Things worth knowing
Understanding private health insurance can be complicated, so we’ve created this section to help make things a little easier. It contains some important information about our covers along with explanations of commonly-used terms you might not be familiar with.
Helping you choose the right cover
Is this cover right for me?
Medibank Visitors Covers are designed for visitors, temporary residents, residents of Norfolk Island and other residents in Australia who are not eligible for full Medicare entitlements. Medibank Working Visitors Covers are designed for visitors who are in Australia for business purposes or are sponsored by an employer and are not eligible for full Medicare entitlements.
How often should I review my cover?
You may have different health cover needs at different stages of your life, so it makes sense to review your health cover regularly. This is especially important if your situation changes, e.g. if you are granted permanent residency, if you’re planning to start a family, the kids are leaving home or either you or someone in your family has developed a health issue. Whatever your situation, it’s a good idea to call us to discuss your options on 132 331.
Reciprocal Health Care Agreements
Australia has Reciprocal Health Care Agreements with the United Kingdom, New Zealand, Italy, Malta, the Netherlands, Sweden, Finland, Norway and the Republic of Ireland. If you’re a resident of a country which has a Reciprocal Health Care Agreement with Australia, you’re entitled to restricted access to Medicare, but only for medically necessary treatment. Post-arrival time limits and other restrictions may apply, so be sure to check what you’re covered for before relying on a Reciprocal Health Care Agreement.
What if I’m an international student?
If you’re an international student with a valid student visa, our Visitors Covers and Working Visitors Covers will not meet your student visa requirements. We recommend you purchase Medibank Overseas Student Health Cover (OSHC) which is specifically designed with the needs and budgets of students in mind. You can purchase your OSHC online or call us on 132 331.
What if I’m on a working visa?
If you’re in Australia on a working visa, our Visitors Covers may not meet any visa requirements you might have. We recommend you purchase one of our Working
Visitors Covers which meet the Australian Government 457 visa requirements. You can purchase Working Visitors covers online
What happens if I become a permanent resident?
If you are granted permanent residency our Visitors Covers or Working Visitors Covers may not be the most suitable cover for your needs. When your residency status changes remember to call us on 132 331 to discuss your options.
About your membership with us
Do you have a ‘cooling-off’ period?
If you join but then decide you’d like to either cancel your membership or move to another cover, we have what is known as a ‘cooling-off’ period. This also applies if you’re already a member and have recently changed your cover. As long as you tell us within 30 days of joining or changing your cover, there’s no problem. We can either transfer you to a more suitable cover or refund your premium in full as long as no claims have been made against your policy. If you close your membership after the cooling-off period we will refund any unused premium less an administration fee.
What’s the difference between a member and a contributor?
There are three terms we use when we’re talking about membership: member, membership and contributor. As a starting point, it’s good to be clear on all three. A member is simply any person covered under a Medibank membership.
A membership is made up of one or more members. It can consist of just one person (yourself), or more than one person (yourself, your partner and/or your children).
The term contributor refers to the person who ‘owns’ the membership. This is the person we contact when we need to communicate important information or confirm any changes to the membership that might have been requested.
Can my partner manage my membership too?
Although you as the contributor ‘own’ the membership, your partner can automatically manage most aspects of the membership too, including: making claims and receiving benefits, adding or removing dependants, changing cover, suspending the membership and changing contact and bank account details. However, as the contributor you’re the only one who can remove yourself from the membership or cancel the membership. It’s important to be aware that this means we may disclose registered membership details to both of you. If at any time you want to be the only person who can manage the membership or you require further information about the handling of personal information, please call us on 132 331.
If I transfer to Medibank from another health insurer, am I covered immediately?
You’ll be covered for services on your new cover from the date you join if: those services were also included on your cover with your old health insurer, you join us within two months of leaving your former health insurer and you’ve already served the applicable waiting periods. So although we’ll recognise how long you served a waiting period with your old health insurer, if you haven’t fully served the applicable waiting periods with your former health insurer, you’ll need to serve the balance of these waiting periods with us before you’re eligible for benefits. Additional waiting periods may also apply if you’ve switched to a higher level of cover with Medibank. For more information see ‘About waiting periods’
What if I want to add my partner to my single membership?
It’s easy to change from a single to a couple membership for our Working Visitors Covers, or from a single to a family membership for our Visitors Covers, but you should be aware that higher premiums apply and waiting periods may apply to your partner.
Can I add a dependent child to my membership?
If you’re on a single or couple membership:
To add a dependent child to your membership you’ll need to change from a single or couple* to a family membership. If you do this within two months of the date of their birth or date of inclusion in your family unit (for example, through marriage, adoption or fostering) your child won’t have to serve any additional waiting periods. However the change will be backdated to the date of birth or inclusion in your family unit. Also, this change of membership means you’ll pay higher premiums.
*Only Working Visitors Covers have the option of a couple membership.
If you’re on a family membership:
You can add a dependent child to your membership at any time and they won’t need to serve any waiting periods already served on the membership. Your premium doesn’t increase when you add a dependent child to your cover.
What if I want more information on adding a dependent child?
Call us on 132 331.
What happens if my newborn baby needs hospital treatment?
When a newborn baby is in hospital with its mother, no accommodation charges apply for the baby unless the baby becomes an admitted patient in their own right.
This happens when the baby requires admission to a neo-natal intensive care unit or it is the second or later child of a multiple birth. See above for when you should add your baby to your membership.
If I have children, how long can they be insured on my cover?
As your little ones are getting bigger they can still be covered at no additional cost on your family membership until they turn 21 or, if they are full-time students, until they turn 25, provided they’re not married or in a de facto relationship. This is because we consider them to be your dependent children.
About benefits for pharmaceuticals
Visitors Cover
Visitors to Australia are generally ineligible for benefits under the Pharmaceutical Benefits Scheme (PBS), so you may have significant out-of-pocket expenses.
Benefits are not payable for oral contraceptives or for pharmaceuticals prescribed for cosmetic purposes.
Working Visitors Covers
International visitors to Australia are generally not eligible for subsidised pharmaceuticals under the Pharmaceutical Benefits Scheme (PBS).
With our Working Visitors Covers, Medibank will pay some benefits towards PBS listed drugs, prescribed according to PBS-approved indications, that are administered during and form part of your admitted episode of care (including drugs prescribed upon discharge). Your benefit is equal to the PBS government subsidy in excess of your patient contribution.
Pharmaceuticals used in oncology (cancer) and other treatments can be very expensive for people who do not have access to subsidised pharmaceuticals under the PBS. If high cost pharmaceuticals are required for your treatment when in hospital, you may incur significant
out-of-pocket expenses.
No benefits are payable for oral contraceptives, or for pharmaceuticals prescribed for cosmetic purposes.
For more information on the PBS, visit health.gov.au
About waiting periods
What is a waiting period?
All health funds have waiting periods. In short, a waiting period is a period of time you need to wait after taking out your cover before you can 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’re serving a waiting period or before you joined Medibank.
How do I know if a waiting period applies to me?
Waiting periods may apply if: you’re a new member, you’re rejoining Medibank after not having health cover for some time or you’re changing to a higher level of cover (either within Medibank or transferring from another fund).
If you’re changing to a higher level of cover, you’ll still be entitled to benefits at the level of your former cover while you’re serving any waiting periods on your new cover if:
- those services were included under your old cover; and
- you’ve already served the waiting periods that applied under your old cover.
Also any excess with your former cover will transfer across with you until you’ve served your waiting periods with us.
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.
| Waiting periods for Young Visitors Health Insurance, Intermediate Visitors Health Insurance and Top Visitors Health Insurance |
| 2 months* |
All services except as specified below: |
| 6 months |
Optical items |
| 12 months |
- Pre-existing aliments
- Obstetrics-related services
- Major dental services
- Endodontic services (e.g. root canal)
- Dental surgical procedures and surgical extractions (e.g. wisdom teeth extraction)
- Nebulisers
- Peak flow meters
- Spacing devices
|
| 24 months |
Blood glucose monitors |
| 36 months |
Hearing aids |
| Waiting periods for Working Visa Hospital Insurance, Working Visa Hospital and Medical Insurance and Top Working Visa Health Insurance |
| 2 months* |
- In-hospital psychiatric treatment, rehabilitation treatment and palliative care, regardless of whether or not the condition is pre-existing
- All extras services except as specified below.
|
| 6 months |
Optical items |
| 12 months |
- Pre-existing aliments
- Obstetrics-related services
- Major dental services
- Endodontic services (e.g. root canal)
- Dental surgical procedures and surgical extractions (e.g. wisdom teeth)
- Nebulisers
- Peak flow meters
- Spacing devices
|
| 24 months |
Blood glucose monitors |
| 36 months |
Hearing aids |
* If you have an accident (excluding a school accident) after joining us or changing cover and require treatment, we’ll waive the 2 month waiting period.
About pre-existing ailments
It’s standard practice in the private health insurance industry to apply a waiting period of 12 months before benefits are payable for a pre-existing ailment.
What’s a pre-existing ailment?
By pre-existing ailment, we mean an ailment, illness or condition where signs or symptoms existed at any time during the six months before you either took out your new cover, or transferred to a higher level of cover.
We’ll appoint a medical or health practitioner to determine whether you have a pre-existing ailment, based on information provided by the practitioner(s) treating you.
What if I have a pre-existing ailment?
If you’re a new member, you’ll have to wait 12 months before you can receive benefits for items or services related to your pre-existing ailment.
If you’re changing to a higher level of cover (either within Medibank or from another fund), you’ll have to wait 12 months to receive the higher benefits, including benefits for services not previously covered.
About extras limits
This section is only relevant to the covers that include an extras component.
What are annual limits and sub-limits?
An annual limit is the maximum amount of money you can get back each calendar year for the services or items within a particular extras category. Examples of extras categories are general dental, physiotherapy, health appliances and alternative therapies.
Within these categories there may be sub-limits that restrict the amount you can claim for specific services and items in a calendar year (or other applicable period).
Once you’ve reached your annual limits or sub-limits for an extras category or item you’ll have to wait until the next calendar year (or other applicable period) before you can claim on these services or items again.
For example, if you have Top Visitors Health Insurance and have both glasses and contact lenses, the most you can claim for items listed under optical items is $250 a year (annual limit). But of that $250, the maximum you can claim for contact lenses is $200 a year (sub-limit) leaving you $50 available for other items.
It’s also important to be aware that the benefits we pay for a particular claim are likely to be less than the annual limit or sub-limit and less than your provider’s charge.
About benefit replacement periods
What’s a benefit replacement period?
It’s a period of time you need to wait after purchasing an item covered by us before you can receive further benefits to replace the item. For example, if you received benefits for an insulin delivery pen, purchased on 1 July 2008, you can only receive benefits for another one purchased on or after 1 July 2010.
How long is a benefit replacement period?
This varies from item to item and generally applies per member unless specified in the table below.
| Benefit replacement period |
| 12 months |
- External mammary prostheses
- Repair of external prostheses and health appliances
|
| 2 years |
- Wigs
- Hip protectors
- Insulin delivery pens
|
| 3 years |
- Blood glucose monitors
- Breathing appliances
- - nebulisers
- - peak flow meters (per membership)
- - spacing devices
- Mouthguards (for members up to 18 years of age a benefit may be payable for a replacement mouthguard each calendar year)
- Dentures, crowns and bridges
- Other health appliances and external prosthesis
|
| 5 years |
- Hearing aids
- Sleep apnoea – continuous pressure devices and other approved sleep apnoea appliances. (Not available under Young Visitors Health Insurance, Working Visa Hospital Insurance and Working Visa Hospital and Medical Insurance)
|
Other rules for paying benefits
Are there any other rules I need to know about?
Yes, here are some other important rules for you to be aware of:
- We only pay benefits for items and services delivered by Medibank-recognised providers
- Some appliances may need to be ordered by a medical practitioner before benefits are payable e.g. a blood glucose monitor
- To claim for a Sleep Apnoea device or similar device approved by Medibank firstly, you’ll need Intermediate Visitors Health Insurance, Top Visitors Health Insurance, or Top Working Visa Health Insurance. You’ll also need to undergo an overnight investigation for Sleep Apnoea which is listed in the Medicare Benefits Schedule. Lastly, the device must be requested by a medical practitioner and purchased or hired within 12 months of undergoing the investigation. No benefits are payable if the sleep study is performed at home
- Limitations apply to some benefits e.g. for an initial consultation for an extras service, we generally pay the higher benefit (if any) only once in a course of treatment
- Limited hospital benefits apply to podiatric surgery (performed by an accredited podiatrist) and dental procedures that are performed in a private non-Members’ Choice hospital
- If you no longer need acute care and stay in hospital for more than 35 days you’ll be classified as a nursing home type patient. If this happens, we’ll only pay a small portion of the hospital charges and you may need to pay the rest of the cost of your care. If you’re in a private hospital, these costs may be substantial.
- We don’t pay benefits for services or treatments where you are, or may be, entitled to compensation and/or damages e.g. State Government workers’ compensation schemes, traffic accident schemes or public liability claims
- We generally don’t pay benefits for hospital procedures not recognised for Medicare benefit purposes such as cosmetic surgery
- Benefits are not payable for treatment not considered medically necessary (e.g. health screening services as required for employment or visa renewal purposes)
- Benefits are not payable for treatment arranged prior to arrival in Australia
- Benefits are not payable for services provided outside of Australia.
It’s important you call us on 132 331 for information on recognised providers and the benefits you’re entitled to before commencing treatment.
About out-of-pocket expenses
What’s an out-of-pocket expense?
It’s any expense for a hospital, medical or extras service or item for which you won’t be reimbursed by us. Having private health insurance helps reduce your out-of-pockets, but you may still have to pay for some things ‘out of your own pocket’.
What out-of-pocket expenses can I expect if I receive an extras service and how can I reduce them?
The out-of-pocket expense will be the difference between the provider’s charge and the benefit we pay. To reduce your out-of-pocket expenses, visit a Members’ Choice provider where you can access capped fees and discounts and generally receive higher benefits than you would with a non-Members’ Choice provider.
What kinds of out-of-pocket expenses can I expect if I go to a private hospital?
Although hospital cover helps reduce the cost of your hospital visit, you’ll still have out-of-pocket expenses for things like your excess and any difference between what the hospital charges and the benefit we pay for the hospital services.
You can also expect to pay the difference between the charge for in-hospital medical services (e.g. doctors’ services, pathology and radiology) and what you receive from us. To explain it further, the benefits you’re entitled to for the medical services you receive while you’re in an overnight hospital or day hospital facility are based on the Medicare Benefits Schedule (MBS) fee. The MBS is a list of all the services Medicare pays benefits for and the rules that apply to payment of those benefits.
If you visit a doctor and they charge you more than the MBS fee, you may have out-of-pocket expenses. These can vary and may be significant, especially for doctors’ visits in hospital.
Is there any way I can reduce my private hospital out-of-pockets?
If possible, go to a Members’ Choice hospital where our agreement limits what you can be charged. This means your out-of-pockets for hospital charges should be limited to things like:
- Any excess you may have with your cover
- Any difference between your doctors’ charges (including pathology and radiology fees) and the benefits we pay you
- Any difference between the amounts you are charged for pharmaceuticals (including drugs issued on discharge from hospital) that are not covered by our agreement with the hospital and the benefits available to you under the extras component of your cover for pharmaceutical prescriptions (if your cover includes extras)
- Any gap for surgically implanted prostheses and other items on the Federal Government’s Prostheses Schedule
- Costs for services not covered, or fully covered, by our agreement with the hospital or under your cover
- Costs for treatment in an emergency department in a private hospital.
If you go to a non-Members’ Choice private hospital, you’re likely to have significant out-of-pocket expenses.
About ambulance transport
How do I know if I’m covered for ambulance transport?
Benefits for medically necessary ambulance transport are included in all Visitors Covers and Working Visitors Covers except where you’re entitled to benefits from another source, such as ambulance subscription or a state ambulance transport scheme.
About my premiums
If I cancel my membership, will I get a refund?
If you need to cancel your membership before you arrive in Australia, you may apply to claim a refund of premiums paid in advance. To obtain a refund you must apply in writing to Medibank and provide proof of your circumstances e.g. a letter from an Australian Embassy advising that your visa to Australia has not been approved, or a receipt for the cancellation of your airfare to Australia. We will apply an administration fee for each application and refund the balance.
Are pre-paid premiums protected from rate increases?
Where premiums have been paid in advance of the rate increase, the new rates will apply from your next payment. However, if you change the level of your cover or membership category, the new rates will apply from the date of the change.
About taxation
If you’re an Australian resident for taxation purposes, including a resident of a country which has a Reciprocal Health Care Agreement with Australia, you may be required to pay the Medicare Levy and the Medicare Levy Surcharge (MLS). The Medicare Levy is imposed by the Australian Government to fund the Medicare scheme. It is normally calculated at 1.5% of your annual taxable income, but this rate may vary depending on your circumstances.
The Medicare Levy Surcharge is a 1% surcharge imposed on individuals and families whose annual taxable income is over the applicable threshold and who do not have an appropriate level of hospital cover for themselves and all of their dependants.
The 1% surcharge applies proportionately for the period during the financial year when an appropriate level of hospital cover was not held.
None of the Visitors Covers or Working Visitors Covers will exempt you from the Medicare Levy Surcharge.
For more information on the MLS and to find out the current thresholds please contact the Australian Taxation Office on 132 861, or visit ato.gov.au
About Goods and Services Tax
Our Visitors Covers and Working Visitors Covers are subject to a Goods and Services Tax (GST), which is included in the premium you pay. Under Medibank’s Fund Rules, if you’re on any of our Visitors Covers or Working Visitors Covers it is assumed you have no entitlement to claim any part of the GST as an input tax credit. If you’re eligible and intend to claim back part or all of the GST you must notify us in writing.
Other important information
What’s the best way for me to give feedback on your products and services?
If you have any feedback on our products and services, or you’d like further explanation on anything to do with your membership, please contact us:
- Call 132 331
- Email ask_us@medibank.com.au
- Visit any of our Medibank stores
- Write to us at Medibank GPO Box 9999 in your capital city.
What if I have a complaint?
We’ll try to resolve any complaint you may have the first time you raise it with us – please contact us with any issues through the contact points listed above. If you 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 Medibank, GPO Box 9999, Melbourne, VIC 3000.
Free, independent advice is also available from the Private Health Insurance Ombudsman on 1800 640 695.
Private Patients’ Hospital Charter
Prepared by the Federal Government, this booklet is designed to advise you on what you can expect from your health fund, doctors and hospitals as a patient with hospital cover. A copy is available from any Medibank store.
Disclaimer
- Medibank encourages providers to offer high-quality products and services at competitive prices to its members.
- Where Medibank recognises a provider, advertises on behalf of a provider, or appears by reference of logo or otherwise in an advertisement of any provider, to the fullest extent allowed by the law, such advertising or reference should not be construed as:
a) an endorsement;
b) an acknowledgment or representation as to fitness for purpose; or
c) a recommendation or warranty of, for, or in relation to, the product and/or service of the provider.
Accordingly, Medibank 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.