
claim. Also, benefits that have been paid
under your previous cover may be taken
into account in determining the benefits
payable under your Medibank cover.
Any loyalty bonus or similar entitlements
built up with your former health insurer
wont transfer to Medibank.
Waiting periods
All health insurers have waiting periods
that everyone serves before they can
receive benefits.
If you havent had health insurance before
or its been over two months since you
had health insurance, youll need to serve
waiting periods.
What if youre changing to a higher level?
Whether youre upgrading within Medibank
or from another health insurer, additional
waiting periods may apply. In the meantime
you can still receive a benefit for services
that are covered in both your old and new
cover and where youve already served
relevant waiting periods.
Waiting periods vary for different services
and items. The following table is a guide.

All services (including ambulance

services) except those set out below

24 months

Blood glucose monitors^

Blood pressure monitors^

36 months

Hearing aids^
Laser eye surgery

higher levels of hospital covers (either

from Medibank or from another health
insurer), youll need to wait 12 months
to receive the higher benefits.
For more information about pre-existing
conditions please refer to the Membership
Guide at medibank.com.au

Added benefits of some packaged covers

With some of our packaged covers youll
benefit from an annual Membership
Bonus (per membership) as well as
increasing annual limits on selected
extras services. These benefits are
exclusive to the covers below and arent
available on other Medibank covers.
For New Families Essentials
For New Families Comprehensive
For Settled Families Essentials

*If you have an accident after joining us or changing

cover and require treatment, well waive the 2
month waiting period. Please note that if you have
our stand-alone Ambulance cover, the 7 day waiting
period for accidents still applies.

For Settled Families Comprehensive

The 12 month pre-existing condition waiting period

does not apply to hospital or hospital substitute
treatment for psychiatric treatment, rehabilitation
treatment or palliative care, but a 2 month waiting
period still applies.

With For Everyday Essentials and For

Security Essentials cover, you receive
increasing annual limits on selected
extras services.

^Benefit replacement periods apply. Please refer to

the Membership Guide at medibank.com.au

Pre-existing conditions
All private health insurers have a waiting
period of 12 months before you can claim
for a pre-existing condition. This is an
ailment, illness or condition with signs
or symptoms that existed as determined
by one of our doctors in the six months
before starting your membership or
changing cover and applies only to
hospital cover. If you go to hospital within
the first 12 months of joining, we may
check whether youre being treated for
a pre-existing condition.
What if you have a pre-existing condition?
If youve never had private hospital cover
or if your cover has lapsed, youll need
to wait 12 months before you can claim
for treatment of a pre-existing condition.
If you have upgraded to one of our

For Everyday Comprehensive

For Security Comprehensive.

Membership Bonus
A separate amount that you can put
towards the cost of approved membership
and health related expenses. This annual
bonus is in addition to benefits you
receive towards the hospital and extras
services of this product. Any unused
Membership Bonus will be added to the
following years entitlement which can
accrue up to the maximum limit.* Theres
a 6 month waiting period before you can
use your Membership Bonus. Then on
1 January every year you will receive your
Membership Bonus entitlement until you
reach your limit.
The bonus can be used for a range of
things like topping up your benefits to
reduce your out-of-pocket expenses
such as using on your extras and paying
towards your hospital excess. You can

also use this bonus for other health

related expenses, to find out more call
us on 132 331.
There are some things you cant use
your Membership Bonus towards which
include your premium, any contributions
towards Pharmaceutical Benefits
Scheme (PBS) prescriptions, out-ofhospital medical expenses covered by
Medicare, other non-approved expenses,
or expenses and costs precluded by law
from being paid.
The expenses you can use your
Membership Bonus towards are subject
to change. For more information,
call us on 132 331.
Increasing annual limits on selected
extras services
For a range of extras services*, your
annual limits increase by $50 per
member, per calendar year (up to the
maximum amount*), starting from
1 January only after a full calendar year
of membership has been completed.
The following table is an example of
a member who takes out For New
Families Essentials cover on 30 June
2013 and how their annual limit will
increase for major dental.
Date

Annual Limit

30 June 2013

$400

1 January 2014

$400 (no increase as

membership still within
1st calendar year)

1 January 2015

$450 (annual limit

increases as full calendar
year of membership has
been completed).

1 January 2016

$500

1 January 2017

$550

1 January 2018

$600

1 January 2019

$650 (maximum)

*Refer to Extras product tables in the Family packages

and Singles and Couples packages brochures for more
details, or visit medibank.com.au

Ambulance services
Ambulance services provide peace of
mind by covering the cost to take you
to hospital if youre injured or too sick
to get there another way. Youre also
covered when an ambulance is called
for immediate medical attention, even
if transport by ambulance isnt needed.
Whats covered?
Ambulance services include:
ambulance transport to hospital
to receive immediate professional
attention
when an ambulance is called to
provide immediate professional
attention even if you dont need
ambulance transport
when, as an admitted patient, youre
transferred between private hospitals
transport by air ambulance, where preapproval is obtained from Medibank
by the air ambulance provider.
Whats not covered?
Ambulance services exclude:
when immediate professional attention
is not required, for example general
patient transport
transfers between public hospitals
any ambulance costs that are fully
covered by a third party arrangement,
such as an ambulance subscription
or a federal/state/territory transport
scheme, WorkCover or the Transport
Accident Commission
any air ambulance services that are
fully subsidised, such as South Care
or NRMA Care Flight.
State schemes
Some states and territories, such as
QLD and TAS, have their own state
ambulance schemes which affect how
youre covered by Medibank. We dont
provide Ambulance Cover for QLD and
TAS residents. You can find out more at
medibank.com.au/ambulance

Out-of-pocket expenses

Understanding our terms

The difference between the cost of

a hospital or extras service and any
benefit received from us or Medicare
is an out-of-pocket expense. Heres
some info that may help reduce some
of those expenses.

Not familiar with some words or

phrases or want to know the definition
of specific terms? Find a list of
frequently used words, terms and
phrases at medibank.com.au/glossary

How much do you pay for extras?

While you may have to pay an out-ofpocket expense on extras, you may save
money by visiting a Members Choice
extras provider. You benefit from capped
charges and/or discounts, which means
youll generally have lower out-of-pocket
expenses than you would at a non
Members Choice provider.
How much do you pay if you go to hospital?
Hospital cover helps pay for your hospital
visit but doesnt always cover all the costs.
You may be able to reduce your
out-of-pocket hospital expenses by
choosing a Members Choice hospital
and by asking your doctor or specialist
to participate in Medibanks GapCover.
For more information about GapCover,
please refer to the Membership Guide
at medibank.com.au
However, you may still have some
out-of-pocket hospital expenses, such
as the difference between the hospitals
charges and the benefit we pay and an
excess (if you choose to have one).
But remember, by choosing a hospital
cover that has an excess, youll pay a
lower premium.
Before your admission you should
confirm all likely out-of-pocket expenses
with your doctor and/or hospital.

Other things you should know

If theres anything else you want to know
thats not covered here such as benefit
replacement periods or our rules on
paying benefits, you should be able to find
what youre looking for by reading our
Membership Guide at medibank.com.au

What is an accident?
We define an accident as an unforeseen
event occurring by chance and caused
by an external force or object resulting
in involuntary injuries to the body which
requires immediate treatment. This
doesnt include conditions brought on
by medical causes such as asthma
attacks and appendicitis.

call 132 331

131 680 for Corporate enquiries
visit medibank.com.au
or ask in store
connect with us on

Well help you be

your best at every
stage in life

Unhappy?
What if you have a complaint?
We try to resolve all enquiries and
concerns the first time you contact us.
If you still need help with your concern
or any aspect of your membership, our
Customer Resolutions team will provide
courteous and respectful service.
Youll just need to provide sufficient
information regarding your enquiry so
we can investigate it for you. You can
do this by:
calling 132 331
emailing the secure form available
in Online Member Services at
medibank.com.au
writing to Medibank Private Customer
Resolutions, GPO Box 9999,
Melbourne, VIC 3000.
If for some reason we are not able to
satisfy your enquiry, you can also get
free, independent advice from the Private
Health Insurance Ombudsman by:
calling 1800 640 695
visiting phio.org.au

Why Medibank?
Medibank is more than just about insuring your health. We have the people, services
and resources to be your personal health partner, helping you to be your best at
every stage in life. Were committed to making health insurance as straightforward
as possible. For a start, we make it easier for you to choose cover thats right for you.
We have an extensive network of stores across Australia where you can drop in for
advice and assistance. And when it comes to claiming, we do everything we can to
make the process how it should be clear, simple, and certain.

Medibank Private is a signatory to the Private Health Insurance Code of Conduct.

The Private Health Insurance Code of Conduct logo is a trademark of, and is used
under authorisation from, Private Healthcare Australia.
In order to provide you with a range of health insurance and health related services, Medibank Private and its
related companies may share your personal (including sensitive) information. Our Privacy Policy sets out how
your personal (including sensitive) information is handled. You can view a copy of our Fund rules and Privacy
Policy at any Medibank store, or online at medibank.com.au
Medibank Private Limited ABN 47 080 890 259

Effective April 2014. MPL34590414

Important
information

Did you know?

Out-of-pocket expenses

Understanding our terms

The difference between the cost of

a hospital or extras service and any
benefit received from us or Medicare
is an out-of-pocket expense. Heres
some info that may help reduce some
of those expenses.

Not familiar with some words or

phrases or want to know the definition
of specific terms? Find a list of
frequently used words, terms and
phrases at medibank.com.au/glossary

How much do you pay for extras?

While you may have to pay an out-ofpocket expense on extras, you may save
money by visiting a Members Choice
extras provider. You benefit from capped
charges and/or discounts, which means
youll generally have lower out-of-pocket
expenses than you would at a non
Members Choice provider.
How much do you pay if you go to hospital?
Hospital cover helps pay for your hospital
visit but doesnt always cover all the costs.
You may be able to reduce your
out-of-pocket hospital expenses by
choosing a Members Choice hospital
and by asking your doctor or specialist
to participate in Medibanks GapCover.
For more information about GapCover,
please refer to the Membership Guide
at medibank.com.au
However, you may still have some
out-of-pocket hospital expenses, such
as the difference between the hospitals
charges and the benefit we pay and an
excess (if you choose to have one).
But remember, by choosing a hospital
cover that has an excess, youll pay a
lower premium.
Before your admission you should
confirm all likely out-of-pocket expenses
with your doctor and/or hospital.

Other things you should know

If theres anything else you want to know
thats not covered here such as benefit
replacement periods or our rules on
paying benefits, you should be able to find
what youre looking for by reading our
Membership Guide at medibank.com.au

What is an accident?
We define an accident as an unforeseen
event occurring by chance and caused
by an external force or object resulting
in involuntary injuries to the body which
requires immediate treatment. This
doesnt include conditions brought on
by medical causes such as asthma
attacks and appendicitis.

call 132 331

131 680 for Corporate enquiries
visit medibank.com.au
or ask in store
connect with us on

Well help you be

your best at every
stage in life

Unhappy?
What if you have a complaint?
We try to resolve all enquiries and
concerns the first time you contact us.
If you still need help with your concern
or any aspect of your membership, our
Customer Resolutions team will provide
courteous and respectful service.
Youll just need to provide sufficient
information regarding your enquiry so
we can investigate it for you. You can
do this by:
calling 132 331
emailing the secure form available
in Online Member Services at
medibank.com.au
writing to Medibank Private Customer
Resolutions, GPO Box 9999,
Melbourne, VIC 3000.
If for some reason we are not able to
satisfy your enquiry, you can also get
free, independent advice from the Private
Health Insurance Ombudsman by:
calling 1800 640 695
visiting phio.org.au

Why Medibank?
Medibank is more than just about insuring your health. We have the people, services
and resources to be your personal health partner, helping you to be your best at
every stage in life. Were committed to making health insurance as straightforward
as possible. For a start, we make it easier for you to choose cover thats right for you.
We have an extensive network of stores across Australia where you can drop in for
advice and assistance. And when it comes to claiming, we do everything we can to
make the process how it should be clear, simple, and certain.

Medibank Private is a signatory to the Private Health Insurance Code of Conduct.

The Private Health Insurance Code of Conduct logo is a trademark of, and is used
under authorisation from, Private Healthcare Australia.
In order to provide you with a range of health insurance and health related services, Medibank Private and its
related companies may share your personal (including sensitive) information. Our Privacy Policy sets out how
your personal (including sensitive) information is handled. You can view a copy of our Fund rules and Privacy
Policy at any Medibank store, or online at medibank.com.au
Medibank Private Limited ABN 47 080 890 259

Effective April 2014. MPL34590414

Important
information

Did you know?