Medibank Private Information Sheet 1p6z2e
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Out-of-pocket expenses
Understanding our
The difference between the cost of a hospital or extras service and any benefit received from us or Medicare is an out-of-pocket expense. Here’s some info that may help reduce some of those expenses.
Not familiar with some words or phrases or want to know the definition of specific ? Find a list of frequently used words, and phrases at medibank.com.au/glossary
How much do you pay for extras? While you may have to pay an out-ofpocket expense on extras, you may save money by visiting a ’ Choice extras provider. You benefit from capped charges and/or discounts, which means you’ll generally have lower out-of-pocket expenses than you would at a non ’ Choice provider. How much do you pay if you go to hospital? Hospital cover helps pay for your hospital visit but doesn’t always cover all the costs. You may be able to reduce your out-of-pocket hospital expenses by choosing a ’ Choice hospital and by asking your doctor or specialist to participate in Medibank’s GapCover. For more information about GapCover, please refer to the hip Guide at medibank.com.au However, you may still have some out-of-pocket hospital expenses, such as the difference between the hospital’s charges and the benefit we pay and an excess (if you choose to have one). But , by choosing a hospital cover that has an excess, you’ll pay a lower . Before your ission you should confirm all likely out-of-pocket expenses with your doctor and/or hospital.
Other things you should know If there’s anything else you want to know that’s not covered here such as benefit replacement periods or our rules on paying benefits, you should be able to find what you’re looking for by reading our hip Guide at medibank.com.au
What is an accident? We define an accident as an unforeseen event occurring by chance and caused by an external force or object resulting in involuntary injuries to the body which requires immediate treatment. This doesn’t include conditions brought on by medical causes such as asthma attacks and appendicitis.
call 132 331 131 680 for Corporate enquiries visit medibank.com.au or ask in store connect with us on
We’ll help you be your best at every stage in life
Unhappy? What if you have a complaint? We try to resolve all enquiries and concerns the first time you us. If you still need help with your concern or any aspect of your hip, our Customer Resolutions team will provide courteous and respectful service. You’ll just need to provide sufficient information regarding your enquiry so we can investigate it for you. You can do this by: • calling 132 331 • emailing the secure form available in Online Member Services at medibank.com.au • writing to Medibank Private Customer Resolutions, GPO Box 9999, Melbourne, VIC 3000. If for some reason we are not able to satisfy your enquiry, you can also get free, independent advice from the Private Health Insurance Ombudsman by: • calling 1800 640 695 • visiting phio.org.au
Why Medibank? Medibank is more than just about insuring your health. We have the people, services and resources to be your personal health partner, helping you to be your best at every stage in life. We’re committed to making health insurance as straightforward as possible. For a start, we make it easier for you to choose cover that’s right for you. We have an extensive network of stores across Australia where you can drop in for advice and assistance. And when it comes to claiming, we do everything we can to make the process how it should be – clear, simple, and certain.
Medibank Private is a signatory to the Private Health Insurance Code of Conduct. The Private Health Insurance Code of Conduct logo is a trademark of, and is used under authorisation from, Private Healthcare Australia. In order to provide you with a range of health insurance and health related services, Medibank Private and its related companies may share your personal (including sensitive) information. Our sets out how your personal (including sensitive) information is handled. You can view a copy of our Fund rules and at any Medibank store, or online at medibank.com.au Medibank Private Limited ABN 47 080 890 259
Effective October 2013. MPL34591013
Important information
Did you know?
Out-of-pocket expenses
Understanding our
The difference between the cost of a hospital or extras service and any benefit received from us or Medicare is an out-of-pocket expense. Here’s some info that may help reduce some of those expenses.
Not familiar with some words or phrases or want to know the definition of specific ? Find a list of frequently used words, and phrases at medibank.com.au/glossary
How much do you pay for extras? While you may have to pay an out-ofpocket expense on extras, you may save money by visiting a ’ Choice extras provider. You benefit from capped charges and/or discounts, which means you’ll generally have lower out-of-pocket expenses than you would at a non ’ Choice provider. How much do you pay if you go to hospital? Hospital cover helps pay for your hospital visit but doesn’t always cover all the costs. You may be able to reduce your out-of-pocket hospital expenses by choosing a ’ Choice hospital and by asking your doctor or specialist to participate in Medibank’s GapCover. For more information about GapCover, please refer to the hip Guide at medibank.com.au However, you may still have some out-of-pocket hospital expenses, such as the difference between the hospital’s charges and the benefit we pay and an excess (if you choose to have one). But , by choosing a hospital cover that has an excess, you’ll pay a lower . Before your ission you should confirm all likely out-of-pocket expenses with your doctor and/or hospital.
Other things you should know If there’s anything else you want to know that’s not covered here such as benefit replacement periods or our rules on paying benefits, you should be able to find what you’re looking for by reading our hip Guide at medibank.com.au
What is an accident? We define an accident as an unforeseen event occurring by chance and caused by an external force or object resulting in involuntary injuries to the body which requires immediate treatment. This doesn’t include conditions brought on by medical causes such as asthma attacks and appendicitis.
call 132 331 131 680 for Corporate enquiries visit medibank.com.au or ask in store connect with us on
We’ll help you be your best at every stage in life
Unhappy? What if you have a complaint? We try to resolve all enquiries and concerns the first time you us. If you still need help with your concern or any aspect of your hip, our Customer Resolutions team will provide courteous and respectful service. You’ll just need to provide sufficient information regarding your enquiry so we can investigate it for you. You can do this by: • calling 132 331 • emailing the secure form available in Online Member Services at medibank.com.au • writing to Medibank Private Customer Resolutions, GPO Box 9999, Melbourne, VIC 3000. If for some reason we are not able to satisfy your enquiry, you can also get free, independent advice from the Private Health Insurance Ombudsman by: • calling 1800 640 695 • visiting phio.org.au
Why Medibank? Medibank is more than just about insuring your health. We have the people, services and resources to be your personal health partner, helping you to be your best at every stage in life. We’re committed to making health insurance as straightforward as possible. For a start, we make it easier for you to choose cover that’s right for you. We have an extensive network of stores across Australia where you can drop in for advice and assistance. And when it comes to claiming, we do everything we can to make the process how it should be – clear, simple, and certain.
Medibank Private is a signatory to the Private Health Insurance Code of Conduct. The Private Health Insurance Code of Conduct logo is a trademark of, and is used under authorisation from, Private Healthcare Australia. In order to provide you with a range of health insurance and health related services, Medibank Private and its related companies may share your personal (including sensitive) information. Our sets out how your personal (including sensitive) information is handled. You can view a copy of our Fund rules and at any Medibank store, or online at medibank.com.au Medibank Private Limited ABN 47 080 890 259
Effective October 2013. MPL34591013
Important information
Did you know?
It pays to understand your Medibank health insurance The more you understand about your Medibank cover the easier it is to make the most of it. From rebates and levies, to pre-existing conditions and cooling off periods, you’ll find it explained simply within these few pages. We know reading about the ins and outs of private health insurance isn’t everyone’s idea of a good time, but it’s certainly time well spent. For more information on Medibank’s policies and Fund rules, read our hip Guide at medibank.com.au
Rebates, Levies and Loadings The Medicare Levy Surcharge The Australian Government encourages all adults to take out private health insurance, with the aim of easing the strain on the public hospital system. From 1 July 2013, single adults with an annual income over $88,000 per year or couples and families with a combined annual income over $176,000, who don’t have private hospital cover, may have to pay the Medicare Levy Surcharge (MLS). The MLS is an additional tax, on top of the existing Medicare Levy. It is deducted from your earnings and ranges from 1% to 1.5% depending on your annual income. You can avoid or minimise the MLS by having a Medibank hospital cover, and you can learn more at ato.gov.au
Australian Government Rebate The Australian Government Rebate on private health insurance (AGR) can reward people who’ve taken out private hospital cover with a rebate on their s. Rebates are calculated on income and age of the oldest person on your cover and vary from 10% to 40%. To find out more go to medibank.com.au or ato.gov.au For example, from 1 July 2013, if your combined income is less than $176,000, and the oldest person on your cover is under 65 years, you may be eligible to receive a 30% rebate. If you’re a Medibank member you should nominate your rebate tier by logging into Online Member Services at medibank.com.au or by visiting a Medibank store. Lifetime Health Cover loading The Australian Government is incentivising people to take out their own private health cover through taxes and rebates. And because they want us to do it sooner rather than later, they also apply a Lifetime Health Cover loading (LHC) to people who haven’t taken out hospital cover by 1 July following their 31st birthday. For every year you don’t have hospital cover after your 31st birthday, you’ll pay a 2% loading on top of the base rate of your hospital cover – up to a maximum of 70%.
The loading will be removed once you’ve had hospital cover continuously for 10 years. Who’s exempt? People born before 1 July 1934 don’t have to pay a LHC loading. You can learn more about other exemption categories at www.health.gov.au What if you drop your hospital cover? Life’s unpredictable and you may be forced to cancel or suspend your hospital cover for a period of time. The good news is you can drop your hospital cover for up to three years (1,094 permitted days) during your lifetime without impacting your LHC loading status. Any longer than this and you’ll have to pay the loading once you take out hospital cover again. There are some circumstances when your days without hospital cover won’t count towards your 1,094 permitted days without hospital cover, such as: • if you’ve been overseas continuously for more than one year (this includes visits back to Australia of less than 90 days at a time), and/or • if your health insurer has agreed to a period of suspension of your cover. Switching from another health insurer? If you switch to us from another health insurer it’s best to keep your existing cover until the day you become a Medibank member. This way you can avoid u any of the 1,094 permitted days you can be without hospital cover during your lifetime. Any period of time you’ve had the loading applied by another health insurer will be transferred to your Medibank cover and counted towards the 10 year loading period. the loading will be removed after having 10 years of continuous hospital cover.
ing Medibank Cooling off period It’s okay to change your mind. You can cancel your hip within 30 days
of ing as long as you haven’t made a claim, and your will be fully refunded. Transfers Coming to us from another health insurer? We’ll make the transition as smooth and painless as possible, and you’ll be covered from the date you if:
Period
Item/Service
No waiting period 2 months*
Mi Health services (available with hospital covers only)
6 months
Optical items Ultra bonus hip Bonus
12 months
Pre-existing conditions† Obstetrics-related services Major dental services Orthodontics Surgical dental procedures and extractions Breathing appliances, including nebulisers, peak flow meters and spacing devices^ betterhealth programs Oral appliances for sleep apnoea^
• those services are also included on the Medibank cover we consider to be most similar to the cover you had with your former health insurer, and • you us within two months of leaving that former insurer, and • you’ve served applicable waiting periods. We’ll credit you with waiting periods you’ve already served, so you’ll only need to serve the balance with us before you can claim. Also, benefits that have been paid under your previous cover may be taken into in determining the benefits payable under your Medibank cover. Any loyalty bonus or similar entitlements built up with your former health insurer won’t transfer to Medibank. Waiting periods All health insurers have waiting periods that everyone serves before they can receive benefits. If you haven’t had health insurance before or it’s been over two months since you had health insurance, you’ll need to serve waiting periods. What if you’re changing to a higher level? Whether you’re upgrading within Medibank or from another health insurer, additional waiting periods may apply. In the meantime you can still receive a benefit for services that are covered in both your old and new cover and where you’ve already served relevant waiting periods. Waiting periods vary for different services and items. The following table is a guide.
All services (including ambulance services) except those set out below
24 months
Blood glucose monitors^ Blood pressure monitors^
36 months
Hearing aids^ Laser eye surgery
higher levels of hospital covers (either from Medibank or from another health insurer), you’ll need to wait 12 months to receive the higher benefits. For more information about pre-existing conditions please refer to the hip Guide at medibank.com.au
Added benefits of some packaged covers With some of our packaged covers you’ll benefit from an annual hip Bonus (per hip) as well as increasing annual limits on selected extras services. These benefits are exclusive to the covers below and aren’t available on other Medibank covers. • For New Families Essentials • For New Families Comprehensive • For Settled Families Essentials
*If you have an accident after ing us or changing cover and require treatment, we’ll waive the 2 month waiting period. Please note that if you have our stand-alone Ambulance cover, the 7 day waiting period for accidents still applies.
• For Settled Families Comprehensive
†
With For Everyday Essentials and For Security Essentials cover, you receive increasing annual limits on selected extras services.
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, but a 2 month waiting period still applies. ^Benefit replacement periods apply. Please refer to the hip Guide at medibank.com.au
Pre-existing conditions All private health insurers have a waiting period of 12 months before you can claim for a pre-existing condition. This is an ailment, illness or condition with signs or symptoms that existed as determined by one of our doctors in the six months before starting your hip or changing cover and applies only to hospital cover. If you go to hospital within the first 12 months of ing, we may check whether you’re being treated for a pre-existing condition. What if you have a pre-existing condition? If you’ve never had private hospital cover or if your cover has lapsed, you’ll need to wait 12 months before you can claim for treatment of a pre-existing condition. If you have upgraded to one of our
• For Everyday Comprehensive • For Security Comprehensive.
hip Bonus A separate amount that you can put towards the cost of approved hip and health related expenses. This annual bonus is in addition to benefits you receive towards the hospital and extras services of this product. Any unused hip Bonus will be added to the following year’s entitlement which can accrue up to the maximum limit.* There’s a 6 month waiting period before you can use your hip Bonus. Then on 1 January every year you will receive your hip Bonus entitlement until you reach your limit. The bonus can be used for a range of things like topping up your benefits to reduce your out-of-pocket expenses such as using on your extras and paying towards your hospital excess. You can
also use this bonus for other health related expenses, to find out more call us on 132 331. There are some things you can’t use your hip Bonus towards which include your , any contributions towards Pharmaceutical Benefits Scheme (PBS) prescriptions, out-ofhospital medical expenses covered by Medicare, other non-approved expenses, or expenses and costs precluded by law from being paid. The expenses you can use your hip Bonus towards are subject to change. For more information, call us on 132 331. Increasing annual limits on selected extras services For a range of extras services*, your annual limits increase by $50 per member, per calendar year (up to the maximum amount*), starting from 1 January only after a full calendar year of hip has been completed. The following table is an example of a member who takes out For New Families Essentials cover on 30 June 2013 and how their annual limit will increase for major dental. Date
Annual Limit
30 June 2013
$400
1 January 2014
$400 (no increase as hip still within 1st calendar year)
1 January 2015
$450 (annual limit increases as full calendar year of hip has been completed).
1 January 2016
$500
1 January 2017
$550
1 January 2018
$600
1 January 2019
$650 (maximum)
*Refer to Extras product tables in the Family packages and Singles and Couples packages brochures for more details, or visit medibank.com.au
Ambulance services Ambulance services provide peace of mind by covering the cost to take you to hospital if you’re injured or too sick to get there another way. You’re also covered when an ambulance is called for immediate medical attention, even if transport by ambulance isn’t needed. What’s covered? Ambulance services include: • ambulance transport to hospital to receive immediate professional attention • when an ambulance is called to provide immediate professional attention – even if you don’t need ambulance transport • when, as an itted patient, you’re transferred between private hospitals • transport by air ambulance, where preapproval is obtained from Medibank by the air ambulance provider. What’s not covered? Ambulance services exclude: • when immediate professional attention is not required, for example general patient transport • transfers between public hospitals • any ambulance costs that are fully covered by a third party arrangement, such as an ambulance subscription or a federal/state/territory transport scheme, WorkCover or the Transport Accident Commission • any air ambulance services that are fully subsidised, such as South Care or NRMA Care Flight. State schemes Some states and territories, such as QLD and TAS, have their own state ambulance schemes which affect how you’re covered by Medibank. We don’t provide Ambulance Cover for QLD and TAS residents. You can find out more at medibank.com.au/ambulance
It pays to understand your Medibank health insurance The more you understand about your Medibank cover the easier it is to make the most of it. From rebates and levies, to pre-existing conditions and cooling off periods, you’ll find it explained simply within these few pages. We know reading about the ins and outs of private health insurance isn’t everyone’s idea of a good time, but it’s certainly time well spent. For more information on Medibank’s policies and Fund rules, read our hip Guide at medibank.com.au
Rebates, Levies and Loadings The Medicare Levy Surcharge The Australian Government encourages all adults to take out private health insurance, with the aim of easing the strain on the public hospital system. From 1 July 2013, single adults with an annual income over $88,000 per year or couples and families with a combined annual income over $176,000, who don’t have private hospital cover, may have to pay the Medicare Levy Surcharge (MLS). The MLS is an additional tax, on top of the existing Medicare Levy. It is deducted from your earnings and ranges from 1% to 1.5% depending on your annual income. You can avoid or minimise the MLS by having a Medibank hospital cover, and you can learn more at ato.gov.au
Australian Government Rebate The Australian Government Rebate on private health insurance (AGR) can reward people who’ve taken out private hospital cover with a rebate on their s. Rebates are calculated on income and age of the oldest person on your cover and vary from 10% to 40%. To find out more go to medibank.com.au or ato.gov.au For example, from 1 July 2013, if your combined income is less than $176,000, and the oldest person on your cover is under 65 years, you may be eligible to receive a 30% rebate. If you’re a Medibank member you should nominate your rebate tier by logging into Online Member Services at medibank.com.au or by visiting a Medibank store. Lifetime Health Cover loading The Australian Government is incentivising people to take out their own private health cover through taxes and rebates. And because they want us to do it sooner rather than later, they also apply a Lifetime Health Cover loading (LHC) to people who haven’t taken out hospital cover by 1 July following their 31st birthday. For every year you don’t have hospital cover after your 31st birthday, you’ll pay a 2% loading on top of the base rate of your hospital cover – up to a maximum of 70%.
The loading will be removed once you’ve had hospital cover continuously for 10 years. Who’s exempt? People born before 1 July 1934 don’t have to pay a LHC loading. You can learn more about other exemption categories at www.health.gov.au What if you drop your hospital cover? Life’s unpredictable and you may be forced to cancel or suspend your hospital cover for a period of time. The good news is you can drop your hospital cover for up to three years (1,094 permitted days) during your lifetime without impacting your LHC loading status. Any longer than this and you’ll have to pay the loading once you take out hospital cover again. There are some circumstances when your days without hospital cover won’t count towards your 1,094 permitted days without hospital cover, such as: • if you’ve been overseas continuously for more than one year (this includes visits back to Australia of less than 90 days at a time), and/or • if your health insurer has agreed to a period of suspension of your cover. Switching from another health insurer? If you switch to us from another health insurer it’s best to keep your existing cover until the day you become a Medibank member. This way you can avoid u any of the 1,094 permitted days you can be without hospital cover during your lifetime. Any period of time you’ve had the loading applied by another health insurer will be transferred to your Medibank cover and counted towards the 10 year loading period. the loading will be removed after having 10 years of continuous hospital cover.
ing Medibank Cooling off period It’s okay to change your mind. You can cancel your hip within 30 days
of ing as long as you haven’t made a claim, and your will be fully refunded. Transfers Coming to us from another health insurer? We’ll make the transition as smooth and painless as possible, and you’ll be covered from the date you if:
Period
Item/Service
No waiting period 2 months*
Mi Health services (available with hospital covers only)
6 months
Optical items Ultra bonus hip Bonus
12 months
Pre-existing conditions† Obstetrics-related services Major dental services Orthodontics Surgical dental procedures and extractions Breathing appliances, including nebulisers, peak flow meters and spacing devices^ betterhealth programs Oral appliances for sleep apnoea^
• those services are also included on the Medibank cover we consider to be most similar to the cover you had with your former health insurer, and • you us within two months of leaving that former insurer, and • you’ve served applicable waiting periods. We’ll credit you with waiting periods you’ve already served, so you’ll only need to serve the balance with us before you can claim. Also, benefits that have been paid under your previous cover may be taken into in determining the benefits payable under your Medibank cover. Any loyalty bonus or similar entitlements built up with your former health insurer won’t transfer to Medibank. Waiting periods All health insurers have waiting periods that everyone serves before they can receive benefits. If you haven’t had health insurance before or it’s been over two months since you had health insurance, you’ll need to serve waiting periods. What if you’re changing to a higher level? Whether you’re upgrading within Medibank or from another health insurer, additional waiting periods may apply. In the meantime you can still receive a benefit for services that are covered in both your old and new cover and where you’ve already served relevant waiting periods. Waiting periods vary for different services and items. The following table is a guide.
All services (including ambulance services) except those set out below
24 months
Blood glucose monitors^ Blood pressure monitors^
36 months
Hearing aids^ Laser eye surgery
higher levels of hospital covers (either from Medibank or from another health insurer), you’ll need to wait 12 months to receive the higher benefits. For more information about pre-existing conditions please refer to the hip Guide at medibank.com.au
Added benefits of some packaged covers With some of our packaged covers you’ll benefit from an annual hip Bonus (per hip) as well as increasing annual limits on selected extras services. These benefits are exclusive to the covers below and aren’t available on other Medibank covers. • For New Families Essentials • For New Families Comprehensive • For Settled Families Essentials
*If you have an accident after ing us or changing cover and require treatment, we’ll waive the 2 month waiting period. Please note that if you have our stand-alone Ambulance cover, the 7 day waiting period for accidents still applies.
• For Settled Families Comprehensive
†
With For Everyday Essentials and For Security Essentials cover, you receive increasing annual limits on selected extras services.
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, but a 2 month waiting period still applies. ^Benefit replacement periods apply. Please refer to the hip Guide at medibank.com.au
Pre-existing conditions All private health insurers have a waiting period of 12 months before you can claim for a pre-existing condition. This is an ailment, illness or condition with signs or symptoms that existed as determined by one of our doctors in the six months before starting your hip or changing cover and applies only to hospital cover. If you go to hospital within the first 12 months of ing, we may check whether you’re being treated for a pre-existing condition. What if you have a pre-existing condition? If you’ve never had private hospital cover or if your cover has lapsed, you’ll need to wait 12 months before you can claim for treatment of a pre-existing condition. If you have upgraded to one of our
• For Everyday Comprehensive • For Security Comprehensive.
hip Bonus A separate amount that you can put towards the cost of approved hip and health related expenses. This annual bonus is in addition to benefits you receive towards the hospital and extras services of this product. Any unused hip Bonus will be added to the following year’s entitlement which can accrue up to the maximum limit.* There’s a 6 month waiting period before you can use your hip Bonus. Then on 1 January every year you will receive your hip Bonus entitlement until you reach your limit. The bonus can be used for a range of things like topping up your benefits to reduce your out-of-pocket expenses such as using on your extras and paying towards your hospital excess. You can
also use this bonus for other health related expenses, to find out more call us on 132 331. There are some things you can’t use your hip Bonus towards which include your , any contributions towards Pharmaceutical Benefits Scheme (PBS) prescriptions, out-ofhospital medical expenses covered by Medicare, other non-approved expenses, or expenses and costs precluded by law from being paid. The expenses you can use your hip Bonus towards are subject to change. For more information, call us on 132 331. Increasing annual limits on selected extras services For a range of extras services*, your annual limits increase by $50 per member, per calendar year (up to the maximum amount*), starting from 1 January only after a full calendar year of hip has been completed. The following table is an example of a member who takes out For New Families Essentials cover on 30 June 2013 and how their annual limit will increase for major dental. Date
Annual Limit
30 June 2013
$400
1 January 2014
$400 (no increase as hip still within 1st calendar year)
1 January 2015
$450 (annual limit increases as full calendar year of hip has been completed).
1 January 2016
$500
1 January 2017
$550
1 January 2018
$600
1 January 2019
$650 (maximum)
*Refer to Extras product tables in the Family packages and Singles and Couples packages brochures for more details, or visit medibank.com.au
Ambulance services Ambulance services provide peace of mind by covering the cost to take you to hospital if you’re injured or too sick to get there another way. You’re also covered when an ambulance is called for immediate medical attention, even if transport by ambulance isn’t needed. What’s covered? Ambulance services include: • ambulance transport to hospital to receive immediate professional attention • when an ambulance is called to provide immediate professional attention – even if you don’t need ambulance transport • when, as an itted patient, you’re transferred between private hospitals • transport by air ambulance, where preapproval is obtained from Medibank by the air ambulance provider. What’s not covered? Ambulance services exclude: • when immediate professional attention is not required, for example general patient transport • transfers between public hospitals • any ambulance costs that are fully covered by a third party arrangement, such as an ambulance subscription or a federal/state/territory transport scheme, WorkCover or the Transport Accident Commission • any air ambulance services that are fully subsidised, such as South Care or NRMA Care Flight. State schemes Some states and territories, such as QLD and TAS, have their own state ambulance schemes which affect how you’re covered by Medibank. We don’t provide Ambulance Cover for QLD and TAS residents. You can find out more at medibank.com.au/ambulance
It pays to understand your Medibank health insurance The more you understand about your Medibank cover the easier it is to make the most of it. From rebates and levies, to pre-existing conditions and cooling off periods, you’ll find it explained simply within these few pages. We know reading about the ins and outs of private health insurance isn’t everyone’s idea of a good time, but it’s certainly time well spent. For more information on Medibank’s policies and Fund rules, read our hip Guide at medibank.com.au
Rebates, Levies and Loadings The Medicare Levy Surcharge The Australian Government encourages all adults to take out private health insurance, with the aim of easing the strain on the public hospital system. From 1 July 2013, single adults with an annual income over $88,000 per year or couples and families with a combined annual income over $176,000, who don’t have private hospital cover, may have to pay the Medicare Levy Surcharge (MLS). The MLS is an additional tax, on top of the existing Medicare Levy. It is deducted from your earnings and ranges from 1% to 1.5% depending on your annual income. You can avoid or minimise the MLS by having a Medibank hospital cover, and you can learn more at ato.gov.au
Australian Government Rebate The Australian Government Rebate on private health insurance (AGR) can reward people who’ve taken out private hospital cover with a rebate on their s. Rebates are calculated on income and age of the oldest person on your cover and vary from 10% to 40%. To find out more go to medibank.com.au or ato.gov.au For example, from 1 July 2013, if your combined income is less than $176,000, and the oldest person on your cover is under 65 years, you may be eligible to receive a 30% rebate. If you’re a Medibank member you should nominate your rebate tier by logging into Online Member Services at medibank.com.au or by visiting a Medibank store. Lifetime Health Cover loading The Australian Government is incentivising people to take out their own private health cover through taxes and rebates. And because they want us to do it sooner rather than later, they also apply a Lifetime Health Cover loading (LHC) to people who haven’t taken out hospital cover by 1 July following their 31st birthday. For every year you don’t have hospital cover after your 31st birthday, you’ll pay a 2% loading on top of the base rate of your hospital cover – up to a maximum of 70%.
The loading will be removed once you’ve had hospital cover continuously for 10 years. Who’s exempt? People born before 1 July 1934 don’t have to pay a LHC loading. You can learn more about other exemption categories at www.health.gov.au What if you drop your hospital cover? Life’s unpredictable and you may be forced to cancel or suspend your hospital cover for a period of time. The good news is you can drop your hospital cover for up to three years (1,094 permitted days) during your lifetime without impacting your LHC loading status. Any longer than this and you’ll have to pay the loading once you take out hospital cover again. There are some circumstances when your days without hospital cover won’t count towards your 1,094 permitted days without hospital cover, such as: • if you’ve been overseas continuously for more than one year (this includes visits back to Australia of less than 90 days at a time), and/or • if your health insurer has agreed to a period of suspension of your cover. Switching from another health insurer? If you switch to us from another health insurer it’s best to keep your existing cover until the day you become a Medibank member. This way you can avoid u any of the 1,094 permitted days you can be without hospital cover during your lifetime. Any period of time you’ve had the loading applied by another health insurer will be transferred to your Medibank cover and counted towards the 10 year loading period. the loading will be removed after having 10 years of continuous hospital cover.
ing Medibank Cooling off period It’s okay to change your mind. You can cancel your hip within 30 days
of ing as long as you haven’t made a claim, and your will be fully refunded. Transfers Coming to us from another health insurer? We’ll make the transition as smooth and painless as possible, and you’ll be covered from the date you if:
Period
Item/Service
No waiting period 2 months*
Mi Health services (available with hospital covers only)
6 months
Optical items Ultra bonus hip Bonus
12 months
Pre-existing conditions† Obstetrics-related services Major dental services Orthodontics Surgical dental procedures and extractions Breathing appliances, including nebulisers, peak flow meters and spacing devices^ betterhealth programs Oral appliances for sleep apnoea^
• those services are also included on the Medibank cover we consider to be most similar to the cover you had with your former health insurer, and • you us within two months of leaving that former insurer, and • you’ve served applicable waiting periods. We’ll credit you with waiting periods you’ve already served, so you’ll only need to serve the balance with us before you can claim. Also, benefits that have been paid under your previous cover may be taken into in determining the benefits payable under your Medibank cover. Any loyalty bonus or similar entitlements built up with your former health insurer won’t transfer to Medibank. Waiting periods All health insurers have waiting periods that everyone serves before they can receive benefits. If you haven’t had health insurance before or it’s been over two months since you had health insurance, you’ll need to serve waiting periods. What if you’re changing to a higher level? Whether you’re upgrading within Medibank or from another health insurer, additional waiting periods may apply. In the meantime you can still receive a benefit for services that are covered in both your old and new cover and where you’ve already served relevant waiting periods. Waiting periods vary for different services and items. The following table is a guide.
All services (including ambulance services) except those set out below
24 months
Blood glucose monitors^ Blood pressure monitors^
36 months
Hearing aids^ Laser eye surgery
higher levels of hospital covers (either from Medibank or from another health insurer), you’ll need to wait 12 months to receive the higher benefits. For more information about pre-existing conditions please refer to the hip Guide at medibank.com.au
Added benefits of some packaged covers With some of our packaged covers you’ll benefit from an annual hip Bonus (per hip) as well as increasing annual limits on selected extras services. These benefits are exclusive to the covers below and aren’t available on other Medibank covers. • For New Families Essentials • For New Families Comprehensive • For Settled Families Essentials
*If you have an accident after ing us or changing cover and require treatment, we’ll waive the 2 month waiting period. Please note that if you have our stand-alone Ambulance cover, the 7 day waiting period for accidents still applies.
• For Settled Families Comprehensive
†
With For Everyday Essentials and For Security Essentials cover, you receive increasing annual limits on selected extras services.
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, but a 2 month waiting period still applies. ^Benefit replacement periods apply. Please refer to the hip Guide at medibank.com.au
Pre-existing conditions All private health insurers have a waiting period of 12 months before you can claim for a pre-existing condition. This is an ailment, illness or condition with signs or symptoms that existed as determined by one of our doctors in the six months before starting your hip or changing cover and applies only to hospital cover. If you go to hospital within the first 12 months of ing, we may check whether you’re being treated for a pre-existing condition. What if you have a pre-existing condition? If you’ve never had private hospital cover or if your cover has lapsed, you’ll need to wait 12 months before you can claim for treatment of a pre-existing condition. If you have upgraded to one of our
• For Everyday Comprehensive • For Security Comprehensive.
hip Bonus A separate amount that you can put towards the cost of approved hip and health related expenses. This annual bonus is in addition to benefits you receive towards the hospital and extras services of this product. Any unused hip Bonus will be added to the following year’s entitlement which can accrue up to the maximum limit.* There’s a 6 month waiting period before you can use your hip Bonus. Then on 1 January every year you will receive your hip Bonus entitlement until you reach your limit. The bonus can be used for a range of things like topping up your benefits to reduce your out-of-pocket expenses such as using on your extras and paying towards your hospital excess. You can
also use this bonus for other health related expenses, to find out more call us on 132 331. There are some things you can’t use your hip Bonus towards which include your , any contributions towards Pharmaceutical Benefits Scheme (PBS) prescriptions, out-ofhospital medical expenses covered by Medicare, other non-approved expenses, or expenses and costs precluded by law from being paid. The expenses you can use your hip Bonus towards are subject to change. For more information, call us on 132 331. Increasing annual limits on selected extras services For a range of extras services*, your annual limits increase by $50 per member, per calendar year (up to the maximum amount*), starting from 1 January only after a full calendar year of hip has been completed. The following table is an example of a member who takes out For New Families Essentials cover on 30 June 2013 and how their annual limit will increase for major dental. Date
Annual Limit
30 June 2013
$400
1 January 2014
$400 (no increase as hip still within 1st calendar year)
1 January 2015
$450 (annual limit increases as full calendar year of hip has been completed).
1 January 2016
$500
1 January 2017
$550
1 January 2018
$600
1 January 2019
$650 (maximum)
*Refer to Extras product tables in the Family packages and Singles and Couples packages brochures for more details, or visit medibank.com.au
Ambulance services Ambulance services provide peace of mind by covering the cost to take you to hospital if you’re injured or too sick to get there another way. You’re also covered when an ambulance is called for immediate medical attention, even if transport by ambulance isn’t needed. What’s covered? Ambulance services include: • ambulance transport to hospital to receive immediate professional attention • when an ambulance is called to provide immediate professional attention – even if you don’t need ambulance transport • when, as an itted patient, you’re transferred between private hospitals • transport by air ambulance, where preapproval is obtained from Medibank by the air ambulance provider. What’s not covered? Ambulance services exclude: • when immediate professional attention is not required, for example general patient transport • transfers between public hospitals • any ambulance costs that are fully covered by a third party arrangement, such as an ambulance subscription or a federal/state/territory transport scheme, WorkCover or the Transport Accident Commission • any air ambulance services that are fully subsidised, such as South Care or NRMA Care Flight. State schemes Some states and territories, such as QLD and TAS, have their own state ambulance schemes which affect how you’re covered by Medibank. We don’t provide Ambulance Cover for QLD and TAS residents. You can find out more at medibank.com.au/ambulance
It pays to understand your Medibank health insurance The more you understand about your Medibank cover the easier it is to make the most of it. From rebates and levies, to pre-existing conditions and cooling off periods, you’ll find it explained simply within these few pages. We know reading about the ins and outs of private health insurance isn’t everyone’s idea of a good time, but it’s certainly time well spent. For more information on Medibank’s policies and Fund rules, read our hip Guide at medibank.com.au
Rebates, Levies and Loadings The Medicare Levy Surcharge The Australian Government encourages all adults to take out private health insurance, with the aim of easing the strain on the public hospital system. From 1 July 2013, single adults with an annual income over $88,000 per year or couples and families with a combined annual income over $176,000, who don’t have private hospital cover, may have to pay the Medicare Levy Surcharge (MLS). The MLS is an additional tax, on top of the existing Medicare Levy. It is deducted from your earnings and ranges from 1% to 1.5% depending on your annual income. You can avoid or minimise the MLS by having a Medibank hospital cover, and you can learn more at ato.gov.au
Australian Government Rebate The Australian Government Rebate on private health insurance (AGR) can reward people who’ve taken out private hospital cover with a rebate on their s. Rebates are calculated on income and age of the oldest person on your cover and vary from 10% to 40%. To find out more go to medibank.com.au or ato.gov.au For example, from 1 July 2013, if your combined income is less than $176,000, and the oldest person on your cover is under 65 years, you may be eligible to receive a 30% rebate. If you’re a Medibank member you should nominate your rebate tier by logging into Online Member Services at medibank.com.au or by visiting a Medibank store. Lifetime Health Cover loading The Australian Government is incentivising people to take out their own private health cover through taxes and rebates. And because they want us to do it sooner rather than later, they also apply a Lifetime Health Cover loading (LHC) to people who haven’t taken out hospital cover by 1 July following their 31st birthday. For every year you don’t have hospital cover after your 31st birthday, you’ll pay a 2% loading on top of the base rate of your hospital cover – up to a maximum of 70%.
The loading will be removed once you’ve had hospital cover continuously for 10 years. Who’s exempt? People born before 1 July 1934 don’t have to pay a LHC loading. You can learn more about other exemption categories at www.health.gov.au What if you drop your hospital cover? Life’s unpredictable and you may be forced to cancel or suspend your hospital cover for a period of time. The good news is you can drop your hospital cover for up to three years (1,094 permitted days) during your lifetime without impacting your LHC loading status. Any longer than this and you’ll have to pay the loading once you take out hospital cover again. There are some circumstances when your days without hospital cover won’t count towards your 1,094 permitted days without hospital cover, such as: • if you’ve been overseas continuously for more than one year (this includes visits back to Australia of less than 90 days at a time), and/or • if your health insurer has agreed to a period of suspension of your cover. Switching from another health insurer? If you switch to us from another health insurer it’s best to keep your existing cover until the day you become a Medibank member. This way you can avoid u any of the 1,094 permitted days you can be without hospital cover during your lifetime. Any period of time you’ve had the loading applied by another health insurer will be transferred to your Medibank cover and counted towards the 10 year loading period. the loading will be removed after having 10 years of continuous hospital cover.
ing Medibank Cooling off period It’s okay to change your mind. You can cancel your hip within 30 days
of ing as long as you haven’t made a claim, and your will be fully refunded. Transfers Coming to us from another health insurer? We’ll make the transition as smooth and painless as possible, and you’ll be covered from the date you if:
Period
Item/Service
No waiting period 2 months*
Mi Health services (available with hospital covers only)
6 months
Optical items Ultra bonus hip Bonus
12 months
Pre-existing conditions† Obstetrics-related services Major dental services Orthodontics Surgical dental procedures and extractions Breathing appliances, including nebulisers, peak flow meters and spacing devices^ betterhealth programs Oral appliances for sleep apnoea^
• those services are also included on the Medibank cover we consider to be most similar to the cover you had with your former health insurer, and • you us within two months of leaving that former insurer, and • you’ve served applicable waiting periods. We’ll credit you with waiting periods you’ve already served, so you’ll only need to serve the balance with us before you can claim. Also, benefits that have been paid under your previous cover may be taken into in determining the benefits payable under your Medibank cover. Any loyalty bonus or similar entitlements built up with your former health insurer won’t transfer to Medibank. Waiting periods All health insurers have waiting periods that everyone serves before they can receive benefits. If you haven’t had health insurance before or it’s been over two months since you had health insurance, you’ll need to serve waiting periods. What if you’re changing to a higher level? Whether you’re upgrading within Medibank or from another health insurer, additional waiting periods may apply. In the meantime you can still receive a benefit for services that are covered in both your old and new cover and where you’ve already served relevant waiting periods. Waiting periods vary for different services and items. The following table is a guide.
All services (including ambulance services) except those set out below
24 months
Blood glucose monitors^ Blood pressure monitors^
36 months
Hearing aids^ Laser eye surgery
higher levels of hospital covers (either from Medibank or from another health insurer), you’ll need to wait 12 months to receive the higher benefits. For more information about pre-existing conditions please refer to the hip Guide at medibank.com.au
Added benefits of some packaged covers With some of our packaged covers you’ll benefit from an annual hip Bonus (per hip) as well as increasing annual limits on selected extras services. These benefits are exclusive to the covers below and aren’t available on other Medibank covers. • For New Families Essentials • For New Families Comprehensive • For Settled Families Essentials
*If you have an accident after ing us or changing cover and require treatment, we’ll waive the 2 month waiting period. Please note that if you have our stand-alone Ambulance cover, the 7 day waiting period for accidents still applies.
• For Settled Families Comprehensive
†
With For Everyday Essentials and For Security Essentials cover, you receive increasing annual limits on selected extras services.
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, but a 2 month waiting period still applies. ^Benefit replacement periods apply. Please refer to the hip Guide at medibank.com.au
Pre-existing conditions All private health insurers have a waiting period of 12 months before you can claim for a pre-existing condition. This is an ailment, illness or condition with signs or symptoms that existed as determined by one of our doctors in the six months before starting your hip or changing cover and applies only to hospital cover. If you go to hospital within the first 12 months of ing, we may check whether you’re being treated for a pre-existing condition. What if you have a pre-existing condition? If you’ve never had private hospital cover or if your cover has lapsed, you’ll need to wait 12 months before you can claim for treatment of a pre-existing condition. If you have upgraded to one of our
• For Everyday Comprehensive • For Security Comprehensive.
hip Bonus A separate amount that you can put towards the cost of approved hip and health related expenses. This annual bonus is in addition to benefits you receive towards the hospital and extras services of this product. Any unused hip Bonus will be added to the following year’s entitlement which can accrue up to the maximum limit.* There’s a 6 month waiting period before you can use your hip Bonus. Then on 1 January every year you will receive your hip Bonus entitlement until you reach your limit. The bonus can be used for a range of things like topping up your benefits to reduce your out-of-pocket expenses such as using on your extras and paying towards your hospital excess. You can
also use this bonus for other health related expenses, to find out more call us on 132 331. There are some things you can’t use your hip Bonus towards which include your , any contributions towards Pharmaceutical Benefits Scheme (PBS) prescriptions, out-ofhospital medical expenses covered by Medicare, other non-approved expenses, or expenses and costs precluded by law from being paid. The expenses you can use your hip Bonus towards are subject to change. For more information, call us on 132 331. Increasing annual limits on selected extras services For a range of extras services*, your annual limits increase by $50 per member, per calendar year (up to the maximum amount*), starting from 1 January only after a full calendar year of hip has been completed. The following table is an example of a member who takes out For New Families Essentials cover on 30 June 2013 and how their annual limit will increase for major dental. Date
Annual Limit
30 June 2013
$400
1 January 2014
$400 (no increase as hip still within 1st calendar year)
1 January 2015
$450 (annual limit increases as full calendar year of hip has been completed).
1 January 2016
$500
1 January 2017
$550
1 January 2018
$600
1 January 2019
$650 (maximum)
*Refer to Extras product tables in the Family packages and Singles and Couples packages brochures for more details, or visit medibank.com.au
Ambulance services Ambulance services provide peace of mind by covering the cost to take you to hospital if you’re injured or too sick to get there another way. You’re also covered when an ambulance is called for immediate medical attention, even if transport by ambulance isn’t needed. What’s covered? Ambulance services include: • ambulance transport to hospital to receive immediate professional attention • when an ambulance is called to provide immediate professional attention – even if you don’t need ambulance transport • when, as an itted patient, you’re transferred between private hospitals • transport by air ambulance, where preapproval is obtained from Medibank by the air ambulance provider. What’s not covered? Ambulance services exclude: • when immediate professional attention is not required, for example general patient transport • transfers between public hospitals • any ambulance costs that are fully covered by a third party arrangement, such as an ambulance subscription or a federal/state/territory transport scheme, WorkCover or the Transport Accident Commission • any air ambulance services that are fully subsidised, such as South Care or NRMA Care Flight. State schemes Some states and territories, such as QLD and TAS, have their own state ambulance schemes which affect how you’re covered by Medibank. We don’t provide Ambulance Cover for QLD and TAS residents. You can find out more at medibank.com.au/ambulance
Out-of-pocket expenses
Understanding our
The difference between the cost of a hospital or extras service and any benefit received from us or Medicare is an out-of-pocket expense. Here’s some info that may help reduce some of those expenses.
Not familiar with some words or phrases or want to know the definition of specific ? Find a list of frequently used words, and phrases at medibank.com.au/glossary
How much do you pay for extras? While you may have to pay an out-ofpocket expense on extras, you may save money by visiting a ’ Choice extras provider. You benefit from capped charges and/or discounts, which means you’ll generally have lower out-of-pocket expenses than you would at a non ’ Choice provider. How much do you pay if you go to hospital? Hospital cover helps pay for your hospital visit but doesn’t always cover all the costs. You may be able to reduce your out-of-pocket hospital expenses by choosing a ’ Choice hospital and by asking your doctor or specialist to participate in Medibank’s GapCover. For more information about GapCover, please refer to the hip Guide at medibank.com.au However, you may still have some out-of-pocket hospital expenses, such as the difference between the hospital’s charges and the benefit we pay and an excess (if you choose to have one). But , by choosing a hospital cover that has an excess, you’ll pay a lower . Before your ission you should confirm all likely out-of-pocket expenses with your doctor and/or hospital.
Other things you should know If there’s anything else you want to know that’s not covered here such as benefit replacement periods or our rules on paying benefits, you should be able to find what you’re looking for by reading our hip Guide at medibank.com.au
What is an accident? We define an accident as an unforeseen event occurring by chance and caused by an external force or object resulting in involuntary injuries to the body which requires immediate treatment. This doesn’t include conditions brought on by medical causes such as asthma attacks and appendicitis.
call 132 331 131 680 for Corporate enquiries visit medibank.com.au or ask in store connect with us on
We’ll help you be your best at every stage in life
Unhappy? What if you have a complaint? We try to resolve all enquiries and concerns the first time you us. If you still need help with your concern or any aspect of your hip, our Customer Resolutions team will provide courteous and respectful service. You’ll just need to provide sufficient information regarding your enquiry so we can investigate it for you. You can do this by: • calling 132 331 • emailing the secure form available in Online Member Services at medibank.com.au • writing to Medibank Private Customer Resolutions, GPO Box 9999, Melbourne, VIC 3000. If for some reason we are not able to satisfy your enquiry, you can also get free, independent advice from the Private Health Insurance Ombudsman by: • calling 1800 640 695 • visiting phio.org.au
Why Medibank? Medibank is more than just about insuring your health. We have the people, services and resources to be your personal health partner, helping you to be your best at every stage in life. We’re committed to making health insurance as straightforward as possible. For a start, we make it easier for you to choose cover that’s right for you. We have an extensive network of stores across Australia where you can drop in for advice and assistance. And when it comes to claiming, we do everything we can to make the process how it should be – clear, simple, and certain.
Medibank Private is a signatory to the Private Health Insurance Code of Conduct. The Private Health Insurance Code of Conduct logo is a trademark of, and is used under authorisation from, Private Healthcare Australia. In order to provide you with a range of health insurance and health related services, Medibank Private and its related companies may share your personal (including sensitive) information. Our sets out how your personal (including sensitive) information is handled. You can view a copy of our Fund rules and at any Medibank store, or online at medibank.com.au Medibank Private Limited ABN 47 080 890 259
Effective October 2013. MPL34591013
Important information
Did you know?
Out-of-pocket expenses
Understanding our
The difference between the cost of a hospital or extras service and any benefit received from us or Medicare is an out-of-pocket expense. Here’s some info that may help reduce some of those expenses.
Not familiar with some words or phrases or want to know the definition of specific ? Find a list of frequently used words, and phrases at medibank.com.au/glossary
How much do you pay for extras? While you may have to pay an out-ofpocket expense on extras, you may save money by visiting a ’ Choice extras provider. You benefit from capped charges and/or discounts, which means you’ll generally have lower out-of-pocket expenses than you would at a non ’ Choice provider. How much do you pay if you go to hospital? Hospital cover helps pay for your hospital visit but doesn’t always cover all the costs. You may be able to reduce your out-of-pocket hospital expenses by choosing a ’ Choice hospital and by asking your doctor or specialist to participate in Medibank’s GapCover. For more information about GapCover, please refer to the hip Guide at medibank.com.au However, you may still have some out-of-pocket hospital expenses, such as the difference between the hospital’s charges and the benefit we pay and an excess (if you choose to have one). But , by choosing a hospital cover that has an excess, you’ll pay a lower . Before your ission you should confirm all likely out-of-pocket expenses with your doctor and/or hospital.
Other things you should know If there’s anything else you want to know that’s not covered here such as benefit replacement periods or our rules on paying benefits, you should be able to find what you’re looking for by reading our hip Guide at medibank.com.au
What is an accident? We define an accident as an unforeseen event occurring by chance and caused by an external force or object resulting in involuntary injuries to the body which requires immediate treatment. This doesn’t include conditions brought on by medical causes such as asthma attacks and appendicitis.
call 132 331 131 680 for Corporate enquiries visit medibank.com.au or ask in store connect with us on
We’ll help you be your best at every stage in life
Unhappy? What if you have a complaint? We try to resolve all enquiries and concerns the first time you us. If you still need help with your concern or any aspect of your hip, our Customer Resolutions team will provide courteous and respectful service. You’ll just need to provide sufficient information regarding your enquiry so we can investigate it for you. You can do this by: • calling 132 331 • emailing the secure form available in Online Member Services at medibank.com.au • writing to Medibank Private Customer Resolutions, GPO Box 9999, Melbourne, VIC 3000. If for some reason we are not able to satisfy your enquiry, you can also get free, independent advice from the Private Health Insurance Ombudsman by: • calling 1800 640 695 • visiting phio.org.au
Why Medibank? Medibank is more than just about insuring your health. We have the people, services and resources to be your personal health partner, helping you to be your best at every stage in life. We’re committed to making health insurance as straightforward as possible. For a start, we make it easier for you to choose cover that’s right for you. We have an extensive network of stores across Australia where you can drop in for advice and assistance. And when it comes to claiming, we do everything we can to make the process how it should be – clear, simple, and certain.
Medibank Private is a signatory to the Private Health Insurance Code of Conduct. The Private Health Insurance Code of Conduct logo is a trademark of, and is used under authorisation from, Private Healthcare Australia. In order to provide you with a range of health insurance and health related services, Medibank Private and its related companies may share your personal (including sensitive) information. Our sets out how your personal (including sensitive) information is handled. You can view a copy of our Fund rules and at any Medibank store, or online at medibank.com.au Medibank Private Limited ABN 47 080 890 259
Effective October 2013. MPL34591013
Important information
Did you know?
Understanding our
The difference between the cost of a hospital or extras service and any benefit received from us or Medicare is an out-of-pocket expense. Here’s some info that may help reduce some of those expenses.
Not familiar with some words or phrases or want to know the definition of specific ? Find a list of frequently used words, and phrases at medibank.com.au/glossary
How much do you pay for extras? While you may have to pay an out-ofpocket expense on extras, you may save money by visiting a ’ Choice extras provider. You benefit from capped charges and/or discounts, which means you’ll generally have lower out-of-pocket expenses than you would at a non ’ Choice provider. How much do you pay if you go to hospital? Hospital cover helps pay for your hospital visit but doesn’t always cover all the costs. You may be able to reduce your out-of-pocket hospital expenses by choosing a ’ Choice hospital and by asking your doctor or specialist to participate in Medibank’s GapCover. For more information about GapCover, please refer to the hip Guide at medibank.com.au However, you may still have some out-of-pocket hospital expenses, such as the difference between the hospital’s charges and the benefit we pay and an excess (if you choose to have one). But , by choosing a hospital cover that has an excess, you’ll pay a lower . Before your ission you should confirm all likely out-of-pocket expenses with your doctor and/or hospital.
Other things you should know If there’s anything else you want to know that’s not covered here such as benefit replacement periods or our rules on paying benefits, you should be able to find what you’re looking for by reading our hip Guide at medibank.com.au
What is an accident? We define an accident as an unforeseen event occurring by chance and caused by an external force or object resulting in involuntary injuries to the body which requires immediate treatment. This doesn’t include conditions brought on by medical causes such as asthma attacks and appendicitis.
call 132 331 131 680 for Corporate enquiries visit medibank.com.au or ask in store connect with us on
We’ll help you be your best at every stage in life
Unhappy? What if you have a complaint? We try to resolve all enquiries and concerns the first time you us. If you still need help with your concern or any aspect of your hip, our Customer Resolutions team will provide courteous and respectful service. You’ll just need to provide sufficient information regarding your enquiry so we can investigate it for you. You can do this by: • calling 132 331 • emailing the secure form available in Online Member Services at medibank.com.au • writing to Medibank Private Customer Resolutions, GPO Box 9999, Melbourne, VIC 3000. If for some reason we are not able to satisfy your enquiry, you can also get free, independent advice from the Private Health Insurance Ombudsman by: • calling 1800 640 695 • visiting phio.org.au
Why Medibank? Medibank is more than just about insuring your health. We have the people, services and resources to be your personal health partner, helping you to be your best at every stage in life. We’re committed to making health insurance as straightforward as possible. For a start, we make it easier for you to choose cover that’s right for you. We have an extensive network of stores across Australia where you can drop in for advice and assistance. And when it comes to claiming, we do everything we can to make the process how it should be – clear, simple, and certain.
Medibank Private is a signatory to the Private Health Insurance Code of Conduct. The Private Health Insurance Code of Conduct logo is a trademark of, and is used under authorisation from, Private Healthcare Australia. In order to provide you with a range of health insurance and health related services, Medibank Private and its related companies may share your personal (including sensitive) information. Our sets out how your personal (including sensitive) information is handled. You can view a copy of our Fund rules and at any Medibank store, or online at medibank.com.au Medibank Private Limited ABN 47 080 890 259
Effective October 2013. MPL34591013
Important information
Did you know?
Out-of-pocket expenses
Understanding our
The difference between the cost of a hospital or extras service and any benefit received from us or Medicare is an out-of-pocket expense. Here’s some info that may help reduce some of those expenses.
Not familiar with some words or phrases or want to know the definition of specific ? Find a list of frequently used words, and phrases at medibank.com.au/glossary
How much do you pay for extras? While you may have to pay an out-ofpocket expense on extras, you may save money by visiting a ’ Choice extras provider. You benefit from capped charges and/or discounts, which means you’ll generally have lower out-of-pocket expenses than you would at a non ’ Choice provider. How much do you pay if you go to hospital? Hospital cover helps pay for your hospital visit but doesn’t always cover all the costs. You may be able to reduce your out-of-pocket hospital expenses by choosing a ’ Choice hospital and by asking your doctor or specialist to participate in Medibank’s GapCover. For more information about GapCover, please refer to the hip Guide at medibank.com.au However, you may still have some out-of-pocket hospital expenses, such as the difference between the hospital’s charges and the benefit we pay and an excess (if you choose to have one). But , by choosing a hospital cover that has an excess, you’ll pay a lower . Before your ission you should confirm all likely out-of-pocket expenses with your doctor and/or hospital.
Other things you should know If there’s anything else you want to know that’s not covered here such as benefit replacement periods or our rules on paying benefits, you should be able to find what you’re looking for by reading our hip Guide at medibank.com.au
What is an accident? We define an accident as an unforeseen event occurring by chance and caused by an external force or object resulting in involuntary injuries to the body which requires immediate treatment. This doesn’t include conditions brought on by medical causes such as asthma attacks and appendicitis.
call 132 331 131 680 for Corporate enquiries visit medibank.com.au or ask in store connect with us on
We’ll help you be your best at every stage in life
Unhappy? What if you have a complaint? We try to resolve all enquiries and concerns the first time you us. If you still need help with your concern or any aspect of your hip, our Customer Resolutions team will provide courteous and respectful service. You’ll just need to provide sufficient information regarding your enquiry so we can investigate it for you. You can do this by: • calling 132 331 • emailing the secure form available in Online Member Services at medibank.com.au • writing to Medibank Private Customer Resolutions, GPO Box 9999, Melbourne, VIC 3000. If for some reason we are not able to satisfy your enquiry, you can also get free, independent advice from the Private Health Insurance Ombudsman by: • calling 1800 640 695 • visiting phio.org.au
Why Medibank? Medibank is more than just about insuring your health. We have the people, services and resources to be your personal health partner, helping you to be your best at every stage in life. We’re committed to making health insurance as straightforward as possible. For a start, we make it easier for you to choose cover that’s right for you. We have an extensive network of stores across Australia where you can drop in for advice and assistance. And when it comes to claiming, we do everything we can to make the process how it should be – clear, simple, and certain.
Medibank Private is a signatory to the Private Health Insurance Code of Conduct. The Private Health Insurance Code of Conduct logo is a trademark of, and is used under authorisation from, Private Healthcare Australia. In order to provide you with a range of health insurance and health related services, Medibank Private and its related companies may share your personal (including sensitive) information. Our sets out how your personal (including sensitive) information is handled. You can view a copy of our Fund rules and at any Medibank store, or online at medibank.com.au Medibank Private Limited ABN 47 080 890 259
Effective October 2013. MPL34591013
Important information
Did you know?
It pays to understand your Medibank health insurance The more you understand about your Medibank cover the easier it is to make the most of it. From rebates and levies, to pre-existing conditions and cooling off periods, you’ll find it explained simply within these few pages. We know reading about the ins and outs of private health insurance isn’t everyone’s idea of a good time, but it’s certainly time well spent. For more information on Medibank’s policies and Fund rules, read our hip Guide at medibank.com.au
Rebates, Levies and Loadings The Medicare Levy Surcharge The Australian Government encourages all adults to take out private health insurance, with the aim of easing the strain on the public hospital system. From 1 July 2013, single adults with an annual income over $88,000 per year or couples and families with a combined annual income over $176,000, who don’t have private hospital cover, may have to pay the Medicare Levy Surcharge (MLS). The MLS is an additional tax, on top of the existing Medicare Levy. It is deducted from your earnings and ranges from 1% to 1.5% depending on your annual income. You can avoid or minimise the MLS by having a Medibank hospital cover, and you can learn more at ato.gov.au
Australian Government Rebate The Australian Government Rebate on private health insurance (AGR) can reward people who’ve taken out private hospital cover with a rebate on their s. Rebates are calculated on income and age of the oldest person on your cover and vary from 10% to 40%. To find out more go to medibank.com.au or ato.gov.au For example, from 1 July 2013, if your combined income is less than $176,000, and the oldest person on your cover is under 65 years, you may be eligible to receive a 30% rebate. If you’re a Medibank member you should nominate your rebate tier by logging into Online Member Services at medibank.com.au or by visiting a Medibank store. Lifetime Health Cover loading The Australian Government is incentivising people to take out their own private health cover through taxes and rebates. And because they want us to do it sooner rather than later, they also apply a Lifetime Health Cover loading (LHC) to people who haven’t taken out hospital cover by 1 July following their 31st birthday. For every year you don’t have hospital cover after your 31st birthday, you’ll pay a 2% loading on top of the base rate of your hospital cover – up to a maximum of 70%.
The loading will be removed once you’ve had hospital cover continuously for 10 years. Who’s exempt? People born before 1 July 1934 don’t have to pay a LHC loading. You can learn more about other exemption categories at www.health.gov.au What if you drop your hospital cover? Life’s unpredictable and you may be forced to cancel or suspend your hospital cover for a period of time. The good news is you can drop your hospital cover for up to three years (1,094 permitted days) during your lifetime without impacting your LHC loading status. Any longer than this and you’ll have to pay the loading once you take out hospital cover again. There are some circumstances when your days without hospital cover won’t count towards your 1,094 permitted days without hospital cover, such as: • if you’ve been overseas continuously for more than one year (this includes visits back to Australia of less than 90 days at a time), and/or • if your health insurer has agreed to a period of suspension of your cover. Switching from another health insurer? If you switch to us from another health insurer it’s best to keep your existing cover until the day you become a Medibank member. This way you can avoid u any of the 1,094 permitted days you can be without hospital cover during your lifetime. Any period of time you’ve had the loading applied by another health insurer will be transferred to your Medibank cover and counted towards the 10 year loading period. the loading will be removed after having 10 years of continuous hospital cover.
ing Medibank Cooling off period It’s okay to change your mind. You can cancel your hip within 30 days
of ing as long as you haven’t made a claim, and your will be fully refunded. Transfers Coming to us from another health insurer? We’ll make the transition as smooth and painless as possible, and you’ll be covered from the date you if:
Period
Item/Service
No waiting period 2 months*
Mi Health services (available with hospital covers only)
6 months
Optical items Ultra bonus hip Bonus
12 months
Pre-existing conditions† Obstetrics-related services Major dental services Orthodontics Surgical dental procedures and extractions Breathing appliances, including nebulisers, peak flow meters and spacing devices^ betterhealth programs Oral appliances for sleep apnoea^
• those services are also included on the Medibank cover we consider to be most similar to the cover you had with your former health insurer, and • you us within two months of leaving that former insurer, and • you’ve served applicable waiting periods. We’ll credit you with waiting periods you’ve already served, so you’ll only need to serve the balance with us before you can claim. Also, benefits that have been paid under your previous cover may be taken into in determining the benefits payable under your Medibank cover. Any loyalty bonus or similar entitlements built up with your former health insurer won’t transfer to Medibank. Waiting periods All health insurers have waiting periods that everyone serves before they can receive benefits. If you haven’t had health insurance before or it’s been over two months since you had health insurance, you’ll need to serve waiting periods. What if you’re changing to a higher level? Whether you’re upgrading within Medibank or from another health insurer, additional waiting periods may apply. In the meantime you can still receive a benefit for services that are covered in both your old and new cover and where you’ve already served relevant waiting periods. Waiting periods vary for different services and items. The following table is a guide.
All services (including ambulance services) except those set out below
24 months
Blood glucose monitors^ Blood pressure monitors^
36 months
Hearing aids^ Laser eye surgery
higher levels of hospital covers (either from Medibank or from another health insurer), you’ll need to wait 12 months to receive the higher benefits. For more information about pre-existing conditions please refer to the hip Guide at medibank.com.au
Added benefits of some packaged covers With some of our packaged covers you’ll benefit from an annual hip Bonus (per hip) as well as increasing annual limits on selected extras services. These benefits are exclusive to the covers below and aren’t available on other Medibank covers. • For New Families Essentials • For New Families Comprehensive • For Settled Families Essentials
*If you have an accident after ing us or changing cover and require treatment, we’ll waive the 2 month waiting period. Please note that if you have our stand-alone Ambulance cover, the 7 day waiting period for accidents still applies.
• For Settled Families Comprehensive
†
With For Everyday Essentials and For Security Essentials cover, you receive increasing annual limits on selected extras services.
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, but a 2 month waiting period still applies. ^Benefit replacement periods apply. Please refer to the hip Guide at medibank.com.au
Pre-existing conditions All private health insurers have a waiting period of 12 months before you can claim for a pre-existing condition. This is an ailment, illness or condition with signs or symptoms that existed as determined by one of our doctors in the six months before starting your hip or changing cover and applies only to hospital cover. If you go to hospital within the first 12 months of ing, we may check whether you’re being treated for a pre-existing condition. What if you have a pre-existing condition? If you’ve never had private hospital cover or if your cover has lapsed, you’ll need to wait 12 months before you can claim for treatment of a pre-existing condition. If you have upgraded to one of our
• For Everyday Comprehensive • For Security Comprehensive.
hip Bonus A separate amount that you can put towards the cost of approved hip and health related expenses. This annual bonus is in addition to benefits you receive towards the hospital and extras services of this product. Any unused hip Bonus will be added to the following year’s entitlement which can accrue up to the maximum limit.* There’s a 6 month waiting period before you can use your hip Bonus. Then on 1 January every year you will receive your hip Bonus entitlement until you reach your limit. The bonus can be used for a range of things like topping up your benefits to reduce your out-of-pocket expenses such as using on your extras and paying towards your hospital excess. You can
also use this bonus for other health related expenses, to find out more call us on 132 331. There are some things you can’t use your hip Bonus towards which include your , any contributions towards Pharmaceutical Benefits Scheme (PBS) prescriptions, out-ofhospital medical expenses covered by Medicare, other non-approved expenses, or expenses and costs precluded by law from being paid. The expenses you can use your hip Bonus towards are subject to change. For more information, call us on 132 331. Increasing annual limits on selected extras services For a range of extras services*, your annual limits increase by $50 per member, per calendar year (up to the maximum amount*), starting from 1 January only after a full calendar year of hip has been completed. The following table is an example of a member who takes out For New Families Essentials cover on 30 June 2013 and how their annual limit will increase for major dental. Date
Annual Limit
30 June 2013
$400
1 January 2014
$400 (no increase as hip still within 1st calendar year)
1 January 2015
$450 (annual limit increases as full calendar year of hip has been completed).
1 January 2016
$500
1 January 2017
$550
1 January 2018
$600
1 January 2019
$650 (maximum)
*Refer to Extras product tables in the Family packages and Singles and Couples packages brochures for more details, or visit medibank.com.au
Ambulance services Ambulance services provide peace of mind by covering the cost to take you to hospital if you’re injured or too sick to get there another way. You’re also covered when an ambulance is called for immediate medical attention, even if transport by ambulance isn’t needed. What’s covered? Ambulance services include: • ambulance transport to hospital to receive immediate professional attention • when an ambulance is called to provide immediate professional attention – even if you don’t need ambulance transport • when, as an itted patient, you’re transferred between private hospitals • transport by air ambulance, where preapproval is obtained from Medibank by the air ambulance provider. What’s not covered? Ambulance services exclude: • when immediate professional attention is not required, for example general patient transport • transfers between public hospitals • any ambulance costs that are fully covered by a third party arrangement, such as an ambulance subscription or a federal/state/territory transport scheme, WorkCover or the Transport Accident Commission • any air ambulance services that are fully subsidised, such as South Care or NRMA Care Flight. State schemes Some states and territories, such as QLD and TAS, have their own state ambulance schemes which affect how you’re covered by Medibank. We don’t provide Ambulance Cover for QLD and TAS residents. You can find out more at medibank.com.au/ambulance
It pays to understand your Medibank health insurance The more you understand about your Medibank cover the easier it is to make the most of it. From rebates and levies, to pre-existing conditions and cooling off periods, you’ll find it explained simply within these few pages. We know reading about the ins and outs of private health insurance isn’t everyone’s idea of a good time, but it’s certainly time well spent. For more information on Medibank’s policies and Fund rules, read our hip Guide at medibank.com.au
Rebates, Levies and Loadings The Medicare Levy Surcharge The Australian Government encourages all adults to take out private health insurance, with the aim of easing the strain on the public hospital system. From 1 July 2013, single adults with an annual income over $88,000 per year or couples and families with a combined annual income over $176,000, who don’t have private hospital cover, may have to pay the Medicare Levy Surcharge (MLS). The MLS is an additional tax, on top of the existing Medicare Levy. It is deducted from your earnings and ranges from 1% to 1.5% depending on your annual income. You can avoid or minimise the MLS by having a Medibank hospital cover, and you can learn more at ato.gov.au
Australian Government Rebate The Australian Government Rebate on private health insurance (AGR) can reward people who’ve taken out private hospital cover with a rebate on their s. Rebates are calculated on income and age of the oldest person on your cover and vary from 10% to 40%. To find out more go to medibank.com.au or ato.gov.au For example, from 1 July 2013, if your combined income is less than $176,000, and the oldest person on your cover is under 65 years, you may be eligible to receive a 30% rebate. If you’re a Medibank member you should nominate your rebate tier by logging into Online Member Services at medibank.com.au or by visiting a Medibank store. Lifetime Health Cover loading The Australian Government is incentivising people to take out their own private health cover through taxes and rebates. And because they want us to do it sooner rather than later, they also apply a Lifetime Health Cover loading (LHC) to people who haven’t taken out hospital cover by 1 July following their 31st birthday. For every year you don’t have hospital cover after your 31st birthday, you’ll pay a 2% loading on top of the base rate of your hospital cover – up to a maximum of 70%.
The loading will be removed once you’ve had hospital cover continuously for 10 years. Who’s exempt? People born before 1 July 1934 don’t have to pay a LHC loading. You can learn more about other exemption categories at www.health.gov.au What if you drop your hospital cover? Life’s unpredictable and you may be forced to cancel or suspend your hospital cover for a period of time. The good news is you can drop your hospital cover for up to three years (1,094 permitted days) during your lifetime without impacting your LHC loading status. Any longer than this and you’ll have to pay the loading once you take out hospital cover again. There are some circumstances when your days without hospital cover won’t count towards your 1,094 permitted days without hospital cover, such as: • if you’ve been overseas continuously for more than one year (this includes visits back to Australia of less than 90 days at a time), and/or • if your health insurer has agreed to a period of suspension of your cover. Switching from another health insurer? If you switch to us from another health insurer it’s best to keep your existing cover until the day you become a Medibank member. This way you can avoid u any of the 1,094 permitted days you can be without hospital cover during your lifetime. Any period of time you’ve had the loading applied by another health insurer will be transferred to your Medibank cover and counted towards the 10 year loading period. the loading will be removed after having 10 years of continuous hospital cover.
ing Medibank Cooling off period It’s okay to change your mind. You can cancel your hip within 30 days
of ing as long as you haven’t made a claim, and your will be fully refunded. Transfers Coming to us from another health insurer? We’ll make the transition as smooth and painless as possible, and you’ll be covered from the date you if:
Period
Item/Service
No waiting period 2 months*
Mi Health services (available with hospital covers only)
6 months
Optical items Ultra bonus hip Bonus
12 months
Pre-existing conditions† Obstetrics-related services Major dental services Orthodontics Surgical dental procedures and extractions Breathing appliances, including nebulisers, peak flow meters and spacing devices^ betterhealth programs Oral appliances for sleep apnoea^
• those services are also included on the Medibank cover we consider to be most similar to the cover you had with your former health insurer, and • you us within two months of leaving that former insurer, and • you’ve served applicable waiting periods. We’ll credit you with waiting periods you’ve already served, so you’ll only need to serve the balance with us before you can claim. Also, benefits that have been paid under your previous cover may be taken into in determining the benefits payable under your Medibank cover. Any loyalty bonus or similar entitlements built up with your former health insurer won’t transfer to Medibank. Waiting periods All health insurers have waiting periods that everyone serves before they can receive benefits. If you haven’t had health insurance before or it’s been over two months since you had health insurance, you’ll need to serve waiting periods. What if you’re changing to a higher level? Whether you’re upgrading within Medibank or from another health insurer, additional waiting periods may apply. In the meantime you can still receive a benefit for services that are covered in both your old and new cover and where you’ve already served relevant waiting periods. Waiting periods vary for different services and items. The following table is a guide.
All services (including ambulance services) except those set out below
24 months
Blood glucose monitors^ Blood pressure monitors^
36 months
Hearing aids^ Laser eye surgery
higher levels of hospital covers (either from Medibank or from another health insurer), you’ll need to wait 12 months to receive the higher benefits. For more information about pre-existing conditions please refer to the hip Guide at medibank.com.au
Added benefits of some packaged covers With some of our packaged covers you’ll benefit from an annual hip Bonus (per hip) as well as increasing annual limits on selected extras services. These benefits are exclusive to the covers below and aren’t available on other Medibank covers. • For New Families Essentials • For New Families Comprehensive • For Settled Families Essentials
*If you have an accident after ing us or changing cover and require treatment, we’ll waive the 2 month waiting period. Please note that if you have our stand-alone Ambulance cover, the 7 day waiting period for accidents still applies.
• For Settled Families Comprehensive
†
With For Everyday Essentials and For Security Essentials cover, you receive increasing annual limits on selected extras services.
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, but a 2 month waiting period still applies. ^Benefit replacement periods apply. Please refer to the hip Guide at medibank.com.au
Pre-existing conditions All private health insurers have a waiting period of 12 months before you can claim for a pre-existing condition. This is an ailment, illness or condition with signs or symptoms that existed as determined by one of our doctors in the six months before starting your hip or changing cover and applies only to hospital cover. If you go to hospital within the first 12 months of ing, we may check whether you’re being treated for a pre-existing condition. What if you have a pre-existing condition? If you’ve never had private hospital cover or if your cover has lapsed, you’ll need to wait 12 months before you can claim for treatment of a pre-existing condition. If you have upgraded to one of our
• For Everyday Comprehensive • For Security Comprehensive.
hip Bonus A separate amount that you can put towards the cost of approved hip and health related expenses. This annual bonus is in addition to benefits you receive towards the hospital and extras services of this product. Any unused hip Bonus will be added to the following year’s entitlement which can accrue up to the maximum limit.* There’s a 6 month waiting period before you can use your hip Bonus. Then on 1 January every year you will receive your hip Bonus entitlement until you reach your limit. The bonus can be used for a range of things like topping up your benefits to reduce your out-of-pocket expenses such as using on your extras and paying towards your hospital excess. You can
also use this bonus for other health related expenses, to find out more call us on 132 331. There are some things you can’t use your hip Bonus towards which include your , any contributions towards Pharmaceutical Benefits Scheme (PBS) prescriptions, out-ofhospital medical expenses covered by Medicare, other non-approved expenses, or expenses and costs precluded by law from being paid. The expenses you can use your hip Bonus towards are subject to change. For more information, call us on 132 331. Increasing annual limits on selected extras services For a range of extras services*, your annual limits increase by $50 per member, per calendar year (up to the maximum amount*), starting from 1 January only after a full calendar year of hip has been completed. The following table is an example of a member who takes out For New Families Essentials cover on 30 June 2013 and how their annual limit will increase for major dental. Date
Annual Limit
30 June 2013
$400
1 January 2014
$400 (no increase as hip still within 1st calendar year)
1 January 2015
$450 (annual limit increases as full calendar year of hip has been completed).
1 January 2016
$500
1 January 2017
$550
1 January 2018
$600
1 January 2019
$650 (maximum)
*Refer to Extras product tables in the Family packages and Singles and Couples packages brochures for more details, or visit medibank.com.au
Ambulance services Ambulance services provide peace of mind by covering the cost to take you to hospital if you’re injured or too sick to get there another way. You’re also covered when an ambulance is called for immediate medical attention, even if transport by ambulance isn’t needed. What’s covered? Ambulance services include: • ambulance transport to hospital to receive immediate professional attention • when an ambulance is called to provide immediate professional attention – even if you don’t need ambulance transport • when, as an itted patient, you’re transferred between private hospitals • transport by air ambulance, where preapproval is obtained from Medibank by the air ambulance provider. What’s not covered? Ambulance services exclude: • when immediate professional attention is not required, for example general patient transport • transfers between public hospitals • any ambulance costs that are fully covered by a third party arrangement, such as an ambulance subscription or a federal/state/territory transport scheme, WorkCover or the Transport Accident Commission • any air ambulance services that are fully subsidised, such as South Care or NRMA Care Flight. State schemes Some states and territories, such as QLD and TAS, have their own state ambulance schemes which affect how you’re covered by Medibank. We don’t provide Ambulance Cover for QLD and TAS residents. You can find out more at medibank.com.au/ambulance
It pays to understand your Medibank health insurance The more you understand about your Medibank cover the easier it is to make the most of it. From rebates and levies, to pre-existing conditions and cooling off periods, you’ll find it explained simply within these few pages. We know reading about the ins and outs of private health insurance isn’t everyone’s idea of a good time, but it’s certainly time well spent. For more information on Medibank’s policies and Fund rules, read our hip Guide at medibank.com.au
Rebates, Levies and Loadings The Medicare Levy Surcharge The Australian Government encourages all adults to take out private health insurance, with the aim of easing the strain on the public hospital system. From 1 July 2013, single adults with an annual income over $88,000 per year or couples and families with a combined annual income over $176,000, who don’t have private hospital cover, may have to pay the Medicare Levy Surcharge (MLS). The MLS is an additional tax, on top of the existing Medicare Levy. It is deducted from your earnings and ranges from 1% to 1.5% depending on your annual income. You can avoid or minimise the MLS by having a Medibank hospital cover, and you can learn more at ato.gov.au
Australian Government Rebate The Australian Government Rebate on private health insurance (AGR) can reward people who’ve taken out private hospital cover with a rebate on their s. Rebates are calculated on income and age of the oldest person on your cover and vary from 10% to 40%. To find out more go to medibank.com.au or ato.gov.au For example, from 1 July 2013, if your combined income is less than $176,000, and the oldest person on your cover is under 65 years, you may be eligible to receive a 30% rebate. If you’re a Medibank member you should nominate your rebate tier by logging into Online Member Services at medibank.com.au or by visiting a Medibank store. Lifetime Health Cover loading The Australian Government is incentivising people to take out their own private health cover through taxes and rebates. And because they want us to do it sooner rather than later, they also apply a Lifetime Health Cover loading (LHC) to people who haven’t taken out hospital cover by 1 July following their 31st birthday. For every year you don’t have hospital cover after your 31st birthday, you’ll pay a 2% loading on top of the base rate of your hospital cover – up to a maximum of 70%.
The loading will be removed once you’ve had hospital cover continuously for 10 years. Who’s exempt? People born before 1 July 1934 don’t have to pay a LHC loading. You can learn more about other exemption categories at www.health.gov.au What if you drop your hospital cover? Life’s unpredictable and you may be forced to cancel or suspend your hospital cover for a period of time. The good news is you can drop your hospital cover for up to three years (1,094 permitted days) during your lifetime without impacting your LHC loading status. Any longer than this and you’ll have to pay the loading once you take out hospital cover again. There are some circumstances when your days without hospital cover won’t count towards your 1,094 permitted days without hospital cover, such as: • if you’ve been overseas continuously for more than one year (this includes visits back to Australia of less than 90 days at a time), and/or • if your health insurer has agreed to a period of suspension of your cover. Switching from another health insurer? If you switch to us from another health insurer it’s best to keep your existing cover until the day you become a Medibank member. This way you can avoid u any of the 1,094 permitted days you can be without hospital cover during your lifetime. Any period of time you’ve had the loading applied by another health insurer will be transferred to your Medibank cover and counted towards the 10 year loading period. the loading will be removed after having 10 years of continuous hospital cover.
ing Medibank Cooling off period It’s okay to change your mind. You can cancel your hip within 30 days
of ing as long as you haven’t made a claim, and your will be fully refunded. Transfers Coming to us from another health insurer? We’ll make the transition as smooth and painless as possible, and you’ll be covered from the date you if:
Period
Item/Service
No waiting period 2 months*
Mi Health services (available with hospital covers only)
6 months
Optical items Ultra bonus hip Bonus
12 months
Pre-existing conditions† Obstetrics-related services Major dental services Orthodontics Surgical dental procedures and extractions Breathing appliances, including nebulisers, peak flow meters and spacing devices^ betterhealth programs Oral appliances for sleep apnoea^
• those services are also included on the Medibank cover we consider to be most similar to the cover you had with your former health insurer, and • you us within two months of leaving that former insurer, and • you’ve served applicable waiting periods. We’ll credit you with waiting periods you’ve already served, so you’ll only need to serve the balance with us before you can claim. Also, benefits that have been paid under your previous cover may be taken into in determining the benefits payable under your Medibank cover. Any loyalty bonus or similar entitlements built up with your former health insurer won’t transfer to Medibank. Waiting periods All health insurers have waiting periods that everyone serves before they can receive benefits. If you haven’t had health insurance before or it’s been over two months since you had health insurance, you’ll need to serve waiting periods. What if you’re changing to a higher level? Whether you’re upgrading within Medibank or from another health insurer, additional waiting periods may apply. In the meantime you can still receive a benefit for services that are covered in both your old and new cover and where you’ve already served relevant waiting periods. Waiting periods vary for different services and items. The following table is a guide.
All services (including ambulance services) except those set out below
24 months
Blood glucose monitors^ Blood pressure monitors^
36 months
Hearing aids^ Laser eye surgery
higher levels of hospital covers (either from Medibank or from another health insurer), you’ll need to wait 12 months to receive the higher benefits. For more information about pre-existing conditions please refer to the hip Guide at medibank.com.au
Added benefits of some packaged covers With some of our packaged covers you’ll benefit from an annual hip Bonus (per hip) as well as increasing annual limits on selected extras services. These benefits are exclusive to the covers below and aren’t available on other Medibank covers. • For New Families Essentials • For New Families Comprehensive • For Settled Families Essentials
*If you have an accident after ing us or changing cover and require treatment, we’ll waive the 2 month waiting period. Please note that if you have our stand-alone Ambulance cover, the 7 day waiting period for accidents still applies.
• For Settled Families Comprehensive
†
With For Everyday Essentials and For Security Essentials cover, you receive increasing annual limits on selected extras services.
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, but a 2 month waiting period still applies. ^Benefit replacement periods apply. Please refer to the hip Guide at medibank.com.au
Pre-existing conditions All private health insurers have a waiting period of 12 months before you can claim for a pre-existing condition. This is an ailment, illness or condition with signs or symptoms that existed as determined by one of our doctors in the six months before starting your hip or changing cover and applies only to hospital cover. If you go to hospital within the first 12 months of ing, we may check whether you’re being treated for a pre-existing condition. What if you have a pre-existing condition? If you’ve never had private hospital cover or if your cover has lapsed, you’ll need to wait 12 months before you can claim for treatment of a pre-existing condition. If you have upgraded to one of our
• For Everyday Comprehensive • For Security Comprehensive.
hip Bonus A separate amount that you can put towards the cost of approved hip and health related expenses. This annual bonus is in addition to benefits you receive towards the hospital and extras services of this product. Any unused hip Bonus will be added to the following year’s entitlement which can accrue up to the maximum limit.* There’s a 6 month waiting period before you can use your hip Bonus. Then on 1 January every year you will receive your hip Bonus entitlement until you reach your limit. The bonus can be used for a range of things like topping up your benefits to reduce your out-of-pocket expenses such as using on your extras and paying towards your hospital excess. You can
also use this bonus for other health related expenses, to find out more call us on 132 331. There are some things you can’t use your hip Bonus towards which include your , any contributions towards Pharmaceutical Benefits Scheme (PBS) prescriptions, out-ofhospital medical expenses covered by Medicare, other non-approved expenses, or expenses and costs precluded by law from being paid. The expenses you can use your hip Bonus towards are subject to change. For more information, call us on 132 331. Increasing annual limits on selected extras services For a range of extras services*, your annual limits increase by $50 per member, per calendar year (up to the maximum amount*), starting from 1 January only after a full calendar year of hip has been completed. The following table is an example of a member who takes out For New Families Essentials cover on 30 June 2013 and how their annual limit will increase for major dental. Date
Annual Limit
30 June 2013
$400
1 January 2014
$400 (no increase as hip still within 1st calendar year)
1 January 2015
$450 (annual limit increases as full calendar year of hip has been completed).
1 January 2016
$500
1 January 2017
$550
1 January 2018
$600
1 January 2019
$650 (maximum)
*Refer to Extras product tables in the Family packages and Singles and Couples packages brochures for more details, or visit medibank.com.au
Ambulance services Ambulance services provide peace of mind by covering the cost to take you to hospital if you’re injured or too sick to get there another way. You’re also covered when an ambulance is called for immediate medical attention, even if transport by ambulance isn’t needed. What’s covered? Ambulance services include: • ambulance transport to hospital to receive immediate professional attention • when an ambulance is called to provide immediate professional attention – even if you don’t need ambulance transport • when, as an itted patient, you’re transferred between private hospitals • transport by air ambulance, where preapproval is obtained from Medibank by the air ambulance provider. What’s not covered? Ambulance services exclude: • when immediate professional attention is not required, for example general patient transport • transfers between public hospitals • any ambulance costs that are fully covered by a third party arrangement, such as an ambulance subscription or a federal/state/territory transport scheme, WorkCover or the Transport Accident Commission • any air ambulance services that are fully subsidised, such as South Care or NRMA Care Flight. State schemes Some states and territories, such as QLD and TAS, have their own state ambulance schemes which affect how you’re covered by Medibank. We don’t provide Ambulance Cover for QLD and TAS residents. You can find out more at medibank.com.au/ambulance
It pays to understand your Medibank health insurance The more you understand about your Medibank cover the easier it is to make the most of it. From rebates and levies, to pre-existing conditions and cooling off periods, you’ll find it explained simply within these few pages. We know reading about the ins and outs of private health insurance isn’t everyone’s idea of a good time, but it’s certainly time well spent. For more information on Medibank’s policies and Fund rules, read our hip Guide at medibank.com.au
Rebates, Levies and Loadings The Medicare Levy Surcharge The Australian Government encourages all adults to take out private health insurance, with the aim of easing the strain on the public hospital system. From 1 July 2013, single adults with an annual income over $88,000 per year or couples and families with a combined annual income over $176,000, who don’t have private hospital cover, may have to pay the Medicare Levy Surcharge (MLS). The MLS is an additional tax, on top of the existing Medicare Levy. It is deducted from your earnings and ranges from 1% to 1.5% depending on your annual income. You can avoid or minimise the MLS by having a Medibank hospital cover, and you can learn more at ato.gov.au
Australian Government Rebate The Australian Government Rebate on private health insurance (AGR) can reward people who’ve taken out private hospital cover with a rebate on their s. Rebates are calculated on income and age of the oldest person on your cover and vary from 10% to 40%. To find out more go to medibank.com.au or ato.gov.au For example, from 1 July 2013, if your combined income is less than $176,000, and the oldest person on your cover is under 65 years, you may be eligible to receive a 30% rebate. If you’re a Medibank member you should nominate your rebate tier by logging into Online Member Services at medibank.com.au or by visiting a Medibank store. Lifetime Health Cover loading The Australian Government is incentivising people to take out their own private health cover through taxes and rebates. And because they want us to do it sooner rather than later, they also apply a Lifetime Health Cover loading (LHC) to people who haven’t taken out hospital cover by 1 July following their 31st birthday. For every year you don’t have hospital cover after your 31st birthday, you’ll pay a 2% loading on top of the base rate of your hospital cover – up to a maximum of 70%.
The loading will be removed once you’ve had hospital cover continuously for 10 years. Who’s exempt? People born before 1 July 1934 don’t have to pay a LHC loading. You can learn more about other exemption categories at www.health.gov.au What if you drop your hospital cover? Life’s unpredictable and you may be forced to cancel or suspend your hospital cover for a period of time. The good news is you can drop your hospital cover for up to three years (1,094 permitted days) during your lifetime without impacting your LHC loading status. Any longer than this and you’ll have to pay the loading once you take out hospital cover again. There are some circumstances when your days without hospital cover won’t count towards your 1,094 permitted days without hospital cover, such as: • if you’ve been overseas continuously for more than one year (this includes visits back to Australia of less than 90 days at a time), and/or • if your health insurer has agreed to a period of suspension of your cover. Switching from another health insurer? If you switch to us from another health insurer it’s best to keep your existing cover until the day you become a Medibank member. This way you can avoid u any of the 1,094 permitted days you can be without hospital cover during your lifetime. Any period of time you’ve had the loading applied by another health insurer will be transferred to your Medibank cover and counted towards the 10 year loading period. the loading will be removed after having 10 years of continuous hospital cover.
ing Medibank Cooling off period It’s okay to change your mind. You can cancel your hip within 30 days
of ing as long as you haven’t made a claim, and your will be fully refunded. Transfers Coming to us from another health insurer? We’ll make the transition as smooth and painless as possible, and you’ll be covered from the date you if:
Period
Item/Service
No waiting period 2 months*
Mi Health services (available with hospital covers only)
6 months
Optical items Ultra bonus hip Bonus
12 months
Pre-existing conditions† Obstetrics-related services Major dental services Orthodontics Surgical dental procedures and extractions Breathing appliances, including nebulisers, peak flow meters and spacing devices^ betterhealth programs Oral appliances for sleep apnoea^
• those services are also included on the Medibank cover we consider to be most similar to the cover you had with your former health insurer, and • you us within two months of leaving that former insurer, and • you’ve served applicable waiting periods. We’ll credit you with waiting periods you’ve already served, so you’ll only need to serve the balance with us before you can claim. Also, benefits that have been paid under your previous cover may be taken into in determining the benefits payable under your Medibank cover. Any loyalty bonus or similar entitlements built up with your former health insurer won’t transfer to Medibank. Waiting periods All health insurers have waiting periods that everyone serves before they can receive benefits. If you haven’t had health insurance before or it’s been over two months since you had health insurance, you’ll need to serve waiting periods. What if you’re changing to a higher level? Whether you’re upgrading within Medibank or from another health insurer, additional waiting periods may apply. In the meantime you can still receive a benefit for services that are covered in both your old and new cover and where you’ve already served relevant waiting periods. Waiting periods vary for different services and items. The following table is a guide.
All services (including ambulance services) except those set out below
24 months
Blood glucose monitors^ Blood pressure monitors^
36 months
Hearing aids^ Laser eye surgery
higher levels of hospital covers (either from Medibank or from another health insurer), you’ll need to wait 12 months to receive the higher benefits. For more information about pre-existing conditions please refer to the hip Guide at medibank.com.au
Added benefits of some packaged covers With some of our packaged covers you’ll benefit from an annual hip Bonus (per hip) as well as increasing annual limits on selected extras services. These benefits are exclusive to the covers below and aren’t available on other Medibank covers. • For New Families Essentials • For New Families Comprehensive • For Settled Families Essentials
*If you have an accident after ing us or changing cover and require treatment, we’ll waive the 2 month waiting period. Please note that if you have our stand-alone Ambulance cover, the 7 day waiting period for accidents still applies.
• For Settled Families Comprehensive
†
With For Everyday Essentials and For Security Essentials cover, you receive increasing annual limits on selected extras services.
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, but a 2 month waiting period still applies. ^Benefit replacement periods apply. Please refer to the hip Guide at medibank.com.au
Pre-existing conditions All private health insurers have a waiting period of 12 months before you can claim for a pre-existing condition. This is an ailment, illness or condition with signs or symptoms that existed as determined by one of our doctors in the six months before starting your hip or changing cover and applies only to hospital cover. If you go to hospital within the first 12 months of ing, we may check whether you’re being treated for a pre-existing condition. What if you have a pre-existing condition? If you’ve never had private hospital cover or if your cover has lapsed, you’ll need to wait 12 months before you can claim for treatment of a pre-existing condition. If you have upgraded to one of our
• For Everyday Comprehensive • For Security Comprehensive.
hip Bonus A separate amount that you can put towards the cost of approved hip and health related expenses. This annual bonus is in addition to benefits you receive towards the hospital and extras services of this product. Any unused hip Bonus will be added to the following year’s entitlement which can accrue up to the maximum limit.* There’s a 6 month waiting period before you can use your hip Bonus. Then on 1 January every year you will receive your hip Bonus entitlement until you reach your limit. The bonus can be used for a range of things like topping up your benefits to reduce your out-of-pocket expenses such as using on your extras and paying towards your hospital excess. You can
also use this bonus for other health related expenses, to find out more call us on 132 331. There are some things you can’t use your hip Bonus towards which include your , any contributions towards Pharmaceutical Benefits Scheme (PBS) prescriptions, out-ofhospital medical expenses covered by Medicare, other non-approved expenses, or expenses and costs precluded by law from being paid. The expenses you can use your hip Bonus towards are subject to change. For more information, call us on 132 331. Increasing annual limits on selected extras services For a range of extras services*, your annual limits increase by $50 per member, per calendar year (up to the maximum amount*), starting from 1 January only after a full calendar year of hip has been completed. The following table is an example of a member who takes out For New Families Essentials cover on 30 June 2013 and how their annual limit will increase for major dental. Date
Annual Limit
30 June 2013
$400
1 January 2014
$400 (no increase as hip still within 1st calendar year)
1 January 2015
$450 (annual limit increases as full calendar year of hip has been completed).
1 January 2016
$500
1 January 2017
$550
1 January 2018
$600
1 January 2019
$650 (maximum)
*Refer to Extras product tables in the Family packages and Singles and Couples packages brochures for more details, or visit medibank.com.au
Ambulance services Ambulance services provide peace of mind by covering the cost to take you to hospital if you’re injured or too sick to get there another way. You’re also covered when an ambulance is called for immediate medical attention, even if transport by ambulance isn’t needed. What’s covered? Ambulance services include: • ambulance transport to hospital to receive immediate professional attention • when an ambulance is called to provide immediate professional attention – even if you don’t need ambulance transport • when, as an itted patient, you’re transferred between private hospitals • transport by air ambulance, where preapproval is obtained from Medibank by the air ambulance provider. What’s not covered? Ambulance services exclude: • when immediate professional attention is not required, for example general patient transport • transfers between public hospitals • any ambulance costs that are fully covered by a third party arrangement, such as an ambulance subscription or a federal/state/territory transport scheme, WorkCover or the Transport Accident Commission • any air ambulance services that are fully subsidised, such as South Care or NRMA Care Flight. State schemes Some states and territories, such as QLD and TAS, have their own state ambulance schemes which affect how you’re covered by Medibank. We don’t provide Ambulance Cover for QLD and TAS residents. You can find out more at medibank.com.au/ambulance
Out-of-pocket expenses
Understanding our
The difference between the cost of a hospital or extras service and any benefit received from us or Medicare is an out-of-pocket expense. Here’s some info that may help reduce some of those expenses.
Not familiar with some words or phrases or want to know the definition of specific ? Find a list of frequently used words, and phrases at medibank.com.au/glossary
How much do you pay for extras? While you may have to pay an out-ofpocket expense on extras, you may save money by visiting a ’ Choice extras provider. You benefit from capped charges and/or discounts, which means you’ll generally have lower out-of-pocket expenses than you would at a non ’ Choice provider. How much do you pay if you go to hospital? Hospital cover helps pay for your hospital visit but doesn’t always cover all the costs. You may be able to reduce your out-of-pocket hospital expenses by choosing a ’ Choice hospital and by asking your doctor or specialist to participate in Medibank’s GapCover. For more information about GapCover, please refer to the hip Guide at medibank.com.au However, you may still have some out-of-pocket hospital expenses, such as the difference between the hospital’s charges and the benefit we pay and an excess (if you choose to have one). But , by choosing a hospital cover that has an excess, you’ll pay a lower . Before your ission you should confirm all likely out-of-pocket expenses with your doctor and/or hospital.
Other things you should know If there’s anything else you want to know that’s not covered here such as benefit replacement periods or our rules on paying benefits, you should be able to find what you’re looking for by reading our hip Guide at medibank.com.au
What is an accident? We define an accident as an unforeseen event occurring by chance and caused by an external force or object resulting in involuntary injuries to the body which requires immediate treatment. This doesn’t include conditions brought on by medical causes such as asthma attacks and appendicitis.
call 132 331 131 680 for Corporate enquiries visit medibank.com.au or ask in store connect with us on
We’ll help you be your best at every stage in life
Unhappy? What if you have a complaint? We try to resolve all enquiries and concerns the first time you us. If you still need help with your concern or any aspect of your hip, our Customer Resolutions team will provide courteous and respectful service. You’ll just need to provide sufficient information regarding your enquiry so we can investigate it for you. You can do this by: • calling 132 331 • emailing the secure form available in Online Member Services at medibank.com.au • writing to Medibank Private Customer Resolutions, GPO Box 9999, Melbourne, VIC 3000. If for some reason we are not able to satisfy your enquiry, you can also get free, independent advice from the Private Health Insurance Ombudsman by: • calling 1800 640 695 • visiting phio.org.au
Why Medibank? Medibank is more than just about insuring your health. We have the people, services and resources to be your personal health partner, helping you to be your best at every stage in life. We’re committed to making health insurance as straightforward as possible. For a start, we make it easier for you to choose cover that’s right for you. We have an extensive network of stores across Australia where you can drop in for advice and assistance. And when it comes to claiming, we do everything we can to make the process how it should be – clear, simple, and certain.
Medibank Private is a signatory to the Private Health Insurance Code of Conduct. The Private Health Insurance Code of Conduct logo is a trademark of, and is used under authorisation from, Private Healthcare Australia. In order to provide you with a range of health insurance and health related services, Medibank Private and its related companies may share your personal (including sensitive) information. Our sets out how your personal (including sensitive) information is handled. You can view a copy of our Fund rules and at any Medibank store, or online at medibank.com.au Medibank Private Limited ABN 47 080 890 259
Effective October 2013. MPL34591013
Important information
Did you know?
Out-of-pocket expenses
Understanding our
The difference between the cost of a hospital or extras service and any benefit received from us or Medicare is an out-of-pocket expense. Here’s some info that may help reduce some of those expenses.
Not familiar with some words or phrases or want to know the definition of specific ? Find a list of frequently used words, and phrases at medibank.com.au/glossary
How much do you pay for extras? While you may have to pay an out-ofpocket expense on extras, you may save money by visiting a ’ Choice extras provider. You benefit from capped charges and/or discounts, which means you’ll generally have lower out-of-pocket expenses than you would at a non ’ Choice provider. How much do you pay if you go to hospital? Hospital cover helps pay for your hospital visit but doesn’t always cover all the costs. You may be able to reduce your out-of-pocket hospital expenses by choosing a ’ Choice hospital and by asking your doctor or specialist to participate in Medibank’s GapCover. For more information about GapCover, please refer to the hip Guide at medibank.com.au However, you may still have some out-of-pocket hospital expenses, such as the difference between the hospital’s charges and the benefit we pay and an excess (if you choose to have one). But , by choosing a hospital cover that has an excess, you’ll pay a lower . Before your ission you should confirm all likely out-of-pocket expenses with your doctor and/or hospital.
Other things you should know If there’s anything else you want to know that’s not covered here such as benefit replacement periods or our rules on paying benefits, you should be able to find what you’re looking for by reading our hip Guide at medibank.com.au
What is an accident? We define an accident as an unforeseen event occurring by chance and caused by an external force or object resulting in involuntary injuries to the body which requires immediate treatment. This doesn’t include conditions brought on by medical causes such as asthma attacks and appendicitis.
call 132 331 131 680 for Corporate enquiries visit medibank.com.au or ask in store connect with us on
We’ll help you be your best at every stage in life
Unhappy? What if you have a complaint? We try to resolve all enquiries and concerns the first time you us. If you still need help with your concern or any aspect of your hip, our Customer Resolutions team will provide courteous and respectful service. You’ll just need to provide sufficient information regarding your enquiry so we can investigate it for you. You can do this by: • calling 132 331 • emailing the secure form available in Online Member Services at medibank.com.au • writing to Medibank Private Customer Resolutions, GPO Box 9999, Melbourne, VIC 3000. If for some reason we are not able to satisfy your enquiry, you can also get free, independent advice from the Private Health Insurance Ombudsman by: • calling 1800 640 695 • visiting phio.org.au
Why Medibank? Medibank is more than just about insuring your health. We have the people, services and resources to be your personal health partner, helping you to be your best at every stage in life. We’re committed to making health insurance as straightforward as possible. For a start, we make it easier for you to choose cover that’s right for you. We have an extensive network of stores across Australia where you can drop in for advice and assistance. And when it comes to claiming, we do everything we can to make the process how it should be – clear, simple, and certain.
Medibank Private is a signatory to the Private Health Insurance Code of Conduct. The Private Health Insurance Code of Conduct logo is a trademark of, and is used under authorisation from, Private Healthcare Australia. In order to provide you with a range of health insurance and health related services, Medibank Private and its related companies may share your personal (including sensitive) information. Our sets out how your personal (including sensitive) information is handled. You can view a copy of our Fund rules and at any Medibank store, or online at medibank.com.au Medibank Private Limited ABN 47 080 890 259
Effective October 2013. MPL34591013
Important information
Did you know?
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