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Your membership number identifies your OSHC policy. It is located on the front of your membership card or on your Policy Certificate.

Please note Medibank will only pay benefits for claims lodged within two (2) years of the date of service, and your membership must be current at date of service. Benefit payments will be made by your preferred method (EFT/Chq). If you wish to update your details, simply visit us online.

If your claim relates to an injury or illness caused by the negligence of a third party (e.g motor vehicle accident, workers' compensation, common law), you may be entitled to compensation. If you think you may be entitled to compensation from a third party (i.e from an entity other than Medibank), please contact our Compensation Team before lodging this form. Please call 1300 880 276

Please ensure the receipts and/or accounts for each claim are attached, and that they are original, itemised in full, written in English, and on the provider's official stationery, or have the provider's official stamp.

    If you indicate that your account is paid in full, please provide any receipts as evidence, otherwise Medibank may:

    1. be unable to pay benefits for the claim; or
    2. pay any benefits for the claim directly to the service provider.

    *Benefits are not payable where you have, or may have, an entitlement to receive compensation or damages. In such circumstances, we expect that you will pursue that entitlement. We may make provisional benefit payments on application, subject to our Fund Rules and policies, but you must agree to repay such payments, in full, from your final settlement.

    All information supplied in connection with this claim is true and correct. I consent to the handling of my personal information provided with this claim in accordance with the Medibank Private Privacy Policy. I authorise any hospital or health service provider to give Medibank Private any information as may be necessary to assess this claim. The expenses detailed in this claim are not, and will not be, subject to a compensation or damages claim.* If I am lodging this claim for another person, I declare that I have their consent to lodge this claim and to make the above declarations and acknowledgements on their behalf.