Medibank Fund Guide

  • Medibank was founded as a government-owned entity but became a private company in 2014.
  • Medibank offers seven types of hospital cover, including ambulance only and accident only, and four types of extras cover.
  • Medibank also sells packaged cover that caters to people in different family stages, including young singles, couples, single parents, and growing families.

Medibank was established by the Australian government in 1976 as a not-for-profit health services provider. In 2009 it acquired ahm, and in that same year became a for-profit company. It was privatised in 2014.

Medibank currently provides health services to 3.7 million Australians across the country. In addition to health insurance, the company also provides travel, life, and pet insurance. It has been awarded ‘Outstanding Value Insurance’ from Canstar for ten consecutive years.

Source: https://www.medibank.com.au/annual-review/

Medibank makes it easy to shop for health cover by offering a range of categories. You can look for packaged hospital and extras cover according to your family type, or you can look for standalone types of cover that can be mixed and matched.

Many of the packages on offer are available across multiple family types, though accident cover is only offered to singles and couples.

Singles Cover and Couples Cover

Medibank offers 19 different options for individual or couples cover. Here are three examples:

  • Growing family core: Accidents, ambulance, tonsil removal, 100% claim back for kids
  • Growing family essentials plus: Give birth in a public hospital as a private patient, no hospital excess for kids
  • Settled families essentials: Heart services, orthodontics, 55% claim back on extras
Family Cover and Single Parents Cover

Medibank offers 13 cover options for families. Here are three examples:

  • Growing family complete: Obstetrics, 100% claim back for kids
  • Everyday starter: covers emergency ambulance, accidents, claim 60% back on extras

  • Everyday essentials: covers shoulder & knee reconstructions, claim 60% back on extras
  • Everyday comprehensive: covers heart services, claim 70% back on extras

Because Medibank allows customers to mix and match their levels of cover, there is a long list of policies available. We’ve broken the policies up by hospital and extras cover.

Hospital Cover

Medibank offers a range of hospital cover policies, starting from basic levels of cover and working up to top cover. The lower levels of cover offer a restricted number of services, while the top levels of cover include most, if not all, services covered by Medicare.

Ambulance Cover

Unlimited emergency ambulance cover across Australia. Not available to residents of Queensland and Tasmania as they are covered by the state.

Accident Cover

Cover for emergency accidents; for singles and couples only. Cannot be packaged with extras cover.

  • $500 hospital excess
  • Emergency ambulance to hospital
  • Benefits of top hospital cover if an accident occurs
Hospital Essentials

Cover for young, healthy people. For singles and couples only, can be combined with extras.

  • Accidents
  • Shoulder and knee reconstructions
  • No excess
  • Hernia surgery
  • Minor gynaecology
Core Hospital

Competitive cover for common services, excluding pregnancy. Can be packaged with extras.

  • Emergency ambulance
  • Colonoscopies
  • Tonsil removal
  • Choice of excess ($250 or $500)
  • No excess for kids on a family policy
Standard Hospital

Broader range of services than Core Hospital to better prepare for the unexpected.

  • Heart services
  • Unlimited emergency ambulance across Australia
Top Hospital Essentials

Wide-ranging level of cover excluding obstetrics and IVF services.

  • Joint replacements
  • Dental
  • Cataract surgery
Complete Hospital

Most comprehensive level of cover.

  • Obstetrics
  • IVF
  • Cover for all in-hospital procedures Medicare recognises
  • Choice of excess (None, $250, $500)
Extras Cover

Medibank offers four kinds of extras cover, most of which can be bundled with hospital cover.

Healthy Start Extras

Good for young, healthy people just getting started with health cover. For singles and couples only.

  • General and major dental
  • 100% back on optical at recognised providers up to your combined limit
  • Physio
  • Ambulance
  • 60% claim back
Basic Extras 70

Low-cost extras cover for common services.

  • Dental, optical, physio, chiro, and more
  • 70% claim back
Growing Families Extras Only

Extra cover for families planning more children. Can also be combined with core, standard, or complete hospital cover.

  • 100% claim back for kids
  • Antenatal classes and pregnancy compression garments
  • Choice of claim back (60% or 70%)
Top Extras

Highest level of extras cover available from Medibank.

  • Choice of claim back (55%, 70%, or 85%)
  • Major dental and orthodontics
  • Hearing aids

Medibank Policies

Singles and Couples Only
Accident Cover
Hospital Essentials
Healthy Start Extras

All Family Types
Core Hospital
Standard Hospital
Top Hospital Essentials
Complete Hospital
Basic Extras 70
Growing Families Extras Only
Top Extras

Medibank has a program in place to help reduce or eliminate out of pocket payments for members. Medibank bases its benefits for in-hospital services on the Medicare Benefits Schedule (MBS). Doctors can elect to charge fees that are higher than this schedule, meaning that patients owe out of pocket costs.

Medical professionals can choose to enter into a GapCover arrangement with Medibank to help lower costs for members. If so, they will either offer ‘no gap’ or ‘known gap’ options to members.

No Gap

If the medical provider agrees to charge no gap, then members pay no out of pocket costs.

Known Gap

If the medical provider agrees to charge a known gap, then members pay a reduced out of pocket cost.
The GapCover scheme does not cover diagnostic services like blood tests or x-rays.

Members’ Choice Network

Medibank has arrangements with Members’ Choice, one of Australia’s largest health provider networks. Members who choose to receive treatment and services from a Members’ Choice provider can get better value and expanded services.

Benefits include:

  • Free annual dental check up and clean
  • Capped prices
  • Flexible claim back of total cost, depending on cover

Use the Find a Provider section of the Medibank website to find network providers in your area.

Medibank offers a variety of member benefits, promotions, and discounts that can change over time.

For example, Medibank is offering to waive 2 and 6 month waits for extras services when you sign up for combined hospital and extras cover.

Medibank also has a mobile app, making it easy to manage your health cover wherever you are. Check your cover limits, update your personal details, or make a payment as needed.

Medibank Member Discounts

Medibank members can access discounts on certain products and services, including:

Medibank also offers free programs to members to help support and improve their health. These programs include:

  • Health Concierge Service: Extra support for members recovering from a hospital stay, including check-in calls and a 24/7 Health Advice Line.
  • CareComplete: For members with chronic health conditions, provides assistance with navigating the healthcare system and making lifestyle changes.
  • Live Better: Online resources for healthy recipes, wellbeing tips, and expert medical advice.

New members: 134 190
Existing members: 132 331
Website: medibank.com.au

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