Glossary
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Terms beginning with A
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- 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.
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- Ambulance services
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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.
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- Annual limit
- An annual limit is the maximum amount of benefits payable for particular extras items or services within a calendar year. Other restrictions may apply to the number of services you can claim in a particular period. Call us on 132 331 for more information.
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Terms beginning with B
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- 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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Terms beginning with C
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- Calendar year
- A 12 month period commencing 1 January and ending 31 December.
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- 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.
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- 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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Terms beginning with D
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- Dependent child
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This is a child of the contributor 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.
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- Doctor
- A registered medical practitioner including a specialist, surgeon or anaesthetist.
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Terms beginning with E
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- 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.
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- Excess
- An amount you pay towards your hospital treatment. It only applies to some hospital covers or the hospital component of a cover. No excess applies to children on your membership on any of our hospital covers.
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- Excluded services
- This is a service for which no benefits are payable.
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- External prostheses
- These are manufactured items designed to replace external parts of the body such as an arm or leg.
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Terms beginning with F
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- Federal Government's Prostheses Schedule
- This is a list issued by the Federal Government which sets out the benefits payable to members of health funds with hospital cover for surgically implanted prostheses and other items.
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- Fixed benefit
- You'll receive a fixed benefit 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.
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- Fund Rules
- These are the rules of your Medibank membership including rules for the payment of benefits. Some of the more important Fund Rules are summarised in the Membership Guide that is sent to all new members. You can view the Fund Rules at medibank.com.au 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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Terms beginning with G
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- 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, gum disease, root canal treatment, crowns or bridges.
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Terms beginning with H
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- Health screening services
- These are Medibank approved health screening services for the detection of an illness or condition and performed by a Medicare registered provider, and where no Medicare benefit is paid for that service. Services may include retinal scans, bone density tests and MRIs.
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- Health subscriptions
- Medibank approved membership or subscription fees for specified health bodies and associations. These may include Australian Crohns and Colitis Association, Brainlink, Coeliac Society, Diabetes Australia and Registered Ostomy Association.
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- 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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- Home nursing
- This is nursing care at home provided by a registered nursing agency. It does not include nursing care provided in a hospital or nursing home.
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- Hospital charges
- These are amounts charged by a hospital for things like accommodation and nursing care, theatre fees and surgically implanted prostheses. It does not include charges for extras services, such as physiotherapy, or fees charged by your hospital doctor.
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Terms beginning with I
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- Included services
- We pay benefits towards these services.
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Terms beginning with L
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- Laser eye surgery
- The correction of vision where the procedure is performed by a registered ophthalmologist in the doctor's surgery and where no Medicare benefit is payable.
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Terms beginning with M
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- Major dental
- Non-routine dental work including things like restorative fillings, dentures, crowns, bridges, and treatment for gum disease and root canals. It does not include orthodontic treatment.
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- Major eye surgery
- This includes cornea and sclera transplants and cataract surgery.
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- 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.
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- Medicare Benefits Schedule (MBS)
- 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's 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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Terms beginning withN
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- Non members’ choice hospital
- A public or private hospital that is not part of Medibank Members' Choice hospital network.
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Terms beginning with O
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- 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.
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- 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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Terms beginning with P
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- Pharmaceutical Benefits Scheme (PBS)
- A Federal Government scheme which allows for many pharmaceuticals to be supplied to Australian residents at reduced or no cost.
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- Plastic and Reconstructive surgery
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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.
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- Prescription pharmaceuticals (non-PBS)
- These are prescription-only items not covered by the Pharmaceutical Benefits Scheme. We'll pay benefits up to a set amount for each prescription item 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.
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- 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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Terms beginning with R
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- 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 132 331.
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- Restricted services
- These are services you receive lower benefits for than included services in a private hospital. You're likely to have significant out-of-pocket expenses if you receive these services in a private hospital.
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Terms beginning with S
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- Same day admission
- This is when you are admitted to a hospital or day hospital facility and discharged on the same day where the stay does not extend beyond midnight.
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- Surgically implanted prosthesis
- An approved 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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Terms beginning with T
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- Teeth whitening
- This is bleaching of the teeth performed by a registered dental practitioner.
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Terms beginning with U
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- Ultra bonus
- If you have Ultra Health Cover, this is a bonus that is automatically applied towards eligible out-of-pocket costs incurred for in-hospital medical treatment and hospital related costs. See page 20 for more information.
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- Terms beginning with G
- Terms beginning with H
- Terms beginning with I
- Terms beginning with J
- Terms beginning with K
- Terms beginning with L
- Terms beginning with M
- Terms beginning with N
- Terms beginning with O
- Terms beginning with P
- Terms beginning with Q
- Terms beginning with R
- Terms beginning with S
- Terms beginning with T
- Terms beginning with U
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