Medibank Private Limited (MBP) Review
Medibank is Australia’s second largest private health insurer in Australia with over 3.6 million members.
Medibank Private was established by the federal government in 1976 as a non-profit organization but changed to a for-profit body in 2009. In that same year Medibank purchased the health fund ‘ahm Insurance’. In 2014, the Australian Government privatised Medibank and they continue to meet the ever-changing health needs of its members with their purpose being ‘Better Health for Better Lives’.
Medibank Private Key Facts
For-Profit or Not-For-Profit? For-Profit
Private Hospitals Agreements Nationwide: 263
Day Hospitals Agreements Nationwide: 222
Headquarters: Melbourne, Australia
Health Deal Represented: No
Medibank Hospital Cover
Medibank Private has 8 hospital policies to suit all individual and family needs. These range from Basic and Accident Hospital Cover all the way up to Gold Complete Hospital Cover. Here is a list of the hospital covers currently available from Medibank Private:
- Basic Accident and Ambulance
- Basic Plus Healthy Start
- Bronze Everyday
- Bronze Plus Progress
- Silver Everyday
- Silver Plus Assured
- Silver Plus Security
- Gold Complete Hospital
Medibank Extras Cover
Extras Cover takes care of the everyday healthcare service expenses that are not generally covered under Medicare such as dental services, prescription glasses, and physiotherapy. Here is a list of some of the current extras covers available:
- Essential Extras 55
- Growing Family 60
- Growing Family 70
- Healthy Start Extras
- Top Extras 55
- Top Extras 70
Medibank Combined Cover
Medibank Private currently offer 3 combined policies, ranging from Basic Everyday Starter all the way up to Gold Ultra Health Cover. Here is a list of the current Medibank Private combined covers:
- Medibank Basic Everyday Starter
- Medibank Silver Plus Families
- Medibank Gold Ultra Health Cover
Medibank Waiting Periods
Medibank recognises the waiting periods you have already served with a previous health fund if you switch; this is called “portability”. For first-timers taking out a hospital cover, members who may have lapsed in hospital coverage and those upgrading their level of cover, the waiting periods below will have to be served before members can claim on services:
Hospital waiting periods
- Ambulance services: None
- Accidental Injury: None
- New Conditions: 2 Months
- Pregnancy and birth-related services: 12 months
- Pre-existing conditions: 12 months
- Rehabilitation & Palliative care: 2 months
- Weight Loss Surgery: 12 months
How do you Claim Extras with Medibank Private?
Claiming on your extras is quick and easy with Medibank. Here are the 4 ways that you can get this done:
On the spot: Swipe your membership card at a health provider that uses the HICAPS system to have your claim processed immediately.
Via a mobile app: You can lodge a claim using the My Medibank App by submitting a photo of your receipt.
Online: You can log into your online account and lodge your claim by providing the details on your receipt.
By Mail: You can lodge your claim by posting a completed claim form with the relevant accounts and receipts to:
Medibank Private Limited
GPO BOX 2984
MELBOURNE VIC 3001
Medibank Private Gap Cover
Medibank’s gap policy is called GapCover. If your doctor charges you more than the standard MBS fee, this is known as the ‘gap’ and can leave you with an out-of-pocket expense. GapCover can help to minimise or eliminate personal expense but it is the choice of the physician to participate in any given gap scheme.
Gap Cover Ratings By State
To determine how beneficial a gap scheme will be, we suggest comparing health funds in the same state or territory to show which of the funds offer a greater proportion of medical services covered with no gap. While it is more likely that a medical service covered under your health fund can be utilized at no personal cost to you, it is entirely the choice of the physician whether or not to participate in the gap cover scheme.
Medical Services with No Gaps — The percentage of claims that were fully refunded.
Medical Services with No or Known Gaps — The percentage of claims that were fully refunded, or where the policy holder knew the cost before the surgery was performed. The information below outlines the percentages of services covered under no-gap and known-gap.
The information below outlines the percentages of services covered under no-gap and known-gap.
Medibank medical services with No Gap: 80%
Industry Average: 79.1%
Medibank medical services with No or Known Gap: 92.4%
Industry Average: 90.5%
Medibank medical services with No Gap: 88.4%
Industry Average: 89.5%
Medibank medical services with No or Known Gap: 96.3%
Industry Average: 95.7%
Medibank medical services with No Gap: 85.1%
Industry Average: 86.7%
Medibank medical services with No or Known Gap: 93.8%
Industry Average: 95.1%
Medibank medical services with No Gap: 88.6%
Industry Average: 89.2%
Medibank medical services with No or Known Gap: 94.8%
Industry Average: 94.5%
Medibank medical services with No Gap: 89.9%
Industry Average: 89.5%
Medibank medical services with No or Known Gap: 99%
Industry Average: 96.6%
Medibank medical services with No Gap: 72.1%
Industry Average: 84.4%
Medibank medical services with No or Known Gap: 87.7%
Industry Average: 96.2%
Medibank medical services with No Gap: 92.1%
Industry Average: 90.2%
Medibank medical services with No or Known Gap: 98.3%
Industry Average: 96.7%
Medibank medical services with No Gap: 82.9%
Industry Average: 84.2%
Medibank medical services with No or Known Gap: 94.2%
Industry Average: 93.8%