What out of pockets will I have?

Eligible Members participating in the program will not incur out of pocket costs for the following services as part of your hospital admission at participating hospitals:

• Pre-admission joint school (where applicable)
• Hospital accommodation and theatre costs
• Surgeon
• Anaesthetist
• Surgical assistant
• Diagnostic tests (where required)

An excess or per day payment may still be payable, depending on the type of cover you have and whether you are claiming under your hospital cover for the first time in a calendar year. Please contact Medibank on 1300 733 338 to check your product eligibility and level of cover.

No Excess Product Information

Members who are on the following products^* – Medibank Silver Plus Support, Medibank Silver Plus Secure or Medibank Gold Protect, are eligible for the No Gap program and have served relevant waiting periods, will not have to pay an excess for their No Gap admission. If eligible, this is claimable once per adult Member per calendar year. For any subsequent claims within the calendar year that are not a Medibank No Gap procedure, the Member will need to pay the standard excess per their product.

General exclusions for No Excess for No Gap:

• Any procedure at a contracted hospital that is not part of the agreed No gap procedures.
• Any procedure outside of a contracted hospital network where a surgeon does not charge above the MBS.
• Any ‘known gap’ treatments.

If you are on one of the above-mentioned products and want to confirm if No Excess applies to you, please contact Medibank’s Customer Health Support team on 1300 733 338.

* The product names outlined here are accurate at time of publishing but subject to change

If a Member seeks additional services beyond what is included in the no-gap joint replacement pilot program, fees may apply. You may incur fees if medication is prescribed during your hospital stay that is not included on the Pharmaceutical Benefits Scheme or for services that are for your comfort or convenience, such as if you wish to be transported by ambulance to a hospital closer to where you live and dry-cleaning of non-hospital items. Please speak with the Participating Medical Provider to confirm and ensure a valid Informed Financial Consent is given.

If rehabilitation care in an inpatient setting is required, we will pay benefits towards your hospital accommodation at a Members Choice Hospital and you will incur no out-of-pocket costs except for any per-day payment under your policy or any associated hospital costs like parking. There may be a cost associated if you are treated by a Rehabilitation Physician or require diagnostic tests, however the doctor will need to provide you with informed financial consent.

There may be out-of-pocket expenses associated with outpatient appointments, such as your initial visit with a participating surgeon in their consulting rooms. Please speak with your participating surgeon to find out more.