COVER SUMMARY
TOP HOSPITAL
This provides an important summary of your cover and we recommend that you read and retain it.
You can find out more about your membership by referring to the Member Guide, which is a summary
of our Fund Rules and terms and conditions, or by calling us on 132 331.
Hospital cover
Hospital cover provides benefits when you are treated as a private patient admitted to hospital. This means any related services that
are provided when you’re not admitted (eg. GP or specialist visits) are not included under this cover.
Here are the services that are Included under your hospital cover. Before booking treatment, you should call
us to ask about the benefits you can expect to receive and any out-of-pocket expenses you might incur.
Services and Treatments
Included
What does it mean?
Ambulance services+
✔
Included service:
Appendicitis treatment
✔
Removal of appendix
✔
Removal of tonsils and adenoids
✔
We pay benefits towards overnight and same day
hospital accommodation, intensive care and medical
services where a Medicare benefit is payable.
Knee reconstruction surgery and investigations
✔
Shoulder reconstruction surgery and investigations
✔
Surgical removal of wisdom teeth
(hospital charges only)
✔
Palliative care
✔
Rehabilitation treatment
✔
Psychiatric treatment
✔
Colonoscopies
✔
Heart-related admissions
✔
Plastic and reconstructive surgery
✔
Hip and knee joint replacement surgery
✔
All other joint replacement surgery
✔
Major eye surgery
(including cataract and other lens-related services)
✔
Renal dialysis
✔
Surgery for slipped disc and scoliosis
✔
Spinal fusion surgery
✔
Cancer treatment*
✔
Weight loss surgery
✔
All other MBS items (includes thousands of additional
in-hospital services)
✔
Obstetrics-related services (eg. pregnancy)
✔
Fertility treatment (including IVF and GIFT programs)
✔
It’s important to know that if you are treated in a
non-Members’ Choice hospital, the benefits we pay
are generally lower than for a Members’ Choice hospital
and you may incur significant out-of-pocket expenses.
Members’ Choice providers are not available in all areas.
Where you are treated as a private patient in a public
hospital, we’ll pay benefits towards overnight and
same day accommodation in a shared room.
Please be aware that cosmetic treatment is an
Excluded service on all Medibank covers.
100% for eligible services where immediate professional attention is
required. QLD and TAS residents are covered by their state schemes.
+
(Refer to the Member Guide for information.)
*Your hospital cover does not include non-PBS drugs.
Cover Summary Top Hospital | 1
Waiting periods
A waiting period is a period of time you need to wait after taking out your cover before you’re entitled to receive benefits for services
or items covered. You’re not able to receive benefits for any items or services you might have obtained while you are serving a
waiting period or before you joined Medibank.
Accident Waiting Period Waiver
The 2 month hospital treatment waiting periods are waived for injuries sustained in an accident after joining this cover.
Waiting Periods
2 months
Psychiatric treatment, rehabilitation treatment, palliative care and ambulance services+.
Hospital treatment for conditions requiring hospitalisation that are not deemed pre-existing conditions.
Pre-existing conditions
12 months
A pre-existing condition is an ailment, illness or condition that in the opinion of a Medical Practitioner appointed by
Medibank, the signs or symptoms of which existed at any time in the period of six months before you either took out
your new cover, or transferred to a higher level of cover.
Obstetrics-related services.
CPAP-type devices.
Excess
An excess is an amount you must contribute towards your same
day or overnight hospital treatment and is deducted from the
benefits we pay. Some hospitals may require you to pay the excess
at the time of admission. It is payable per member per calendar year.
The excess does not apply to children on family memberships.
This means any child, student or adult dependant will not have
to pay the excess if they’re admitted to hospital.
The following
excesses
are available
on this cover
$500
$250
$0
Other features and benefits
GapCover available for eligible medical services
Medibank’s GapCover is a way to eliminate or reduce your out-of-pocket expenses for in-hospital doctor’s charges. Check with your
doctor if they will participate in Medibank’s GapCover. Find out more at medibank.com.au
Choice of treating doctor or specialist
You can choose your doctor or specialist when you’re treated in hospital as a private patient
Surgically implanted prostheses
For an Included service, we’ll pay the minimum benefit as listed in the Australian Government’s Prostheses List
CPAP-type devices
Up to $500 benefit per member every 5 years towards the hire or purchase of an approved device
Mi Health services
As part of your hospital cover, you have access to the Mi Health range of support services including:
•24/7 Health Advice Line – Medibank nurses can answer any health question, call 1800 Mi Health (1800 644 325)
•Mobile Health Apps – to help you make healthier decisions on the go, visit medibank.com.au/mihealth for more information
How to find out more
Health insurance can be complicated, that’s why we’ve prepared a glossary of useful terms that you can access online
at medibank.com.au/health-insurance/glossary
This information is current as at 30 September 2016 and subject to change from time to time. If you’d like to change your cover, please contact us on 132 331.
Membership of Medibank Private is subject to our Fund Rules and policies which are summarised in our Member Guide.
Medibank Private Limited ABN 47 080 890 259
CS0001
Cover Summary Top Hospital | 2