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Accidental Injury
An injury caused by an unforseen event, occurring by chance and caused by an external force or object.
Accommodation (Hospital Accommodation)
Accommodation includes a bed/chair in hospital or day facility, all meals and other hospital provided services including nursing care for the purpose of receiving treatment by a doctor. It does not include treatment by doctors and other health professionals.
Admission
When a person is admitted to hospital by their treating doctor/specialist for the purpose of receiving treatment. . This may be a booked admission or through the Emergency Department. Treatment in the emergency room of a public or private hospital is an out-patient service and therefore not an admission.
Authorised Person
An authorised person is someone who has been granted authority by the main member of a membership to access that person’s membership and act on their behalf in some instances. Under Health Partners delegation of authority the authorised person can make changes or enquiries to the membership regarding: personal details (such as address, phone number), level of cover, financial information (such as change the payment method), and add or remove a dependant form the membership.
They are not authorised to change the status of the main member, cancel the membership, or access personal information of the main member or any other dependants over the age of 18.
Benefit
A benefit is the amount Health Partners will pay towards expenses incurred by a member for a treatment or service that is covered under that member’s level of cover. A benefit may be paid directly to you or on your behalf.
Certified Age
The age of a member when they purchase hospital cover for the first time (also known as Certified Age at Entry). The minimum certified age is 30. See Lifetime Health Cover for more information.
Condition
Any actual or perceived state of health for which treatment is sought.
Contributor
The contributor is the person who applied for Health Partners membership and whose name in which an application for membership has been accepted. The Contributor is also known as the Main Member.
Co-payment
A co-payment is an amount that a member agrees to pay towards the cost of each day spent in hospital, in return for lower premiums that would otherwise apply.
Day Surgery
A private hospital or facility where patients are admitted, treated and discharged on the same day.
Default Benefits
The minimum level of benefits payable for hospital treatment or accommodation, as determined by the Government.
Dependant
A dependant is a person other than the contributor who is listed on the membership. Dependants include the contributor’s spouse/partner, single child under 18 years or a registered student dependant under 25 years.
On a Family Focus membership a dependant can be a single child under 25 years, studying or not studying, even if living away from home.
Excess
An excess is the amount a member agrees to pay towards hospital accommodation, when admitted to hospital. By selecting a hospital cover with an excess you can reduce your membership contributions.. The excess amount will depend on the chosen cover.
Extras Cover
Extras cover is private health insurance for non-hospital health services that are not covered by Medicare, such as dental, optical and physiotherapy and much more. Also referred to as Ancillary Cover or General Treatment Cover.
Exclusions
Exclusions are services which are not included on a cover and therefore no benefits apply. These vary depending on the level of cover; refer to specific cover information for details.
Floating year
In relation to hospital admissions, a floating year is a year that commences on the date that you are first admitted to hospital in a 365 day period.
Gap
The gap is the amount a member pays on top of any Medicare benefit and/or Health Partners benefit for medical services when admitted to hospital. The gap will vary depending on the fees charged by the doctors and specialists treating you. For details on how to reduce the gap click here.
Government Rebate
The Federal Government 30% rebate on private health insurance is available to all Australians eligible for Medicare. The Rebate applies to both Hospital and Extras cover. The rebate increases to 35% for those aged between 65 and 69 years and to 40% for those 70 and over.
HICAPS
HICAPS is an electronic claiming service that allows members to claim Extras benefits on the spot at recognised providers with HICAPS. This means the members only pays the gap at the time of the visit..
In-patient
An in-patient is a person who is admitted to hospital, by their treating doctor, for treatment. This does not include treatment in an emergency department as this is an out-patient service..
Lifetime Health Cover
Lifetime Health Cover is a Government initiative that started on 1 July 2000. It was designed to encourage people to take out hospital insurance earlier in life, and to maintain their cover. This initiative involves a loading on Hospital cover contributions based on the age at which a person takes out Hospital cover for the first time. Click here for more information.
Lifetime Limit
A lifetime limit is the maximum amount you can claim for a certain service in your lifetime. Once this limit has been reached, no further benefits are payable. Some lifetime limits (such as Orthodontics) are transferred between funds.
Limit
A limit is the maximum amount you can claim for a service in a given time period. All Health Partners limits are quoted per person per calendar year, unless otherwise stated.
Loyalty Bonus
A loyalty bonus is an increase in benefits and/or limits you receive after a certain period of continuous membership with Health Partners.
Medicare Benefits Schedule
The Medicare Benefits Schedule (MBS) is a schedule of fees for all services covered by Medicare. For in-patient services, Medicare pays 75% of the MBS and Health Partners pays the remaining 25%. For out-patient services, Medicare pays 85% of the MBS however health funds are not allowed to contribute to the remaining 15%.
Medicare Levy Surcharge
The Medicare Levy surcharge is a Government imitative which involves an additional tax of 1% of your income (on top of the 1.5% Medicare Levy), and applies only to people who do not have private hospital cover and earn over a certain amount.
Medically Necessary
When treatment is considered necessary by a medical practitioner.
Main Member
The main member is the person who is legally responsible for the membership and for ensuring that contributions are up-to-date. This person has the right to add or remove others from the membership and obtain information about claims made. Dependant members can also access this information with approval from the main member. The main member is also kown as the Contributor.
Member
A member is any person registered on a Health Partners membership, including the Main Member and any Dependants.
Membership
A membership is a policy of private health insurance and is activated only once an application for membership is accepted by Health Partners. A membership is made up of the contributor (Main Member), plus all other registered dependants, including spouse/partner (if applicable).
Membership type
The membership type refers to the number and status of persons that are covered under a particular membership. Membership types include: Single, Couples, Family, Family Focus Sole Parent Family, Sole Parent Family Focus.
Non-emergency (ambulance treatment)
Non-emergency ambulance treatment refers to treatment and services that are not classed as ‘emergency cases’ by the ambulance service provider. This can include treatment at the scene with or without transport.
Outpatient
An outpatient is a person who is receiving hospital or medical services but is not admitted to the hospital.
Permitted days without hospital cover
Include days a member has suspended their membership in accordance with the fund rules, allowed lifetime health cover days (1094 lifetime limit), and days that a member is overseas not including days they have suspended their membership in accordance with the lifetime health cover rules.
Pharmaceutical Benefits Scheme (PBS)
The PBS is a Government run scheme that subsidises the cost of some pharmaceuticals.
Pre-Existing Condition
A Pre-existing Condition is an ailment, illness or condition the signs or symptoms of which, in the opinion of a medical practitioner appointed by the Fund, existed at any time during the six months preceding the day on which the contributor began contributions to the Fund or upgraded to a higher level of benefits.
Recognised Provider
A recognised provider is one that has registered with Health Partners. Benefits are not payable on services received from providers that are not recognised with Health Partners.
Standard Information Statement (SIS)
A Standard Information Statement gives a summary of the key product features of any level of cover available from the Fund. It is provided in a standard A4 format and provides basic cover information for easy comparison. All health funds are required by law to produce these. For more information go to privatehealth.gov.au
Waiting Period
A waiting period is the amount of time a member will have to wait from the time of joining to be eligible for health fund benefits. Waiting periods apply for benefits for hospital and extras services and will vary depending on whether a member is new to health insurance, has transferred from another fund or is upgrading their cover |