Glossary
Accident
An unforeseen event occurring by chance and caused by an external force or object, resulting 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.
Annual limit and sub-limit
An annual limit is the maximum amount of benefits payable for particular groups of extras services within a calendar year. 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.
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 2 people living in a de facto relationship.
Doctor
A registered medical practitioner who may be either a general practitioner or a specialist and who is registered with the relevant state or territory.
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 under sterile conditions. 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.
External prostheses
Please refer to prostheses.
Fund Rules
These are the rules of membership of Medibank Private. Some of the more important Fund Rules are summarised in the visitors covers Membership Guides. The Fund Rules are available to view at any Medibank store or here. All members of Medibank Private are subject to the Fund Rules as varied from time to time with the approval of the Minister for Health and Ageing
General dental
General dental services include preventative treatments, fillings and extractions. General dental services do 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 two 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 type care), theatre fees, surgically implanted prostheses and other items, but may not include charges for pharmaceutical prescriptions or extras services such as physiotherapy or fees levied by your hospital doctor.
Major dental
Dental services relating to orthodontic (eg braces and corrective plates), periodontic, dentures, crowns, bridges and inlay/onlay restorative services.
Medically necessary ambulance transport
Cover for transportation by ambulance which is necessary as, due to the patient’s medical condition, they could not be transported by any other means.
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.
Medicare Benefits Schedule (MBS)
This is a schedule that 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 that is payable for that service.
Member
Any person covered under a Medibank Private membership.
Membership
A Visitors Cover 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, and/or spouse and/or dependent children for a family membership.
Please note, for the purposes of our Working Visa Health Insurance covers, family membership also includes single parent families (being the contributor and dependent children).
For the purposes of our Basic Visitors Cover, Essential Visitors Cover and Optimal Visitors Cover, family membership also includes single parent families (being the contributor and dependent children) and couples (being the contributor and spouse).
Members’ Choice hospitals, Members’ Choice extras providers and Members’ Choice network
More About our Members’ Choice Network.
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.
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 pharmaceutical prescriptions.
Pre-existing ailment
Please refer to Further Information.
Prostheses
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.
Federal Government's Prostheses Schedule
This is a schedule 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.
Gap prostheses
Items on the Federal Government’s Prostheses Schedule for which you will have to pay an amount towards the cost.
No-gap prostheses
Items on the Federal Government’s Prostheses Schedule for which you will be fully covered.
External prostheses
Manufactured items designed to replace external parts of the body, such as an arm or leg. Benefits for external prostheses are payable under the extras component of Essential Visitors Cover, Optimal Visitors Cover and Working Visa Health Insurance. The benefit payable will differ for each cover.
Recognised providers
Providers approved by Medibank Private for the purpose of paying benefits. Should you wish to check if a provider is recognised by Medibank Private, please call 132 331.
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 dependent 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 registered medical practitioner. The device must be purchased or hired within 12 months of the investigation. Benefits for replacement devices are not payable for a period of five years from the date of the original purchase or hire.
Surgically implanted prostheses
Please refer to prostheses.
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.
More on waiting periods.