Glossary
Accident
An unforeseen event occurring by chance and caused by an external force or object, resulting in involuntary injury to the body which requires immediate treatment, but does not include unforeseen conditions, the onset of which were brought on by medical causes.
Adult dependant
A child of the contributor or spouse who is at least 21 but under 25 years old, not married or in a de facto relationship, not a full-time student and is a member of an eligible cover or combination of eligible covers. An adult dependant does not need to be living at home.
Annual limit
An annual limit is the maximum amount of benefits payable for particular groups of extras services within a calendar year.
Benefit
A benefit is an amount of money payable by Medibank Private to, or on behalf of, a member for an expense approved by Medibank Private.
Calendar year
A 12 month period commencing 1 January and ending 31 December.
Cardio-thoracic procedures
Includes open heart and bypass surgery, and invasive cardiac investigations and procedures, such as angiograms, angioplasties and stent insertions.
Condition
A condition means any actual or perceived state of health for which treatment is sought. It includes but is not limited to states variously described as: abnormality, ailment, disability, disease, disorder, health problem, illness, impairment, impediment, infirmity, injury, malady, sickness or unwellness.
Contributor
The person who owns the Medibank Private membership is the contributor. The contributor is the person we contact about changes to your cover, membership benefits and premiums as well as major changes to our Fund Rules.
Dependant child
A dependant child under a Medibank Private family or single parent family membership can only be:
- an unmarried child of the contributor or their spouse/partner, up to the age of 21
- an unmarried child of the contributor or their spouse/partner, aged 21 or over but under 25 and undertaking full-time study in an approved course as defined by Medibank Private.
Note: ‘Married’ includes two people living in a de facto relationship.
Endodontic services
Endodontic treatment (eg root canal treatment) is a method of saving infected or damaged teeth. It involves the treatment of infections of the dental pulp (nerves) of teeth by removing the nerve. The nerve canals are filled and the tooth can then be structurally restored. A 12 month waiting period applies to endodontic services.
Excess
An excess is an amount that you pay when admitted to hospital in exchange for lower premiums.
Check out Things Worth Knowing for more information.
Excluded service
An excluded service is a service for which no benefits are payable.
External prostheses
Manufactured items designed to replace external parts of the body, such as an arm. Benefits for external prostheses are only paid under certain Medibank Private extras and packaged covers.
Federal Government’s Prostheses Schedule
This is a list of surgically implanted prostheses and other items issued by the Federal Government. It sets out the benefits payable for surgically implanted prostheses and other items by registered private health funds to members with hospital cover that includes cover for any associated treatment.
Check out Things Worth Knowing for more information.
Federal Government Rebate
An initiative introduced by the Federal Government to make private health insurance more affordable, regardless of your income level.
Check out Things Worth Knowing for more information.
Fund Rules
These are the rules of Medibank Private membership. Some of the more important Fund Rules are summarised in the Membership Guide sent to all new members. The Fund Rules can be viewed here or at any of our Medibank stores.
All members are subject to the Fund Rules as varied from time to time with the approval of the Minister for Health and Ageing.
GapCover
This is a billing scheme we have created to help minimise your out-of-pocket expenses when a doctor charges above the Medicare Benefits Schedule fee.
Check out Things Worth Knowing for more information.
Gap prostheses
Items on the Federal Government’s Prostheses Schedule for which you will have to pay an amount towards the cost.
General dental
General dental services include preventative treatments, fillings and extractions. It does not include orthodontic, periodontic, dentures, crowns, and bridges or endodontic services. A 12 month waiting period applies to surgical procedures and surgical extractions (eg extraction of wisdom teeth), and a 2 month waiting period applies to all other general dental services.
Hospital charges
Charges raised by a hospital for accommodation and nursing care (including accommodation involving intensive and coronary care), theatre fees, surgically implanted prostheses and other items, but may not include charges for extras services, such as physiotherapy or fees levied by your hospital doctor.
You should contact Medibank Private on 132 331 and/or the hospital to check your benefit entitlement before admission.
Included services
These are services for which benefits are payable under the hospital component of MyOptions. Benefits for included services are typically higher than restricted services.
Lifetime Health Cover (LHC)
This Federal Government initiative is designed to encourage people to take out hospital cover early in life and maintain it. It allows them to pay lower premiums throughout their life, compared with others who take out hospital cover when they’re older, or who allow their cover to lapse for long periods.
Check out Things Worth Knowing for more information.
Major dental
Dental services relating to orthodontic (eg braces and corrective plates), periodontic, dentures, crowns, bridges and inlay/onlay restorative services.
Major eye surgery
Includes cornea and sclera transplants and cataract surgery.
Medically necessary ambulance transport
Cover for transportation by ambulance which is necessary because, due to the patient’s medical condition, they cannot be transported by any other means.
Check out Things Worth Knowing for more information.
Medicare Benefits Schedule
This schedule lists all the services for which Medicare pays benefits and the rules that apply to the payment of those benefits. Each service has a fee that has been set by the Federal Government for the purpose of calculating the Medicare benefit payable for that service.
Medicare Levy Surcharge
Check out Things Worth Knowing .
Member
Any person covered under a Medibank Private membership.
Membership
A membership consists of one or more persons, being:
- the contributor in the case of a single membership
- the contributor and spouse/partner for a couple membership
- the contributor, spouse/partner and dependent children for a family membership
- the contributor and dependent children for a single parent family membership
- the contributor and/or spouse/partner and/or dependant children and adult dependant/s for a Families With Adult Children membership.
Members' Choice hospitals and Members' Choice extras providers (Members' Choice provider)
A hospital or extras provider who has entered into a Member's Choice agreement with us. Members who use their services can get greater value from their private health insurance such as higher benefits, capped fees and discounts to help reduce out-of-pocket expenses.
No-gap prostheses
Items on the Federal Government’s Prostheses Schedule for which you will be fully covered.
Obstetrics-related services
All treatment specified in the Medicare Benefits Schedule (MBS) as ‘obstetrics’ including antenatal and post-natal care and management of labour and delivery.
PackageBonus
A yearly bonus, when you have a HealthyPlus, SmartPlus, AdvantagePlus or PremierPlus packaged cover that you can use to help pay for a range of approved membership-related and health-related expenses.
Check out Things Worth Knowing for more information.
Pharmaceutical Benefits Scheme
This Federal Government scheme allows for many pharmaceuticals to be supplied to Australian residents at reduced or no cost.
Pharmaceutical Prescriptions (non-PBS)
Prescription-only items not covered by the Pharmaceutical Benefits Scheme. Benefits are payable up to a set amount for each prescription, by State, and after a set charge has been deducted. The set charge is equivalent to the current PBS patient contribution. No benefits are payable for oral contraceptives or for pharmaceutical prescriptions when prescribed for cosmetic purposes.
Pre-existing ailment
An ailment, illness or condition where signs or symptoms existed at any time during the six months before you either took out your new cover or transferred to a cover with higher benefits. The only person authorised to decide if you have a pre-existing ailment is a medical practitioner appointed by Medibank Private. A different rule is applied to waiting periods for pre-existing ailments.
For information about how the pre-existing ailment rule works, check out Things Worth Knowing.
Recognised providers
A provider approved by Medibank Private for the purpose of paying benefits. To check if a provider is recognised, please call us on 132 331.
Restricted services
These are services for which we pay lower benefits in private hospitals.
Check out Things Worth Knowing for more information.
Same day admission
An admission to, and discharge from, a hospital or day hospital facility on the same day (where the stay does not extend beyond midnight).
School accident
An accident suffered by a dependant child who is a pre-school, primary or secondary school student. Covers services that are provided within 12 months of an accident that occurs while attending, or travelling to or from, school or an organised school activity. Excludes services covered by Medicare or where compensation or damages are payable.
Sleep Apnoea - continuous pressure device
Benefits for Sleep Apnoea devices or similar devices as approved by Medibank Private, are payable only under hospital cover when the member has undergone an investigation for Sleep Apnoea for which treatment is listed in the Medicare Benefits Schedule, and when the device is requested by a treating medical practitioner. The device must be purchased or hired within 12 months of undergoing the investigation. Benefits for replacement devices are not payable for a period of five years from the date of the original purchase or hire.
Sub-limit
A sub-limit is a limit applied annually (or within other defined periods of time) on benefits paid for a certain item or service within an overall annual limit.
For more about extras limits, check out Things Worth Knowing .
Surgically implanted prostheses
Approved manufactured items that are surgically implanted or applied, generally during a hospital surgical procedure. Benefits for surgically implanted prostheses are payable only under Medibank Private hospital covers. However, benefits are not payable for prostheses associated with an excluded service under your cover.
Waiting period
A waiting period is a period of time a member must wait before benefits are payable. Benefits are not payable for goods and services obtained while you are serving a waiting period. A two month waiting period applies to all services, but some services have longer waiting periods, as shown in Things Worth Knowing .