What is the waiting period?
A set period of time you need to wait before you can receive benefits for services or items included in your cover. You can’t receive benefits for any items or services you obtained while you’re serving a waiting period. This means you will have to pay the full cost of the service.
What is a pre-existing condition?
An ailment, illness or condition that, in the opinion of a Medical Practitioner appointed by Medibank, the signs or symptoms existed at any time during the six months before you either took out your new cover or transferred to a higher level of cover (12 month waiting period applies).
| Inclusions | Waiting Period
What is a waiting period? A set period of time you need to wait before you can receive benefits for services or items included in your cover. You can’t receive benefits for any items or services you obtained while you’re serving a waiting period. This means you will have to pay the full cost of the service. What is a pre-existing condition? An ailment, illness or condition that, in the opinion of a Medical Practitioner appointed by Medibank, the signs or symptoms existed at any time during the six months before you either took out your new cover, or transferred to a higher level of cover (12 month waiting period applies). Icon help |
|---|---|
| Unlimited emergency ambulance services Australia-wide. For ambulance attendance or transportation to a hospital where immediate professional attention is required and your medical condition is such that you couldn’t be transported any other way.
Waiting Period Icon help |
Nil |
| If you need to attend a Public hospital accident and emergency department, we’ll pay 100% of any ‘facility fee’ charged by the hospital for attending their accident and emergency department.~
Waiting Period Icon help |
Nil |
| Hospital treatment for physical rehabilitation for a patient related to surgery or illness.
For example: inpatient and admitted day patient rehabilitation, stroke recovery, cardiac rehabilitation. Waiting Period Icon help |
2 months |
| Hospital treatment for the investigation and treatment of the brain, brain-related conditions, spinal cord and peripheral nervous system.
For example: stroke, brain or spinal cord tumours, head injuries, epilepsy and Parkinson’s disease. Treatment of spinal column (back bone) conditions is listed separately under Back, neck and spine. Chemotherapy and radiotherapy for cancer is listed separately under Chemotherapy, radiotherapy and immunotherapy for cancer. Waiting Period Icon help |
Nil
(12 months for pre-existing conditions) |
| Hospital treatment for the investigation and treatment of the eye and the contents of the eye socket.
For example: retinal detachment, tear duct conditions, eye infections and medically managed trauma to the eye. Cataract procedures are listed separately under Cataracts. Eyelid procedures are listed separately under Plastic and reconstructive surgery. Waiting Period Icon help |
Nil
(12 months for pre-existing conditions) |
| Hospital treatment for the investigation and treatment of the ear, nose, throat, middle ear, thyroid, parathyroid, larynx, lymph nodes and related areas of the head and neck.
For example: damaged eardrum, sinus surgery, removal of foreign bodies, stapedectomy and throat cancer. Tonsils, adenoids and grommets are listed separately under Tonsils, adenoids and grommets. The implantation of a hearing device is listed separately under Implantation of hearing devices. Orthopaedic neck conditions are listed separately under Back, neck and spine. Sleep studies are listed separately under Sleep studies. Waiting Period Icon help |
Nil
(12 months for pre-existing conditions) |
| Hospital treatment of the tonsils, adenoids and insertion or removal of grommets.
Waiting Period Icon help |
Nil
(12 months for pre-existing conditions) |
| Hospital treatment for the investigation and treatment of diseases, disorders and injuries of the musculoskeletal system.
For example: carpal tunnel, fractures, hand surgery, joint fusion, bone spurs, osteomyelitis and bone cancer. Chest surgery is listed separately under Lung and chest. Spinal cord conditions are listed separately under Brain and nervous system. Spinal column conditions are listed separately under Back, neck and spine. Joint reconstructions are listed separately under Joint reconstructions. Joint replacements are listed separately under Joint replacements. Podiatric surgery performed by a registered podiatric surgeon is listed separately under Podiatric surgery (provided by a registered podiatric surgeon). Waiting Period Icon help |
Nil
(12 months for pre-existing conditions) |
| Hospital treatment for surgery for joint reconstructions.
For example: torn tendons, rotator cuff tears and damaged ligaments. Joint replacements are listed separately under Joint replacements. Bone fractures are listed separately under Bone, joint and muscle. Procedures to the spinal column are listed separately under Back, neck and spine. Podiatric surgery performed by a registered podiatric surgeon is listed separately under Podiatric surgery (provided by a registered podiatric surgeon). Waiting Period Icon help |
Nil
(12 months for pre-existing conditions) |
| Hospital treatment for the investigation and treatment of the kidney, adrenal gland and bladder.
For example: kidney stones, adrenal gland tumour and incontinence. Dialysis is listed separately under Dialysis for chronic kidney failure. Waiting Period Icon help |
Nil
(12 months for pre-existing conditions) |
| Hospital treatment for the investigation and treatment of the male reproductive system including the prostate.
For example: male sterilisation, circumcision and prostate cancer. Chemotherapy and radiotherapy for cancer is listed separately under Chemotherapy, radiotherapy and immunotherapy for cancer. Waiting Period Icon help |
Nil
(12 months for pre-existing conditions) |
| Hospital treatment for the investigation and treatment of the digestive system, including the oesophagus, stomach, gall bladder, pancreas, spleen, liver and bowel.
For example: oesophageal cancer, irritable bowel syndrome, gall stones and haemorrhoids. Endoscopy is listed separately under Gastrointestinal endoscopy. Hernia and appendicectomy procedures are listed separately under Hernia and appendix. Bariatric surgery is listed separately under Weight loss surgery. Waiting Period Icon help |
Nil
(12 months for pre-existing conditions) |
| Hospital treatment for the investigation and treatment of a hernia or appendicitis.
Digestive conditions are listed separately under Digestive system. Waiting Period Icon help |
Nil
(12 months for pre-existing conditions) |
| Hospital treatment for the diagnosis, investigation and treatment of the internal parts of the gastrointestinal system using an endoscope.
For example: colonoscopy, gastroscopy, endoscopic retrograde cholangiopancreatography (ERCP) Non-endoscopic procedures for the digestive system are listed separately under Digestive system.. Waiting Period Icon help |
Nil
(12 months for pre-existing conditions) |
| Hospital treatment for the investigation and treatment of the female reproductive system.
For example: endometriosis, polycystic ovaries, female sterilisation and cervical cancer. Fertility treatments are listed separately under Assisted reproductive services. Pregnancy and birth-related conditions are listed separately under Pregnancy and birth. Miscarriage or termination of pregnancy is listed separately under Miscarriage and termination of pregnancy. Waiting Period Icon help |
Nil
(12 months for pre-existing conditions) |
| Hospital treatment for the investigation and treatment of a miscarriage or for termination of pregnancy.
Waiting Period Icon help |
Nil
(12 months for pre-existing conditions) |
| Hospital treatment for chemotherapy, radiotherapy and immunotherapy for the treatment of cancer or benign tumours.
Surgical treatment of cancer is listed separately under each body system. We will only pay towards cancer-related surgery related to an Included service under your cover. Waiting Period Icon help |
Nil
(12 months for pre-existing conditions) |
| Hospital treatment for pain management that does not require the insertion or surgical management of a device.
For example: treatment of nerve pain and chest pain due to cancer by injection of a nerve block. Pain management using a device (for example an infusion pump or neurostimulator) is listed separately under Pain management with device. Waiting Period Icon help |
Nil
(12 months for pre-existing conditions) |
| Hospital treatment for the investigation and treatment of skin, skin-related conditions and nails. The removal of foreign bodies is also included. Plastic surgery that is medically necessary and relating to the treatment of a skin-related condition is also included.
For example: melanoma, minor wound repair and abscesses. Removal of excess skin due to weight loss is listed separately under Weight loss surgery. Waiting Period Icon help |
Nil
(12 months for pre-existing conditions) |
| Hospital treatment for the investigation and treatment of breast disorders and associated lymph nodes, and reconstruction and/or reduction following breast surgery or a preventative mastectomy.
For example: breast lesions, breast tumours, asymmetry due to breast cancer surgery, and gynecomastia. This clinical category does not require benefits to be paid for cosmetic breast surgery that is not medically necessary. Waiting Period Icon help |
Nil
(12 months for pre-existing conditions) |
| Hospital treatment for the investigation and management of diabetes.
For example: stabilisation of hypo- or hyper- glycaemia, contour problems due to insulin injections. Treatment for diabetes-related conditions is listed separately under each body system affected. For example, treatment for diabetes-related eye conditions is listed separately under Eye. Treatment for ulcers is listed separately under Skin. Provision and replacement of insulin pumps is listed separately under Insulin pumps. Waiting Period Icon help |
Nil
(12 months for pre-existing conditions) |
| Hospital treatment for the investigation and treatment of the heart, heart-related conditions and vascular system.
For example: heart failure and heart attack, monitoring of heart conditions, varicose veins and removal of plaque from arterial walls. Chemotherapy and radiotherapy for cancer is listed separately under Chemotherapy, radiotherapy and immunotherapy for cancer. Waiting Period Icon help |
Nil
(12 months for pre-existing conditions) |
| Hospital treatment for the investigation and treatment of the lungs, lung-related conditions, mediastinum and chest.
For example: lung cancer, respiratory disorders such as asthma, pneumonia, and treatment of trauma to the chest. Chemotherapy and radiotherapy for cancer is listed separately under Chemotherapy, radiotherapy and immunotherapy for cancer. Waiting Period Icon help |
Nil
(12 months for pre-existing conditions) |
| Hospital treatment for the investigation and treatment of blood and blood-related conditions.
For example: blood clotting disorders and bone marrow transplants. Treatment for cancers of the blood is listed separately under Chemotherapy, radiotherapy and immunotherapy for cancer. Waiting Period Icon help |
Nil
(12 months for pre-existing conditions) |
| Hospital treatment for the investigation and treatment of the back, neck and spinal column, including spinal fusion.
For example: sciatica, prolapsed or herniated disc, and spine curvature disorders such as scoliosis, kyphosis and lordosis. Joint fusions are listed separately under Bone, joint and muscle. Spinal cord conditions are listed separately under Brain and nervous system. Management of back pain is listed separately under Pain management. Pain management that requires a device is listed separately under Pain management with device. Waiting Period Icon help |
Nil
(12 months for pre-existing conditions) |
| Hospital treatment which is medically necessary for the investigation and treatment of any physical deformity, whether acquired as a result of illness or accident, or congenital.
For example: burns requiring a graft, cleft palate, club foot and angioma. Plastic surgery that is medically necessary relating to the treatment of a skin-related condition is listed separately under Skin. Waiting Period Icon help |
Nil
(12 months for pre-existing conditions) |
| Hospital treatment for surgery to the teeth and gums.
For example: surgery to remove wisdom teeth and dental implant surgery. For Dental surgery performed by a dentist rather than a medical practitioner we only pay benefits towards hospital charges. If the surgery is performed by a medical practitioner and an MBS item number is billed, we will pay benefits towards the hospital and medical charges. Waiting Period Icon help |
Nil
(12 months for pre-existing conditions) |
| Hospital treatment for the investigation and treatment of conditions affecting the foot and/or ankle, provided by a registered podiatric surgeon, but limited to benefits towards: • accommodation; and • the cost of a prosthesis as listed in the prostheses list set out in the Private Health Insurance (Prostheses) Rules, as in force from time to time. For Podiatric surgery we only pay benefits towards hospital charges. There are no MBS items for podiatric surgery. This means we also don’t pay any benefits towards the podiatric surgeon’s fees under Hospital cover and you could incur significant out-of-pocket expenses. Waiting Period Icon help |
Nil
(12 months for pre-existing conditions) |
| Services that are Excluded |
|---|
| Hospital treatment for the treatment and care of patients with psychiatric, mental, addiction or behavioural disorders.
For example: psychoses such as schizophrenia, mood disorders such as depression, eating disorders and addiction therapy. |
| Hospital treatment for care where the intent is primarily providing quality of life for a patient with a terminal illness, including treatment to alleviate and manage pain. |
| Hospital treatment to correct hearing loss, including implantation of a prosthetic hearing device.
Stapedectomy is listed separately under Ear, nose and throat. |
| Hospital treatment for surgery to remove a cataract and replace with an artificial lens. |
| Hospital treatment for surgery for joint replacements, including revisions, resurfacing, partial replacements and removal of prostheses.
For example: replacement of shoulder, wrist, finger, hip, knee, ankle, or toe joint. Joint fusions are listed separately under Bone, joint and muscle. Spinal fusions are listed separately under Back, neck and spine. Joint reconstructions are listed separately under Joint reconstructions. Podiatric surgery performed by a registered podiatric surgeon is listed separately under Podiatric surgery (provided by a registered podiatric surgeon). |
| Hospital treatment for dialysis treatment for chronic kidney failure.
For example: peritoneal dialysis and haemodialysis. |
| Hospital treatment for investigation and treatment of conditions associated with pregnancy and child birth.
Treatment for the baby is included under the clinical category relevant to their condition. Female reproductive conditions are listed separately under Gynaecology. Fertility treatments are listed separately under Assisted reproductive services. Miscarriage and termination of pregnancy is listed separately under Miscarriage and termination of pregnancy. |
| Hospital treatment for fertility treatments or procedures.
For example: retrieval of eggs or sperm, In vitro Fertilisation (IVF), and Gamete Intra-fallopian Transfer (GIFT). Treatment of the female reproductive system is listed separately under Gynaecology. Pregnancy and birth-related services are listed separately under Pregnancy and birth. |
| Hospital treatment for surgery that is designed to reduce a person’s weight, remove excess skin due to weight loss and reversal of a bariatric procedure.
For example: gastric banding, gastric bypass and sleeve gastrectomy. |
| Hospital treatment for the provision and replacement of insulin pumps for treatment of diabetes. |
| Hospital treatment for the implantation, replacement or other surgical management of a device required for the treatment of pain.
For example: treatment of nerve pain, back pain, and pain caused by coronary heart disease with a device (for example an infusion pump or neurostimulator). Treatment of pain that does not require a device is listed separately under Pain management. |
| Hospital treatment for the investigation of sleep patterns and anomalies.
For example: sleep apnoea and snoring. |
Please note: Medibank does not pay any benefits towards the cost of cosmetic surgery/procedures e.g. surgery that isn’t clinically necessary and which an MBS item is not billable.
Hospital cover explained
For the services listed as Inclusions in the table above, we pay benefits towards:
Other hospital items we pay benefits towards:
- Doctors’ fees for Included in-hospital medical services (as set out in Medical benefits below).
- Surgically implanted prostheses (such as an artificial body part like a limb) and other items on the Federal Government’s Prostheses List^^.
- Pharmaceutical Benefits Scheme (PBS)** listed medication given to you as part of your admitted treatment for most medical conditions, including medication prescribed for after you leave hospital.
- Overnight accommodation in a private or shared room
- Same-day admissions
- Intensive care
Other benefits as set out in ‘Hospital benefits’ below.
Public Hospital (as a private patient)
- Overnight accommodation in a private or shared room
- Same-day admissions
- Intensive care
- Operating theatre fees
- Outpatient and emergency department charges
Hospital benefits
Members’ Choice hospitals
Medibank has agreements with most private hospitals and day surgeries in Australia. We call this our Members’ Choice network. When you visit a Members’ Choice hospital you will generally get better value for money compared to a non-Members’ Choice private hospital, provided the service is uncluded under our agreement with the hospital and not Excluded under your cover.
To find your nearest Members’ Choice hospital, visit medibank.com.au/memberschoice. Members’ Choice hospitals are subject to change from time to time and are not available in all areas.
Hospital excess
With Overseas Visitors Starter Hospital and Medical you can choose from a $250 or $750 excess.
This is the amount you pay towards your hospital treatment before we pay any benefits. It’s payable once per member, per calendar year if admitted to hospital. If you choose a higher excess you will pay a lower premium, but will need to pay more to your own accommodation costs.
For example:
You choose an excess of $750. You’d need to pay $750 towards your accomodation costs before we’ll pay any benefits.
Medical benefits
Overseas Visitors Starter Hospital and Medical includes benefits towards medical services provided by a doctor, that is listed in the government’s Medicare Benefits Schedule (MBS). The MBS is a list of medical services and corresponding fees.
Overseas Visitors Starter Hospital and Medical pays 100% of the MBS fee for:
- general practitioner (GP) consultations
- other medical services provided out-of-hospital (for example specialists, pathology and x-rays), except where that service is Excluded under your Hospital cover
- in-hospital medical services provided as part of an Included service (for example surgeon and anaesthetist fees)
- allied health services billed with an MBS item number (for example eye checks and services related to chronic disease management plans), except for mental health services
If your doctor chooses to charge above the MBS fee you will likely have to pay an out-of-pocket expense to cover the difference.
For example:
The MBS fee for item 23 (a GP visit) is $38.20. You visit a doctor that charges $50. Overseas Visitors Starter Hospital and Medical pays 100% of the MBS fee. You would pay $50, get back $38.20 from Medibank. Your out-of-pocket expense would be $11.80.
Further benefits
- 24/7 Medibank Nurse
Members are supported around the clock by Medibank nurses on our 24/7 Medibank Nurse telephone service.
Call 1800 644 325 for expert health-related advice any time of the day.
If your situation changes
If at any time you gain access to full Medicare entitlements or your visa status changes (e.g. you are granted permanent residency), Overseas Visitors Starter Hospital and Medical
may no longer be suitable. In these instances, you should notify us of the change in your circumstances. Medibank can still remain an important part of your private health insurance plans as we offer a large range of other covers.
Supporting documents
Need a little extra help?
Find out more about things like waiting periods and pre-existing conditions or check our list of definitions if you don’t know the meaning of a word or phrase
Things worth knowing Contact us
~The fee may not include all medical services provided and out-of-pocket expenses may apply such as for x-rays, blood tests and any charges raised by the doctor above the benefit we pay.
^^If you need to be hospitalised for a procedure requiring a surgically implanted prosthesis (for example: a pacemaker or cardiac stent), we’ll pay the minimum benefit for the thousands of items set out in the Australian Government’s Prostheses List.
**The PBS provides subsidised prescription drugs to residents of Australia, as well as certain foreign visitors covered by a Reciprocal Health Care Agreement.
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