healthslips.com.au Policy Information

Medibank Private Limited

Medibank Gold Advantage $250 Excess

$834.70 / month

(Before Rebate, Discount & Loading)

Available in SA

You may be entitled to an Australian Government Rebate on the above premium. Your premium may also include a Lifetime Health Cover Loading, an Age-based Discount or an insurer discount. Check with your insurer for details.

This policy covers: One adult & dependants, including non-student dependants (2 or more people, only one of whom is an adult).

Children (0 - 17), non-classified* dependant (18 - 20), students (21 - 30) and non-students (21 to 30), as well as persons with a disability who qualify as a child, non-classified* dependant, student and non-student in these age ranges. *Non-classified dependant: Medibank considers a child dependant to be aged up to 21.

Policy ID: MBP/J136/SQSR1Y

Source: Private Health Information Statement (PHIS)

Hospital Cover

  • This policy exempts you from the Medicare Levy Surcharge.
  • This policy provides accident cover - check with insurer for details.
  • This policy provides benefits for travel or accommodation outside of hospital - check with insurer for details.
Covered
Restricted Cover
Not Covered
This policy includes cover for
Assisted reproductive services
Back, neck and spine
Blood
Bone, joint and muscle
Brain and nervous system
Breast surgery (medically necessary)
Cataracts
Chemotherapy, radiotherapy and immunotherapy for cancer
Dental surgery
Diabetes management (excluding insulin pumps)
Dialysis for chronic kidney failure
Digestive system
Ear, nose and throat
Eye (not cataracts)
Gastrointestinal endoscopy
Gynaecology
Heart and vascular system
Hernia and appendix
Hospital psychiatric services
Implantation of hearing devices
Insulin pumps
Joint reconstructions
Joint replacements
Kidney and bladder
Lung and chest
Male reproductive system
Miscarriage and termination of pregnancy
Pain management
Pain management with device
Palliative care
Plastic and reconstructive surgery (medically necessary)
Podiatric surgery (provided by a registered podiatric surgeon)
Pregnancy and birth
Rehabilitation
Skin
Sleep studies
Tonsils, adenoids and grommets
Weight loss surgery

The benefits paid for hospital treatment will depend on the type of cover you purchase and whether your fund has an agreement in place with the hospital in which you are treated. See ‘Agreement Hospitals’ on privatehealth.gov.au for which hospitals have arrangements with your insurer – https://privatehealth.gov.au/dynamic/agreementhospitals.

Under this policy, you may have to pay out-of-pocket costs above what you get from Medicare or your private health insurer. Before you go to hospital, you should ask your doctors, hospital and health insurer about any out-of-pocket costs that may apply to you.

The following payments may also apply for hospital admissions

Excess: You will have to pay an excess on admission. This is limited to a maximum of $250 per person per year.

Excess payments do not apply to hospital admissions for dependants.

Co-payments: No co-payments

The following waiting periods for hospital admissions apply to new or upgrading members

Waiting periods:

  • 2 months for palliative care, rehabilitation and hospital psychiatric treatments, even if pre-existing
  • 12 months for other pre-existing conditions
  • 12 months for pregnancy and birth (obstetrics)
  • 2 months for all other treatments

Gap Cover

This provider offers 'known gap' or 'no gap' cover for medical bills for this product. The Medical Costs Finder (https://www.health.gov.au/resources/apps-and-tools/medical-costs-finder) lets you find out more about the cost of specialist medical services.

Other features of this hospital cover

Includes a Private Room Promise at a Medibank Members' Choice private hospital and Medibank Nurse 24/7. Includes Hospital Bonus to help pay for a range of approved hospital charges related to a hospital admission. See Cover Summary for more information.

Extras Cover

At Members' Choice extras providers you may get more for your cover. This includes 100% back on a dental check up, scale and clean each year and great optical deals. See https://www.medibank.com.au/health-insurance/find-provider/#/.

This policy includes General treatment (Extras) cover for

Treatment & waiting period (months)
Benefit limits per 12 months unless otherwise stated
Examples of maximum benefits
Acupuncture 2

$400 per person

  • Initial visit: $27.1
  • Subsequent visit: $15.8
Blood glucose monitors 24

$240 per person

  • Per monitor: $150
Chinese medicine 2

$150 per person

combined limit for chinese medicine, exercise physiology & remedial massage

  • Initial visit: $20
  • Subsequent visit: $20
Chiropractic 2

$400 per person

combined limit for chiropractic & osteopathy

  • Initial visit: $32.9
  • Subsequent visit: $19.2
Dietetics/dietary advice 2

$400 per person

  • Initial visit: $34.6
  • Subsequent visit: $17.1
Endodontic 12

$2,000 per person

combined limit for endodontic & major dental

  • Filling of one root canal: $85
Exercise physiology 2

$150 per person

combined limit for chinese medicine, exercise physiology & remedial massage

  • Initial visit: $20
  • Subsequent visit: $12
Eye therapy (orthoptics) 2

$400 per person

  • Initial visit: $18.4
  • Subsequent visit: $15.3
General dental* 2

No annual limit

  • Fluoride treatment: $16.1
  • Scale & clean: $51.2
  • Surgical tooth extraction: $50.6
  • Periodic oral examination: $29.9
Hearing aids 36

$800 per person

  • Hearing aid: $600
Major dental 12

$2,000 per person

combined limit for endodontic & major dental

  • Full crown veneered: $510
Non PBS pharmaceuticals 2

$600 per person

  • Per eligible prescription: $30.6
Occupational therapy 2

$400 per person

  • Initial visit: $47.2
  • Subsequent visit: $19.5
Optical 6

$250 per person

  • Multi-focal lenses & frames: $175
  • Single vision lenses & frames: $115
Orthodontic 12

$800 per person

$2,400 lifetime limit

  • Braces for upper & lower teeth, including removal plus fitting of retainer: $400
Orthotics (podiatric orthoses) 2

$400 per person

combined limit for orthotics (podiatric orthoses) & podiatry

  • Orthotics supply & fit: 60% of charge
Osteopathy 2

$400 per person

combined limit for chiropractic & osteopathy

  • Initial visit: $32.9
  • Subsequent visit: $19.2
Physiotherapy 2

$700 per person

  • Initial visit: $32.9
  • Subsequent visit: $23
Podiatry 2

$400 per person

combined limit for orthotics (podiatric orthoses) & podiatry

  • Initial visit: $27.1
  • Subsequent visit: $19.5
Psychology 0

$400 per person

  • Initial visit: $131.96
  • Subsequent visit: $109.28
Remedial massage 2

$150 per person

combined limit for chinese medicine, exercise physiology & remedial massage

  • Initial visit: $20
  • Subsequent visit: $20
Speech therapy 2

$400 per person

  • Initial visit: $58.5
  • Subsequent visit: $30.2

Acupuncture

Waiting period:  2 months

Benefit limits per 12 months unless otherwise stated

{$400 per person}

Examples of maximum benefits

{Initial visit: $27.1}

{Subsequent visit: $15.8}

Blood glucose monitors

Waiting period:  24 months

Benefit limits per 12 months unless otherwise stated

{$240 per person}

Examples of maximum benefits

{Per monitor: $150}

Chinese medicine

Waiting period:  2 months

Benefit limits per 12 months unless otherwise stated

{$150 per person}

{combined limit for chinese medicine, exercise physiology & remedial massage}

Examples of maximum benefits

{Initial visit: $20}

{Subsequent visit: $20}

Chiropractic

Waiting period:  2 months

Benefit limits per 12 months unless otherwise stated

{$400 per person}

{combined limit for chiropractic & osteopathy}

Examples of maximum benefits

{Initial visit: $32.9}

{Subsequent visit: $19.2}

Dietetics/dietary advice

Waiting period:  2 months

Benefit limits per 12 months unless otherwise stated

{$400 per person}

Examples of maximum benefits

{Initial visit: $34.6}

{Subsequent visit: $17.1}

Endodontic

Waiting period:  12 months

Benefit limits per 12 months unless otherwise stated

{$2,000 per person}

{combined limit for endodontic & major dental}

Examples of maximum benefits

{Filling of one root canal: $85}

Exercise physiology

Waiting period:  2 months

Benefit limits per 12 months unless otherwise stated

{$150 per person}

{combined limit for chinese medicine, exercise physiology & remedial massage}

Examples of maximum benefits

{Initial visit: $20}

{Subsequent visit: $12}

Eye therapy (orthoptics)

Waiting period:  2 months

Benefit limits per 12 months unless otherwise stated

{$400 per person}

Examples of maximum benefits

{Initial visit: $18.4}

{Subsequent visit: $15.3}

General dental*

Waiting period:  2 months

Benefit limits per 12 months unless otherwise stated

{No annual limit}

Examples of maximum benefits

{Fluoride treatment: $16.1}

{Scale & clean: $51.2}

{Surgical tooth extraction: $50.6}

{Periodic oral examination: $29.9}

Hearing aids

Waiting period:  36 months

Benefit limits per 12 months unless otherwise stated

{$800 per person}

Examples of maximum benefits

{Hearing aid: $600}

Major dental

Waiting period:  12 months

Benefit limits per 12 months unless otherwise stated

{$2,000 per person}

{combined limit for endodontic & major dental}

Examples of maximum benefits

{Full crown veneered: $510}

Non PBS pharmaceuticals

Waiting period:  2 months

Benefit limits per 12 months unless otherwise stated

{$600 per person}

Examples of maximum benefits

{Per eligible prescription: $30.6}

Occupational therapy

Waiting period:  2 months

Benefit limits per 12 months unless otherwise stated

{$400 per person}

Examples of maximum benefits

{Initial visit: $47.2}

{Subsequent visit: $19.5}

Optical

Waiting period:  6 months

Benefit limits per 12 months unless otherwise stated

{$250 per person}

Examples of maximum benefits

{Multi-focal lenses & frames: $175}

{Single vision lenses & frames: $115}

Orthodontic

Waiting period:  12 months

Benefit limits per 12 months unless otherwise stated

{$800 per person}

{$2,400 lifetime limit}

Examples of maximum benefits

{Braces for upper & lower teeth, including removal plus fitting of retainer: $400}

Orthotics (podiatric orthoses)

Waiting period:  2 months

Benefit limits per 12 months unless otherwise stated

{$400 per person}

{combined limit for orthotics (podiatric orthoses) & podiatry}

Examples of maximum benefits

{Orthotics supply & fit: 60% of charge}

Osteopathy

Waiting period:  2 months

Benefit limits per 12 months unless otherwise stated

{$400 per person}

{combined limit for chiropractic & osteopathy}

Examples of maximum benefits

{Initial visit: $32.9}

{Subsequent visit: $19.2}

Physiotherapy

Waiting period:  2 months

Benefit limits per 12 months unless otherwise stated

{$700 per person}

Examples of maximum benefits

{Initial visit: $32.9}

{Subsequent visit: $23}

Podiatry

Waiting period:  2 months

Benefit limits per 12 months unless otherwise stated

{$400 per person}

{combined limit for orthotics (podiatric orthoses) & podiatry}

Examples of maximum benefits

{Initial visit: $27.1}

{Subsequent visit: $19.5}

Psychology

Waiting period:  0 month

Benefit limits per 12 months unless otherwise stated

{$400 per person}

Examples of maximum benefits

{Initial visit: $131.96}

{Subsequent visit: $109.28}

Remedial massage

Waiting period:  2 months

Benefit limits per 12 months unless otherwise stated

{$150 per person}

{combined limit for chinese medicine, exercise physiology & remedial massage}

Examples of maximum benefits

{Initial visit: $20}

{Subsequent visit: $20}

Speech therapy

Waiting period:  2 months

Benefit limits per 12 months unless otherwise stated

{$400 per person}

Examples of maximum benefits

{Initial visit: $58.5}

{Subsequent visit: $30.2}

This policy does not include General treatment (Extras) cover for

Ante-natal/Post-natal classes
Audiology
Health management / Healthy lifestyle
Home nursing
Vaccinations

Other features of this general treatment cover: Health appliances and external prostheses (2 month waiting period) fixed benefits, benefit replacements apply - $500 annual limit. Breathing appliances (12 month waiting period), fixed benefits, benefit replacement periods apply and $180 limit per member every 3 years. Blood glucose monitors share a per member limit of $240 every 3 years with Blood pressure monitors (24 month waiting period). Counselling and Pharmacogenetic Testing share an annual limit of $400 with Psychology. School accidents for pre-school, primary and secondary school students only, $800 annual limit, 2 month waiting period. Contact Medibank for more information.

Ambulance cover

In SA this policy provides:

Emergency: Unlimited with a waiting period of 1 day.

Call-out fees: Will be paid for each attendance, including emergency treatment without transport to hospital.

Other features of this ambulance cover: Cover for an ambulance when you require immediate professional attention and you need to be transported to hospital or other approved facility and your medical condition is such that you cannot be transported any other way, or where an ambulance is called but transport is not needed. Cover for air ambulance where pre-approval has been obtained from Medibank. In all cases the ambulance provider must be Medibank approved. Please contact Medibank for further details.

Insurer Details

Medibank Private Limited

Medibank Gold Advantage $250 Excess

$834.70 / month

(Before Rebate, Discount & Loading)

Available in SA

Disclaimer: This document is not a Private Health Information Statement (PHIS), and it is not intended to replace that document. The details contained in the healthslips.com.au Policy Information was provided by the insurer to the Australian Government. It is intended as general information. It may not take into account your circumstances. For further information contact the insurer. Information used is Licensed from the Commonwealth of Australia under a Creative Commons 3.0 licence.Private Health Information Statement is available from the Private Health Insurance Ombudsman website at https://privatehealth.gov.au/dynamic/Premium/PHIS/MBP/J136/SQSR1Y

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