Medibank Health Insurance Review
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Medibank, private health insurance, is one of Australia's largest private health funds, providing Hospital and Extras policies tailored to singles, couples and families. They serve over 3.7 million customers across Australia, and as of June 2019 own 26.9% of the health insurance market.
If you are considering private health insurance, Medibank may have an option that suits your requirements.
Medibank was launched in 1976 by the Australian government, making it one of the oldest health insurers in Australia. While it was originally a government-owned business, it was privatised in 2014 and today is a shareholder-owned company, operating on a for-profit basis.
Aside from offering their core private health insurance products, select Medibank policies also include a range of additional health services. These other services typically include mental health support, preventative care and better integrated primary care, as well as after-hours health support.
Australian Government reforms implemented since 1 April 2019
- Discounts for young Australians: 18 to 29-year-olds who takes out eligible Hospital cover can save up to 10% on their premiums.
- New Hospital categories: Medibank has simplified its product categories to make it easier for you to compare. You can now choose between Basic, Bronze, Silver or Gold Hospital plans.
- Choice of $750 excess: choosing a Hospital product with a higher excess may help you reduce your premiums
- Mental Health Waiver: Members with Restricted inpatient psychiatric services under their Hospital cover may now be able to upgrade and access higher mental health benefits without any additional waiting period. Generally, the Mental Health Waiver can only be used once in a member’s lifetime.
- Benefits for travel and accommodation: Included on some Medibank Hospital cover options, members in regional and rural areas, travelling more than 200km for hospital treatment might receive travel and accommodation benefits.
Health Cover Options
Medibank private insurance offers you the opportunity to choose Hospital only cover, Extras only or combine Hospital and Extras into a package that suits your specific stage of life.
Take note: Some Hospital plans must be taken with an Extras cover; and similarly, some Extras covers must be purchased with a Hospital Cover.
Medibank Hospital cover
Medibank’s Hospital policies help you cover the cost of treatments and services received inside the hospital. The benefit amount paid depends on your cover option: Basic, Bronze, Silver or Gold. The insurer also offers Plus options on their Hospital policies, which includes additional benefits on top of the minimal clinical categories set out by the Government.
You can generally select an Excess of $0, $250, $500 or $750 depending on the level of cover you choose. The higher your Excess, the lower your premium for Hospital cover will typically be. The Excess applies per member, per calendar year and usually excludes children, student or adult dependants on a family membership package.
Take note: Your out of pocket expenses will typically vary, depending on whether you visited a Medibank Members Choice Hospital, a Non-Member choice or a Public Hospital.
Basic Accident and Ambulance
This is Medibank’s most basic Hospital policy and generally the cheapest as it only covers you for accidents and is not available with Extras cover.
- Choice of Excess amount.
- Unlimited emergency ambulance services Australia-wide.
- Treatment for injuries sustained due to an accident.
- Rural and regional transport and accommodation support.
Restricted Service for the following:
- Hospital psychiatric services.
- Palliative care.
For an extra fee, you can upgrade to the Basic Plus Healthy Start option, which additionally includes benefits for hernia and appendix treatment, joint reconstruction surgery and dental surgery.
The Bronze Hospital policy includes a wide range of services tailored toward the young and healthy. Includes everything listed in the Bronze option, as well as:
- No Excess for kids on a family membership.
- Investigation and treatment of bone, joint and muscle.
- Brain and nervous system investigations and treatments.
- Medically necessary breast surgery.
- Chemotherapy, radiotherapy and immunotherapy for cancer.
- Diabetes management (excluding insulin pumps).
- Digestive system investigation and treatment, including the stomach, pancreas, spleen and bowel.
- Ear, nose and throat, for example, damaged eardrum and sinus surgery.
- Treatment of the eye (not cataracts).
- Gastrointestinal endoscopy.
- Gynaecology, for example, polycystic ovaries and endometriosis.
- Hernia and appendix.
- Kidney and bladder, for example, kidney stones.
- Male reproductive system, including the prostate.
- Miscarriage and termination of pregnancy.
- Pain management, for example, nerve and chest pain due to cancer.
- Skin, including the removal of foreign bodies.
- Treatment and removal of tonsils, adenoids and grommets.
For a slightly higher monthly premium, you can buy the Bronze Plus Progress which adds full coverage for Palliative care, as well as providing benefits for blood and blood-related conditions, dental surgery, implantation of hearing devices, insulin pumps and treatments and investigation of sleep patterns and anomalies.
A more inclusive policy that provides benefits for everything listed in the Bronze Plus policy, including coverage for:
- Lung and chest, for example, lung cancer, respiratory disorders such as asthma, pneumonia, or trauma to the chest.
- Podiatric surgery includes some coverage of a prosthesis.
- Back, neck and spine
- The investigation and treatment of blood and blood-related conditions.
- Dental surgery for teeth and gums, for example, wisdom teeth removal.
- Heart and vascular system.
- Implantation of hearing devices, including the implantation of a prosthetic hearing device.
- Medically necessary plastic and reconstructive surgery.
For a slightly higher premium, you can upgrade to Medibank Silver Plus Assured. This option includes full cover for palliative care, sleep studies and rehabilitation.
Gold Complete Hospital cover
Medibank’s Gold Complete hospital policy is their most comprehensive options that include:
- Assisted reproductive services, for example, IVF.
- Surgery to remove cataracts.
- Surgical implantation, replacement or management of a pain management device.
- Insulin pumps, provision and replacement.
- Dialysis for chronic kidney failure.
- Joint replacements and removal of prostheses.
- Pregnancy and birth-related services.
- Sleep studies, for the investigation of sleep patterns and anomalies.
- Weight loss surgery, for example, gastric banding, gastric bypass and sleeve gastrectomy.
Source: Medibank’s website (27 September 2019).
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Extras cover general treatments received outside of the hospital, such as dental, physio, and optical. The amount you can claim back depends on the level of cover you have, along with your annual limit. Medibank Extras starts at the most affordable Healthy Start Extras option and goes up to the most comprehensive option, the Medibank Top Extras policy.
Generally, all Medibank Extras include:
- 100% back on up to 2 dental check-ups every year (including bitewing x-rays) at any Members’ Choice Advantage dentist, OR
- 100% back on an annual dental check-up and cleanings at any Members' Choice dentist, on top of your yearly dental limit (excludes x-rays).
- 100% back on optical at all recognised providers.
Healthy Start Extras
Claim up to 60% back at Member’s Choice providers, up to your annual limit.
This policy is generally for the young and healthy Australian, looking for basic Extras cover. It gives you the option to use a $500 combined limit on popular Extras services such as physio, psychology and chiropractic. Meaning, you can choose the services you feel is most suited to your needs.
With Essential Extras, you can claim 70% back on Member's Choice providers, up to the annual limit.
Includes more general services than the Healthy Start option to support you in looking after your day-to-day health. You can claim benefits for general dental, optical, physiotherapy, chiropractic, remedial massage and natural therapies.
Growing Family Extras Only
Choice of 60% or 70% claim back on benefits such as general and major dental, orthodontics, optical, and physiotherapy. There's also a combined limit for speech therapy, psychology, and health appliances.
This Extras plan is generally more suited toward new and growing families as it includes cover for antenatal classes and pregnancy compression garments, as well as membership to the Australian Breastfeeding Association.
Take note: Growing Family Extras option is only available with Bronze Plus Progress, Silver Plus Assured, or Gold Complete Hospital policies or as an Extras only cover
You can claim back 55%, 70% or 85% on Extras benefits. Generally, the higher your claim back percentage, the more expensive your policy.
Medibank Top Extras is the highest level of Extras cover and includes everything listed in the Growing Family policy, but with higher benefit limits and less combined limit. You'll also be able to claim for hearing aids, non-PBS pharmaceuticals, occupational therapy and eye therapy.
Important: Please consult Medibank’s Private Health Information Statement for a complete list of benefits and their terms and conditions. You might also want to compare their offerings with other major health insurance brands in Australia.
What are the waiting periods for treatment and services?
- Psychology: 0 days
- Private room: 0 days
- Transport and accommodation of rural and regional: 0 days
- Ambulance services: 1 day
- Optical: 6 months
- Major dental: 12 months
- Pre-existing conditions: 12 months
- Birth and pregnancy-related services: 12 months
- Blood glucose monitors: 24 months
- Hearing aids and laser eye surgery: 36 months
- All other services: 2 months. For example, palliative care, rehabilitation, general dental, remedial massage and physiotherapy.
Take note: the 12-month pre-existing condition waiting period does not apply to hospital or hospital substitute treatment for psychiatric treatment, rehabilitation treatment or palliative care.
How do you make a Medibank claim?
In-hospital claims will be billed directly to the insurer if your Doctors participate in Medibank Gap cover. If they do not participate in gap cover, you'll be billed directly. Whatever Medicare doesn't cover can be mailed to the insurer. Remember to include the Medicare Statement of Benefits, copies of any receipts and your completed claim form.
Extras claims can be made online via the insurer’s website or by using the Medibank App. Simply register online and use your Medibank login. Medibank then pays the applicable benefits directly into your bank account or sends a cheque via mail.
Alternatively, you can mail your completed claim forms and receipts to Medibank; this might be required when claiming for ambulance services, Gap cover accommodation and natural therapies.
Frequently asked questions and answers
Contact them via the Medibank health Insurance Website or call 134 190 if you’re a new member. For existing member queries call 132 331.
Medibank health insurance has entered into agreements with most private hospitals in Australia and several Extras providers. These agreement providers make up the Medibank Members Choice Network. When you visit a Members' Choice provider, it means you may be able to access services at a capped fee and/or receive higher benefits. To find a Members’ Choice provider close to you visit the Medibank website.
To change from your current provider to Medibank, you first need to choose the Medibank health cover option that meets your requirements and budget. After that, apply online, or call Medibank directly. Remember to contact your previous insurer and cancel your cover.
Yes, if you notify Medibank that you want to cancel your policy within 30 days after joining, any premiums you've paid will generally be refunded in full. However, this is only the case when no claims have been made.
No. While, Medibank was established by the Australian Government in 1976 as a not-for-profit private health insurer, it was privatised in 2014 and has become one of the largest for-profit private health insurance funds in Australia.
Yes, Medibank policies generally cover you for emergencies and medically necessary ambulance services on both Hospital and Extras policies. However, there are instances when benefits are not payable, for example, when your state or territory covers ambulance services or when transported from one public hospital to another.
Take note: Medibank does offer stand-alone Ambulance cover to members living in states and territories that does not provide full ambulance services.
You can pay your Medibank health insurance premiums online using Post Billpay. You will need a credit card to pay your insurance online.
Medibank health insurance members can save up to 25% on the cost of each gym visit when using the GymBeter app. Participating gyms include Good Health Clubs, Fernwood Fitness and YMCA.
Medibank offers private health insurance to overseas students, helping them cover expensive health services. Services generally covered include emergency ambulance trips and specific treatments in a private hospital. Please visit Medibank Overseas Student Health Cover (OSHC) for more information.
Medicare prescribes set rates for specific procedures and services on the Medicare Benefits Schedule (MBS). Your Medibank policy generally pays out according to the listed MBS fees. The 'gap' is the difference between the fees charged by your medical provider and the MBS. Medibank's gap cover pays out the difference to limit your out-of-pocket expenses.
Medibank generally pays benefits to Medibank health members towards in-hospital medical services as set out by Medicare’s MBS. These services typically include diagnostic services such as blood tests. However, blood tests done outside of the hospital is typically not covered.
It may be possible to suspend your Medibank membership for a predetermined time if you are experiencing financial difficulties or travelling overseas. You generally can’t make claims during this time, but you will also not be held liable to pay premiums for the agreed suspension time and can continue cover after the specified period.
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