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 Frank. We're here to help.
Accident: An unforeseen event, occurring by chance and caused by an external force or object which results in involuntary injury to the body requiring immediate treatment. For an accident to be covered, treatment must be sought through a Doctor or Emergency Department within 48 hours of sustaining the injury. An Accident Declaration form must be supplied.
Admitted patient: A person who is formally admitted into hospital to receive hospital treatment or care
Adult: A person who is not a Child Dependant and is over the age of 18.
Australian Health Service Alliance (AHSA): An organisation that acts on behalf of 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
Benefits: The money payable from the Fund to the member or on their behalf for approved services claimable under their level of cover
Calendar year: The period between 1 January and 31 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 member
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 membership
Cosmetic Surgery: Surgery to improve your appearance that is not medically necessary
Dependent: A person who is not married or living in a de facto relationship and is a Child Dependant being a Child of the Policy Holder or Principal Member who is under the age of 21.
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 Frank 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 Private Health Insurance 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 Frank 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 Frank = out of pocket expense.
Overseas Visitor: A person who;
a) is not an Australian citizen, does not hold an Australian passport and does not reside permanently in Australia;
b) Holds a valid work Visa
Pre-existing Condition: An ailment, illness or condition that there were signs or symptoms in the 6 months immediately before you joined Frank. 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 Frank will provide benefits for treatment of the condition.
Premiums: The money paid to Frank for your membership
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, New Zealand, Norway, Republic of Ireland, Slovenia, Sweden and United Kingdom.
Repatriation: Transportation of the policyholder and/or other members on the policy back to their country of citizenship due to terminal illness or life altering injury. This also includes transportation of mortal remains in the event of death.
Waiting Period: The length of time you to wait before being eligible for health insurance benefits