134 190

Glossary

  1. Terms beginning with A
  2. Terms beginning with B
  3. Terms beginning with C
  4. Terms beginning with D
  5. Terms beginning with E
  6. Terms beginning with F
  7. Terms beginning with G
  8. Terms beginning with H
  9. Terms beginning with I
  10. Terms beginning with J
  11. Terms beginning with K
  12. Terms beginning with L
  13. Terms beginning with M
  14. Terms beginning with N
  15. Terms beginning with O
  16. Terms beginning with P
  17. Terms beginning with Q
  18. Terms beginning with R
  19. Terms beginning with S
  20. Terms beginning with T
  21. Terms beginning with U
  22. Terms beginning with V
  23. Terms beginning with W
  24. Terms beginning with X
  25. Terms beginning with Y
  26. Terms beginning with Z

  1. Terms beginning with A

    1. 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.
    2. Annual limit
      An annual limit is the maximum amount of benefits payable for particular extras items or services within a calendar year.
    3. Ambulance services
      Ambulance services are included under all covers described in this brochure. Unless you’re already covered (e.g. under a state scheme), we’ll cover the cost of eligible ambulance services if you need immediate professional attention and your medical condition is such that you couldn’t be transported any other way.
    4. Australian Government’s 457 Working Visa
      This is also known as the Australian Government’s Temporary Business (Long Stay) Subclass 457 visa.


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  2. Terms beginning with B

    1. Benefit
      This is an amount of money we pay for an approved health-related expense you've incurred. It can be paid to you or on your behalf.


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  3. Terms beginning with C

    1. Calendar year
      A 12 month period commencing 1 January and ending 31 December.
    2. 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.
    3. Cosmetic surgery
      A service that is not clinically necessary that can’t be billed to Medicare. Under all Medibank covers, no benefits are payable towards procedures or hospital costs associated with cosmetic surgery or procedures not recognised by Medicare.


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  4. Terms beginning with D

    1. Dependent child
      This is a child of the policy holder or their partner who is:
      • under the age of 21 and not married or living in a de facto relationship
      • aged 21–24, not married or living in a de facto relationship and studying full-time in a course approved by Medibank.
    2. Doctor
      A registered medical practitioner including a specialist, surgeon or anaesthetist.


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  5. Terms beginning with E

    1. Endodontic services
      Treatment to save an infected or damaged tooth. It involves removing the nerve and, where possible, restoring the structure of the tooth. A common example of an endodontic treatment is a root canal.
    2. Excess
      An amount you agree to pay if you're admitted to hospital. It only applies to hospital covers or the hospital component of Visitors Health Insurance covers and Working Visa Health Insurance covers. No excess applies to children covered under any of our Visitors Health Insurance and Working Visa Health Insurance covers.
    3. Excluded services
      This is a service for which no benefits are payable.
    4. External prostheses
      These are manufactured items designed to replace external parts of the body such as an arm or leg. Benefits for these are only paid under the extras component of Intermediate 70 Visitors Health Insurance, Top 85 Visitors Health Insurance and Top 85 Working Visa Health Insurance.


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  6. Terms beginning with F

    1. Federal Government's Prostheses Schedule
      This is a list published by the Federal Government which sets out the benefits for surgically implanted prostheses and other items.
    2. Fixed benefit
      You'll receive a fixed bnefit when you visit a non Members' Choice provider. A fixed benefit is the maximum amount we'll pay for each service or item (up to applicable limits). Usually it will be less than the provider's charge, which means you may have out-of-pocket expenses to pay.
    3. Fund Rules
      These are the rules of your Medibank membership. Some of the more important Fund Rules are summarised in your Membership Guide that is sent to all new members. You can view the Fund Rules online or at any of our Medibank stores. All members are subject to the Fund Rules as varied from time to time.


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  7. Terms beginning with G

    1. General dental
      This is routine dental work and includes things such as check-ups, x-rays, scale and cleans, fillings and extractions. It doesn't include more complicated treatments or procedures such as orthodontic work, endodontic treatment, crowns or bridges.


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  8. Terms beginning with H

    1. Hospital charges
      These are amounts charged by a hospital for things like accommodation and nursing care, theatre fees and surgically implanted prostheses. It may not include charges for extras services, such as physiotherapy, or fees charged by your hospital doctor.
    2. Heart-related services
      Includes open heart and bypass surgery and invasive cardiac investigations and procedures such as angiograms, angioplasties and stent insertions.


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  9. Terms beginning with I

    1. Included services
      We pay benefits toward these services.


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  10. Terms beginning with M

    1. Major dental
      This includes things like restorative fillings, dentures, crowns, bridges, and gum disease and root canal treatment. It does not include orthodontic treatment.
    2. Major eye surgery
      This includes cornea and sclera transplants and cataract surgery.
    3. Medical costs
      These are costs you incur in an overnight or day-hospital facility for things such as doctors' fees, blood tests, scans and x-rays.
    4. Medical services, in-hospital
      Treatment from medical practitioners, provided in-hospital such as surgeon’s fees and anaesthetist’s fees. Where a benefit is payable, cover is provided for all medical services listed in the Medicare Benefits Schedule (MBS).
    5. Medical services, out-of-hospital
      Treatment for medical practitioners, provided out-of-hospital such as doctor’s visits and pathology. Where a benefit is payable, cover is provided for all medical services listed in the Medicare Benefits Schedule (MBS).
    6. Medicare
      Australia's national health care system which provides permanent Australian residents with access to free treatment in public hospitals and free or subsidised treatment by doctors.
    7. Medicare Benefits Schedule (MBS)
      This is a schedule that lists all the services for which Medicare pays benefits to Australian residents 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 (called the MBS fee).


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  11. Terms beginning with N

    1. Non members’ choice hospital
      A public or private hospital that is not part of Medibank Members' Choice hospital network.


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  12. Terms beginning with O

    1. Obstetrics-related services
      This includes all treatment specified in the Medicare Benefits Schedule (MBS) as ‘obstetrics' including antenatal and post-natal care and the management of labour and delivery.
    2. Orthodontic treatment
      This involves the use of corrective appliances, such as braces and plates, to bring the teeth and jaws into proper alignment.


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  13. Terms beginning with P

    1. Pharmaceutical Benefits Scheme (PBS)
      The PBS is a Federal Government scheme for subsidising the cost of many pharmaceutical prescriptions for Australian residents. For each pharmaceutical prescription supplied, Australian residents are required to pay a co-payment set by the Government. The PBS is generally not available to visitors, temporary residents or people not entitled to benefits under Medicare. As a result, you can incur significant out-of-pocket expenses when purchasing prescription pharmaceuticals.
    2. Pharmaceutical prescriptions (non-PBS)
      These are prescription-only items not covered by the Pharmaceutical Benefits Scheme. If your cover includes an extras component, we'll pay benefits up to a set amount for each prescription after a set charge has been deducted. The set charge is equivalent to the current PBS patient contribution. It's important to note that we don't pay benefits for oral contraceptives or for pharmaceutical prescriptions prescribed for cosmetic purposes.
    3. Plastic and Reconstructive surgery

      Plastic surgery is a medical specialty concerned with the evaluation and treatment of any physical deformity that can be corrected by surgery, whether acquired or congenital. Reconstructive plastic surgery is usually performed to improve function, but it may be done to approximate a normal appearance.

      Examples of plastic and reconstructive surgery are skin grafts after burns treatment, reconstruction after cancer surgery, surgeries on congenital abnormalities such as nasal deformities causing breathing problems, some surgeries that require repair of facial bone fractures and breaks and other plastic surgery services for which there is a Medicare benefit payable.

    4. Provider
      A provider is any health or medical professional who provides you with a service and may include your doctor, dentist, anaesthetist or acupuncturist. It also includes people or organisations who provide you with health items or aids – things like hearing aids, mouthguards or nebulisers.


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  14. Terms beginning with R

    1. Recognised provider
      This is a provider approved by Medibank for the purpose of paying benefits. To check if a provider is recognised, please call us on 134 190.


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  15. Terms beginning with S

    1. Same day admission
      This is when you're admitted to a hospital or day hospital facility and discharged on the same day where the stay does not extend beyond midnight.
    2. Surgically implanted prosthesis
      An improved manufactured item or piece of equipment that is surgically implanted or applied, generally during a hospital surgical procedure to replace or assist a body part or function. Examples include pacemakers, defibrillators, cardiac stents and joint replacements.


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