An unforeseen event, occurring by chance and caused by an external force or object, resulting in involuntary injury to the body requiring immediate treatment.

Accident does not include any unforeseen conditions the onset of which is due to medical causes nor does it include pre-existing conditions, falling pregnant or accidents arising from surgical procedures.

Adult Dependant

child of the policy holder or their partner, who:

a) is not married or in a de-facto relationship,

b) is between 21 and 30 years old (inclusive), and

c) is not a Student Dependant

Please note that only some Medibank covers allow the addition of an Adult Dependant.


A road vehicle, boat or aircraft operated by a service approved by Medibank and equipped for the transport and/or paramedical treatment of a person requiring medical attention.

Annual limit

An annual limit is the maximum amount of benefits we pay towards services and/or items within a calendar year. A combined limit is an annual limit that applies to a group of services and/or items. Where the annual limit increases, it will increase on 1 January each year, up to the maximum limit. The first increase will be applied only after you’ve served one full calendar year of membership.

Appendicitis treatment

Admission to hospital for an inflamed appendix (appendicitis). It includes admission to hospital with suspected appendicitis and may include surgery to remove the appendix (appendectomy).

Assisted reproductive services (clinical category)

Hospital treatment for fertility treatments or procedures.

For example: retrieval of eggs or sperm, In vitro Fertilisation (IVF), and Gamete Intra-fallopian Transfer (GIFT).

Australian Government Rebate (AGR)

A rebate provided by the Australian Government to help Australians reduce the cost of their health insurance premiums. The rebate is means tested, and applies only to the base premium of a residential cover. Click here for more information on determining and applying for your eligible rebate.

Authorised person

A person that a member authorises to act on their behalf in dealing with Medibank.

Members can nominate an authorised person by:

a) calling us on 132 331, or

b) completing and returning an authority form.


Back, neck and spine (clinical category)

Hospital treatment for the investigation and treatment of the back, neck and spinal column, including spinal fusion.

For example: sciatica, prolapsed or herniated disc, spinal disc replacement and spine curvature disorders such as scoliosis, kyphosis and lordosis.


The amount of money we contribute towards the cost of an item or service included under a member's cover. The benefit we pay for services or items is likely to be less than your annual limit and less than your provider’s charge, which means you may have out-of-pocket expenses to pay.

Benefit replacement period (BRP)

This is the period of time you need to wait from the date of purchase of an item before you can receive another benefit to replace it. This is separate to a waiting period.

Blood (clinical category)

Hospital treatment for the investigation and treatment of blood and blood-related conditions.

For example: blood clotting disorders and bone marrow transplants.

Bone, joint and muscle (clinical category)

Hospital treatment for the investigation and treatment of diseases, disorders and injuries of the musculoskeletal system.

For example: carpal tunnel, fractures, hand surgery, joint fusion, bone spurs, osteomyelitis and bone cancer.

Bowel surgery

Surgery for conditions affecting the small and/or large bowel. Bowel surgery may be required to treat conditions such as inflammatory bowel disease, bowel cancer, perforation of the bowel and bowel obstruction. It includes removal or repair of damaged or diseased segments of the bowel.

Brain and nervous system (clinical category)

Hospital treatment for the investigation and treatment of the brain, brain-related conditions, spinal cord and peripheral nervous system.

For example: stroke, brain or spinal cord tumours, head injuries, epilepsy and Parkinson’s disease.

Brain surgery

Surgery to treat and investigate conditions involving the brain and the skull.

Breast surgery (medically necessary)  (clinical category)

Hospital treatment for the investigation and treatment of breast disorders and associated lymph nodes, and reconstruction and/or reduction following breast surgery or a preventative mastectomy.

For example: breast lesions, breast tumours, asymmetry due to breast cancer surgery, and gynecomastia.

Breathing appliances

An instrument, apparatus, or device to assist with the treatment of respiratory conditions which helps a person to breathe. It includes nebulisers, peak flow meters and spacing devices.


CPAP-type device

An external device used to increase the flow or pressure of air that is available for respiration. These devices include Continuous Positive Airway Pressure (CPAP) and Bi-level Positive Airway Pressure (BiPAP) or similar devices, as approved by Medibank from time to time.

Calendar year

The period from 1 January to 31 December.

Cataracts (clinical category)

Hospital treatment for surgery to remove a cataract and replace with an artificial lens.

Chemotherapy, radiotherapy and immunotherapy for cancer (clinical category)

Hospital treatment for chemotherapy, radiotherapy and immunotherapy for the treatment of cancer or benign tumours. Surgical treatment of cancer is listed separately under each body system.

Chemotherapy and radiotherapy for cancer

Chemotherapy involves the administration of medication to kill cancer cells and to treat cancer. Radiation treatment uses high doses of radiation to destroy cancerous tumours, usually at one specific site in the body.


Child means one of the following:

a) a natural child,

b) an adopted child,

c) a foster child,

d) a step-child, or

e) a child being cared for under guardianship arrangements approved by Medibank from time to time.

Child Dependant

child of the policy holder or their partner, who:

a) is not married or in a de-facto relationship, and

b) is less than 21 years old.


Chiropractic treatment involves the manipulation or adjustment of the spine and the diagnosis and management of spinal health related problems and is intended to treat conditions such as back or neck pain and injuries, headaches/migraines and joint problems to promote mobility.

It includes consultations and x-rays. Benefits are payable for one-on-one sessions only. Where x-rays are provided under a person’s cover, the practitioner must be licensed to provide them. 

The provider must be an AHPRA registered health practitioner. The peak body for Chiropractors is the Australian Chiropractors Association (ACA).

Clearance certificate

See: Transfer certificate.


A procedure to examine the lining of the large bowel (colon). It is used to screen, investigate and/or treat the cause of abdominal pain, bleeding, irregular bowel habit, remove polyps or detect cancer. Where a colonoscopy procedure is included under a cover, it must be performed in-hospital for benefits to be payable.

Commonwealth Medicare Benefits Schedule (CMBS)

See: Medicare Benefit Schedule (MBS).


An actual or perceived stated 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.

Cooling-off period

The 30 day period from the date a member joins Medibank or changes their cover, to review and make sure they are happy with it. If a member changes their mind during this period, Medibank will either provide a full premium refund or transfer them to a more appropriate cover from the cover start date, provided no claims have been made.

Cosmetic treatment

Means any treatment which is not medically necessary and aims to revise or change the appearance, colour, texture, structure or position of normal bodily features.

Couple membership

membership that includes the policy holder and their partner.


Counselling, including psychotherapy, are professional activities that utilise an interpersonal relationship to enable people to develop self-understanding and to make changes in their lives. Benefits are payable towards face to face individual, family, couple and group consultations, and individual, family and couple telehealth consultations under mental health support. Medibank only pays benefits towards recognised Counsellors, subject to annual limits.


Default benefit

See: Minimum benefit.

Dental surgery (clinical category)

Hospital treatment for surgery to the teeth and gums.

For example: surgery to remove wisdom teeth, and dental implant surgery.


Is a person who is included under an eligible membership who is either :

a) a Child Dependant,

b) a Student Dependant, or

c) an Adult Dependant.

Diabetes management (excluding insulin pumps) (clinical category)

Hospital treatment for the investigation and management of diabetes.

For example: stabilisation of hypo- or hyper- glycaemia, contour problems due to insulin injections.

Dialysis for chronic kidney failure (clinical category)

Hospital treatment for dialysis treatment for chronic kidney failure.

For example: peritoneal dialysis and haemodialysis.


Dietetics applies nutritional principles to the planning and preparation of food to maintain health and treat disease. It's purpose is to promote good health through proper eating and development of modified diets. It includes consultations with a registered dietician where they have a Medicare provider number. Any consumables are not claimable. The peak body for Dietitians is the Dietitians Association of Australia (DAA).

Digestive system (clinical category)

Hospital treatment for the investigation and treatment of the digestive system, including the oesophagus, stomach, gall bladder, pancreas, spleen, liver and bowel.

For example: oesophageal cancer, irritable bowel syndrome, gall stones and haemorrhoids.

Direct debit

An arrangement between a person and Medibank where the person authorises Medibank to automatically debit money from their nominated bank account or credit card subject to agreed terms, governed by Medibank’s direct debit agreement.


Ear, nose and throat (clinical category)

Hospital treatment for the investigation and treatment of the ear, nose, throat, middle ear, thyroid, parathyroid, larynx, lymph nodes and related areas of the head and neck.

For example: damaged ear drum, sinus surgery, removal of foreign bodies, stapedectomy and throat cancer.

Equivalent cover

The Medibank product we consider to be most similar in coverage to a member's previous cover.


This is the amount you pay towards your hospital admission (same-day or overnight) before we pay any benefits. The excess applies per member, per calendar year and it doesn’t apply to child, student or adult dependants on a family membership. Some hospitals may require you to pay the excess at the time of admission.

Excluded service

A service that we don't pay benefits towards, including hospital accommodation or in-hospital medical service like specialists' fees.

Exercise physiology

Exercise physiology involves the design, implementation and supervision of exercise programs for the prevention and management of illness and injury and aims to assist the body’s recovery from illness or injury.

Extras benefits

See: Benefits.

Eye (not cataracts) (clinical category)

Hospital treatment for the investigation and treatment of the eye and the contents of the eye socket.

For example: retinal detachment, tear duct conditions, eye infections and medically managed trauma to the eye.

Eye therapy (Orthoptics)

The investigation and treatment of vision problems resulting from defects in the eye muscles (such as squint and lazy eye) or faulty visual habits. It is used to treat eye strain, visually-induced headaches and people who are cross-eyed or experience double vision. Therapy involves eye exercises and treatment designed to correct the alignment of the eyes. It includes consultations only.


Family membership

membership that includes the policy holder, their partner and one or more dependants.

Fertility treatment

Treatment in hospital to facilitate the implantation of a viable embryo in order to achieve pregnancy. It includes retrieval and implantation of eggs and collection of semen. In Vitro Fertilisation (IVF) treatment and Gamete Intra Fallopian Transfer (GIFT) are two of the most common procedures. Benefits are only payable for parts of the treatment where a member is admitted to hospital.

Financial year

The period from 1 July to 30 June.

Fixed Amount

This is the amount we’ll pay towards the cost of an Extras service or item if you visit a non-Members’ Choice provider. It will generally be lower than the amount you would receive when you visit a Members’ Choice provider. The amount of the Fixed Amount depends on the cover you hold and the type of service or item you receive.

Full-time education

Means a course of study:

a) being undertaken at an Australian Educational Institution, and

b) requiring a full-time study workload as determined by Medibank.

Fund rules

The rules that set out the arrangement for membership of, and the payment of benefits by the Fund in respect of Medibank health insurance products. All members of the Fund, are bound by the Fund Rules and any supplementary Fund Policies as amended from time to time.



See: Out-of-pocket expense.


Medibank’s GapCover is designed to help eliminate or reduce out-of-pocket expenses for in-hospital doctors' charges. Doctors can choose to participate in GapCover on a claim-by-claim basis. So it is important to check upfront with each doctor involved in a treatment if they will participate in GapCover for all of their claims. Out-of-pocket costs may still apply. GapCover doesn't apply to diagnostic services or to some other services. See Member Guide for more information

Gastrointestinal endoscopy (clinical category)

Hospital treatment for the diagnosis, investigation and treatment of the internal parts of the gastrointestinal system using an endoscope.

For example: colonoscopy, gastroscopy, endoscopic retrograde cholangiopancreatography (ERCP).

Gynaecological surgery

Surgery to the female reproductive organs including the vagina, cervix, uterus and ovaries.

At Medibank, we consider major gynaecological surgery to be an operation to remove or repair major parts of the female's reproductive system. This includes hysterectomy and vaginal repair. Excludes surgery associated with childbirth.

We consider minor gynaecological surgery to include procedures to repair or investigate parts of the female's reproductive system. This includes colposcopy (treatment of the cervix), hysteroscopy (treatment of the lining of the uterus) and surgery to treat endometriosis. Excludes major surgery such as hysterectomy and vaginal repair.

Also excludes IVF and assisted reproduction.

Gynaecology (clinical category)

Hospital treatment for the investigation and treatment of the female reproductive system.

For example: endometriosis, polycystic ovaries, female sterilisation and cervical cancer.


Health cover account (HCA)

A notification sent to members to inform them of their cover date paid to (DPT), when their next payment is due, the amount they should pay and available methods of payment.

Hearing aids

An external device fitted to the ear. The device must operate independently of any other audio equipment and improve hearing ability. It includes the purchase of In the ear (ITE), In the canal (ITC) and Behind the ear (BTE) hearing aids as well as the repair of hearing aids.

Where a government subsidy is available, it must be claimed prior to any health insurance benefit and the account must be paid in full. It does not include benefits for batteries.

Heart and vascular system (clinical category)

Hospital treatment for the investigation and treatment of the heart, heart-related conditions and vascular system.

 For example: heart failure and heart attack, monitoring of heart conditions, varicose veins and removal of plaque from arterial walls.

Heart-related admissions

Medical and surgical admissions intended to investigate, diagnose, monitor and/or treat heart-related conditions. It includes medical admissions for heart-related conditions, angiograms, insertion of stents, pacemakers and defibrillators, open heart surgery, valve replacement or repair and other invasive cardiac procedures.

Hernia and appendix (clinical category)

Hospital treatment for the investigation and treatment of a hernia or appendicitis.

Hernia repair

Surgery to repair and treat a range of different hernias. Excludes some major hernias associated with newborn children.

Home nursing

Services provided in the member's home by a registered nurse who is employed by a nursing service to provide medical treatment in the home. This includes wound care and injections where the nursing service is approved by Medibank.

Hospital cover

A cover that helps with the cost of a member's hospital stay as a private patient including:
- hospital accommodation on the ward,
in-patient medical treatment; and
- associated appliances provided during the admission e.g. approved internal prostheses.

Hospital psychiatric services (clinical category)

Hospital treatment for the treatment and care of patients with psychiatric, mental, addiction or behavioural disorders.

For example: psychoses such as schizophrenia, mood disorders such as depression, eating disorders and addiction therapy.


Implantation of hearing devices (clinical category)

Hospital treatment to correct hearing loss, including implantation of a prosthetic hearing device..


A person who is admitted to hospital to receive medical care or treatment.

Included service

A service that we pay benefits towards, including inpatient hospital accommodation (overnight and same-day) and medical services subsidised by Medicare; however, out-of-pocket expenses can still apply.

Insulin pumps (clinical category)

Hospital treatment for the provision and replacement of insulin pumps for treatment of diabetes.

Informed Financial Consent (IFC)

The provision of cost information to patients in writing, including notification of likely out-of-pocket expenses, by all relevant service providers. Where possible, this is provided prior to admission to hospital or provision of treatment .


Joint investigation and reconstruction

Surgery to investigate and repair a joint that has been damaged by injury or illness. This includes an arthroscopy, removal of loose bodies, repair/reconstruction of ligaments and tendons, joint surface, meniscus or other joint associated structures. This excludes joint replacement surgery.

Joint reconstructions (clinical category)

Hospital treatment for surgery for joint reconstructions.

For example: torn tendons, rotator cuff tears and damaged ligaments.

Joint replacements (clinical category)

Hospital treatment for surgery for joint replacements, including revisions, resurfacing, partial replacements and removal of prostheses.

For example: replacement of shoulder, wrist, finger, hip, knee, ankle, or toe joint.

Joint replacement surgery

Surgery to replace a joint with a prosthesis by replacing all or part of the joint or joint resurface. It includes joint replacement surgery after fracture as well as revision of previous replacement surgery. Any prosthesis provided must be on the Australian Government Prostheses List for benefits to be payable.


Kidney and bladder (clinical category)

Hospital treatment for the investigation and treatment of the kidney, adrenal gland and bladder.

For example: kidney stones, adrenal gland tumour and incontinence.


Laser eye surgery

Surgery to the eye which uses laser beams to correct refractive vision problems by reshaping the cornea (front of the eye) in order to reduce or eliminate the need for glasses or contact lenses. This can includes LASIK, LASEK and PRK treatment.

Laser eye surgery is only included under Gold Ultra Health Cover and subject to waiting periods and lifetime limits.

Lifetime Health Cover (LHC)

An Australian Government scheme designed to encourage people to take out hospital cover by the time they are 31. For more information on the calculation and application of LHC, click here.

Lung and chest (clinical category)

Hospital treatment for the investigation and treatment of the lungs, lung-related conditions, mediastinum and chest.

For example: lung cancer, respiratory disorders such as asthma, pneumonia, and treatment of trauma to the chest.


Male reproductive system (clinical category)

Hospital treatment for the investigation and treatment of the male reproductive system including the prostate. For example: male sterilisation, circumcision and prostate cancer.

Major eye surgery

Surgery to treat conditions and disorders associated with the eye. This includes cataract surgery as well as surgery to the cornea, retina, eyelid, tear duct and muscles of the eye, however does NOT include laser eye surgery for the correction or improvement of vision instead of wearing glasses or contact lens.

Medically necessary

Surgery or treatment that if not performed, could adversely affect the patient’s condition and is undertaken in accordance with accepted standards of medical practice, appropriate to the treatment, diagnosis and care required for the particular condition, illness or injury.


The basis of Australia's public health care system that provides free or subsidised medical treatment to eligible persons, including as a public patient in a public hospital. More information on the Medicare services can be found on their website.

Medicare Benefits Schedule (MBS)

A list of medical services for which Medicare pays a benefit and the rules that apply to the payment of those benefits. Each service has a fee that has been set by the Australian Government for the purpose of calculating the Medicare benefit payable for that service. Also known as the Commonwealth Medicare Benefits Schedule (CMBS).

Medicare eligibility

The level of coverage a person is entitled to receive under Medicare. It determines the type of health insurance cover most appropriate to supplement any existing entitlements. Levels of Medicare eligibility are:
• Full Medicare (Green card)
• Interim Medicare (Blue card)
• Reciprocal Medicare (Yellow card); or
• No Medicare.

Medicare levy surcharge (MLS)

An additional surcharge, on top of the Medicare levy, which Australian taxpayers are charged if they earn above a certain income threshold and do not hold residential hospital cover. For more information or to see if this applies to you visit the ATO's website.


A person who is insured under a Medibank membership.


Means being insured under a policy with Medibank through the payment of Premiums in line with our Fund rules.

Membership category

The category to which a membership belongs. Also known as the membership scale. Medibank offers the following membership categories:

Single membership – covers the Policy holder.
Couple membership – covers the Policy holder and their partner.
Single parent family membership – covers the Policy holder and any of their child dependants and/or student dependants.
Family membership – covers the Policy holder, their partner and any of their child dependants and/or student dependants.

We also provide an option for families with adult dependants, where, for an additional cost, some covers can be extended to also include an adult dependant/s.

Not all membership categories are available on all covers.

Membership scale

See: Membership category.


A feature included on some covers which can be used for:
- benefits for approved health related items,
- a top up towards extras benefits where the member has an out-of-pocket expense, or
- towards a hospital excess.

Members’ Choice hospital

See: Members' Choice Providers.

Members’ Choice network

The collective term for all Medibank Members’ Choice providers.

Members’ Choice provider

One of the following:
a) an extras provider Medibank has negotiated with so you won’t be charged more than the maximum agreed price, or
b) a hospital Medibank has an agreement with to help minimise members' out-of-pocket expenses

Members’ Choice hospitals/extras providers are subject to change. Search for a current Members' Choice provider online.

Mental Health Waiver

The Mental Health Waiver allows members who have served their two month waiting period for Restricted (Limited) in-hospital psychiatric treatment to upgrade to a cover with Included in-hospital psychiatric treatment and elect to have the two month waiting period for those higher benefits waived

Members can elect to use their waiver at the point of upgrading or after upgrading, prior to serving the two month waiting period for Included psychiatric treatment.  Members need to have held Hospital cover without a break of more than two months to be eligible to use the waiver.

The waiver only applies to the two month waiting period for the higher Included benefits for in-hospital psychiatric treatment. All other applicable waiting periods will continue to apply. 

Members will only be able to use the Mental Health Waiver once in their lifetime.

Minimum benefit

An amount set by the Australian Government as the minimum amount that a health fund must contribute towards hospital accommodation charges for an Included or Restricted service or treatment. Also known as a default benefit. Where a minimum benefit applies a member may have significant out-of-pocket expenses.

Miscarriage and termination of pregnancy (clinical category)

Hospital treatment for the investigation and treatment of a miscarriage or for termination of pregnancy.


Nerve treatment

As a service inclusion in our products, we define nerve treatment as procedures to repair damaged nerves, excluding procedures aimed at treating chronic pain.

Non-PBS pharmaceutical

Medication that is prescribed by an approved prescriber (medical practitioner, dentist, optometrist, nurse practitioner, midwife) not subsidised by the Pharmaceutical Benefits Scheme (PBS) and is not otherwise available over the counter. The pharmaceutical should aim to prevent or manage a medical condition, excluding cosmetic treatment. It includes contraceptives for specified medical conditions, allergen extracts, travel and other vaccinations and hormonal implants. Any items available without a prescription including over the counter, off the shelf, herbal medicines and vitamins cannot be claimed.


Obstetrics-related admissions

Services and treatment provided in hospital that deal with the care of women during pregnancy, childbirth and following delivery. It includes delivery of the baby and complications of pregnancy. This does not include any treatment that the baby may require. 

Occupational therapy

Occupational therapy helps people develop, recover, or maintain their daily living and work skills where they have a physical, mental or developmental condition. Its purpose is to enable people to participate more fully in the activities of everyday life.

Benefits are payable for consultations only and providers must have a Medicare provider number. The peak body for occupational therapist is Occupational Therapy Australia.


The dental specialty concerned with the diagnosis, prevention and treatment of any abnormalities associated with the developing dentofacial structures. It aims to assist with the correction and alignment of the teeth and jaw. It generally involves the use of braces, removable appliances, functional appliances or headgear.

Orthodontics service descriptions are derived from the Australian Dental Association Schedule of Dental Services and Glossary which is widely accepted by the health insurance industry as the basis for the numerical coding (itemisation) of dental services for the purpose of paying benefits.


See: Eye therapy.


It involves stretching and the manipulation of bones and muscles in order to treat conditions such as back or neck pain and injuries, headaches/migraines and joint problems to promote mobility.

Benefits are payable for consultations only and providers must be an AHPRAregistered health practitioner. The peak body for osteopaths is the Australian Osteopathic Association (AOA).

Out-of-pocket expense

An Out-of-Pocket Expense (previously known as the ‘gap’) is a difference between the fee charged by a provider (a surgeon, dentist, or physiotherapist etc.) and the benefit Medibank will pay for the service. The term ‘gap’ will continue to be used for our GapCover scheme.

Outpatient services

Medical care or treatment received when a person is not admitted to hospital. This includes visits to an emergency department, specialist or general practitioner (GP). Private health insurers are not permitted to pay benefits towards these services.

Overseas Student Health Cover (OSHC)

A type of cover which is only available to people who hold an eligible student visa. OSHC covers are designed to meet the criteria set by a Deed issued by the Australian Government’s Department of Health. For more information visit the Department of Health website.



A feature included on some covers which can be used for:
- benefits for approved health related items;
- a top up towards extras benefits where the member has an out-of-pocket expense; or
- towards a hospital excess.

Pain management (clinical category)

Hospital treatment for pain management that does not require the insertion or surgical management of a device.

For example: treatment of nerve pain and chest pain due to cancer by injection of a nerve block.

Pain management with device (clinical category)

Hospital treatment for the implantation, replacement or other surgical management of a device required for the treatment of pain.

For example: treatment of nerve pain, back pain, and pain caused by coronary heart disease with a device (for example an infusion pump or neurostimulator).

Palliative care (clinical category)

Hospital treatment for care where the intent is primarily providing quality of life for a patient with a terminal illness, including treatment to alleviate and manage pain.


A person who lives with the policy holder in a marital or de-facto relationship.

Per-Day Payment

A Per-Day Payment is a daily amount that you contribute towards your accommodation costs when admitted to hospital, and is separate to any applicable excess. The amount payable is determined by the cover held and is payable directly to the hospital.

Pharmaceutical Benefits Scheme (PBS)

The Pharmaceutical Benefits Scheme (PBS) is funded by the government and makes subsidised prescription medicines available to Australian residents. Residents eligible for the PBS contribute to the cost of subsidised medicines by paying a per day payment for each item set by the government.


Physiotherapy assesses, diagnoses, treats, and works to prevent disease and disability through physical means in order to help a person recover from injury, reduce pain and stiffness, and increase mobility.

It includes one-on-one and group physiotherapy consultations, clinical Pilates, hydrotherapy (group sessions only). 

The provider must be an AHPRA registered health practitioner. The peak body for physiotherapist is the Australian Physiotherapy Association (APA).

Plastic and reconstructive surgery (clinical category)

Hospital treatment which is medically necessary for the investigation and treatment of any physical deformity, whether acquired as a result of illness or accident, or congenital.

For example: burns requiring a graft, cleft palate, club foot and angioma.

Podiatric surgery (provided by a registered podiatric surgeon) (clinical category)

Hospital treatment for the investigation and treatment of conditions affecting the foot and/or ankle, provided by a registered podiatric surgeon, but limited to cover for:

  • accommodation; and
  • the cost of a prosthesis as listed in the prostheses list set out in the Private Health Insurance (Prostheses) Rules, as in force from time to time.


The diagnosis, treatment and prevention of conditions affecting the toe, foot and ankle in order to help members maintain good foot hygiene and posture. It may include the treatment of toe nail conditions, calluses and ulcers of the feet and assessment of gait to correct poor posture. The provider must be an AHPRAregistered health practitioner.

Policy holder

The main member on a Medibank membership who owns, and is responsible for the cover.

Pre-existing condition (PEC)

An ailment, illness or condition that in the opinion of a medical practitioner appointed by Medibank, the signs or symptoms of that ailment, illness or condition existed at any time in the period of 6 months prior to the day on which the person became insured under the policy or changed their cover.

Pregnancy and birth (clinical category)

Hospital treatment for investigation and treatment of conditions associated with pregnancy and child birth.


An amount of money that must be paid towards a membership for a specified period of cover.

Prescribed List of Medical Devices and Human Tissue Products

A list outlining the minimum benefits payable for surgically implanted medical devices and human tissue products (previously known as surgically implanted prostheses). This is published by the Australian government and revised from time to time.

Private patient

A person admitted into a public or private hospital to receive medical treatment as a private patient. A private patient can be self-funded or have health insurance.

Professional attention

Consists of:
a) medical or surgical treatment by or under the supervision of a medical practitioner,

b) obstetric treatment by or under the supervision of a medical practitioner or a registered nurse with obstetric qualifications,

c) dental treatment by or under the supervision of a dental practitioner, or

d) podiatric treatment by or under the supervision of an accredited podiatrist.

Psychiatric treatment

Psychiatric treatment involves prevention, diagnosis and treatment of a wide range of mental health conditions in order to improve a person’s social functioning. It includes treatment of disorders such as: depression, anxiety, personality disorders, eating disorders and addiction. Where included under a person's cover, treatment must be provided at an approved psychiatric facility for benefits to be payable.


Psychology focuses on the diagnosis and treatment of behavioural and mental health conditions such as depression, anxiety, phobias, personality disorder such as obsessive compulsive disorder (OCD) and other behavioural problems.

It includes one on one and family/couple consultations where no Medicare benefit is payable. Benefits are not payable for telephone consultations. The provider must be an AHPRA registered health practitioner. The peak body for psychologist is the Australian Psychological Society (APS).


Reciprocal health care agreement (RHCA)

An agreement between the Australian Government and certain overseas countries to provide visitors with access to subsidised health services for essential medical treatment. These arrangements vary from country to country. Additional information and confirmation of entitlements can be checked with Medicare. Holders of reciprocal Medicare entitlements are generally eligible to receive the AGR if they hold a Resident cover.

Rehabilitation (clinical category)

Hospital treatment for physical rehabilitation for a patient related to surgery or illness.

For example: inpatient and admitted day patient rehabilitation, stroke recovery, cardiac rehabilitation.

Removal of appendix

Surgery to remove an inflamed appendix (appendicitis). Also known as an appendectomy.

Removal of tonsils and adenoids

Surgery to remove tonsils and/or adenoids.

Renal dialysis

Treatment aimed at assisting or replacing the function of the kidneys. It can include both haemodialysis (circulating the blood through a machine) and peritoneal dialysis (infusing and draining a sterile solution into the abdomen). Where included under a person's cover, treatment must be provided in hospital for benefits to be payable.

Resident cover

A type of cover designed for residents of Australia who are entitled to full Medicare benefits.

Restricted service

A service where we pay the minimum amount set by the government for hospital accommodation.


Similar cover

See: Equivalent cover.

Single membership

membership that includes one member, known as the policy holder.

Single parent family membership

membership that includes the policy holder and one or more dependants.

Skin (clinical category)

Hospital treatment for the investigation and treatment of skin, skin-related conditions and nails. The removal of foreign bodies is also included. Plastic surgery that is medically necessary and relating to the treatment of a skin-related condition is also included.

For example: melanoma, minor wound repair and abscesses.

Sleep studies (clinical category)

Hospital treatment for the investigation of sleep patterns and anomalies.

For example: sleep apnoea and snoring.

Speech Therapy

Speech therapy diagnoses, manages and treats individuals who are unable to communicate effectively or who have difficulty with feeding or swallowing. It's purpose is to assist people who have communication disabilities. Speech pathologists also assist with a variety of conditions associated with feeding, swallowing or breathing problems Benefits are only payable for consultations and providers must have a Medicare provider number. Speech Pathology Australia (SPA) is the peak body.

Spinal fusion

Surgery to join two or more vertebrae in the spinal column. Spinal fusion often involves a bone graft and may involve the insertion of screws, rods or cages to hold the fused joints in place.

It may include surgical treatment of conditions such as chronic low back pain, spondylolisthesis, spondylosis and degeneration of the spine, but does not include the treatment of developmental deformities such as scoliosis or kyphosis.

State of residence

The State or Territory in which the policy holder resides.

Student Dependant

child of the policy holder or partner who:

a) is not married or in a de-facto relationship,

b) is 21-30 years old (inclusive), and

c) is undertaking full-time education as determined by Medibank at an Australian educational institution.

Surgery for slipped discs and scoliosis

Surgery to treat a bent spine (scoliosis) and back pain or sciatica by removing a bulging spinal disc.

Surgical removal of wisdom teeth

The surgical removal of wisdom teeth in hospital. It includes the hospital and anaesthetic charges associated with surgical removal of wisdom teeth, but does not pay for charges raised by a dentist (these charges are normally covered through the dental component of an extras cover).


A period of time where a membership is temporarily 'discontinued'. During this time a member is not required to pay premiums for their membership, cannot make any claims and is not exempt from the MLS. Refer our Medibank Member Guide for more information.


Tonsils, adenoids and grommets (clinical category)

Hospital treatment of the tonsils, adenoids and insertion or removal of grommets.

Transfer Certificate

A transfer certificate (also known as a clearance certificate) serves as a record of your health insurance cover. The certificate confirms the following details:

A transfer certificate is provided when you leave an insurer or transfer to another fund.


Vascular surgery

Surgery to the arteries and veins. Includes varicose vein surgery, endarterectomy, peripheral artery bypass surgery.


Waiting period (WP)

A waiting period applies when you join Medibank, or change your cover to include new or upgraded services. We won’t pay benefits for any items purchased or services received while you are serving a waiting period.

Weight loss surgery (clinical category)

Hospital treatment for surgery that is designed to reduce a person’s weight, remove excess skin due to weight loss and reversal of a bariatric procedure.

For example: gastric banding, gastric bypass, sleeve gastrectomy.

Working Visa cover

A type of cover which is designed to comply with the conditions of the 457 Working Visa and similar visa types including ‘visa condition 8501’ regarding the holding of a minimum level of insurance. They are only available to those who are in Australia on certain working-type visas, as determined by Medibank. More information on these covers can be found here.