Glossary
A
B
C
D
E
F
G
H
I
J
K
L
M
N
O
P
Q
R
S
T
U
V
W
X
Y
Z
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.
Annual limit
An annual limit is the maximum amount of benefits payable for particular groups of extras services within a calendar year.
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.
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.
Dependent child
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.
Doctor
A registered medical practitioner including a general practitioner or specialist, surgeon or anaesthetist.
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.
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 Covers and Working Visitors Covers. No excess applies to children on any of our hospital covers.
Excluded services
This is a service for which no benefits are payable.
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 Visitors Health Insurance, Top Visitors Health Insurance and Top Working Visa Health Insurance.
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.
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.
General dental
This is straightforward dental work and includes things such as routine check-ups, scale and cleans, fillings and extractions. It doesn’t include more complicated treatments or procedures such as orthodontic work, crowns or bridges.
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.
Major dental
This is the more serious dental work including things like restorative fillings, dentures, crowns, bridges, the treatment of gum disease and orthodontic work such as braces and corrective plates.
Major eye surgery
This includes cornea and sclera transplants and cataract surgery.
Medical costs
These are costs you incur out-of-hospital or in an overnight or day-hospital facility for things such as doctors’ fees, blood tests, scans and x-rays.
Medically necessary ambulance transport
Cover for transportation by ambulance which is necessary, because due to your medical condition, you can’t be transported any other way. Benefits for this are included in all covers described in this brochure except where you’re entitled to benefits from another source, such as ambulance subscription or a state ambulance transport schemes.
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 payable for that service (called the MBS fee).
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.
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.
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.
Prostheses
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.
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.
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.
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.
School accident
This is an accident suffered by a dependent child who is a pre-school, primary or secondary school student while attending, or travelling to or from, school or an organised school activity (e.g. an excursion). It provides cover for services that are received within 12 months of the accident but excludes services covered by Medicare or where compensation or damages are payable.
Sub-limits
A sub-limit is a maximum amount you can receive on an annual basis (or within other defined periods of time) for a particular item or service within an overall annual limit.
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 of function. Examples include pacemakers, defibrillators, cardiac stents and joint replacements.