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When you join Medibank, what do you get for
your money? Put simply, greater peace of
mind, more control over where you’re treated,
who treats you and, above all, how soon.
But that’s not all. You’ll be able to access
great value through our Members’ Choice
network, one of the largest health provider
networks in Australia, covering more services
than any other fund. And you’ll also be able to
take advantage of our betterhealth programs
– a great range of programs to keep you
healthy and on track.
We’re sure you’ll agree that private health
insurance can be confusing. That’s why, at
Medibank, we do all we can to keep things
simple – from the way we explain things,
to the covers we offer. So you not only know
what to expect, but also how to get the most
out of your cover.
That’s precisely why more Australians are
insured with us than any other health insurer.
More than three million, in fact.
Welcome to Medibank Private
Simply better off p5
Private health insurance makes sense –
here are some valuable reasons why.
Getting more from our cover p7
Here’s a snapshot of what we offer to help
you and your family get the most out of your cover.
Choosing what’s right for us p8
A snapshot of our covers and a guide to help you
decide what’s right for you and your family.
Hospital covers
Read about our hospital cover options to pick the cover
that matches your family’s health needs and lifestyle.
Basic cover – First Choice Hospital p10
Intermediate cover – Intermediate Hospital p11
Comprehensive cover – Blue Ribbon Hospital p13
Hospital cover comparison table p15
Extras covers
Choose an extras cover to help with the cost of everyday
treatments for you and your family. Includes dental services,
optical items and alternative therapies.
Basic cover – First Choice Extras p16
Intermediate cover – Smart Choice Extras p17
Comprehensive cover – Blue Ribbon Extras p19
Comprehensive cover – Blue Ribbon Extras Plus p19
Extras cover comparison table p20
The information contained in this brochure
is current at the time of issue, 1 June 2010, and
supersedes all previously published material.
Packaged covers with a bonus
Membership of Medibank Private, including
entitlement to and payment of benefits, is subject A range of covers that combine hospital and extras
to our Fund Rules and policies. If you anticipate into one convenient bundle with an annual bonus.
treatment for which you are expecting a benefit
from Medibank Private, please contact us before Basic cover – HealthyPlus p22
commencing treatment to confirm that the Intermediate cover – SmartPlus p24
benefit you expect will be paid. A summary of the
main Fund Rules and policies is contained in our Comprehensive cover – AdvantagePlus p26
Membership Guide which is issued to you when
you join. Premium rates, and the Fund Rules and
Comprehensive cover – PremierPlus p28
policies, change from time to time. Your personal Packaged cover comparison table p30
information is handled in accordance with our
Privacy Policy. You can view a copy of our Fund
Rules and Privacy Policy at any Medibank store,
or online at medibank.com.au
Members’ Choice network p35
The hospital and packaged covers described in this
brochure are generally not suitable for visitors from betterhealth p36
overseas, including visitors from countries with
which the Australian Government has Reciprocal
Health Care Arrangements. Please refer to our
Travel, Pet and Life insurance p37
brochures for international students and visitors,
for health cover that may be more appropriate.
Things worth knowing p39
Answers to some frequently asked questions
and explanations of commonly-used terms.
3
How long do you want to wait?
Did you know for some of the most common
Simply hospital procedures, in the public hospital
system, waiting lists can be lengthy and you
could wait up to:
better • 66 days for heart surgery^
• 12 months for hip replacement surgery^
• 13 months for knee replacement surgery.^
How much do you want to pay?
off If you want to go to a private hospital but
don’t have private health insurance you could
be looking at costs of:
• $6,949 for childbirth*
• $37,327 for heart bypass surgery *
• $25,838 for hip replacement surgery *
• $21,992 for knee replacement surgery.*
^National waiting times at 90 th percentile as reported
by the Australian Institute of Health and Welfare 2008,
Australian Hospital Statistics 2006-2007.
* These figures are an average of Medibank Private’s
claims information for 2008/09. They are hospital,
in-hospital medical and prostheses charges only. Costs
may vary depending on the hospital or provider you
receive treatment from and from state to state.
4
Private health insurance makes sense –
here are some valuable reasons why.
Pay less tax Lower your premiums with an excess payment
The Medicare Levy Surcharge works like a tax and An excess is an amount you agree to pay if you’re
applies to Australian residents who are high income admitted to hospital. In short, it’s a trade-off for paying
earners. If your taxable income is over an amount set by a lower premium – so the higher the excess, the lower
the government, and you don’t have an appropriate level the premium you pay.
of cover for you and your dependants, you may have to pay
the Medicare Levy Surcharge. This will add up to an extra No excess for kids
1% to your tax bill. So having hospital cover could help you You won’t be charged for an excess if your child
pay less tax. More information can be found at ato.gov.au is hospitalised. This applies to all our hospital and
packaged covers.
Get the Federal Government Rebate
The Federal Government 30% Rebate on private health What will it cost?
insurance reduces your premium and makes private Things like the type and level of cover you choose, which
health insurance more affordable. If eligible, you get state you live in, whether you have an excess
at least a 30% rebate on your private health insurance and if you’re a single, a couple or a family will influence
premium. As you get older you get even more back as the your premium.
rebate increases. Plus, you only need one person on your
But, unlike taking out insurance for your home or car,
membership to be in the higher age bracket to be eligible
your private health insurance premiums aren’t affected
for the higher rebate.
by things like gender, health condition or claims history.
• 30% off your premium if you’re 64 or under
Take a look in the back pocket of this brochure for more
• 35% if you’re 65-69 information on premiums.
• 40% if 70 or over
What’s more, you can choose to have it automatically
deducted from your Medibank premiums, claim it
through Medicare or when you do your tax return.
Avoid paying a Lifetime Health Cover loading
The Lifetime Health Cover loading is a Federal Government
initiative. It’s an incentive for Australian residents to
take out private hospital cover early on in life and keep it.
Basically, if you haven’t taken out hospital cover by July 1
following your 31st birthday, you’ll end up paying a loading
on your premium when you do decide to take it out.
This means for every year you don’t have hospital cover,
you’ll pay a 2% loading on top of a base rate on your
premium (up to 70%). So join before you’re 31 to make
sure you don’t have future loadings. See page 41 for more
details.
For more information go to,
Things worth knowing p39
5
Getting more from ou r
cover
6
So why Medibank? Here’s a snapshot of what we
offer to help you and your family get the most out
of your cover.
Value with Members’ Choice network The easiest way to claim on extras
As a Medibank member, you’ll have access to great It doesn’t get any easier. If your health care provider offers
value through our Members’ Choice network – one of on-the-spot claiming, just present your membership card
the largest health provider networks in the country. and the benefits are automatically deducted from your
If you go to a private hospital, you’ll end up paying less bill. Then all you need to do is pay the balance.
if it’s part of our Members’ Choice network of hospitals If your health care provider doesn’t offer on-the-spot
across Australia. And by using a Members’ Choice claiming or you prefer to do it yourself, just visit
extras provider you can enjoy higher benefits, capped medibank.com.au and register for our Online Member
fees or special deals to help keep your out-of-pockets Services, so you can claim online for a range of extras
to a minimum. See page 35 for more about Members’ services. From there we’ll either send you a cheque or
Choice – our network of providers covering more transfer the money directly into your bank account
services than any other fund. – whichever works best for you.
Ambulance transport More rewarding
If your medical condition means you can’t be transported Our feelbetter Rewards program gives members great
any other way, we’ll cover the cost of your ambulance deals from over 50 different retailers and organisations
transport (unless you already have cover eg. under nationally. These discounts and special offers are
a state scheme). This is something that’s included in all available on a wide variety of everyday items – not just
our hospital, extras (except in Qld and Tas) and packaged health-related things.
covers. See page 45 for details.
Say you’re thinking of joining a gym or need some new
running shoes. It’s worth checking out the special offers
Your big kids are covered too we’ve negotiated with participating gym networks and
Your kids can stay on your membership at no extra cost sportswear retailers.
until they’re 21, or if they’re studying full-time until
So before you next go shopping, check out the deals
they’re 25 (provided they’re not married or in a de facto
online at medibank.com.au
relationship). But if they’re not full-time students we have
our families with adult children option. You do pay a higher
premium but it can be cheaper than if they were To find out more
to take out their own cover at the same level. Confused or have a question about private health
insurance? We’ve put together a Things worth knowing
Better ways to look after you section to explain some important information you
should know before joining and answers common queries
Want to get fit? Get in shape? Eat better? Quit smoking?
we get. Go to page 39.
Or better manage your diabetes or a chronic health
condition? Then help and advice is either a click or
a phone call away with our betterhealth programs.
See page 36 for more details about how we invest in
health prevention and health management programs. Can’t find what you want?
Then visit us at medibank.com.au
More than just health cover
or if you prefer to talk to someone,
While we’re known for our top quality, value-for-money just call us on 132 331 or pop into
health cover, Medibank also gives you access to great a Medibank store. It’s that easy.
value travel, pet and life insurance. And as a Medibank
Private member, you’ll get 10% off all of these great
products. See page 37 for details.
For more information go to,
Things worth knowing p39
7
Choosing what’s
right for us
Finding the right cover is easy – just follow these steps
1 What type of cover do you need?
We’ve kept it simple with three types of cover for you to choose from.
Firstly there’s hospital cover. With it comes the peace of mind of knowing that if you need to go to hospital
you’ll have greater control over who treats you, where and how soon. See pages 10-15.
Then there’s extras cover. This provides cover for everyday health services, like dental, physio, as well as
optical items. See pages 16-21.
You can choose to mix and match any of our hospital and extras covers or just take one or the other.
Lastly there are packaged covers, which combine the same level of hospital and extras cover for you with
an annual bonus. See pages 22-32.
Once you’ve decided on the type of cover you want, it’s then a case of choosing what level of cover you want
– basic, intermediate or comprehensive – depending on your needs, lifestyle and budget.
Throughout this brochure we’ve colour coded the three different levels of cover:
Basic – orange
Intermediate – green
Comprehensive – blue
8
2 What level of cover suits you?
Here’s a snapshot of the different levels and range of covers you can choose from:
Basic
We’re a one income family, so money is a
Hospital covers
First Choice
Hospital
Extra covers
First Choice
Extras
Packaged covers
HealthyPlus
bit tight. We’re all healthy but I’m interested
in a budget-friendly cover so I know we
have some protection for the unexpected. p10 p16 p22
Intermediate Intermediate Smart Choice SmartPlus
Gordon and I got married 3 months ago. Hospital Extras
We’re both fit and healthy and thinking
about starting a family next year. I also
need the occasional remedial massage and
Gordon wears glasses.
p11 p17 p24
Comprehensive Blue Ribbon Blue Ribbon AdvantagePlus
Being a family of six you can’t take any Hospital Extras
chances, so we’ve had top hospital cover
Blue Ribbon PremierPlus
for a while now. But as the kids are getting
older it’s looking like they’ll need braces Extras Plus
so now we want top extras cover with cover
for orthodontics and other services a growing
family needs.
p13 p19 p26, 28
Comparison table
To quickly compare covers p15 p20-21 p30-32
3 Next steps
If you’d like to speak to someone directly, please give us a call or drop into a Medibank store.
It’s easy to join
• Call 132 331
• Go to medibank.com.au
• Visit a Medibank store
• Post your application forms
9
First Choice Hospital
Basic hospital cover
We’ve got two children and aren’t planning to have any more.
We’re a pretty fit and healthy family and don’t want to pay Key features
1. Budget-friendly
for services we’re less likely to use. 2. Basic hospital cover for a
limited range of services
What’s covered? What’s not covered?
3. Choose a higher excess
We cover all services where a We don’t pay benefits towards the to reduce your premium
Medicare benefit is payable unless it’s following excluded services:
on the list of excluded or restricted • Cardio-thoracic procedures such Key information
services. Covered services include: as angiograms or open heart and In Things worth knowing on
• Colonoscopies bypass surgery page 39, you’ll find information
• Appendicitis treatment • Major eye surgery – including on waiting periods (including
• Removal of tonsils and adenoids cataract and lens-related pre-existing ailments) and
services other benefit assessment
• Knee reconstruction surgery
• Hip and knee joint replacement information.
and investigations.
surgery
For these services we pay benefits
towards (less any applicable • Obstetrics-related services
hospital excess): • Assisted reproductive services
• Private hospital accommodation such as IVF and GIFT
- Overnight accommodation • Plastic and reconstructive
in a private or shared room surgery
- Same day admissions • Renal dialysis.
- Intensive care
Your excess options
- Theatre fees
An excess is an amount that you
• Public hospital accommodation agree to pay if admitted to hospital
as a private patient in exchange for lower premiums.
- Overnight accommodation It’s paid per member per calendar
in a private or shared room year but does not apply to any child
- Same day admissions on the membership. Your excess
(shared room only) options are:
• Surgically implanted
prostheses and other items Level 1 Level 2 Level 3
on the Federal Government’s Excess
$150 $250 $500
Prostheses Schedule options
• Medically necessary
ambulance transport.
What’s restricted?
We cover the following restricted
services but pay lower benefits
It’s easy to join
towards them in a private hospital:
• Call 132 331
• Psychiatric treatment
• Go to medibank.com.au
• Rehabilitation treatment.
• Visit a Medibank store
See page 47 to find out what we
mean by restricted services. • Post your application forms
For more information go to, To compare covers, go to the
Things worth knowing p39 comparison table p15
10
Intermediate Hospital
Intermediate hospital cover
Hospital cover
We’re a growing, active family so need more than
basic hospital cover. Key features
1. Cover for a wide range
of services with some
exclusions
What’s covered? What’s not covered? 2. Optional excess to help
We cover all services where a We don’t pay benefits towards the reduce your premium
Medicare benefit is payable unless following excluded services: 3. Includes obstetrics-related
it’s on the list of excluded services. • Major eye surgery – including services
Covered services include: cataract and lens-related
• Obstetrics-related services services Key information
• Assisted reproductive services • Hip and knee joint In Things worth knowing on
• Cardio-thoracic procedures such replacement surgery page 39, you’ll find information
as angiograms or open heart and • Renal dialysis. on waiting periods (including
bypass surgery pre-existing ailments) and
Your excess options other benefit assessment
• Colonoscopies
information.
• Appendicitis treatment An excess is an amount that you
agree to pay if admitted to hospital
• Removal of tonsils and adenoids
in exchange for lower premiums.
• Knee reconstruction surgery and It’s paid per member per calendar
investigations year but does not apply to any child
• Plastic and reconstructive on the membership. Your excess
surgery (doesn’t include cosmetic options are:
surgery)
• Psychiatric treatment No excess Level 2
• Rehabilitation treatment. Excess
$0 $250
For these included services we’ll options
pay benefits towards (less any
applicable hospital excess):
• Private hospital accommodation
- Overnight accommodation
in a private or shared room
- Same day admissions
- Intensive care
- Theatre fees
• Public hospital accommodation
as a private patient
- Overnight accommodation
in a private or shared room
- Same day admissions It’s easy to join
(shared room only)
• Call 132 331
• Surgically implanted prostheses
and other items on the Federal • Go to medibank.com.au
Government’s Prostheses • Visit a Medibank store
Schedule • Post your application forms
• Medically necessary ambulance
transport.
For more information go to, To compare covers, go to the
Things worth knowing p39 comparison table p15
11
The best for them
12
Blue Ribbon Hospital
Comprehensive hospital cover
I simply want a great hospital cover for my family.
Key features
1. Comprehensive cover
2. Optional excess to help
reduce your premium
What’s covered? • Public hospital accommodation 3. Includes obstetrics-related
We cover all services where a as a private patient services
Medicare benefit is payable, - Overnight accommodation
including: in a private or shared room Key information
• Obstetrics-related services - Same day admissions In Things worth knowing on
• Assisted reproductive services (shared room only) page 39, you’ll find information
• Cardio-thoracic procedures such • Surgically implanted prostheses on waiting periods (including
as angiograms or open heart and and other items on the Federal pre-existing ailments) and
bypass surgery Government’s Prostheses other benefit assessment
Schedule information.
• Colonoscopies
• Medically necessary ambulance
• Appendicitis treatment
transport.
• Removal of tonsils and adenoids
• Knee reconstruction surgery and Your excess options
investigations An excess is an amount that you
• Plastic and reconstructive agree to pay if admitted to hospital
surgery (doesn’t include in exchange for lower premiums.
cosmetic surgery) It’s paid per member per calendar
• Major eye surgery – including year but does not apply to any child
cataract and lens-related on the membership. Your excess
services options are:
• Hip and knee joint
replacement surgery No Level Level Level
excess 1 2 3
• Renal dialysis Excess
$0 $150 $250 $500
• Psychiatric treatment options
• Rehabilitation treatment.
For these services we pay benefits
towards (less any applicable
hospital excess):
• Private hospital accommodation
- Overnight accommodation
in a private or shared room
- Same day admissions
- Intensive care
- Theatre fees
It’s easy to join
• Call 132 331
• Go to medibank.com.au
• Visit a Medibank store
• Post your application forms
For more information go to, To compare covers, go to the
Things worth knowing p39 comparison table p15
13
Hospital cover scenario
My son Tom is normally an active five year
old but over the last 12 months he’s had
So we don’t tonsillitis five times. After several visits to the
doctor and courses of antibiotics it was
recommended he have his tonsils removed.
Luckily we had hospital cover because in the
wait
have to
public system Tom could have waited up to
11 months* for the operation. Having hospital
cover meant Tom could have the surgery
sooner and we could choose the surgeon.
*National waiting times at 90th percentile as reported
by the Australian Institute of Health and Welfare 2008.
Australian Hospital Statistics 2006 – 2007.
14
Hospital cover comparison table
Item/Service
Basic Intermediate Comprehensive
First Choice Hospital Intermediate Hospital Blue Ribbon Hospital
Excess ✓ Optional Optional
Medically necessary
ambulance transport* ✓ ✓ ✓
Psychiatric treatment Restricted ✓ ✓
Rehabilitation treatment Restricted ✓ ✓
Cardio-thoracic procedures ✗ ✓ ✓
Obstetrics-related services ✗ ✓ ✓
Assisted reproductive services ✗ ✓ ✓
Plastic and reconstructive surgery ✗ ✓ ✓
Major eye surgery – including cataract
and lens-related services ✗ ✗ ✓
Hip and knee joint replacement surgery ✗ ✗ ✓
Renal dialysis ✗ ✗ ✓
All other services where a Medicare benefit
is payable ✓ ✓ ✓
Cover overview go to p10 Cover overview go to p11 Cover overview go to p13
*Benefits are not available Restricted services
where there’s an entitlement
If you choose a cover with
to cover under third party
restricted services, we
arrangements such as
will pay lower benefits for
State Government
these services in a private
ambulance transport
hospital. It’s important to
schemes or ambulance
consider whether you’re likely
subscription services.
to need these services, because
the benefits for restricted
services generally won’t cover
the full cost of treatment
in a private hospital and you
may end up with significant
out-of-pocket expenses.
Cosmetic surgery
We don’t pay benefits
towards cosmetic surgery.
To know more, go to Things worth knowing
for information on waiting periods and other
benefit assessment information. p39 15
First Choice Extras
Basic extras cover
We just need cover for everyday things like going to the
Key features
dentist, and a little physio from time to time.
1. Cover for basic services
2. Budget-friendly
What’s covered? Key information
We’ll pay benefits towards: In Things worth knowing on
• General dental and endodontic page 39, you’ll find information
services (eg. root canal) on waiting periods (including
• Optical items pre-existing ailments) and
other benefit assessment
• Physiotherapy information.
• Pharmaceutical prescriptions
(non-PBS)
• Medically necessary ambulance
transport (except in Qld and Tas).
For information about annual
limits and sub-limits for the above
services, see the comparison
table on pages 20-21 and page 41
of Things worth knowing.
It’s easy to join
• Call 132 331
• Go to medibank.com.au
• Visit a Medibank store
• Post your application forms
For more information go to, To compare covers, go to the
Things worth knowing p39 comparison table p20-21
16
Smart Choice Extras
Intermediate extras cover
We’re after a cover for a little more than just the everyday
Key features
things – like reflexology and naturopathy.
1. Generous annual limits
for general dental and optical
items
What’s covered? Flexibility with Flexi-Fund 2. Great options with
We’ll pay benefits towards: Each year you’ll be able to claim up Flexi-Fund
• General dental and endodontic to $300 per person to a maximum 3. Cover for alternative
services (eg. root canal) of $600 per couple/family therapies including
membership to spend on the acupuncture and
• Optical items
following services: myotherapy
• Physiotherapy
• Major dental such as orthodontic
• Pharmaceutical prescriptions treatment Key information
(non-PBS) In Things worth knowing on
• Alternative and natural therapies
• Medically necessary ambulance such as chiropractic and page 39, you’ll find information
Extras cover
transport (except in Qld and Tas). remedial massage on waiting periods (including
• Other therapies such as podiatry pre-existing ailments) and
For information about annual other benefit assessment
limits and sub-limits for the above and speech therapy
information.
services, see the comparison • Health appliances such
table on pages 20-21 and page 41 as nebulisers and blood
of Things worth knowing. glucose monitors
• Clinical psychology consultations.
Sub-limits may apply – see the
comparison table on pages 20-21
for more information and page 41
of Things worth knowing.
It’s easy to join
• Call 132 331
• Go to medibank.com.au
• Visit a Medibank store
• Post your application forms
For more information go to, To compare covers, go to the
Things worth knowing p39 comparison table p20-21
17
For the
little extras
he needs Blue Ribbon Extras cover scenario
When Jacob first showed interest in playing
footy I was a little worried but at least they
made him play with a mouthguard. Getting
the mouthguaxrd made was all pretty straight
forward and because we have Blue Ribbon
Extras cover and our dentist is part of the
Members’ Choice network we didn’t have to
pay as much.
18
Blue Ribbon Extras
Blue Ribbon Extras Plus
Comprehensive extras cover
The family uses a range of services, like major dental,
remedial massage and even podiatry, so I want top Key features
1. Our top covers with benefits
cover with generous limits. for the widest range of
services
What’s covered? Plus you’ll also get benefits for: 2. Generous annual limits
We’ll pay benefits towards: • Major dental such as orthodontic 3. No annual limit on
• General dental and endodontic treatment general dental
services (eg. root canal) • Alternative and natural therapies 4. Cover for alternative
• Optical items such as chiropractic and therapies such as remedial
myotherapy massage and reflexology
• Physiotherapy
• Other therapies such as podiatry
• Pharmaceutical prescriptions Key information
and speech therapy
(non-PBS)
• Health appliances such In Things worth knowing on
• Medically necessary ambulance
as hearing aids and blood page 39, you’ll find information
transport (except in Qld and Tas).
glucose monitors on waiting periods (including
• Clinical psychology consultations pre-existing ailments) and
other benefit assessment
• School accident treatment. information.
For a full list of services and for
information about annual limits and
and sub-limits see the comparison
table on pages 20-21 and page 41 of
Things worth knowing.
Blue Ribbon Extras Plus
Blue Ribbon Extras Plus is our
most comprehensive extras cover.
It provides the same cover as
Blue Ribbon Extras, but with
generally higher benefits.
See the comparison table on
pages 20-21 for more details.
For more information go to, To compare covers, go to the
Things worth knowing p39 comparison table p20-21
19
Extras cover comparison table
This table shows the annual limits and sub-limits that apply to benefits for extras items
and services. Unless otherwise shown, limits are per person, per calendar year.
Comprehensive
Basic Intermediate Blue Ribbon Extras &
Item/Service Waiting period First Choice Extras Smart Choice Extras Blue Ribbon Extras Plus
2 months* $500 Combined general dental and endodontic $800 Combined general dental and endodontic No annual limit
Limits General dental eg. dental examination, scale and clean 12 months for surgical procedures services annual limit services annual limit $300 sub-limit during the first 6 months
and extractions $300 sub-limit during the first 6 months $300 sub-limit during the first 6 months of membership of any extras cover
Each of our extras covers
Endodontic services eg. root canal treatment 12 months of membership of any extras cover of membership of any extras cover $400-$800#
has annual limits and
sub-limits. See page 41 $225 A sub-limit of $92 for frames and $200
$250 A sub-limit of $92 under Blue Ribbon Extras and
for more information. Optical items eg. frames, prescription lenses and contact lenses 6 months $200 A sub-limit of $92 for frames $115 under Blue Ribbon Extra Plus for frames
for contact lenses
and $200 for contact lenses under both
The benefit we pay for a
Physiotherapy eg. consultations (includes group pilates
particular claim is likely 2 months* $300 $300 $700
and hydrotherapy sessions)
to be less than the annual Pharmaceutical prescriptions Includes most prescribed
limit or sub-limit and less non-PBS items. Benefits will be paid after a set charge has been 2 months* $300 $300 $600
than your provider’s charge. deducted
This means you’ll usually Medically necessary ambulance transport† 2 months* No annual limit No annual limit No annual limit
have out-of-pocket expenses
$2,000 For services in this category but not to exceed
for each service or item. Major dental
the amount shown for each sub-category
Additional restrictions apply Inlay/onlay restorative eg. restorative fillings 12 months $300-$700#
to the payment of benefits
Dentures, crowns and bridges 12 months $400-$800#
for some services. Please
call us for more information. Orthodontic eg. braces 12 months $400-$800# LIfetime limit of $2,400 per member
Periodontic eg. treatment of gum disease 12 months $300-$700#
Benefit replacement period
$500 For services in this category but not to exceed
Alternative therapies Consultations for:
You might need to wait for the amount shown for each sub-category
a period of time from the Chiropractic and osteopathy 2 months* $400
date of purchase of some Acupuncture 2 months* $400
items before you’re entitled
Naturopathy 2 months* $400
to another benefit to replace
the item. See page 43 for Natural Therapies: Remedial massage and myotherapy, reflexology, $150 for Blue Ribbon Extras and
shiatsu, homeopathy, western and Chinese herbalism, Alexander technique, 2 months* $100 Sub-limit
more information. $200 for Blue Ribbon Extras Plus
Bowen therapy, aromatherapy, kinesiology and exercise physiology Flexi-Fund
Up to $300 per $1,000 For services in this category but not to exceed
Other therapies Consultations for:
person up to the amount shown for each sub-category
Podiatry: Includes specified orthotics 2 months* a maximum of $400
Notes
$600 per couple/
Note: For the approved
* The 2 month waiting family membership Jenny Craig weight loss $400 Note: For the approved Jenny Craig weight
period is waived when across all these program, sub-limits of loss program, sub-limits of $200 per
Dietetics: Includes Jenny Craig weight loss benefit 2 months* covered services
the service arises from $200 per membership per membership per calendar year and
an accident. (sub-limits calendar year and $100 per $100 per person per lifetime apply.
may apply) person per lifetime apply.
#
Increases by $50 per Occupational therapy 2 months* $400
calendar year of
Speech therapy 2 months* $400
continuous membership
to the maximums shown. Orthoptics (eye therapy) 2 months* $400
You’ll be eligible for the $1,000 For services in this category but not to exceed
Health appliances
increases once you have the amount shown for each sub-category
served one full calendar Hearing aids 36 months $800 Sub-limits and other restrictions apply
year’s membership.
Breathing appliances eg. peak flow meters, nebulisers $180 per membership
12 months $180 per membership every 3 years
†
Benefits aren’t available and spacing devices every 3 years
where there’s an $240 per membership $240 per membership every 3 years and $150 per
entitlement to cover Blood glucose monitors 24 months every 3 years and $150 per person for Blue Ribbon Extras or $180 per person
person every 3 years for Blue Ribbon Extras Plus every 3 years
under a state scheme
or any other source. Other health appliances (including external prostheses) 2 months*
Sub-limits and other
$500 Sub-limits and other restrictions apply
restrictions apply
Clinical psychology Consultations only 2 months* $400
School accident For preschool, primary and
2 months $800
secondary school students
Cover overview go to p16 Cover overview go to p17 Cover overview go to p19
To know more, go to Things worth knowing
20 for information on waiting periods and other 21
benefit assessment information. p39
HealthyPlus: Hospital + Extras + Bonus
Basic packaged cover
We just want basic hospital and extras cover plus a bonus.
Hospital What’s not covered?
We don’t pay benefits towards the following
What’s covered? excluded services:
We cover all services where a Medicare benefit is payable • Cardio-thoracic procedures such as angiograms
unless it’s on the list of excluded or restricted services. or open heart and bypass surgery
Covered services include:
• Major eye surgery – including cataract and
• Colonoscopies lens-related services
• Appendicitis treatment • Hip and knee joint replacement surgery
• Removal of tonsils and adenoids • Obstetrics-related services
• Knee reconstruction surgery and investigations • Assisted reproductive services such as IVF and GIFT
• Shoulder reconstruction surgery and investigations • Plastic and reconstructive surgery
• Surgical extraction of wisdom teeth • Renal dialysis.
• Palliative care.
For these services we pay benefits towards Your excess
(less any applicable hospital excess): This cover includes an excess of $500, which applies
when a member is admitted to hospital. You won’t pay
• Private hospital accommodation
more than $500 per member per calendar year.
- Overnight accommodation in a private or shared room If your child is admitted to hospital you won’t have to
- Same day admissions pay the excess.
- Intensive care
Extras
- Theatre fees
• Public hospital accommodation as a private patient What’s covered?
- Overnight accommodation in a private or shared room We’ll pay benefits towards:
- Same day admissions (shared room only) • General dental and endodontic services
• Surgically implanted prostheses and other items on (eg. root canal)
the Federal Government’s Prostheses Schedule. • Optical items
• Physiotherapy
What’s restricted? • Pharmaceutical prescriptions (non-PBS)
We cover the following restricted services but pay lower
• Medically necessary ambulance transport.
benefits towards them in a private hospital:
For information about annual limits and sub-limits for
• Psychiatric treatment
the above extras services, see the comparison tables
• Rehabilitation treatment. on pages 31-32 and page 41 of Things worth knowing.
See page 47 to find out more about what we mean
by restricted services.
It’s easy to join
• Call 132 331
• Go to medibank.com.au
• Visit a Medibank store
• Post your application forms
For more information go to, To compare covers, go to the
Things worth knowing p39 comparison table p30-32
22
Key features Key information
1. Budget-friendly In Things worth knowing
2. PackageBonus on page 39, you’ll find
information on waiting
periods (including
pre-existing ailments)
and other benefit
assessment information.
Take the package, get a bonus
PackageBonus is an amount of money that accumulates each year to help you pay for a range of approved membership
and health-related expenses (eg. payment towards your hospital excess, travel vaccinations and stop smoking programs).
See page 45 for more details.
How the PackageBonus works
Any member can claim PackageBonus benefits up to the maximum membership limit.
PackageBonus entitlements
There is a 6 month waiting period and entitlements apply from 1 January each year.
Couple, family and single
Single membership
parent family membership
Packaged cover
First calendar year of membership $50 $100
Second calendar year of membership
$100 $200
and each calendar year thereafter
Maximum membership limit $500 $1,000
Any unused PackageBonus will be added to the following year’s entitlement up to the maximum membership limit shown above,
provided you stay on the same membership and on a cover with a PackageBonus.
23
SmartPlus: Hospital + Extras + Bonus
Intermediate packaged cover
We’re planning to start a family so want both hospital and extras cover.
Hospital Your excess
This cover includes an excess of $500, which applies when
What’s covered? a member is admitted to hospital. You won’t pay more than
We cover all services where a Medicare benefit is $500 per member per calendar year. If your child is
payable unless it’s on the list of excluded services. admitted to hospital you won’t have to pay the excess.
Covered services include:
• Obstetrics-related services Extras
• Assisted reproductive services What’s covered?
• Cardio-thoracic procedures such as angiograms We’ll pay benefits towards:
or open heart and bypass surgery
• General dental and endodontic services
• Colonoscopies (eg. root canal)
• Appendicitis treatment • Optical items
• Removal of tonsils and adenoids • Physiotherapy
• Knee reconstruction surgery and investigations • Pharmaceutical prescriptions (non-PBS)
• Shoulder reconstruction surgery and investigations • Medically necessary ambulance transport.
• Surgical extraction of wisdom teeth
• Plastic and reconstructive surgery (doesn’t include Flexibility with Flexi-Fund
cosmetic surgery) SmartPlus includes a Flexi-Fund which allows you to
• Palliative care claim up to $300 per person to a maximum of $600
per couple/family membership across the following
• Psychiatric treatment services (sub-limits may apply):
• Rehabilitation treatment. • Major dental such as orthodontic treatment
For these services we pay benefits towards • Alternative therapies such as chiropractic
(less any applicable hospital excess): and naturopathy
• Private hospital accommodation • Other therapies such as podiatry and speech therapy
- Overnight accommodation in a private or shared room • Health appliances such as nebulisers and blood
- Same day admissions glucose monitors
- Intensive care • Clinical psychology consultations.
- Theatre fees For information about annual limits and sub-limits for
• Public hospital accommodation as a private patient the above extras services, see the comparison tables
- Overnight accommodation in a private or shared room on pages 31-32 and page 41 of Things worth knowing.
- Same day admissions (shared room only)
• Surgically implanted prostheses and other items
on the Federal Government’s Prostheses Schedule.
It’s easy to join
What’s not covered? • Call 132 331
We don’t pay benefits towards the following • Go to medibank.com.au
excluded services: • Visit a Medibank store
• Major eye surgery – including cataract and • Post your application forms
lens-related services
• Hip and knee joint replacement surgery
• Renal dialysis.
For more information go to, To compare covers, go to the
Things worth knowing p39 comparison table p30-32
24
Key features Key information
1. Cover for a wide range In Things worth knowing
of hospital treatments on page 39, you’ll find
2. Greater extras options information on waiting
with the Flexi-Fund periods (including
feature pre-existing ailments)
3. PackageBonus and other benefit
assessment information.
Take the package, get a bonus
PackageBonus is an amount of money that accumulates each year to help you pay for a range of approved membership
and health-related expenses (eg. payment towards your hospital excess, travel vaccinations and stop smoking programs).
See page 45 for more details.
How the PackageBonus works
Any member can claim PackageBonus benefits up to the maximum membership limit.
PackageBonus entitlements
There is a 6 month waiting period and entitlements apply from 1 January each year.
Couple, family and single
Single membership
parent family membership
First calendar year of membership $50 $100
Second calendar year of membership
$100 $200
and each calendar year thereafter
Maximum membership limit $500 $1,000
Any unused PackageBonus will be added to the following year’s entitlement up to the maximum membership limit shown above,
provided you stay on the same membership and on a cover with a PackageBonus.
25
AdvantagePlus: Hospital + Extras + Bonus
Comprehensive packaged cover
We’re a young family and want comprehensive cover.
Hospital Your excess
This cover includes an excess of $200, which applies
What’s covered? when a member is admitted to hospital. You won’t
We cover all services where a Medicare benefit pay more than $500 per member per calendar year.
is payable, including: If your child is admitted to hospital you won’t have to
• Obstetrics-related services pay the excess.
• Assisted reproductive services
Extras
• Cardio-thoracic procedures such as angiograms
or open heart and bypass surgery What’s covered?
• Colonoscopies We’ll pay benefits towards:
• Appendicitis treatment • General dental
• Removal of tonsils and adenoids • Endodontic services (eg. root canal)
• Knee reconstruction surgery and investigations • Optical items
• Shoulder reconstruction surgery and investigations • Physiotherapy
• Surgical extraction of wisdom teeth • Pharmaceutical prescriptions (non-PBS)
• Plastic and reconstructive surgery (doesn’t include • Medically necessary ambulance transport.
cosmetic surgery) Plus you’ll also get benefits for:
• Major eye surgery – including cataract and • Major dental such as orthodontic treatment
lens-related services
• Alternative therapies such as chiropractic and
• Hip and knee joint replacement surgery naturopathy
• Renal dialysis • Other therapies such as podiatry and speech therapy
• Palliative care • Health appliances such as hearing aids and blood
• Psychiatric treatment glucose monitors
• Rehabilitation treatment. • Clinical psychology consultations
For these services we pay benefits towards • School accident treatment.
(less any applicable hospital excess):
For information about annual limits and sub-limits for
• Private hospital accommodation
the above extras services, see the comparison tables
- Overnight accommodation in a private or shared room on pages 31-32 and page 41 of Things worth knowing.
- Same day admissions
- Intensive care
- Theatre fees
It’s easy to join
• Public hospital accommodation as a private patient
• Call 132 331
- Overnight accommodation in a private or shared room
• Go to medibank.com.au
- Same day admissions (shared room only)
• Visit a Medibank store
• Surgically implanted prostheses and other items
on the Federal Government’s Prostheses Schedule. • Post your application forms
For more information go to, To compare covers, go to the
Things worth knowing p39 comparison table p30-32
26
Key features Key information
1. Cover for alternative In Things worth knowing
therapies on page 39, you’ll find
2. No annual limit information on waiting
on general dental periods (including
pre-existing ailments)
3. Generous annual limits
and other benefit
for things like physio
assessment information.
and optical items
4. PackageBonus
Take the package, get a bonus
PackageBonus is an amount of money that accumulates each year to help you pay for a range of approved membership
and health-related expenses (eg. payment towards your hospital excess, travel vaccinations and stop smoking programs).
See page 45 for more details.
How the PackageBonus works
Any member can claim PackageBonus benefits up to the maximum membership limit.
PackageBonus entitlements
There is a 6 month waiting period and entitlements apply from 1 January each year.
Couple, family and single
Single membership
parent family membership
First calendar year of membership $50 $100
Second calendar year of membership
$100 $200
and each calendar year thereafter
Maximum membership limit $500 $1,000
Any unused PackageBonus will be added to the following year’s entitlement up to the maximum membership limit shown above,
provided you stay on the same membership and on a cover with a PackageBonus.
27
PremierPlus: Hospital + Extras + Bonus
Comprehensive packaged cover
I simply want top hospital and extras cover for my family.
Hospital Private Room Guarantee
As an additional feature of PremierPlus, we offer our
What’s covered? Private Room Guarantee. This means, if there isn’t a
We cover all services where a Medicare benefit is private room available at a Members’ Choice hospital and
payable, including: you’re eligible to receive benefits under PremierPlus for
• Obstetrics-related services the treatment you received during your stay, you may be
• Assisted reproductive services entitled to receive $50 a night up to a maximum of five
nights per stay.
• Cardio-thoracic procedures such as angiograms
or open heart and bypass surgery You’ll need to make sure you request a private room
at least 24 hours before your stay as well as provide
• Colonoscopies
supporting documentation from the hospital about your
• Appendicitis treatment request. But, the Private Room Guarantee won’t apply to
• Removal of tonsils and adenoids same day admissions or admissions for sleep studies or
• Knee reconstruction surgery and investigations where your doctor considers that you should be located
in a shared room for clinical reasons.
• Shoulder reconstruction surgery and investigations
• Surgical extraction of wisdom teeth Extras
• Plastic and reconstructive surgery (doesn’t include
What’s covered?
cosmetic surgery)
We’ll pay benefits towards:
• Major eye surgery – including cataract and
lens-related services • General dental
• Hip and knee joint replacement surgery • Endodontic services (eg. root canal)
• Renal dialysis • Optical items
• Palliative care • Physiotherapy
• Psychiatric treatment • Pharmaceutical prescriptions (non-PBS)
• Rehabilitation treatment. • Medically necessary ambulance transport.
For these services we pay benefits towards: Plus you’ll also get benefits for:
• Private hospital accommodation • Major dental such as orthodontic treatment
- Overnight accommodation in a private or shared room • Alternative therapies such as chiropractic and naturopathy
- Same day admissions • Other therapies such as podiatry and speech therapy
- Intensive care • Health appliances such as hearing aids and blood
glucose monitors
- Theatre fees
• Clinical psychology consultations
• Public hospital accommodation as a private patient
• School accident treatment.
- Overnight accommodation in a private or shared room
For information about annual limits and sub-limits for
- Same day admissions (shared room only)
the above extras services, see the comparison tables
• Surgically implanted prostheses and other items on pages 31-32 and page 41 of Things worth knowing.
on the Federal Government’s Prostheses Schedule.
It’s easy to join
• Call 132 331
• Go to medibank.com.au
• Visit a Medibank store
• Post your application forms
For more information go to, To compare covers, go to the
Things worth knowing p39 comparison table p30-32
28
Key features Key information
1. No excess In Things worth knowing
2. Private Room Guarantee on page 39, you’ll find
information on waiting
3. No annual limit on general
periods (including
dental
pre-existing ailments)
4. Cover for an extensive range and other benefit
of extras services paying assessment information.
typically higher benefits
than AdvantagePlus
5. PackageBonus
Take the package, get a bonus
PackageBonus is an amount of money that accumulates each year to help you pay for a range of approved membership
and health-related expenses (eg. travel vaccinations and stop smoking programs). See page 45 for more details.
How the PackageBonus works
Any member can claim PackageBonus benefits up to the maximum membership limit.
PackageBonus entitlements
There is a 6 month waiting period and entitlements apply from 1 January each year.
Couple, family and single
Single membership
parent family membership
First calendar year of membership $50 $100
Second calendar year of membership
$100 $200
and each calendar year thereafter
Maximum membership limit $500 $1,000
Any unused PackageBonus will be added to the following year’s entitlement up to the maximum membership limit shown above,
provided you stay on the same membership and on a cover with a PackageBonus.
29
Packaged cover comparison table – hospital component
Basic Intermediate Comprehensive Comprehensive
Item / Service HealthyPlus SmartPlus AdvantagePlus PremierPlus
Excess 3 3 3 No excess applies
Knee reconstruction surgery and
investigations 3 3 3 3
Shoulder reconstruction surgery
and investigations 3 3 3 3
Appendicitis treatment 3 3 3 3
Removal of tonsils and adenoids 3 3 3 3
Surgical extraction of wisdom teeth 3 3 3 3
Palliative care 3 3 3 3
Psychiatric treatment Restricted 3 3 3
Rehabilitation treatment Restricted 3 3 3
Cardio-thoracic procedures ✗ 3 3 3
Obstetrics-related services ✗ 3 3 3
Assisted reproductive services ✗ 3 3 3
Plastic and reconstructive surgery ✗ 3 3 3
Major eye surgery – including cataract
and lens-related services ✗ ✗ 3 3
Hip and knee joint replacement surgery ✗ ✗ 3 3
Renal dialysis ✗ ✗ 3 3
All other services where a
Medicare benefit is payable 3 3 3 3
Bonus 3 PackageBonus 3 PackageBonus 3 PackageBonus 3 PackageBonus
Private Room Guarantee ✗ ✗ ✗ 3
Cover overview Cover overview Cover overview Cover overview
go to p22 go to p24 go to p26 go to p28
Restricted services
If you choose a cover with restricted
services, we’ll pay lower benefits for
these services in a private hospital.
It’s important to consider whether
you’re likely to need these services,
because the benefits for restricted
services generally won’t cover the
full cost of treatment in a private
hospital and you may end up with
significant out-of-pocket expenses.
Cosmetic surgery
We don’t pay benefits towards
cosmetic surgery.
To know more, go to Things worth knowing
for information on waiting periods and other
30 benefit assessment information. p39
Packaged cover comparison table – extras component
This table shows the annual limits and sub-limits that apply to benefits for extras items and services. Unless otherwise shown, limits are per person, per calendar year.
Basic Intermediate Comprehensive Comprehensive
Item / Service Waiting period HealthyPlus SmartPlus AdvantagePlus PremierPlus
2 months* $500 Combined general dental and $800 Combined general dental and No annual limit No annual limit
Limits General dental eg. dental examinations, scale and clean 12 months for surgical procedures and endodontic services annual limit endodontic services annual limit $300 sub-limit during the first 6 months $300 sub-limit during the first 6 months
extractions $300 sub-limit during the first 6 months $300 sub-limit during the first 6 months of membership of any extras cover of membership of any extras cover
Each of our extras covers
Endodontic services eg. root canal treatment 12 months of membership of any extras cover of membership of any extras cover $400–$800 #
$400–$800#
has annual limits and
sub-limits. See page 41 $225 A sub-limit of $92 for frames and $250 A sub-limit of $92 for frames and $250 A sub-limit of $115 for frames and
Optical items eg. frames, prescription lenses and contact lenses 6 months $200 A sub-limit of $92 for frames
$200 for contact lenses $200 for contact lenses $200 for contact lenses
for more information.
Medically necessary ambulance transport˜ 2 months* No annual limit No annual limit No annual limit No annual limit
The benefit we pay for a
particular claim is likely Physiotherapy eg. consultations (includes group pilates and
2 months* $300 $300 $700 $700
hydrotherapy sessions)
to be less than the annual
Pharmaceutical prescriptions Includes most prescribed non-PBS
limit or sub-limit and less items. Benefits will be paid after a set charge has been deducted
2 months* $300 $300 $600 $600
than your provider’s charge.
$2,000 For services in this category but $2,000 For services in this category but
This means you’ll usually Major dental not to exceed the amount shown not to exceed the amount shown
have out-of-pocket expenses for each sub-category for each sub-category
for each service or item. Inlay/onlay restorative eg. restorative fillings 12 months $300–$700# $300–$700#
Additional restrictions apply Dentures, crowns and bridges 12 months $400–$800 #
$400–$800#
to the payment of benefits $400–$800 #
$400–$800#
for some services. Please Orthodontic eg. braces 12 months
Lifetime limit of $2,400 per member Lifetime limit of $2,400 per member
call us for more information. Periodontic eg. treatment for gum disease 12 months $300–$700 #
$300–$700#
Benefit replacement period $500 For services in this category but $500 For services in this category but
Alternative therapies Consultations for: not to exceed the amount shown for not to exceed the amount shown for
You might need to wait for each sub-categor y each sub-category
a period of time from the Chiropractic and osteopathy 2 months* $400 $400
date of purchase of some
Acupuncture 2 months* $400 $400
items before you’re entitled to
another benefit to replace Naturopathy 2 months* $400 $400
the item. See page 43 for Natural therapies: Remedial massage and myotherapy, reflexology,
shiatsu, homeopathy, western and Chinese herbalism, Alexander
more information. 2 months* Flexi-Fund $100 sub-limit $150 $200
technique, Bowen therapy, exercise physiology, aromatherapy and
kinesiology Up to $300
per person
$1,000 For services in this category but $1,000 For services in this category but
Other therapies Consultations for: up to a not to exceed the amount shown not to exceed the amount shown
maximum
Notes for each sub-category for each sub-category
of $600 per
* The 2 month waiting period Podiatry: Includes specified orthotics 2 months* $400 $400
couple/family
is waived when the service membership Note: For the approved
arises from an accident. across all Jenny Craig weight loss $400 Note: For the approved Jenny $400 Note: For the approved Jenny
program, sub-limits of Craig weight loss program, Craig weight loss program,
#
Increases by $50 per these
Dietetics: Includes Jenny Craig weight loss benefit 2 months* $200 per membership sub-limits of $200 per membership sub-limits of $200 per membership
covered
calendar year of continuous per calendar year and per calendar year and $100 per per calendar year and $100 per
services $100 per person per person per lifetime apply. person per lifetime apply.
membership to the (sub-limits lifetime apply.
maximums shown. may apply)
Occupational therapy 2 months* $400 $400
You’ll be eligible for the
increases once you have Speech therapy 2 months* $400 $400
served one full calendar Orthoptics (eye therapy) 2 months* $400 $400
year’s membership. $1,000 For services in this category but $1,000 For services in this category but
Health appliances not to exceed the amount shown not to exceed the amount shown
˜Benefits aren’t available
for each sub-category for each sub-category
where there’s an entitlement
$800 Sub-limits and other $800 Sub-limits and other
to cover under a state Hearing aids 36 months
restrictions apply restrictions apply
scheme or other source.
Breathing appliances eg. peak flow meters, nebulisers $180 per membership
12 months every 3 years
$180 per membership every 3 years $180 per membership every 3 years
and spacing devices
$240 per membership
every 3 years and $150
$240 per membership every $240 per membership every 3 years
Blood glucose monitors 24 months per person every 3
3 years and $150 per person and $180 per person every 3
every 3 years. years.
years
Sub-limits and other $500 Sub-limits and other $500 Sub-limits and other
Other health appliances (including external prostheses) 2 months* restrictions apply restrictions apply restrictions apply
Clinical psychology Consultations only 2 months* $400 $400
School accident For preschool, primary and secondary school students 2 months $800 $800
Cover overview go to p22 Cover overview go to p24 Cover overview go to p26 Cover overview go to p28
31 32
Packaged cover scenario
There’s Paul, me and the three kids so
we’re always trying to make the most of
our private health cover. So switching to a
packaged cover two years ago was one of
the best things we could have done. We now
get an annual bonus which I use to top up the
benefits for my remedial massage and most
recently we put it towards travel vaccinations
for our family holiday.
And we get a
bonus!
33
Something to really
smile about
Members’ Choice scenario
My wife and I are always reminding the kids
to brush their teeth morning and night to try
and avoid unnecessary visits to the dentist.
With our Medibank extras cover though, we all
get to visit a Members’ Choice dentist for a free
check-up, scale and clean twice a year. That’s
valued at over $1,000 a year for a family of four.
The kids aren’t keen on the strict dental regime,
but they’ll thank us when they’re older.
34
So, what exactly is Members’ Choice?
Our Members’ Choice network is one of the largest health provider networks in Australia,
covering more services than any other health fund. We’ve negotiated agreements with many
healthcare professionals, groups and hospitals to help you save money through discounted
rates or capped fees and typically higher benefits.
What does it mean for me? Members’ Choice hospitals
It’s pretty simple: visit a Members’ Choice provider or By visiting a Members’ Choice hospital, you’ll get better
hospital and you can reduce your out-of-pockets. value for money compared to a non Members’ Choice
private hospital as long as the service you receive is
Members’ Choice extras providers covered by our agreements and is not restricted under
your cover.
Why should I choose a Members’ Choice extras provider?
You can save money through typically higher benefits
Will I have out-of-pocket expenses?
as well as the capped fees or discounts we’ve negotiated
Yes, even if you go to a Members’ Choice hospital, you’re
on your behalf.
still likely to have out-of-pocket expenses including any
excess on the cover you select and for services provided
Enjoy greater value from our Members’ Choice network
by your doctors such as your surgeon or anaesthetist.
Apart from capped fees, we’ve got some great The hospital and doctors treating you should tell you
deals available. about their costs before you go to hospital – so it’s
At a Members’ Choice dentist you’ll get a free dental important to ask.
check-up, scale and clean twice a year – valued at over
$1,000 a year for a family of four. That’s not bad. So you can focus on what’s important – getting better
And through our Members’ Choice optical retail network sooner – we recommend that, where possible, you give
you can get: us a call before you go to hospital. This way we can let
you know what benefits will be paid to help you work out
• At least 20% off the normal retail price of frames
what your out-of-pocket expenses are likely to be.
• At least 15% off lenses, contact lenses, add-ons and See page 44 for more.
sunglasses
• No out-of-pocket expenses on a select range of
prescription glasses for most members (subject to
annual limits and sub-limits). Find a Members’
Choice provider
What services do they provide? • Phone 132 331
Our Members’ Choice network covers more types of • Go to medibank.com.au
extras services than any other insurer and includes some
of the following health providers:
• Dentists
• Dental prosthetists
• Optical retail outlets
• Chiropractors
• Physiotherapists
Getting more from our health cover
• Podiatrists
• Acupuncturists
• Naturopaths.
Members’ Choice extras providers are limited in number
and may not be available in some areas. Call us on 132 331
to find your nearest provider.
35
Look after yourself with betterhealth
Think of this as a valuable resource to keep your health in check.
Maybe you’re pretty healthy — you watch what you eat, you try to get out and exercise. Or maybe you’re not quite as healthy
as you’d like: maybe heart disease or diabetes runs in your family and you’ve got some early signs. Perhaps you’ve already
developed a chronic health condition — chances are there’s something you’d like to improve about your health. You may just
want to cope better with stress or get up-to-date info on nutrition and fitness. Or you may want to lose some weight, or learn
to better manage an existing health condition.
Whatever your story, betterhealth is here to help.
You Your program What is it?
An interactive website packed with resources to help you get and
stay healthy. It includes personalised programs for specific goals,
I want to develop and maintain a healthy
betterhealth online from weight loss to improving fitness to quitting smoking or
lifestyle on my own terms
managing blood glucose and more.
Check out medibank.fitness2live.com.au
Telephone support from qualified health consultants to help you
achieve a range of health goals including weight loss and physical
I need some extra support to help me activity. If you have hospital cover and have an existing health
betterhealth Coaching
make a change for the better concern, our health consultants can help give you the extra
motivation you need to make lasting changes to your health.
Call 1800 817 635
A 24 hour telephone support service for people with certain chronic
health problems such as diabetes, respiratory or heart disease and
mental health conditions such as anxiety and depression. If you have
I need assistance to manage my ongoing
betterhealth On Call hospital cover and are eligible, our health professionals will be on
health problems
hand to answer any questions you might have about your condition
and offer advice and a program of scheduled calls. It’s simply there
to give you a little more peace of mind. Call 1800 817 635
Our betterhealth programs are provided by Medibank Private trading as ‘Medibank Health Solutions’.
36
Competitively priced travel, pet and life insurance
While we’re known for our top quality, value-for-money health insurance, that same quality and
value for money is available with Medibank travel, pet and life insurance. As a Medibank Private
member you’ll receive a 10% discount on each of these products.
Travel insurance Life insurance
Medical emergencies affect thousands of Australians With Medibank Life Insurance* there are no medical or
who travel overseas each year. blood tests, just a simple application process, and you can:
With Medibank Travel Insurance* you can travel with • be covered for up to $1.5 million (depending on your age)
confidence and peace of mind knowing: with a guarantee to be renewed for life
• you have cover for overseas medical assistance • receive early payment in the case of terminal illness
– whether it’s a trip to the local doctor or something or accidental injury
more serious that requires you to be medically • also have the option to take out permanently unable to
evacuated back home work cover, trauma insurance and children’s insurance.
• you have access to our 24 hour worldwide hotline so no
matter where you are in the world, help is only a phone
call away
• you’ll also be covered for lost or damaged luggage, Medibank Travel Insurance
personal items, travel documents, credit cards and cash.
• Phone 132 331
Pet insurance • Go to medibank.com.au/
If you own a cat or dog you’ll probably know how much travelinsurance
unexpected vet bills can eat into your wallet. No one wants • Visit a Medibank store
to choose between their pets and what they can afford.
Now with Medibank Pet Insurance* your ‘other’ family Medibank Pet Insurance
member can: • Phone 132 331
• be covered for up to 100% of vet bills • Go to medibank.com.au/
• have cover options for accident, illness and routine care petinsurance
• visit the vet of your choice. • Visit a Medibank store
Medibank Life Insurance
• Phone 1300 722 568
• Go to medibank.com.au/
lifeinsurance
• Visit a Medibank store
*Medibank Private Limited (Medibank) ABN 47 080 890 259 AR 286089 is an authorised representative of ETI Australia Pty Ltd ABN 52 097 227 177, AFSL 245631
who arranges Medibank Travel Insurance, Hollard Insurance Company Pty Ltd (Hollard) ABN 78 090 584 473, AFSL 241436 who underwrite Medibank Pet Insurance
and Hollard Financial Services (HFS) ABN 53 128 692 884, AFSL 343079 who arrange and issue Medibank Life Insurance. Medibank Travel Insurance is arranged
by Medibank as authorised representative of ETI Australia Pty Ltd (ETI) ABN 52 097 227 177, AFSL 245631 trading as Mondial Assistance. Mondial Assistance issues
the travel insurance as agent of the insurer Allianz Australia Insurance Limited ABN 15 000 122 850, AFSL 234708. Medibank Life Insurance is underwritten by
Swiss Re Life & Health Australia Limited ABN 74 000 218 306, AFSL 324908. For any Medibank Life Insurance policy arranged by HFS and distributed by Medibank
Private, Swiss Re may pay a commission of up to 31.64% of each premium to HFS. HFS may then pay an amount up to 25% of each premium to Medibank Private.
These amounts are paid out of the total premium payable by you for the policy. Medibank Private may receive from Hollard, a commission of up to 23% of the
premium for arranging Medibank Pet Insurance policies. This commission is included in the premium so you don’t pay extra. Medibank Private’s employees and
representatives who provide services in relation to Medibank Life and Pet Insurances receive an annual salary from Medibank Private, which includes bonuses based
on performance. We do not provide any advice on these products based on your objectives, financial situation or needs. To decide if a product is right for you please
consider the relevant Product Disclosure Statement available from medibank.com.au
37
Things we
need to know
38
Things worth knowing
Understanding private health insurance can be tricky. Can my partner manage my membership too?
So we’ve created this Things worth knowing section to help Although you as the contributor ‘own’ the membership,
make things a little easier for you. It contains some important your partner can automatically manage most aspects of
information about our covers along with explanations of the membership too, including: making claims and receiving
commonly-used terms you might be grappling with. benefits, adding or removing dependants, changing cover,
It also gives you an overview of some of our key rules. But it’s suspending the membership and changing contact and
important you have a good look through the Membership bank account details.
Guide you’ll receive after you join. This contains a summary of However, as the contributor you’re the only one who can
the rules of your membership (known as our Fund Rules) – remove yourself from the membership or cancel the
things like your entitlements and responsibilities as a member. membership. It’s important to be aware that this means we
may disclose registered membership details to both of you.
About your membership with us If at any time you want to be the only person who can manage
the membership or you require further information about the
Do you have a ‘cooling-off’ period? handling of personal information, please call us on 132 331.
If you join but then decide you’d like to either cancel your
membership or move to another cover, we have what is If I transfer to Medibank from another health fund,
known as a ‘cooling-off’ period. This also applies if you’re
am I covered immediately?
already a member and have recently changed your cover.
In some cases yes, in other cases no. You’ll be covered
As long as you tell us within 30 days of joining or changing for services on your new cover from the date you join if:
your cover, there’s no problem. We can either transfer you those services were also included on your cover with your
to a more suitable cover or refund your premium in full as former fund, you join us within two months of leaving your
long as no claims have been made against your policy. former fund and you’ve already served the applicable
waiting periods. So although we’ll recognise any waiting
What’s the difference between a member and a periods you’ve served with your former fund, if you haven’t
contributor? fully served the applicable waiting periods, you’ll need to
There are three terms we use when we’re talking about serve the balance with us before you’re eligible for benefits.
membership: member, membership and contributor. As a Additional waiting periods may also apply if you’ve switched
starting point, it’s good to be clear on all three. to a higher level of cover with Medibank. For more
A member is simply any person covered under a Medibank information see page 42.
Private membership.
A membership is made up of one or more members. It can What if I want to add my partner to my single membership?
consist of just one person (yourself), or more than one person It’s easy to change from a single to a couple membership, but
(yourself, your partner and/or your children). The term you should be aware that higher premiums apply to a couple
contributor refers to the person who ‘owns’ the membership. membership and waiting periods may apply to your partner.
This is the person we contact when we need to communicate
important information or confirm any changes to the
membership that might have been requested.
39
Things worth knowing
Can I add a dependent child to my membership? If I have children, how long can they be insured
on my cover?
If you’re on a single membership:
As your little ones are getting bigger they can still be
To add a dependent child to your membership you’ll need covered at no additional cost on your family or single parent
to change from a single to a family or single parent family family membership until they turn 21 or, if they are full-time
membership. If you do this within two months from the date students, until they turn 25, provided they’re not married or
of their birth or inclusion in your family unit (for example, in a de facto relationship (‘unmarried’). This is because we
through marriage, adoption or fostering) your child won’t consider them to be your dependent children.
have to serve any additional waiting periods. However the
change will be backdated to the date of birth or the date of If you have unmarried children aged 21 to 24 who aren’t
inclusion in your family unit. Also, this change of membership studying full-time, we also have a membership option called
means you’ll pay higher premiums. families with adult children. Although you’ll pay a higher
premium, it can prove to be a more economical option for
As MyOptions (and its corporate equivalent) is only available your children than if they were to take out their own cover
as a single or couple membership, you can’t add a dependent at the same level. Waiting periods may apply.
child to that cover.
If you’re on a couple or family membership: Which of your covers include the families with
adult children option?
You can add a dependent child to your membership at any
time and they won’t need to serve any waiting periods already The families with adult children membership option
served on the membership. Your premium doesn’t increase if is available under most of our hospital and extras covers to
you change from a couple to family membership, or add a members with a family or single parent family membership.
dependent child to a family membership. Covers which don’t offer the families with adult children
membership option include: MyOptions (and its corporate
What if I want more information on adding a equivalent), Accident Cover, Visitors Covers, Overseas
dependent child? Student Health Cover and Ambulance Cover.
Call us on 132 331.
How often should I review my cover?
What happens if my newborn baby needs You may have different health cover needs at different
hospital treatment? stages of your life, so it makes sense to review your health
When a newborn baby is in hospital with its mother, no cover regularly. This is especially important if your situation
accommodation charges apply for the baby unless the changes. For example, if you’re planning to start a family,
baby becomes an admitted patient in their own right. This the kids are leaving home or either you or someone in your
happens when the baby requires admission to a neo-natal family has developed a health issue. Whatever your situation,
intensive care unit or it is the second or later child of a it’s a good idea to call us to discuss your options on 132 331.
multiple birth. See above for when you should add your
baby to your membership.
40
Things worth knowing
About Lifetime Health Cover (LHC) What happens if I change health funds?
If you switch to us from another fund we recommend
What is LHC? you keep your cover with your old fund until the date you
This is a Federal Government initiative where a loading can transfer to us. This way you avoid using up any of the 1,094
be applied to your premium if you take out hospital cover permitted days you can be without hospital cover during
later in life. It’s aimed at encouraging people to take out your lifetime. Also, if you already have a LHC loading, it will
hospital cover early in life and maintain it. move with you.
When does the loading apply? About extras limits
The loading applies if you don’t have hospital cover on 1 July
What are annual limits and sub-limits?
following your 31st birthday. This means for every year you
don’t have hospital cover, you’ll pay a 2% loading on top of a An annual limit is the maximum amount of money you can
base rate on your premium or your share of a couple or family get back each calendar year for the services or items within
premium (up to a maximum loading of 70%). The loading a particular extras category. Examples of extras categories
applies only to hospital cover or the hospital component of our are general dental, physiotherapy, health appliances and
packaged covers – not to extras covers. Any loading that alternative therapies.
applies to your premium will be removed after you’ve held Within these categories there may be sub-limits that
hospital cover continuously for 10 years. restrict the amount you can claim for specific services and
items in a calendar year (or other applicable period).
Does the LHC loading apply to everyone? Once you’ve reached your annual limits or sub-limits for
No, the LHC loading doesn’t apply to people born on or an extras category or item, you’ll have to wait until next
before 1 July 1934. There are also special rules that apply calendar year (or other applicable period) before you can
to people who fall under a LHC exemption category, such claim on these services or items again.
as Australians returning from overseas, Norfolk Islanders, For example, if you have Smart Choice Extras and have
Veterans’ Affairs Gold Card holders, former members of both glasses and contact lenses, the most you can claim for
the Australian Defence Force, staff of the Australian items listed under optical items is $225 a year (annual limit).
Antarctic Division, refugees and all other categories of But of that $225, the maximum you can claim for contact
migrants to Australia. lenses is $200 a year (sub-limit) leaving you $25 available
for other services or items.
What if I drop my hospital cover? It’s also important to be aware that the benefits we pay for a
You can drop your hospital cover for a sum total of three years particular claim are likely to be less than the annual limit or
(1,094 permitted days) during your lifetime without any change sub-limit and less than your provider’s charge.
to your LHC loading status. If you drop your hospital cover for
longer than this, in most circumstances you’ll have to pay a
LHC loading (or, if you were already paying the loading, it will
be higher) once you take out hospital cover again.
The following won’t count towards your 1,094 permitted days
without hospital cover:
• if you’ve been living overseas continuously for more than
one year (this includes visits back home of 90 days or
less at a time)
• if your health fund has agreed to a period of suspension.
41
Things worth knowing
About waiting periods 2 months*
What is a waiting period? All services, except those set out below
All health funds have waiting periods. In short, a waiting
period is a period of time you need to wait after taking out 6 months
your cover before you can receive benefits for services or
items covered. Optical items
You’re not able to receive benefits for any items or PackageBonus
services you might have obtained while you are serving
a waiting period or before you joined Medibank. 12 months
How do I know if a waiting period applies to me? Pre-existing ailments. However, the 12 month pre-existing
ailment waiting period does not apply to hospital or hospital-
Waiting periods may apply if you’re a new member, you’re substitute treatment for psychiatric treatment, rehabilitation
rejoining Medibank after not having health cover for some treatment or palliative care.
time or you’re changing to a higher level of cover (either
within Medibank or transferring from another fund). Obstetrics-related services
If you’re changing to a higher level of cover, you’ll still be
Major dental services
entitled to benefits at the level of your former cover while
you’re serving any waiting periods on your new cover if: Endodontic services (eg. root canal)
• those services were included under your old cover; and
Dental surgical procedures and surgical extractions
• you’ve already served the waiting periods that applied (eg. wisdom teeth)
under your old cover.
Also, any excess with your former cover will transfer across Nebulisers
with you until you’ve served your waiting periods with us.
Peak flow meters
How long is the waiting period? Spacing devices
That depends on the types of services or items included on
your cover. Have a look at the following table for a guide. 24 months
Blood glucose monitors
36 months
Hearing aids
In addition, waiting periods may apply to some of our
betterhealth programs.
*If you have an accident (excluding a school accident) after
joining us or changing cover and require treatment, we’ll
waive the 2 month waiting period.
About pre-existing ailments
It’s standard practice in the private health insurance industry
to apply a waiting period of 12 months before benefits are
payable for a pre-existing ailment.
What’s a pre-existing ailment?
By pre-existing ailment, we mean an ailment, illness or
condition where 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.
We’ll appoint a medical or health practitioner to determine
whether you have a pre-existing ailment, based on
information provided by the practitioner(s) treating you.
42
Things worth knowing
What if I have a pre-existing ailment? Other rules for paying benefits
If you’re a new member, you’ll have to wait 12 months before
you can receive benefits for items or services related to your Are there any other rules I need to know about?
pre-existing ailment. Yes, here are some other important rules for you to be
If you’re changing to a higher level of cover (either within aware of:
Medibank or from another fund), you’ll have to wait • We only pay benefits for items and services delivered by
12 months to receive the higher benefits, including benefits Medibank-recognised providers.
for services not previously covered. • Some appliances may need to be ordered by a medical
practitioner before benefits are payable eg. a blood
About benefit replacement periods glucose monitor.
What’s a benefit replacement period? • To claim for a Sleep Apnoea device or similar device
approved by Medibank, firstly, you’ll need hospital cover.
It’s a period of time you need to wait after purchasing an item
You’ll also need to undergo an overnight investigation for
covered by us before you can receive further benefits to replace
Sleep Apnoea which is listed in the Medicare Benefits
the item. For example, if you received benefits for an insulin
Schedule. Lastly, the device must be requested by a
delivery pen, purchased on 1 July 2009, you can only receive
medical practitioner and purchased or hired within
benefits for another one purchased on or after 1 July 2011.
12 months of undergoing the investigation. No benefits
are payable if the sleep study is performed at home.
How long is a benefit replacement period?
• Limitations apply to some benefits. For example, for an
This varies from item to item and generally applies per
initial consultation for an extras service, we generally pay
member unless specified in the following table.
the higher benefit (if any) only once in a course of treatment.
12 months
• Limited hospital benefits apply to podiatric surgery
(performed by an accredited podiatrist) and dental
External mammary prostheses procedures that are performed in a non Members’
Choice private hospital.
Repairs of external prostheses and health appliances • If you no longer need acute care and stay in hospital for
more than 35 days, you’ll be classified as a nursing home
2 years
type patient. If this happens, we’ll only pay a small portion
Wigs of the daily hospital charges and you may need to pay the
rest of the cost of your care. If you’re in a private hospital,
Hip protectors these costs may be substantial. Your doctor and hospital
will be aware of this rule which applies to all health funds
Insulin delivery pens and they can advise you.
• We don’t pay benefits for services or treatments where
3 years
you are, or may be, entitled to compensation and/or
Blood glucose monitors damages. For example State Government workers’
compensation schemes, traffic accident schemes or
Breathing appliances public liability claims.
- nebulisers
• We don’t generally pay benefits for hospital procedures
- peak flow meters (per membership)
- spacing devices
not recognised for Medicare benefit purposes such as
cosmetic surgery.
Mouthguards (for members up to 18 years of age, benefits may be It’s important you call us on 132 331 for information on
payable for a replacement mouthguard each calendar year)
recognised providers and the benefits you’re entitled to
Dentures, crowns and bridges before commencing treatment.
Other health appliances and external prostheses
5 years
Hearing aids
Sleep Apnoea – continuous pressure devices and other similar
approved appliances under our hospital cover (excluding
MyOptions (and its corporate equivalent) and Accident Cover)
43
Things worth knowing
About out-of-pocket expenses Is there any way I can reduce my hospital
out-of-pockets?
What’s an out-of-pocket expense?
It’s any expense for a hospital or extras service or item for Hospital charges
which you won’t be reimbursed – from either us or Medicare. If possible, go to a Members’ Choice hospital where our
Having private health insurance helps reduce your out-of- agreement limits what you can be charged. This means your
pockets, but you may still have to pay for some things ‘out of out-of-pockets for hospital charges should be limited to
your own pocket’. things like:
• any excess you may have with your cover
What out-of-pocket expenses can I expect if I receive an
• any pharmaceuticals not covered by our agreement
extras service and how can I reduce them? with the hospital. This includes the cost of any drugs
The out-of-pocket expense will be the difference between issued on discharge from hospital
the provider’s charge and the benefit we pay. To reduce your
• any gap for surgically implanted prostheses and other
out-of-pocket expenses, visit a Members’ Choice provider
items on the Federal Government’s Prostheses Schedule
where you can access capped fees and discounts and generally
receive higher benefits than you would with a non Members’ • costs for services not covered, or fully covered, by our
Choice provider. agreement with the hospital or under your cover
• costs for treatment in an emergency department in a
What kinds of out-of-pocket expenses can I expect private hospital.
if I go to a private hospital? If you go to a non Members’ Choice private hospital, you’re
Although hospital cover helps reduce the cost of your likely to have significant out-of-pocket expenses.
private hospital visit, you’ll still have out-of-pocket expenses
for things like your excess and any difference between Doctors’ charges
what the hospital charges and the benefit we pay for the Before you go to hospital, try to arrange to have a doctor
hospital services. who’ll participate in our GapCover scheme. This is because
You can also expect to pay the difference between the charge GapCover can help reduce or eliminate your out-of-pocket
for in-hospital medical services (eg. doctors’ services, expenses for doctors’ services received in a private hospital.
pathology and radiology) and what you receive from Medibank It’s important to be aware that doctors can choose to
and Medicare. To explain it further, the benefits you’re entitled participate in GapCover on a case-by-case or episode-by-
to for the medical services you receive while you’re in an episode basis and more than one doctor may be involved in
overnight or day hospital facility are based on the Medicare your treatment. Also, GapCover doesn’t apply to pathology
Benefits Schedule (MBS) fee. The MBS is a list of all the and radiology services, any agreed excess payment, services
services Medicare pays benefits for and the rules that apply not included under your cover or out-of-hospital consultations.
to payment of those benefits.
Medicare pays 75% of the MBS fee and Medibank pays 25%
(if the treatment is covered under your policy).
When a doctor charges more than the MBS fee, you’ll Rule of thumb for when you’re going
have out-of-pocket expenses. These can vary and may be to hospital?
significant. This is what’s referred to as a ‘gap’. Have a look
at the diagram below – it shows you the amount Medicare Call us first on 132 331 so we can help
takes care of and the amount we cover for in-hospital you understand what’s involved and the
medical services. It also shows you the gap. types of questions you need to ask your
doctor or specialist.
Medibank Private GapCover can
help you minimise or even avoid
this out-of-pocket expense.
Doctor’s total charge for in-hospital medical services
Medicare Benefits Schedule (MBS) fee. This fee is set by the Federal Government.
The gap is the amount your doctor may
Medibank pays 25% of the charge over and above the MBS fee,
Medicare pays 75% of the MBS fee for in-hospital
MBS fee for in-hospital leaving you out-of-pocket.
medical services.
medical services.
Note: Doctors can choose whether they participate in GapCover on a case-by-case or episode-by-episode basis.
44
Things worth knowing
About the PackageBonus About ambulance transport
What’s a PackageBonus? How do I know if I’m covered for ambulance transport?
It’s an incentive for taking out HealthyPlus, SmartPlus, Benefits for medically necessary ambulance transport are
AdvantagePlus or PremierPlus (or their corporate included in all covers described in this brochure except
equivalents). Each year, you receive a bonus that you can where you’re entitled to benefits from another source, such
put towards a wide range of approved membership and as ambulance subscription or state ambulance transport
health-related expenses. schemes, including:
You can spend it on things like: • if you’re 65 or over and live in WA – you may be eligible
for free or subsidised ambulance services. If eligible for
Membership-related expenses: subsidised services, you may be able to claim the
• payment towards your hospital excess remaining cost from Medibank
• payment towards your out-of-pocket expenses for • if you live in NSW or the ACT – you’ll pay an ambulance
in-hospital medical costs or hospital charges levy as part of your hospital cover premiums, and you’re
• payment towards your out-of-pocket expenses for extras entitled to cover under your state scheme. If you have a
charges, such as for dental. Commonwealth concession card you might be exempt
from paying the ambulance levy
Health-related expenses: • if you live in Qld or Tas – you may be entitled to cover for
• travel vaccinations ambulance transport under the State Government scheme.
• health management program costs approved by us For more information on this, call us on 132 331.
(excludes goods purchased)
• health-related appliances or equipment such as Terms to be familiar with
wheelchairs and blood pressure monitors
Accident
• stop smoking programs
An unforeseen event occurring by chance and caused by
• any out-of-pocket expenses for non-PBS pharmaceutical an external force or object, resulting in involuntary injury to
prescriptions the body which requires immediate treatment, but does not
• a range of other health-related expenses including include unforeseen conditions, the onset of which were
services, appliances and equipment. brought on by medical causes.
If you’re expecting to use your PackageBonus for a particular
item or service, it’s best to call us first as the rules around Annual limit
PackageBonus are subject to review and can change. An annual limit is the maximum amount of benefits payable
for particular groups of extras services within a calendar year.
Is there anything I’m not able to use my
PackageBonus for? Benefit
Yes, there are some things, such as: This is an amount of money we pay for an approved health-
related expense you’ve incurred. It can be paid to you or on
• your premium
your behalf.
• any contributions towards PBS prescriptions
• out-of-hospital medical expenses partially covered Calendar year
by Medicare A 12 month period commencing 1 January and ending
• other non-approved expenses or costs precluded by 31 December.
law from being paid.
Cardio-thoracic procedures
Includes open heart and bypass surgery and invasive
cardiac investigations and procedures such as angiograms,
angioplasties and stent insertions.
Condition
A condition means any actual or perceived state of health for
which treatment is sought. It includes but is not limited to
states variously described as: abnormality, ailment, disability,
disease, disorder, health problem, illness, impairment,
impediment, infirmity, injury, malady, sickness or unwellness.
45
Things worth knowing
Dependent child General dental
This is a child of the contributor or their partner who is: This is straightforward dental work and includes things
• under the age of 21 and not married or living in a such as routine check-ups, scale and cleans, fillings and
de facto relationship extractions. It doesn’t include more complicated treatments
or procedures such as orthodontic work, crowns or bridges.
• aged 21–24, not married or living in a de facto relationship
and studying full-time in a course approved by Medibank.
Hospital charges
Doctor These are amounts charged by a hospital for things like
accommodation and nursing care, theatre fees and surgically
A registered medical practitioner including a specialist,
implanted prostheses. It may not include charges for extras
surgeon or anaesthetist.
services, such as physiotherapy, or fees charged by your
hospital doctor.
Endodontic services
Treatment to save an infected or damaged tooth. It involves Major dental
removing the nerve and, where possible, restoring the
This is the more serious dental work including things like
structure of the tooth. A common example of an endodontic
restorative fillings, dentures, crowns, bridges, the treatment
treatment is a root canal.
of gum disease and orthodontic work such as braces and
corrective plates.
Excess
An amount you agree to pay if you’re admitted to hospital Major eye surgery
in exchange for lower premiums. It only applies to hospital
This includes cornea and sclera transplants and
covers or the hospital component of packaged covers.
cataract surgery.
No excess applies to children on any of our hospital covers.
Medical costs
Excluded services
These are costs you incur in an overnight or day-hospital
This is a service for which no benefits are payable.
facility for things such as doctors’ fees, blood tests, scans
and x-rays.
External prostheses
These are manufactured items designed to replace external Medically necessary ambulance transport
parts of the body such as an arm or leg. Benefits for these
Cover for transportation by ambulance which is necessary
are only paid under certain extras and packaged covers.
because, due to your medical condition, you can’t be
transported any other way. Benefits for this are included
Federal Government’s Prostheses Schedule in all covers described in this brochure (other than Qld and
This is a list issued by the Federal Government which sets Tas extras) except where you’re entitled to benefits from
out the benefits payable to members of health funds with another source, such as ambulance subscription or a state
hospital cover for surgically implanted prostheses and ambulance transport schemes.
other items.
Medicare Benefits Schedule
Fund Rules This schedule lists all the services for which Medicare pays
These are the rules of your Medibank membership. Some benefits and the rules that apply to the payment of those
of the more important Fund Rules are summarised in the benefits. Each service has a fee that’s been set by the Federal
Membership Guide that is sent to all new members. You can Government for the purpose of calculating the Medicare
view the Fund Rules at medibank.com.au or at any of our benefit payable for that service (called the MBS fee).
Medibank stores.
All members are subject to the Fund Rules as varied from
time to time.
46
Things worth knowing
Obstetrics-related services School accident
This includes all treatment specified in the Medicare Benefits This is an accident suffered by a dependent child who is a
Schedule (MBS) as ‘obstetrics’ including antenatal and pre-school, primary or secondary school student while
post-natal care and the management of labour and delivery. attending, or travelling to or from, school or an organised
school activity (eg. an excursion). It provides cover for
Pharmaceutical Benefits Scheme (PBS) services that are received within 12 months of the accident
A Federal Government scheme which allows for many but excludes services covered by Medicare or where
pharmaceuticals to be supplied to Australian residents at compensation or damages are payable.
reduced or no cost.
Sub-limits
Pharmaceutical prescriptions (non-PBS) A sub-limit is a maximum amount you can receive on an
These are prescription-only items not covered by the annual basis (or within other defined periods of time) for
Pharmaceutical Benefits Scheme. We’ll pay benefits up a particular item or service within an overall annual limit.
to a set amount for each prescription item after a set
charge has been deducted. The set charge is equivalent Surgically implanted prosthesis
to the current PBS patient contribution. It’s important to An approved manufactured item or piece of equipment
note that we don’t pay benefits for oral contraceptives or that is surgically implanted or applied, generally during a
for pharmaceutical prescriptions prescribed for hospital surgical procedure to replace or assist a body part
cosmetic purposes. or function. Examples include pacemakers, defibrillators,
cardiac stents and joint replacements.
Provider
A provider is any health or medical professional who provides Other important information
you with a service and may include your doctor, dentist,
What’s the best way for me to give feedback on your
anaesthetist or acupuncturist. It also includes people or
organisations who provide you with health items or aids – products and services?
things like hearing aids, mouthguards or nebulisers. If you have any feedback on our products and services,
or you’d like further explanation on anything to do with your
Recognised provider membership, please contact us:
This is a provider approved by Medibank for the purpose of • call 132 331
paying benefits. To check if a provider is recognised, please • email ask_us@medibank.com.au
call us on 132 331. • visit any of our Medibank stores
• write to us at Medibank Private GPO Box 9999
Restricted services
in your capital city.
These are services you receive lower benefits for in a private
hospital. You’re likely to have significant out-of-pocket
What if I have a complaint?
expenses if you receive these services in a private hospital.
We’ll try to resolve any complaint you may have the first
time you raise it with us – please contact us with any issues
Same day admission
through the contact points listed above. If you believe your
This is when you are admitted to a hospital or day hospital complaint has not been satisfactorily dealt with, let us know
facility and discharged on the same day where the stay does and we’ll escalate your complaint. You can also write to our
not extend beyond midnight. Customer Resolutions team at Medibank Private, GPO Box
9999, Melbourne, VIC 3000.
Free, independent advice is also available from the Private
Health Insurance Ombudsman on 1800 640 695.
Private Patients’ Hospital Charter
Prepared by the Federal Government, this booklet is designed
to advise you on what you can expect from your health fund,
doctors and hospitals as a patient with hospital cover. A copy
is available from any Medibank store.
47
Things worth knowing
Private Health Insurance Code of Conduct
We’re proud to be a signatory to the Private Health Insurance
Code of Conduct. The code was developed by the private
health insurance industry and aims to promote the standards
of service to be applied throughout the industry. The code
is designed to help you by ensuring that:
• information which we provide to you is written in
plain language
• our employees are competently trained to deal
with your enquiries
• we protect the privacy of your information in line
with the privacy legislation
• you have access to a reliable and free system of
addressing complaints with us.
A copy of the code is available online at
privatehealth.com.au/codeofconduct
Disclaimer
• Medibank Private encourages providers to offer high-quality
products and services at competitive prices to its members.
• Where Medibank Private recognises a provider, advertises on
behalf of a provider, or appears by reference of logo or
otherwise in an advertisement of any provider, to the fullest
extent allowed by the law, such advertising or reference
should not be construed as:
- an endorsement;
- an acknowledgment or representation as to fitness for
purpose; or
- a recommendation or warranty of, for, or in relation to,
the product and/or service of the provider.
Accordingly, Medibank Private neither takes nor assumes
any responsibility for the product and/or service provided.
• Members should make and rely on their own enquiries
and seek any assurance or warranties directly from the
provider of the service or product.
48
Phone
132 331
Email
ask_us@medibank.com.au
Website
medibank.com.au
Write to us
Medibank Private
GPO Box 9999
in your capital city
Visit us
Call us or visit our website
for your nearest Medibank store
Medibank also offers covers for
travel, pet and life insurance.
Medibank Private
is a signatory to
the Private Health
Insurance Code
of Conduct.
Medibank Private Limited ABN 47 080 890 259
The Private Health Insurance Code of Conduct logo is a trademark of, and is used
under authorisation from, Australian Health Insurance Association Limited.
The information contained in this brochure supersedes all previously published material.
Effective 1 June 2010
MPLM21701010
