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					     health insurance

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  Choosing private health insurance can be confusing,
  from trying to decide whether you need hospital cover,
  extras cover or both, to which cover suits you best.
  At Medibank Private we keep things simple – from
  the covers we offer to the way we explain things.
  Our simple range of hospital and extras covers
  makes it easy to choose what’s right for you. With
  the flexibility to mix and match, you can choose the
  combination that best suits your needs, lifestyle and
  budget. Plus you’ll also have certainty about what
  you’re covered for and how much you get back.
  With Medibank you also get more control over who
  treats you, where you’re treated and above all how
  soon. You’ll have greater value through access to our
  Members’ Choice network, which is one of the largest
  networks of hospital and health providers in Australia.
  That’s why we received the CANSTAR CANNEX
  award for Outstanding Value Health Insurance
  in 2009 and 2010, and why more than 3 million
  Australians are insured with us.

a simple
Hospital covers
What benefits are paid?                                    What’s an excess?
For the services included under each of our covers,        If you have an excess on your cover, you pay
we’ll pay benefits (less any applicable excess) towards:   this amount towards the cost of your hospital
                                                           treatment. The higher the excess on your cover,
• private hospital accommodation
                                                           the lower your premium. An excess applies per
  – overnight accommodation in a private
                                                           person per calendar year and doesn’t apply to
    or shared room
                                                           children on your membership.
  – 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 (shared room only)
• doctors’ fees for in-hospital medical services when
  you are treated as a private patient
• surgically implanted prostheses and other items on
  the Federal Government’s Prostheses Schedule.

Hospital covers
What’s covered?
                                                    Young                  Basic                   Mid                     Top                 Ultra
            Item/Service                                                                                                                    Health Cover
                                                   Hospital               Hospital               Hospital                Hospital            (hospital component)

 Ambulance services
 (see page 34 for more information)                                                                                                              
 Knee reconstruction surgery
 and investigations                                                                                                                              
 Shoulder reconstruction
 surgery & investigations                                                                                                                        
 Appendicitis treatment                                                                                                                          
 Removal of tonsils and adenoids                                                                                                                 
 Surgical removal of wisdom teeth                                                                                                                
 Colonoscopies                                                                                                                                   
 Palliative care                                    Restricted                                                                                    
 Psychiatric treatment                              Restricted             Restricted                                                              
 Rehabilitation treatment                           Restricted             Restricted                                                              
 Cardio-thoracic procedures                                                                                                                      
 Obstetrics-related services
 eg. pregnancy                                                                                                                                   
 Assisted reproductive services
 eg. IVF                                                                                                                                         
 Plastic & reconstructive surgery
 (excludes cosmetic surgery)                                                                                                                     
 Major eye surgery – including cataract
 & lens-related services                                                                                                                         
 Hip & knee joint replacement surgery                                                                                                            
 Renal dialysis                                                                                                                                  
 All other in-hospital services where
 a Medicare benefit is payable                                                                                                                   

                                                                                                                                                
                                                                                                                         No excess
                                                                             $250                 No excess
            Excess options                            $500
                                                                             $500                   $250
                                                                                                                           $250                 No excess

Waiting periods apply including the general 2 month waiting period, 12 months for pre-existing ailments and a 12 month waiting period for obstetrics-related
services. For more information including other benefit assessment information, please refer to Things worth knowing on pages 36-37.
Note: no benefits are payable for cosmetic surgery on any of our covers.

 = services we pay benefits for.                                Young Hospital
 = services we don’t pay benefits for.
Restricted = services we pay limited                             • For single or couple memberships only
benefits for in a private hospital.
Because the benefits for restricted                              • Only available with an extras cover
services generally won’t cover the                                 featured in this brochure
full cost of treatment in a private
hospital and you may end up with
significant out-of-pocket expenses,
                                                                 • Services which are normally excluded or
it’s important to consider whether                                 restricted will be covered where treatment is
you’re likely to need these services.                              required for injuries sustained in an accident.
Extras covers
Our flexible range provides great   Cover for everyday health services
                                    Whether you’re fit and healthy or in need of some
value whatever level of cover       extra care, you choose the cover you want from basic
you choose. Plus if you visit a     or top. So the higher your level of cover, the higher
                                    your annual limits and percentage back at a Members’
Members’ Choice extras provider,    Choice extras provider.

you’ll have certainty knowing you   Percentage back at Members’ Choice providers
get a percentage back of:           With our extras covers we give you certainty and
                                    choice, so you’ll know what you’re getting back. You’ll
• 55%                               get a percentage back of the charge when you visit a
                                    Members’ Choice extras provider for eligible services
• 70%                               (up to applicable limits) and for other providers and
                                    some items you’ll get a fixed benefit. For more details,
• 85% or                            see the comparison table on pages 15-16.
• 100% back of the charge.          Fixed benefit
The choice is yours.                You’ll receive a fixed benefit when you visit a non
                                    Members’ Choice provider. A fixed benefit is the
                                    maximum amount we’ll pay for each service or item
                                    (up to applicable limits). Usually it will be less than
                                    the provider’s charge, which means you may have
                                    out-of-pocket expenses to pay.

                             Knowing what
                              I get with my

12                                                                                       12
Extras covers
                       Item/service                                 Basic Extras*         Top Extras         Ultra Health Cover
                                                                                                               (extras component)

  Ambulance services
  (see page 34 for more information)                                                                                
  General dental                                                                                                    
  Optical items                                                                                                     
  Physiotherapy                                                                                                     
  Chiropractic & osteopathy                                                                                         
  Natural therapies                                                                                                 
  Major dental                                                                                                       
  Orthodontic treatment                                                                                              
  Prescription pharmaceuticals (non-PBS)                                                                             
  Podiatry                                                                                                           
  Dietetics                                                                                                          
  Clinical psychology                                                                                                
  Occupational therapy                                                                                               
  Speech therapy                                                                                                     
  Eye therapy                                                                                                        
  Breathing appliances                                                                                               
  Blood glucose monitors                                                                                             
  Hearing aids                                                                                                       
  Health appliances & external prostheses                                                                            
  Laser eye surgery                                                                                                   
  Health subscriptions                                                                                                
  Health screening services                                                                                           
  Private hospital accident & emergency facility fees                                                                 
  Home nursing                                                                                                        

                                                                                                                   
          Select a level of cover to choose
               the % you get back at
                                                                                        55%    70%    85%            100%
            Members’ Choice providers.                                                  back   back   back           back
                                                                      55%*       70%
                                                                      back     back

*Basic Extras 55 cover must be taken with a hospital cover featured in this brochure.

Extras cover compared

You’ll get great benefits whatever
                                                                           I get a free dental check-up
extras cover you choose.
                                                                           With Top Extras you get one free dental check up,
Visit a Members’ Choice extras provider and you’ll                         scale and clean (excludes x-rays) per person per
receive a percentage of the charge back. You’ll also get                   calendar year at a Members’ Choice dentist.
great fixed benefits at non Members’ Choice providers.
Generally the higher your level of cover the more
you’re able to get back.

Fixed benefit
You’ll receive a fixed benefit when you visit a non
Members’ Choice provider. A fixed benefit is the
maximum amount we’ll pay for each service or item
(up to applicable limits). Usually it will be less than
the provider’s charge, which means you may have
out-of-pocket expenses to pay.

   Members’ Choice extras providers
   We’ve negotiated capped charges or discounts
   with the following healthcare professionals so
   you can claim a percentage back* of 55%, 70%,
   85% or 100% depending on your level of cover:
    Dental                           Acupuncture
    Physio                           Remedial Massage
    Chiro                            Podiatry
    Naturopathy

    Optical
   Plus at all optical retailers, you can claim
   100%* back on a range of glasses or contact
   lenses regardless of your level of extras cover.
   See page 22 for more information about
   Members’ Choice.
  *Where eligible and subject to your annual limits and waiting periods.

                                                                                                                                                        Basic               Basic                  Top                           Top                          Top                        Ultra
                                                                                                                                                      Extras 55#          Extras 70             Extras 55                     Extras 70                    Extras 85                  Health Cover
                                                                                                                                          Waiting                                                                                                                                       (extras component)
Extras cover                                                                                                                                           55% back at a
                                                                                                                                                                          70% back at a
                                                                                                                                                                                              55% back at a
                                                                                                                                                                                                                             70% back at a
                                                                                                                                                                                                                                                          85% back at a
                                                                                                                                                                                                                                                                                       100% back at a
comparison table                                                                                                                                      Choice provider    Choice provider     Choice provider                Choice provider              Choice provider               Choice provider

                                                                                      100% cover under all levels of extras
                                                 Ambulance services                   (see page 34 for more information)
                                                                                                                                          2 months     No annual limit    No annual limit       No annual limit               No annual limit              No annual limit               No annual limit
We’ll pay benefits towards the items
and services listed in this table. It                                                 Includes preventative treatment, dental
                                                                                                                                          2 months
                                                                                      examinations, scale & clean
shows the annual limits that apply               General dental                                                                                             $400               $750                   $800                    No annual limit              No annual limit               No annual limit
                                                                                      Surgical dental procedures & extractions            12 months
per person per calendar year under
each different level of cover.                                                        100% back under all levels of extras includes
                                                 Optical items                        frames, prescription lenses & contact lenses
                                                                                                                                          6 months          $150               $200                   $200                          $225                          $250                          $300

Annual limits
                                                                                      Includes consultations, group pilates &
                                                 Physiotherapy                                                                            2 months                                                    $300                          $600                          $700                         $1,000
This is the maximum amount we’ll                                                      hydrotherapy sessions
pay for items or services in a                   Chiropractic                                                                             2 months
calendar year.                                                                                                                                                                                        $200                          $400                          $500                          $750
                                                 Osteopathy                                                                               2 months
                                                                                                                                                          Combined           Combined
The benefit we pay for a particular item                                                    Consultations for naturopathy,                              limit of $300      limit of $450
or service may be less than the annual                                                      acupuncture & remedial massage

limit and less than your provider’s                                                   Consultations for myotherapy, reflexology,
                                                 Natural therapies                    kinesiology, Chinese & Western herbalism,           2 months                                                    $200                          $300                          $400                          $500
charge, which means you may have                                                      exercise physiology, shiatsu, aromatherapy,
                                                                                      homeopathy, Bowen therapy & Alexander
out-of-pocket expenses to pay. See                                                    technique
page 38 for more information.
                                                                                      • Endodontic services (eg. root canal)
                                                                                      • Periodontics (i.e. treatment of gum disease)
                                                 Major dental^                                                                            12 months                                                   $500                         $1,000                        $1,200                        $1,600
Orthodontic entitlement                                                               • Crowns, dentures & bridges
                                                                                      • Major restorative fillings (eg. veneers)
You start with an opening balance in
the first year and you’re topped up                                                                                                                                                           $400 opening balance          $800 opening balance         $1,000 opening balance        $1,500 opening balance
                                                                                      eg. braces
with an additional amount each full              Orthodontics                         (see page 35 for more information)
                                                                                                                                          12 months                                          top up of $200 per year       top up of $400 per year       top up of $500 per year       top up of $500 per year
                                                                                                                                                                                            up to $1,200 lifetime limit   up to $2,400 lifetime limit   up to $3,000 lifetime limit   up to $3,500 lifetime limit
calendar year of membership up to a
maximum lifetime limit for your level                                                 Includes most prescribed items not subsidised
                                                 Prescription                         by the Government (non-PBS items). Benefits         2 months                                                    $200                          $400                          $600                          $800
of cover. Once you’ve served your 12             Pharmaceuticals (non-PBS)            will be paid after a set charge has been deducted
month waiting period, you can claim
up to 100% of your balance.                      Dietetics                                                                                2 months                                                    $200                          $400                          $500                          $600

                                                 Podiatry                             Includes specified orthotics                        2 months                                                    $200                          $400                          $500                          $600
Benefit replacement period                       Clinical psychology                  Consultations only                                  2 months                                                    $200                          $400                          $500                          $600
Benefit replacement periods may
                                                 Occupational therapy                                                                     2 months                                                    $200                          $400                          $500                          $600
apply for some services/items. See
page 37 for more information.                    Speech therapy                                                                           2 months                                                    $200                          $400                          $500                          $600

                                                 Eye therapy                                                                              2 months                                                    $200                          $400                          $500                          $600

                                                                                      Peak flow meters, nebulisers &
                                                 Breathing appliances                 spacing devices
                                                                                                                                          12 months
                                                                                                                                                                                                      $150                          $200                          $250                          $300
                                                 Blood glucose monitors                                                                   24 months

                                                 Hearing aids                                                                             36 months                                                   $400                          $800                         $1,200                        $1,600

                                                 Health appliances &                  eg. insulin delivery pens                           2 months                                                    $200                          $400                          $500                          $600
                                                 external prostheses
                                                 Laser eye surgery                    Where no Medicare benefit is payable                36 months                                                                                                                                   $3,500 lifetime limit

                                                 Health subscriptions                 For specified health bodies & associations          2 months                                                                                                                                              $100

                                                 Health screening services            Where no Medicare benefit is payable                2 months                                                                                                                                              $200

                                                 Private hospital accident &                                                              2 months                                                                                                                                              $250
                                                 emergency facility fees

                                                 Home nursing                                                                             2 months                                                                                                                                              $500

                                               Basic Extras 55 cover must be taken with a hospital cover featured in this brochure.

                                           ^Note higher annual limits apply to major dental treatment received in WA,
                                            please call us on 132 331 for more details.

      15                                                                                                                                                                                                                                                                                                            16
How much do I

want      back?

                      Ultra Health Cover

     I simply want    Our most comprehensive hospital and
                      extras cover in one simple package.

           the best

18                                                          19
Ultra Health Cover
                                       What benefits are paid?
          5 great ways                 For services covered we pay benefits towards:
                                       • private hospital accommodation
       we help reduce your
                                       • public hospital accommodation as a private patient
         out-of-pockets                • doctors’ fees for in-hospital medical services when
                                         you are treated as a private patient

1. No excess to pay                    • surgically implanted prostheses and other items on
                                         the Federal Government’s Prostheses Schedule
2. No out-of-pockets if your doctor    • medically necessary ambulance services.
   agrees to participate in GapCover
   for your treatment*
                                       Private room priority at a Members’
3. Ultra bonus to help reduce          Choice hospital
   out-of-pocket hospital and other    You can receive $50 a night up to a maximum of five
   in-hospital medical costs           nights per stay if there isn’t a private room available
                                       and you’re eligible to receive benefits for the
4. 100% back on extras services up     treatment you received during your stay.
   to the annual limit at Members’
                                       You’ll need to make sure you request a private room
   Choice providers
                                       at least 24 hours before your stay as well as provide
5. Our highest extras annual limits    supporting documentation from the hospital about your
                                       request. For information about eligibility see page 37.
*See page 38 for more information

                                       How does the Ultra bonus work?
                                       The Ultra bonus will be used automatically to help
                                       reduce eligible out-of-pocket costs. The Ultra bonus
                                       can only be used towards hospital and in-hospital
                                       medical out-of-pocket expenses where a benefit has
                                       been paid under Ultra Health Cover.
                                       The Ultra bonus works in the following way:
                                       • you have an amount on joining and an amount each
                                         year on 1 January
                                       • any unused bonus will be added to the following
                                         year’s entitlement
                                       • a 6 month waiting period applies before you can use it.
                                       The Ultra bonus can only be used where we pay
       For more information on         benefits under this cover.
       services covered under
       hospital, see page 10 and
       see page 14 for extras.
                                                                                             Couple, family and
                                                                                            single parent family

                                           Amount that           $100 on joining and          $200 on joining
                                         the membership          $100 each year on 1        and $200 each year
                                           is allocated               January                  on 1 January

                                       Note: Ultra bonus limit applies per membership - not per person.

Ultra Health Cover                                                                                                  Ultra Health Cover
                                                                                                                       Annual limits
                                                                                  Item/Service                          (extras component)
Extras                                                                                                             100% back at a Members’
                                                                                                                       Choice provider
100% back at Members’ Choice providers
You’ll get 100% back of the charge when you visit                            Ambulance services
                                                                                                                         No annual limit
a Members’ Choice extras provider for eligible                               (see page 34 for more information)

services (up to applicable limits) and for other
                                                                             General dental                              No annual limit
providers and some items you’ll get a fixed benefit.
                                                                             Optical items                                     $300
Fixed benefit
                                                                             Physiotherapy                                    $1,000
You’ll receive a fixed benefit when you visit a non
Members’ Choice provider. A fixed benefit is the                             Chiropractic
maximum amount we’ll pay for a service or item (up                                                                             $750
to applicable limits). Usually it will be less than the                      Osteopathy
provider’s charge, which means you may have out-of-
                                                                             Natural therapies
pocket expenses to pay.                                                      (see page 15 for more information)

Annual limits                                                                Major dental^                                    $1,600

This is the maximum amount we’ll pay for items or                                                                    $1,500 opening balance
services in a calendar year. The benefit we pay for                          Orthodontics                            top up of $500 per year
                                                                                                                    up to $3,500 lifetime limit
a particular item or service may be less than the
annual limit and less than your provider’s charge,
                                                                             Laser eye surgery                         $3,500 lifetime limit
which means you may have out-of-pocket expenses
to pay.                                                                      Hearing aids                                     $1,600

Teeth whitening                                                              Prescription                                      $800
                                                                             pharmaceuticals (non PBS)
Teeth whitening is an additional benefit available with
Ultra Health Cover with a $400 limit that can be used                        Dietetics                                         $600
every 3 years. Very limited teeth whitening is available
on other extras cover under general dental.                                  Podiatry                                          $600

                                                                             Clinical psychology                               $600
Key information
In Things worth knowing on page 36, you’ll find                              Occupational therapy                              $600
information on waiting periods (including the 12
                                                                             Speech therapy                                    $600
month waiting period for pre-existing ailments) and
other benefit assessment information.                                        Eye therapy                                       $600

                                                                             Breathing appliances
   Members’ Choice extras providers                                                                                            $300
                                                                             Blood glucose monitors
   We’ve negotiated capped charges or discounts
   with the following healthcare professionals so
                                                                             Health appliances and                             $600
   you can claim 100%* back of the charge.                                   external prostheses

    Dental                           Acupuncture
                                                                             Health subscriptions                              $100
    Physio                           Remedial Massage
    Chiro                            Podiatry                              Health screening services                         $200

    Naturopathy                      Optical
                                                                             Private hospital accident &                       $250
   See page 22 for more information about                                    emergency facility fees
   Members’ Choice.
                                                                             Home nursing                                      $500
  *Where eligible and subject to your annual limits and waiting periods.
                                                                           ^ Note higher annual limits apply to major dental treatment
                                                                             received in WA, please call 132 331 for more information.

Members’ Choice
It’s pretty simple: visit a Members’ Hospitals
Choice extras provider or hospital Visit a Members’ Choice hospital and you’ll get better
and you can save money.              value for money compared to a non Members’ Choice
                                     private hospital as long as the service you receive
                                                       is covered by our agreement with the hospital and is
Our Members’ Choice network is one of the largest      included under your cover.
health provider networks in Australia, covering most
private hospitals and the widest range of extras       What about out-of-pocket expenses?
services of any health fund.
                                                       Even if you go to a Members’ Choice hospital, you’re
We’ve negotiated with many healthcare professionals    still likely to have out-of-pocket expenses. The hospital
so you won’t be charged more than the agreed price.    and doctors treating you should tell you about their
We’ve also negotiated discounts off normal prices at   costs before you go to hospital – so it’s important to
optical retailers and for orthotics.                   ask. Give us a call before you go to hospital so we can
                                                       help you ask the right sort of questions. See page 38
A Members’ Choice extras provider must agree to and
                                                       for more information.
meet Medibank’s customer service standards in
addition to meeting any registration standards for
practising that profession.

How can I reduce
                                   my costs?

                                                                Find a Members’ Choice provider
                                                                • Visit
                                                                • Call us on 132 331
                                                                • Drop into a Medibank store

Members’ Choice
    Extras providers
    Benefits of Members’ Choice extras providers                               Enjoy greater value from our Members’
     Capped charges*                                                          Choice network
                                                                               We’ve also got some great deals available. With our
     Discounts at optical retailers and for orthotics                         Top Extras covers, you’ll get one free dental check-up,
                                                                               scale and clean (excludes x-rays) per person per
     % back of the charge. This could be 55%, 70%,                            calendar year – valued at over $130 – when you
         85% or 100% depending on your cover#
                                                                               visit a Members’ Choice dentist.
     Wider range of extras services                                           To find out more call us on 132 331.
         than other insurers
                                                                               What types of providers are included in
     Generally lower out-of-pockets than non                                  Members’ Choice?
         Members’ Choice providers.
                                                                               Our Members’ Choice network covers more types of
*excludes optical retailers
                                                                               extras services than any other private health insurer
                                                                               and includes the following:
    How does it work?
                                                                               • Dentists
    Here’s an example of how you can get the most out
    of Members’ Choice.                                                        • Dental prosthetists

    Elizabeth has Basic Extras 70 and lives in NSW. The                        • Optical retail outlets
    table below shows typically how much she can save                          • Chiropractors
    when she visits a Members’ Choice physiotherapist
    for a subsequent consultation.                                             • Physiotherapists
                                                                               • Podiatrists

                            Members’ Choice            Non Members’            • Acupuncturists
                               provider                Choice provider
                                                                               • Naturopaths
       Charge                           $55.00              $60.00^            • Remedial massage therapists
                                 (capped charge)

       Benefit                       70%                                       Go to or call us on 132 331 to find
      payable#                 of charge back               $31.60†            your nearest Members’ Choice provider. Please
        (% back or
      fixed benefit)               ($38.50)                                    note, Members’ Choice extras providers may not be
                                                                               available in some areas.
                                        $16.50               $28.40
    subject to annual limits and waiting periods
^most common charge in NSW for a subsequent physio consultation for non
 Members’ Choice providers for claims during July, August and September 2010
 (processed on or before 6 October 2010)
    fixed benefit that can be claimed

Medibank – the right choice
Medibank Private was           Here are some more reasons why Medibank is such a
                               great choice:
awarded a five-star rating
                               Percentage back at Members’ Choice providers
for “Outstanding Value” in     With our extras covers we give you certainty and
private health insurance for   choice, so you’ll know what you’re getting back. You’ll
                               get a percentage back of the charge when you visit a
2009 and 2010 by leading       Members’ Choice extras provider for eligible services
research organisation          (up to applicable limits) and for other providers and
                               some items you’ll get a fixed benefit. For more details,
CANSTAR CANNEX. This           see the comparison table on pages 15-16.

recognition confirms our       No hospital excess for kids
commitment to value for        With our hospital covers, you won’t be charged an
                               excess if a child on your membership needs to go to
money health cover.            hospital (including adult children).

         better off

Your grown up kids are also covered                       Managing your membership online
Your adult children can stay on your cover at no extra    Our Online Member Services is an easy secure way
cost until they’re 21, or if they’re studying full-time   for you to manage your membership details, claims
until they’re 25 provided they’re not married or in       and payments, and you can even change your cover
a de facto relationship. But if they’re not full-time     online whenever and wherever suits you. Just visit
students we have our families with adult children and register for Online Member
option. You do pay a higher premium but it can be         Services. It’ll take you less than a minute to sign up.
cheaper than if they were to take out their own cover     For more information see page 29.
at the same level. For more information see page 32.
                                                          On-the-spot claiming for extras
Better ways to betterhealth                               If your health care provider offers on-the-spot
Want to get fit? Get in shape? Eat better? Stop           electronic claiming, just swipe your Medibank
smoking? Or better manage your diabetes or a chronic      membership card and your claim will be processed
health condition? Then help and advice is just a click    on the spot. Then all you do is pay the balance.
or phone call away with our betterhealth programs.
For more information see page 28.                         feelbetter rewards
                                                          Our feelbetter rewards program gives you access
More than just health cover                               to great deals from over 50 different retailers and
As a member, you also get a 10% discount on travel,       organisations across Australia. You can also get a
pet and life insurance. For more information see          copy of our feelbetter magazine (available in stores
pages 30-31.                                              and online) which comes packed with heaps of
                                                          information to help you stay fit and healthy.

                                                             Am I covered
                                                             for ambulance?
                                                             Ambulance services are included under
                                                             our hospital, Ultra Health Cover and extras
                                                             covers. If your medical condition means you
                                                             need immediate professional attention and/
                                                             or you can’t be transported to a hospital in
                                                             any other way, we’ll cover the cost of your
                                                             ambulance services (unless you’re already
                                                             covered eg.under a state scheme).

                Like to know more?
                • Take a look at Things worth
                  knowing on page 32
                • Visit
                • Call us on 132 331
                • Drop into a Medibank store

cover f us
 when it

             Like to know more?
             • Take a look at Things worth
               knowing on page 32
             • Visit
             • Call us on 132 331
             • Drop into a Medibank store

Private health insurance makes sense
Without private health insurance, common                                     Save on tax
procedures in a private hospital could cost                                  If your taxable income is over an amount set by the
                                                                             Government, you can avoid paying the extra 1%
you thousands of dollars:                                                    Medicare Levy Surcharge by taking out any one of our
                                                                             hospital covers for you and your dependants. More
• $7,461 for childbirth*
                                                                             information can be found at
• $38,590 for heart bypass surgery*
• $26,431 for hip replacement surgery*                                       Reduce your premium by 30%
                                                                             The Federal Government 30% Rebate on private
• $20,797 for knee replacement surgery.*
                                                                             health insurance reduces your premium and makes
*These figures are an average of Medibank Private’s claims information for   private health insurance more affordable. If you’re
2009/10. They include hospital, in-hospital medical and prostheses charges   eligible, your premium will be reduced by at least
only. Costs may vary depending on the hospital or provider you receive
treatment from and from state to state.                                      30%, and as you get older it reduces even further. You
                                                                             only need one person on your membership to be in the
Get benefits for things not covered by                                       higher age bracket to be eligible for the higher rebate.
Medicare with extras cover                                                   • 30% off your premium if you’re aged 64 or under
Having extras cover also makes sense. With extras you’ll
                                                                             • 35% if you’re aged 65-69
be able to claim benefits on everyday health services,
such as dental and physio, that aren’t generally covered                     • 40% if you’re aged 70 or over.
by Medicare. Extras also provides cover for services that
can help you maintain your health and wellbeing, like                        Avoid a higher premium by joining early
naturopathy and remedial massage.                                            Generally, if you take out hospital cover by the
                                                                             1 July following your 31st birthday and maintain
                                                                             it, you can avoid paying a Federal Government
                                                                             Lifetime Health Cover loading on your premium.
                                                                             See page 34 for more details.

                                                                               Treatment when I need it
                                                                               Some of the most common hospital procedures
                                                                               in the public hospital system can have lengthy
                                                                               waiting lists:
                                                                               • 335 days for removal of tonsils^
                                                                               • 76 days for heart surgery^
                                                                               • 364 days for hip replacement surgery^
                                                                               • 393 days for knee replacement surgery.^
                                                                               But with private health insurance, you have more
                                                                               control over when you’re treated, who treats you
                                                                               and where.
                                                                               ^National waiting times at 90th percentile as reported by the
                                                                               Australian Institute of Health and Welfare 2010, Australian
                                                                               Hospital Statistics 2008-2009.

Look after yourself with betterhealth
Our betterhealth programs are designed to                                         Maybe you’re pretty healthy — you watch what you eat,
                                                                                  you try to get out and exercise. Or maybe you’re not
support members in managing their health                                          quite as healthy as you’d like: maybe heart disease or
at every life stage. So whatever your goal,                                       diabetes runs in your family and you’ve got some early
betterhealth has something for you.                                               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 weight, or learn to better manage an
                                                                                  existing health condition.

              You                   Your program                                                      What is it?

                                                              An interactive website packed with resources to help you get
 I want to develop                                            and stay healthy. It includes personalised programs for specific
 and maintain a                       betterhealth            goals, from losing weight to improving fitness to quitting smoking
 healthy lifestyle                       online               or managing blood glucose and more. The great news is that it’s
 on my own terms                                              available to all members.
                                                              Check out

                                                              Telephone support from qualified health consultants to help you
                                                              achieve a range of health goals including stress management,
 I need some extra                                            better nutrition, weight loss and physical activity. If you have
 support to help                      betterhealth            hospital cover and have an existing health concern, our health
 me make a change                      coaching               consultants can help give you the extra motivation you need to
 for the better                                               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
 I need assistance to                                         you have hospital cover and are eligible, our health professionals
 manage my ongoing                                            will be on hand to answer any questions you might have about your
                                        on Call
 health problems                                              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 and related companies trading as ‘Medibank Health Solutions’.

Managing your membership online
Online Member Services is an easy,
secure way to manage your claims,
payments and other membership
services at your convenience.
Manage most aspects of your membership when
it suits you, online at home, at work or on the go,
24 hours a day 7 days a week.
You can use Online Member Services to:

 make an extras claim
 view online claim history
 pay premiums or renew membership
 change payment type
 view payment details
 view membership details
 add or remove dependants
 change level of cover
 download brochures and forms
 order a replacement membership card
 request statements
 view annual statements
 suspend membership
 update contact details
 register bank account for claim payment
 send secure mail

Please note: all current Medibank Private
members aged 16 years and over can use Online
Member Services. If you’re the contributor, you will
have access to all the features under your cover
type. Access to some functions may be limited for
your spouse/partner and dependants.

Competitively priced pet, travel and life insurance
While we’re known for our                Pet insurance
top quality, value-for-money             If you own a cat or dog, you’d agree that your four-
health insurance, that same              legged friend is an important part of your life. Their
                                         love for you is unconditional, but no matter how well
quality and value for money is           you care for them life is unpredictable and a trip to
                                         the vet could happen at any time.
available with Medibank travel,
                                         With Medibank Pet Insurance* your ‘other’ family
pet and life insurance.                  member can also get access to the best care possible.
                                         It’s health cover for dogs and cats and features:
                                         • cover for up to 100% of your vet bills
                                         • three cover options, with generous annual
                                           limits up to $15,000
                                         • your choice of vet or specialist (including your
                                           pet’s regular vet)
      As a Medibank Private member       • choice of excess levels, to help you lower
      you’ll receive a 10% discount on     your premiums
      each of these products.
                                         • plus, a further 5% discount for each additional pet.
      Plus you’ll also receive a 10%
      discount on travel vaccinations
                                         Medibank Pet Insurance
      and products from The Travel
                                         • Phone 132 331
                                         • Go to
                                         • Visit a Medibank store

Travel insurance                                                                  Life insurance
We all know how important our health is, especially                               There are some things in life you’d probably rather not
when travelling far from home. Medical emergencies                                think about, even though you know they’re important.
affect thousands of Australians who travel overseas                               But having life insurance can give you the peace of
each year. No matter where your travels take you,                                 mind that even if something unexpected happens to
in Australia or overseas, with Medibank Travel                                    you, your loved ones would be helped financially.
Insurance you can relax and enjoy yourself knowing
                                                                                  With Medibank Life Insurance* there are no medical
you’re never far from care.
                                                                                  or blood tests, just a simple application process, with
With Medibank Travel Insurance* even when you’re                                  a list of benefits to make you feel secure about your
a million miles from home, you can travel with                                    family’s future:
confidence knowing you have:
                                                                                  • comprehensive Life cover for up to $1.5 million
• unlimited overseas emergency medical cover and
                                                                                  • an advance payment to help with funeral expenses
  24/7 assistance
                                                                                  • accidental injury benefits
• worldwide hotline – free call 24/7
                                                                                  • Optional Permanently Unable to Work cover, trauma
• cover for luggage, personal items, travel
                                                                                    insurance, and children’s insurance
  documents, credit cards and cash
                                                                                  • guaranteed to be renewed for life
• cancellation and travel delay cover
                                                                                  • plus, great value with discounted premiums on
• plus, receive a 10% discount for travel vaccinations,
                                                                                    cover amounts over $500,000.
  products and travellers’ medical kits from
  participating The Travel Doctor-TMVC clinics.
                                                                                  Children’s Insurance cover
The Travel Doctor                                                                 If you have children, you’ll find it reassuring that you
                                                                                  can get special insurance for them too. Medibank Life
The Travel Doctor-TMVC provides up-to-date
                                                                                  Insurance includes an option for Children’s Insurance
international health advice and medical services
                                                                                  Cover that can provide a lump sum benefit of up to
to those intending to travel overseas for leisure or
                                                                                  $50,000 if your child suffers a covered traumatic
business. The Travel Doctor-TMVC is part of the
                                                                                  illness. This could be invaluable to help pay for things
Medibank group and is internationally recognised
                                                                                  like ongoing specialist care or allowing a parent to
as an expert and leader in its field.
                                                                                  take extended time off work to care for the child.
To find out how to redeem the 10% discount or
to view a list of participating clinic locations
                                                                                  Medibank Life Insurance
go to and
                                                                                  • Phone 1300 722 568
click on travel tips.
                                                                                  • Go to
                                                                                  • Visit a Medibank store
Medibank Travel Insurance
• Phone 132 331
• Go to
• 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 Pty Ltd (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
Things worth knowing
Understanding private health insurance                    What is the difference between a member,
                                                          a membership and a contributor?
can be tricky. This section is designed to
                                                          There are three terms we use when we’re talking
help make things a little easier for you. It              about membership: member, membership and
contains some important information                       contributor. As a starting point, it’s good to be clear
about our covers along with explanations                  on all three.

of terms you may not be familiar with. It                 A member is simply any person covered under a
                                                          Medibank Private membership.
also gives you an overview of some of our
key rules.                                                A membership is made up of one or more members
                                                          and can consist of:
It’s also important you have a good look through          • just one person (single membership)
the Membership Guide which is available at You’ll also receive a copy               • a couple membership which covers you (the
of this once you join. This contains a summary              contributor) and your spouse/partner
of the rules of your membership (known as our             • single parent family* membership, which covers
Fund Rules) – things like your responsibilities as          you and
a member. It’s also important to read the Cover             – any of your child dependants and/or
Summary you’ll receive for further details about
                                                            – any of your student dependants
your cover and entitlements.
                                                          • family membership*, which covers you and your
                                                            spouse/partner and
                                                            – any of your child dependants and/or
About your membership with us                               – any of your student dependants
                                                          • family with adult children* membership option,
Do you have a ‘cooling-off’ period?
                                                            which can, for an additional cost, extend a single
If you join but then decide you’d like to either cancel     parent family or family membership to include any
your membership or move to another cover, we have           of your children who:
what is known as a ‘cooling-off’ period. This also          – have reached the age of 21 but are under 25,
applies if you’re already a member and have recently        – are not studying full-time, and
changed your cover.                                         – are neither married nor living in a de facto
As long as you tell us within 30 days of joining or           relationship.
changing your cover, and no claims have been made         *These membership categories do not apply to Young Hospital cover.

against your policy there’s no problem. We can either
                                                          The term contributor refers to the person who ‘owns’
transfer you to a more suitable cover or refund your
                                                          the membership. This is the person we contact when
premium in full.
                                                          we need to communicate important information.

How often should I review my cover?
                                                          Can my partner manage my membership too?
You may have different health needs at different
                                                          Although you as the contributor ‘own’ the membership,
stages of your life, so it makes sense to review your
                                                          your partner (if he or she is also covered by the same
health cover regularly. This is especially important
                                                          membership) can automatically manage most aspects
if your situation changes. For example, if you’re
                                                          of the membership too, including: making claims,
planning to start a family, the kids have grown up or
                                                          adding or removing dependants, changing cover,
either you or someone in your family has developed a
                                                          suspending the membership and changing contact
health issue. Whatever your situation, it’s a good idea
                                                          and bank account details.
to call us to discuss your options on 132 331 or drop
into one of our stores. Alternatively you can log into    However, as the contributor you’re the only one who
Online Member Services and compare covers.                can remove yourself from the membership or cancel

the membership. It’s important to be aware that this        months from the date of their birth or inclusion in
means we may disclose registered membership                 your family unit (eg. through marriage, adoption or
details to both of you. If at any time you want to be       fostering) your child won’t have to serve any additional
the only person who can manage the membership or            waiting periods. The change will be backdated to the
you require further information about the handling of       date of birth or inclusion in your family unit. Also,
personal information, please call us on 132 331.            this change of membership means you’ll pay higher
If I transfer to Medibank from another health               If you’re on a couple or family membership:
fund, am I covered immediately?                             You can add a dependent child to your membership
In some cases yes, in other cases no. You’ll be             at any time and they won’t need to serve any waiting
covered for services on your new cover from the date        periods already served on the membership. Your
you join if: (i) those services were also included on       premium doesn’t increase if you change from a couple
your cover with your former fund, (ii) you join us within   to family membership, or add a dependent child to a
two months of leaving your former fund and (iii) you’ve     family membership.
already served the applicable waiting periods. So           As Young Hospital is only available as a single or
although we’ll recognise any waiting periods you’ve         couple membership, you can’t add a dependent child
served with your former fund, if you haven’t fully          to that cover.
served the applicable waiting periods, you’ll need
to serve the balance with us before you’re eligible         What if I want more information on adding a
for benefits.                                               dependent child?
Additional waiting periods will also apply if you’ve        Call us on 132 331.
switched to a higher level of cover with Medibank or
if you wait more than two months after leaving your         What happens if my newborn baby needs
former fund before you join Medibank. For more              hospital treatment?
information see page 36.                                    When a newborn baby is in hospital with its mother,
                                                            no accommodation charges apply for the baby unless
Any loyalty bonus or other similar entitlements
                                                            the baby becomes an admitted patient in their own
built up with your former fund (eg. orthodontic
                                                            right. This happens when the baby requires admission
entitlements) will not transfer to Medibank.
                                                            to a neo-natal intensive care unit or it is the second or
If you transfer to Medibank or to another Medibank          later child of a multiple birth.
cover, any benefits that may have been paid under
your previous cover may be taken into account               If I have children, how long can they be insured
in determining the benefits payable under your              on my cover?
new cover.                                                  As your children grow older they can still be covered at
                                                            no additional cost on your family or single parent family
What if I want to add my partner to                         membership until they turn 21 or, if they are full-time
my single membership?                                       students, until they turn 25, provided they’re not married
It’s easy to change from a single to a couple               or in a de facto relationship. This is because we consider
membership, but you should be aware that higher             them to be your dependent children.
premiums apply to a couple membership and                   If you have unmarried children aged 21 to 24 who
additional waiting periods may apply to your partner.       aren’t studying full-time and are not in a de facto
                                                            relationship, we also have a membership option
Can I add a dependent child to my membership?               called families with adult children. Although you’ll
If you’re on a single membership:                           pay a higher premium, it can prove to be a more
To add a dependent child to your membership you’ll          economical option for your children than if they were
need to change from a single to a family or single          to take out their own cover at the same level. Waiting
parent family membership. If you do this within two         periods may apply.

About Lifetime Health Cover (LHC)                                  Ambulance services
                                                                   Benefits are payable in the following circumstances:
What is LHC?
This is a Federal Government initiative where a loading            • when you need to be transported in an ambulance to
can be applied to your premium if you take out hospital              a hospital or other approved facility in order to receive
cover later in life. It’s aimed at encouraging people to             immediate professional attention
take out hospital cover early in life and maintain it.             • when, as an admitted patient, you are transferred to
                                                                     another hospital (excluding transfers between public
When does the loading apply?                                         hospital facilities)
The loading generally applies if you don’t have hospital
                                                                   • when an ambulance is called to attend to you, but
cover on the 1 July following your 31st birthday. This
                                                                     having received immediate professional attention
means for every year you don’t have hospital cover, you’ll
                                                                     transport by ambulance is not subsequently required
pay a 2% loading on top of a base rate on your premium
(or on your share of a couple or family premium) up to             • air ambulance where pre-approval has been obtained
a maximum loading of 70%. The loading applies only to                from Medibank.
hospital cover or the hospital component of your cover
                                                                   Benefits for medically necessary ambulance services are
– not to extras covers. Any loading that applies to your
                                                                   included in all covers described in this brochure.
premium will be removed after you’ve held hospital cover
continuously for 10 years. However, the loading may be             Exceptions could include the following, where:
reapplied if you then cease to hold a hospital cover and           • you’re entitled to benefits from another source, such as
subsequently take it up again.                                       ambulance subscription or state ambulance transport
Does the LHC loading apply to everyone?
                                                                   • you’re aged 65 or over and live in WA, and are eligible
No, the LHC loading doesn’t apply to people born on or
                                                                     for free or subsidised ambulance services. If eligible
before 1 July 1934. There are also special rules that apply
                                                                     for subsidised services, you may be able to claim the
to people who fall under an LHC exemption category.
                                                                     remaining cost from Medibank
For more information please refer to the Department of
Health and Ageing website –                      • you live in NSW or the ACT and pay an ambulance levy
                                                                     as part of your hospital cover premium, and you’re
What if I drop my hospital cover?                                    entitled to cover under your state scheme. If you have a
You can drop your hospital cover for a sum total of three            Commonwealth concession card you might be exempt
years (1,094 permitted days) during your lifetime without            from paying the ambulance levy
any change to your LHC loading status. If you drop your            • you live in Qld or Tas and are entitled to cover for
hospital cover for longer than this, in most circumstances           ambulance transport under the State Government scheme
you’ll have to pay an LHC loading (or, if you were already
paying the loading, it will be higher) once you take               • you live in Qld or Tas and hold extras cover only, no
out hospital cover again. The following are additional               benefits are payable.
permitted days without hospital cover that won’t count             For more information call us on 132 331.
towards your 1,094 permitted days without hospital cover:
• if you’ve been overseas continuously for more than one
  year (this includes visits back home of less than 90
  days at a time)
• if your health fund has agreed to a period of suspension.

What happens if I change health funds?
If you switch to us from another fund we recommend
you keep your cover with your old fund until the date you
transfer to us. This way you avoid using up any of the 1,094
permitted days you can be without hospital cover during
your lifetime. Also, if you already have an LHC loading, it will
move with you.

How do orthodontic benefits work?
Your orthodontic entitlement starts with an opening
balance, which you can access once your 12 month
waiting period is served. The balance is then topped
up with an additional amount each 1 January (following
the completion of your waiting period) up to a maximum
lifetime limit.

                                                                                                            The benefit you
   Opening Balance               +            Any top ups            –        Any benefits
                                                                              ever claimed
                                                                                                     =         can claim
                                                                                                         (after waiting period)

Orthodontic entitlements available on each relevant product:

             Cover                            Opening balance            Additional annual top ups         Lifetime limit

          Top Extras 55                             $400                           $200                        $1,200

          Top Extras 70                             $800                           $400                        $2,400

          Top Extras 85                            $1,000                          $500                        $3,000

        Ultra Health Cover                         $1,500                          $500                        $3,500

Example of orthodontic entitlements on Top Extras 85:

                          What you get           Your available
     Dates            towards orthodontics     balance if no claim
                           each year             has been made

   Date joined –               $1,000
   30 Jun 2011            (opening balance)

Waiting period ends
                                  x                   $1,000
  – 30 Jun 2012

    1 Jan 2013                                        $1,500
                              (top up)

    1 Jan 2014                                        $2,000
                              (top up)

    1 Jan 2015                                        $2,500
                              (top up)

                                $500                   $3,000
    1 Jan 2016
                              (top up)            (lifetime limit)

About waiting periods                                                                       About pre-existing ailments
What is a waiting period?                                                                   It’s standard practice in the private health
All health funds have waiting periods. In short, a waiting                                  insurance industry to apply a waiting period of
period is a period of time you need to wait after taking out
your cover before you can receive benefits for services or
                                                                                            12 months before benefits are payable for a
items covered.                                                                              pre-existing ailment.
You’re not able to receive benefits for any items or services
you might have obtained while you’re serving a waiting                                      What’s a pre-existing ailment?
period or before you joined Medibank.                                                       By pre-existing ailment, we mean an ailment, illness or
                                                                                            condition where signs or symptoms existed at any time
How do I know if a waiting period applies to me?                                            during the 6 months before you either took out your new
Waiting periods will apply if you’re a new member, you’re                                   cover, or transferred to a higher level of cover.
rejoining Medibank after not having health cover for
                                                                                            We’ll appoint a medical or health practitioner to
some time or you’re changing to a higher level of cover
                                                                                            determine whether you have a pre-existing ailment,
(either within Medibank or transferring from another fund).
                                                                                            based on information provided by the practitioner(s)
If you’re changing to a higher level of cover, you’ll still be                              treating you.
entitled to benefits at the level of your former cover while
you’re serving any waiting periods on your new cover if:                                    What if I have a pre-existing ailment?
• those services were included under your old cover; and                                    If you’re a new member, you’ll have to wait 12 months
                                                                                            before you can receive benefits for items or services
• you’ve already served the waiting periods that applied                                    related to a pre-existing ailment.
  under your old cover.
                                                                                            If you’re changing to a higher level of cover (either within
Waiting periods may apply to some of our betterhealth                                       Medibank or from another fund), you may have to wait 12
programs.                                                                                   months to receive the higher benefits, including benefits
                                                                                            for services not previously covered.
How long is the waiting period?
That depends on the types of services or items included on
your cover. Have a look at the following table for a guide.

                             All services (including ambulance services) -
      2 months*
                             except those set out below

                             Optical items
       6 months
                             Ultra bonus
                             Pre-existing ailments. However, the 12 month
                             pre-existing ailment waiting period does not apply
                             to hospital or hospital substitute treatment for
                             psychiatric treatment, rehabilitation treatment or
                             palliative care
                             Obstetrics-related services
                             Major dental services
      12 months
                             Orthodontic treatment

                             Dental surgical procedures and surgical
                             extractions (eg. wisdom teeth)

                             Peak flow meters
                             Spacing devices

      24 months              Blood glucose monitors

                             Hearing aids
      36 months
                             Laser eye surgery

* If you have an accident after joining us or changing cover and require treatment, we’ll
 waive the 2 month waiting period.

About benefit replacement periods                                   • To claim for a Sleep Apnoea device or similar device
                                                                      approved by Medibank, you’ll need hospital cover
                                                                      (excludes Young Hospital). You’ll also need to undergo
What’s a benefit replacement period?                                  an overnight investigation for Sleep Apnoea which is
It’s a period of time you need to wait after purchasing               listed in the Medicare Benefits Schedule. The device
an item covered by us before you can receive further                  must also be requested by a medical practitioner and
benefits to replace the item. For example, if you received            purchased or hired within 12 months of undergoing
benefits for an insulin delivery pen, purchased on 1                  the investigation.
July 2011, you can only receive benefits for another one
                                                                    • Limitations apply to some benefits. For example,
purchased on or after 1 July 2013.
                                                                      for an initial consultation for an extras service, we
                                                                      generally pay the higher benefit (if any) per person,
How long is a benefit replacement period?                             per provider, per calendar year only once in a course
This varies from item to item and generally applies per               of treatment.
member unless specified in the following table.
                                                                    • 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’
   12 months
                  Repairs of external prostheses                      Choice private hospital.
                  and health appliances
                  Wigs                                              • If you no longer need acute care and stay in hospital
                  Hip protectors
                                                                      for more than 35 days, you’ll be classified as a nursing
    2 years
                                                                      home type patient. If this happens, we’ll only pay a
                  Insulin delivery pens
                                                                      small portion of the daily hospital charges and you may
                  Blood glucose monitors                              need to pay the rest of the cost of your care. If you’re in
                  Breathing appliances:
                                                                      a private hospital, these costs may be substantial. Your
                  - nebulisers                                        doctor and hospital will be aware of this rule which
                  - peak flow meters
                  - spacing devices
                                                                      applies to all health funds and they can advise you.
    3 years                                                         • We don’t pay benefits for services or treatments where
                  Mouthguards (for members up to 18 years of
                  age, benefits may be payable for a replacement      you are, or may be, entitled to compensation and/or
                  mouthguard each calendar year)                      damages. For example, State Government workers’
                  Dentures, crowns and bridges                        compensation schemes, traffic accident schemes
                                                                      or public liability claims.
                  Other health appliances and external prostheses

                  Hearing aids
                                                                    • We don’t generally pay benefits for hospital procedures
                                                                      not recognised for Medicare benefit purposes (such as
    5 years       Sleep Apnoea – continuous pressure devices          cosmetic surgery).
                  and other similar approved appliances under
                  our hospital cover (excluding Young Hospital)     • To claim for private room priority under Ultra Health
                                                                      Cover, you’ll need to make sure you request a private
                                                                      room at least 24 hours before your stay as well as provide
                                                                      supporting documentation from the hospital about your
Other rules for paying benefits                                       request. Private room priority won’t apply to:
                                                                      – same day admissions
Are there any other rules I need to know about?                       – admissions for sleep studies
Yes, there are some other important rules for you                     – nursing home type patients
to be aware of.                                                       – where your doctor considers that you should be
                                                                        located in a shared room for clinical reasons.
• We only pay benefits for items and services delivered
  by Medibank-recognised providers.                                 • No Medibank benefit is payable under extras
                                                                      where there is an entitlement to a Medicare
• Some appliances may need to be ordered by a medical                 benefit (eg. allied health services).
  practitioner before benefits are payable eg. nebulisers.
                                                                    It’s important you call us on 132 331 for information
• Restrictions may apply to the number of services you              on recognised providers and the benefits you’re entitled
  can claim in a particular period.                                 to before commencing treatment.

About out-of-pocket expenses                                              How can I reduce my hospital out-of-pockets?
                                                                          Hospital charges
                                                                          If possible, go to a Members’ Choice hospital where
What’s an out-of-pocket expense?
                                                                          our agreement with the hospital limits what you can be
It’s any expense for a hospital or extras service or item                 charged. This means your out-of-pockets for hospital
for which you won’t be reimbursed – by either us or                       charges should be limited to things like:
                                                                          • any excess you may have with your cover

What out-of-pocket expenses can I expect if I receive                     • any pharmaceuticals not covered by our agreement
an 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 help                     • any gap for surgically implanted prostheses and other
reduce your out-of-pocket expenses, visit a Members’                        items on the Federal Government’s Prostheses Schedule
Choice extras provider where you can access capped
charges and/or discounts and generally receive higher                     • costs for services not covered, or not fully covered, by
benefits than you would with a non Members’ Choice                          our agreement with the hospital or under your cover
provider.                                                                 • costs for treatment in an emergency department in a
                                                                            private hospital. Note, with Ultra Health Cover you can
What kind of out-of-pocket expenses can I expect if I                       claim benefits on the facility fee charged (subject to
go to a private hospital?                                                   annual limits).
Although hospital cover helps reduce the cost of your                     If you go to a non Members’ Choice private hospital,
private hospital visit, you’ll still have out-of-pocket                   you’re likely to have significant out-of-pocket expenses.
expenses for things like your excess and any difference
between what the hospital charges and the benefit we                      Doctors’ charges
pay for the hospital services.                                            Before you go to hospital, try to arrange to see a doctor
                                                                          who’ll participate in our GapCover scheme. This is
You can also expect to pay the difference between the                     because GapCover can help reduce or eliminate your
charge for in-hospital medical services (eg. doctors’                     out-of-pocket expenses for doctors’ services received in
services, pathology and radiology) and what you receive                   a private hospital.
from Medibank and Medicare. To explain it further,
the benefits you’re entitled to for the medical services                  It’s important to be aware that doctors can choose to
you receive while you’re in an overnight or day hospital                  participate in GapCover on a claim-by-claim basis and
facility are based on the Medicare Benefits Schedule                      more than one doctor may be involved in your treatment.
(MBS) fee. The MBS is a list of all the services Medicare                 GapCover doesn’t apply to pathology and radiology
pays benefits for and the rules that apply to payment of                  services, any applicable excess payment, services not
those benefits.                                                           included under your cover or out-of-hospital consultations.

Medicare pays 75% of the MBS fee and Medibank pays                        Ultra Health Cover
25% (if the treatment is covered under your policy).                      Ultra Health Cover includes additional features to help
                                                                          reduce or eliminate your out-of-pocket costs when you are
When a doctor charges more than the MBS fee, you’ll                       admitted to hospital. For example, if your doctor agrees to
have out-of-pocket expenses. These can vary and may                       participate in GapCover there will be no out-of-pockets for
be significant. This is what’s referred to as a ‘gap’. Have               your doctor’s charge. There is also an Ultra bonus which is
a look at the diagram below – it shows you the amount                     automatically applied to reduce any eligible out-of-pocket
Medicare takes care of and the amount we cover for                        costs for in-hospital medical treatment and hospital
in-hospital medical services. It also shows you the gap.                  related costs. Call us to find out more on 132 331.

                                                                   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                charge over and above
         Medicare pays 75% of the MBS fee for in-hospital medical services.                  the MBS fee for in-hospital            the MBS fee, leaving
                                                                                                 medical services.                   you out-of-pocket.

                                                                     Note: Doctors can choose whether they participate in GapCover on a claim-by-claim basis.

Other important information                                     Private Health Insurance Code of Conduct
                                                                We’re proud to be a signatory to the Private Health
What’s the best way for me to give feedback?                    Insurance Code of Conduct. The code was developed
                                                                by the private health insurance industry and aims
If you have any feedback on our products and services, or
                                                                to promote the standards of service to be applied
you’d like further explanation on anything to do with your
                                                                throughout the industry. The code is designed to help you
membership, please contact us:
                                                                by ensuring that:
• call 132 331
                                                                • information which we provide to you is written in plain
• email                                     language
• visit any of our Medibank stores                              • our employees are competently trained to deal with
                                                                  your enquiries
• write to us at Medibank Private GPO Box 9999
  in your capital city.                                         • we protect the privacy of your information in line with
                                                                  the privacy legislation
What if I have a complaint?
                                                                • you have access to a reliable and free system of
We’ll try to resolve any complaint you may have the first         addressing complaints with us.
time you raise it with us – please contact us with any
issues through the contact points listed above. If you          A copy of the code is available online at
believe your complaint has not been satisfactorily dealt
with, let us know and we’ll escalate your complaint. You
can also write to our Customer Resolutions team at              Disclaimer
Medibank, GPO Box 9999, Melbourne, VIC 3000.                    • Medibank Private encourages providers to offer
                                                                  high-quality products and services at competitive
Free, independent advice is also available from the
                                                                  prices to its members.
Private Health Insurance Ombudsman on 1800 640 695.
                                                                • Where Medibank Private recognises a provider,
Private Patients’ Hospital Charter                                advertises on behalf of a provider, or appears by
Prepared by the Federal Government, this booklet is               reference or logo or otherwise in an advertisement of any
designed to advise you on what you can expect from your           provider, to the fullest extent allowed by the law, such
health fund, doctors and hospitals as a patient with hospital     advertising or reference should not be construed as:
cover. A copy is available from any Medibank store.                   – an endorsement by Medibank Private;
                                                                      – an acknowledgment or representation by
                                                                        Medibank Private as to fitness for purpose; or
                                                                      – a recommendation or warranty by Medibank
                                                                    of, for, or in relation to, the product and/or service of the
                                                                    provider. Accordingly, to the fullest extent allowed by
                                                                    law, 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.

          Rule of thumb before you go to hospital               Note
          Call us first on 132 331 so we can help you           Policies of insurance issued under, or on the terms of,
          understand what’s involved and the types              any products described in this publication are referable
          of questions you need to ask your doctor              to the Medibank Private Limited (ABN 47 080 890 259)
          or specialist.                                        health benefits fund.

Accident                                                           Cosmetic surgery
An unforeseen event occurring by chance and caused by an           A service that is not clinically necessary that can’t be billed to
external force or object, resulting in involuntary injury to the   Medicare.
body which requires immediate treatment, but does not              Dependent child
include unforeseen conditions brought on by medical causes.        This is a child of the contributor or their partner who is:
Ambulance services                                                 • under the age of 21 and not married or living in a
Cover for transportation by ambulance which is necessary             de facto relationship
because, due to your medical condition, you can’t be
transported any other way. It includes the following               • aged 21–24, not married or living in a de facto relationship
circumstances:                                                       and studying full-time in a course approved by Medibank.
• when you need to be transported in an ambulance to a             Doctor
  hospital or other approved facility in order to receive          A registered medical practitioner including a specialist,
  immediate professional attention                                 surgeon or anaesthetist.

• when, as an admitted patient, you are transferred to             Endodontic services
                                                                   Treatment to save an infected or damaged tooth.
  another hospital (excluding transfers between public
                                                                   It involves removing the nerve and, where possible, restoring
  hospital facilities)
                                                                   the structure of the tooth. A common example
• when an ambulance is called to attend to you and you             of an endodontic treatment is a root canal.
  require immediate professional attention and transport           Excess
  by ambulance is not subsequently required                        An amount you pay towards your hospital treatment.
• air ambulance where pre-approval has been                        It only applies to some hospital covers or the hospital
                                                                   component of a cover. No excess applies to children
  obtained from Medibank.
                                                                   on your membership on any of our hospital covers.
Benefits for ambulance services are included in all covers         Excluded services
described in this brochure (other than Qld and Tas) except         This is a service for which no benefits are payable.
where you’re entitled to benefits from another source, such
as ambulance subscription or a state ambulance transport           External prostheses
scheme.                                                            These are manufactured items designed to replace external
                                                                   parts of the body such as an arm or leg.
Annual limit
An annual limit is the maximum amount of benefits payable          Federal Government’s Prostheses Schedule
for particular extras items or services within a calendar year.    This is a list issued by the Federal Government which sets out
Other restrictions may apply to the number of services you         the benefits payable to members of health funds with hospital
can claim in a particular period. Call us on 132 331 for more      cover for surgically implanted prostheses and other items.
information.                                                       Fixed benefit
Benefit                                                            You’ll receive a fixed benefit when you visit a non Members’
This is an amount of money we pay for an approved                  Choice provider. A fixed benefit is the maximum amount we’ll
health-related expense you’ve incurred. It can be paid             pay for each service or item (up to applicable limits). Usually
to you or on your behalf.                                          it will be less than the provider’s charge, which means you
                                                                   may have out-of-pocket expenses to pay.
Calendar year
A 12 month period commencing 1 January and ending                  Fund Rules
31 December.                                                       These are the rules of your Medibank membership including
                                                                   rules for the payment of benefits. Some of the more
Cardio-thoracic procedures                                         important Fund Rules are summarised in the Membership
Includes open heart and bypass surgery and invasive cardiac        Guide and Cover Summary that is sent to all new members.
investigations and procedures such as angiograms,                  You can view the Fund Rules at or at any of
angioplasties and stent insertions.                                our Medibank stores. All members are subject to the Fund
Condition                                                          Rules as varied from time to time.
A condition means any actual or perceived state of health for      General dental
which treatment is sought. It includes but is not limited to       This is routine dental work and includes things such as
states variously described as: abnormality, ailment,               check-ups, x-rays, scale and cleans, fillings and extractions.
disability, disease, disorder, health problem, illness,            It doesn’t include more complicated treatments or
impairment, impediment, infirmity, injury, malady, sickness        procedures such as orthodontic work, gum disease, root
or unwellness.                                                     canal treatment, crowns or bridges.

Health screening services                                         Pharmaceutical Benefits Scheme (PBS)
These are Medibank approved health screening services for         A Federal Government scheme which allows for many
the detection of an illness or condition and performed by a       pharmaceuticals to be supplied to Australian residents
Medicare registered provider, and where no Medicare benefit       at reduced or no cost.
is paid for that service. Services may include retinal scans,     Plastic and reconstructive surgery
bone density tests and MRIs.                                      A clinically necessary service listed in the Medicare Benefits
Health subscriptions                                              Schedule as plastic and reconstructive surgery that is
Medibank approved membership or subscription fees for             generally accepted by the medical profession as necessary
specified health bodies and associations. These may include       for the appropriate treatment of a patient.
Australian Crohns and Colitis Association, Brainlink, Coeliac     Prescription pharmaceuticals (non-PBS)
Society, Diabetes Australia and Registered Ostomy Association.    These are prescription-only items not covered by the
Home nursing                                                      Pharmaceutical Benefits Scheme. We’ll pay benefits
This is nursing care at home provided by a registered nursing     up to a set amount for each prescription item after a
agency. It does not include nursing care provided in a            set charge has been deducted. The set charge is
hospital or nursing home.                                         equivalent to the current PBS patient contribution. It’s
Hospital charges                                                  important to note that we don’t pay benefits for oral
These are amounts charged by a hospital for things like           contraceptives or for pharmaceutical prescriptions
accommodation and nursing care, theatre fees and surgically       prescribed for cosmetic purposes.
implanted prostheses. It does not include charges for extras      Provider
services, such as physiotherapy, or fees charged by your          A provider is any health or medical professional who provides
hospital doctor.                                                  you with a service and may include your doctor, dentist,
Included services                                                 anaesthetist or acupuncturist. It also includes people or
We pay benefits towards these services.                           organisations who provide you with health items or aids –
                                                                  things like hearing aids, mouthguards or nebulisers.
Laser eye surgery
The correction of vision where the procedure is performed         Recognised provider
by a registered ophthalmologist in the doctor’s surgery and       This is a provider approved by Medibank for the purpose of
where no Medicare benefit is payable.                             paying benefits. To check if a provider is recognised, please
                                                                  call us on 132 331.
Major dental
This is the more serious dental work including things             Restricted services
like restorative fillings, dentures, crowns, bridges,             These are services you receive lower benefits for than
and treatment for gum disease and root canals. It does not        included services in a private hospital. You’re likely to
include orthodontic treatment.                                    have significant out-of-pocket expenses if you receive these
                                                                  services in a private hospital.
Major eye surgery
This includes cornea and sclera transplants and                   Same day admission
cataract surgery.                                                 This is when you are admitted to a hospital or day hospital
                                                                  facility and discharged on the same day where the stay does
Medical costs                                                     not extend beyond midnight.
These are costs you incur in an overnight or day-hospital
facility for things such as doctors’ fees, blood tests, scans     Surgically implanted prosthesis
and x-rays.                                                       An approved manufactured item or piece of equipment that is
                                                                  surgically implanted or applied, generally during a hospital
Medicare Benefits Schedule (MBS)                                  surgical procedure to replace or assist a body part or
This schedule lists all the services for which Medicare pays      function. Examples include pacemakers, defibrillators,
benefits and the rules that apply to the payment of those         cardiac stents and joint replacements.
benefits. Each service has a fee that’s been set by the
Federal Government for the purpose of calculating the             Teeth whitening
Medicare benefit payable for that service (called the MBS fee).   This is bleaching of the teeth performed by a registered
                                                                  dental practitioner.
Obstetrics-related services
This includes all treatment specified in the Medicare Benefits    Ultra bonus
Schedule (MBS) as ‘obstetrics’ including antenatal and            If you have Ultra Health Cover, this is a bonus that is
post-natal care and the management of labour and delivery.        automatically applied towards eligible out-of-pocket costs
                                                                  incurred for in-hospital medical treatment and hospital
Orthodontic treatment                                             related costs. See page 20 for more information.
This involves the use of corrective appliances, such as
braces and plates, to bring the teeth and jaws into
proper alignment.
41                                                                                                                           41
Better health for all Australians

Medibank is well known as one of Australia’s
leading private health insurers. However,
over the past few years we’ve become much
more than simply an insurance provider.
In 2010, we launched a wide range of health services to companies,
government and members under our Medibank Health Solutions division.
We’re proud of our comprehensive network where:

• We employ over 1,500 clinical staff to deliver health services.
• We own and operate over 65 clinics across Australia that provide
  face-to-face injury prevention advice and injury management
  services, specialist clinical and rehabilitation services, and travel
  health advice (through the Travel Doctor-TMVC).
• We’ve become Australia’s largest provider of telephone-based health
  services giving expert advice about a range of health issues and ‘what
  to do next’, through healthdirect Australia and the NURSE-ON-CALL
  telephone service.
• We offer a range of betterhealth programs and advice designed to
  help our members maintain a healthy lifestyle, achieve their health
  goals and manage their health problems.
That’s why we believe our members are clearly better off with Medibank,
supporting them along the journey to better health.

                                                        Still can’
For more information
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call 132 331                                            posted we
visit a Medibank store
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Medibank also provides access to
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travel, pet and life insurance
                                                        Let’ aim
                                                        Talk soon

                      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.
Effective 1 January 2011.

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