Glossary

Health cover can be confusing. To help, we've provided a list of definitions for commonly used words or phrases. If you still need help understanding the health system or your cover, make sure you get in touch with health.com.au. We're here to help.

Accident: An unexpected and unintentional event that results in harm, injury, damage or loss where medical treatment is sought from a Doctor or an emergency department within 24 hours of sustaining the injury.

Admitted patient: A person who is formally admitted into hospital to receive hospital treatment or care

Adult: Defined in the Private Health Insurance Act as a person who is not a dependent and over the age of 18.

Australian Health Service Alliance (AHSA): An organisation that acts on behalf on a number of health funds to arrange contracts between hospitals and health service providers.

Ambulance services: The services provided by an approved ambulance service (or a third party approved by the ambulance service) to transport a person, when medically necessary, to a hospital for admission or for emergency treatment

Antenatal and postnatal services: Classes or care before or after (and relating to) the birth of a baby

Benefits: The money payable from the Fund to the customer or on their behalf for approved services claimable under their level of cover

Calendar year: The period between 1 January and 31st December

Claim: A formal request to the Fund for payments of benefits

Compensation: The payment, or possibility of payments, by a third party for expenses incurred by the customer

Condition: An illness, injury, disease or disorder of the body for which you need treatment

Contracted Rate: The cost for hospital services, as agreed between the AHSA and the hospital

Commencement Date: Start date of the policy

Cosmetic Surgery: Surgery to improve your appearance that is not medically necessary

Dependent: Someone who is on the same visa as, lives at home with and is financially dependent on the customer

Emergency Department: A department at the hospital for emergency treatment. You usually arrive there by ambulance or by your own means without an appointment. It can also be known as "emergency room", "accident and emergency (A and E)" or "casualty"

Excess: The amount you need to pay for your hospital admission before health.com.au will start paying benefits

Hospital: A facility for medical and surgical treatment or for caring for the unwell or injured. This is further defined under Section 121-5(60) of the Act.

In-patient: A person who is admitted to a hospital for medical care or surgical treatment

Medicare Benefits Schedule (MBS): A list of medical fees for each medical service set by the Government based on a fair price and how much Australia can afford to pay for the total health system.

Participating Hospital: These are hospitals with which health.com.au has an agreement to charge contracted rates

Out of Pocket: This is the amount you pay toward your medical expenses. This is calculated as follows: total fee – benefits from health.com.au = out of pocket expense.

Overseas Visitor: A temporary visa holder who is not in Australia for only study purposes. This includes family members on the same visa.

Pre-existing Condition: An ailment, illness or condition that there were signs or symptoms in the 6 month immediately before you joined health.com.au. This is decided by an independent Medical Advisor by obtaining information from your doctor. If your condition is deemed pre-existing, there will be a 12 month waiting period before health.com.au will provide benefits for treatment of the condition.

Premiums: The money paid to health.com.au for your policy

Provider: This includes hospitals and medical practitioners

Public Hospital: A hospital administered by a state or territory government

Reciprocal Health Care Agreement (RHCA): Covers the cost of essential medical treatment for citizens of some countries while they are in Australia. These counties are Belgium, Finland, Italy, Malta, Netherlands, Norway, Republic of Ireland, Slovenia, Sweden and United Kingdom.

Repatriation: The process of returning a person to their place of origin or citizenship

Waiting Period: The length of time you to wait before being eligible for health insurance benefits