Access Gap Cover.

Police Health's scheme to eliminate or reduce out-of-pocket expenses for medical services (doctors, radiology, pathology) during hospital stays. We participate in this scheme through our affiliation with Australia Health Service Alliance.

Accident and Emergency Services Fee

A fee charged to patients by private hospitals for the treatment in an accident and emergency department. It is not covered by Medicare or private health insurance.

Ancillary cover/extras

Generally refers to non-hospital and non-medical health services, such as dental, optical, physiotherapy. Also sometimes referred to as extras by Police Health or as general treatment..

Annual Maximum

The maximum benefit payable for services received during any calendar for particular services or groups of services. The Annual Maximums start new on the 1st of January each year.

Accommodation-Hospital

Accommodation included in your hospital cover generally includes all in-hospital services such as meals, bed and nursing care. Accommodation does not include take home or personal items, e.g. toiletries, television, hairdressing, manicure etc.

Benefit.

The amount payable by Police Health to you, or on your behalf to a service provider in respect of a claim made relating to the provision of health services, treatment care or goods by a recognised provider.

Calendar year

From January 1 to December 31.

Claim

A request submitted by a member to Police Health for the payment of benefits for hospital treatment, in-patient medical treatment or extras treatment. Hospitals will generally submit your claim directly to Police Health. All claims must be made within two years of receiving treatment.

Code of conduct

A set of rules outlining responsibilities, best practices and ethical codes for a health insurance organisation to conduct itself.

Complementary therapies

Therapies that complement conventional medical treatment. Under Police Health extras, complementary therapies can include Chinese medicine, Western Herbal Medicine, Remedial Therapy, Remedial Massage Therapy, Acupuncture, Homoeopathy, Myotherapy and Aromatherapy.

Contributor

A Contributor in Police Health Fund Rules refers to the person who is registered as the Contributor of the policy, in which the policy holds their name as the authorising contact, recipient for all written communications and is responsible for premiums of the policy. In the website we refer to the Contributor as being the policy holder.

Co-payments

A co-payment is an amount that a member agrees to pay towards the cost of each day spent in hospital. Police Health does not have co-payments on its hospital coverage. However if you transfer to Police Health and your previous cover had a co-payment, you will be required to serve waiting periods in relation to the co-payment and you may be required to pay the co-payment if you receive hospital treatment during the waiting periods.

Dependent

Police Health's literature refers to three different types of dependents, spouse/partner, child and student dependents.

Our Fund Rules refer to the contributor and dependents. Dependents are any spouse/partner and any children dependents or student dependents of the contributor and/or their spouse/partner.

A child dependent under SureCover Extras, Top Hospital and Platinum Health policies means a person who is child of the contributor and/or their spouse/partner who is under 21 years of age.  Under Platinum Plus policies it is a child who is under 25 years of age.

A student dependent means under all policies, a person who is child of the contributor and/or their spouse/partner who is over 21 years of age but under 25 years of age, who is considered to be a full time student of a school, college, university or other tertiary institution recognised by Police Health.

In all cases a child is taken to include a natural child, adopted child, foster child or a child who is a legal ward of the contributor or their spouse/partner. A child ceases to be eligible as a dependent if married or in a defacto relationship.

Eligibility

Police Health is a restricted health insurer which means applicants need to meet certain qualifying criteria relating to police service employment for themselves, their spouse/partner, parent or grandparent to be eligible to join Police Health.

Excesses

An excess is an amount that a member agrees to pay upfront before your health insurance benefit is paid towards hospital accommodation as set out under a health insurance policy, similar to a motor insurance policy. Police Health does not have excesses on any of its hospital products, as they all offer premium coverage. However, during waiting periods you may be required to pay an excess if you were subject to one under your previous fund's policy.

Exclusions or excluded services

Exclusions are services for the treatment of defined conditions which are specifically not included on a policy and therefore no benefits apply. While Police Health does not have exclusions on its hospital coverage, there may be services provided by a hospital which may not be or cannot be covered. For example, if a service is not covered by Medicare, benefits are not payable from your hospital policy or may be restricted. You should always check with us to confirm what you're covered for before receiving treatment.

Fund Rules

Rules that set out your rights and responsibilities as a member of Police Health, including establishing the rules for payment of benefits. All persons covered by a health insurance policy with Police Health are subject to the Fund Rules, which are subject to change.

Gap

This commonly refers to the difference between the Medicare Benefits Schedule fee for a medical service and the amount covered by Medicare. It can also refer to the uninsured difference between the fee charged for a service and the benefit paid by Police Health (and Medicare if applicable), in effect your out-of-pocket cost.

In-patient

A person who has been admitted to a hospital. This does not include a person being treated in the out-patient or accident & emergency section of a hospital.

Lifetime Heath Cover (LHC)

A Government initiative that rewards people who take out private hospital cover early in life by guaranteeing lower premiums than what would apply if joining later in life.

Lifetime Limit

The maximum cumulative total benefit limits payable in the lifetime of the member on a particular service. Where lifetime limits apply, any benefits paid by your previous private health insurer are treated as part of this Lifetime Limit. You will find our lifetime limits are quite competitive with the other health funds.


Medicare Benefits Schedule (MBS)

A list of medical services and fees recognised by the Australian Government.

Member

The use of the words "membership" and "member" in this website relates to the policy holder (contributor) and all dependents under the policy of the Police Health insurance. It does not imply member voting rights as described in the constitution of Police Health Limited ABN 86 135 221 519.

Member of the company

Someone who has member voting rights as described in the constitution of Police Health Limited ABN 86 135 221 519.

Membership arrears

When a member is not up-to-date with policy payments, membership will be in arrears and no benefits will be paid to or on behalf the member. The policy may be cancelled by Police Health if in arrears greater than two months.

Not-for-profit

Police Health operates on a not-for-profit basis. This means we do not pay dividends to shareholders, and any surpluses are retained to benefit members.

Out-of-pocket expenses

 The portion of charges you incur that is not covered by Medicare or health fund benefits.

Out-patient

A person receiving treatment at a hospital but not admitted to hospital.

Palliative Care

Specialised health care to support and comfort people with life-limiting illnesses.

Pharmaceutical Benefits Scheme (PBS)

An Australian Government subsidy scheme that lowers the cost of prescription medicine. Health funds are not permitted to pay benefits towards medicines that receive a government subsidy except when the are supplied while an in-patient of a hospital.

Private Health Insurance Ombudsman (PHIO)

An Australian Government agency which helps consumers deal with enquiries and complaints about health insurance or health funds.

Policy/product

This refers to your health insurance agreement with Police Health and the treatment you are insured for in exchange for a set premium. The policy is governed by the Fund Rules of Police Health.

Policy holder

Police Health's web reference to a policy holder refers to the contributor of the policy (not everyone covered under the policy).

Pre-existing condition

Where signs or symptoms of an ailment, illness or condition (in the opinion of a medical practitioner appointed by Police Health) existed at any time during the six months before you purchased your policy or upgraded to a higher level of cover.

Premium

The amount you pay for your hospital, extras or combined cover policy. You must pay the premium that applies to your policy in the state in which you live. This means that if you move states, different premiums will apply.

Prostheses

Prostheses include screws and plates, intraocular lenses, replacement joints, cardiac stents, defibrillators and other devices that are surgically implanted during your stay in hospital.

Provider

An individual or institution that provides preventive, curative, palliative or rehabilitative health care services to individuals, families or communities.

Recognised health providers

Recognised health providers are those who are in private practice in Australia and recognised by Police Health.

Restricted membership

Police Health is a restricted membership private health insurer, meaning that people must meet criteria to be eligible to become a member, ie. the general public cannot join.

Restrictions

Restrictions refer to hospital treatment services for specified conditions for which you have agreed to receive only limited benefits under your health insurance policy. The extent of you coverage for those services is very limited and usually means that you will pay significant out-of-pocket expenses for treatment by a private hospital as usually only a small amount of benefit is paid towards accommodation fees and no benefits are paid for theatre fees. Police Health does not have restricted products as sold by some other health funds, but you should always check with us, the extent of you coverage prior to any hospital treatment.

State of residence

The state or territory where you live.

Suspension of private health cover

Under certain circumstances, such as travelling overseas, members may suspend the payment of their premiums for an agreed period of time. (conditions apply)

Travel and accommodation assistance

Government sponsored schemes in each State and Territory for patients who travel long distances to access specialist medical services.

Waiting Periods

A `waiting period' in the context of the private health insurance means the period of time from the commencement of cover or increase in cover,  to when the new benefit can be claimed by the member under their chosen cover (excludes accidents).

More information

If you are unsure about any other terms please call our office on .