visitors insurance brochure

7/28/2019 Visitors Insurance Brochure

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Freedom of hoiePeae of mindFor etter health

Visitors HealthInsurance



Australia is an exitingplae to holiday, visit familyand friends or work.

Australia is one of the most culturally diverse countries offeringgreat lifestyle choices and opportunities.

Regardless of your reason for visiting, it’s important to makesure you have planned all the details, including looking afteryour health and wellbeing. Medibank offers specially designedVisitors Health Insurance. It’s easy to join and as a Medibankmember, you’ll soon see that we do more than just pay bills.We deliver real benefits that will help you make the most ofyour time in Australia.

Medibank is here to help you access the right advice and supportyou may need in relation to your health cover needs.

If you’re studying or working in Australia, the covers outlinedin this brochure probably aren’t for you. For more informationplease see page 13 or refer to our Working Visa and OverseasStudent Health Cover brochures.

2



Welometo Mediank

Keeping your health a top priority while in Australia 4

Medibank – health cover that gives you more 6

Mi Health – better health support for our members 8

Members’ Choice 10

Choosing the right cover is easy 12Cover for hospital treatment 14

Cover for medical treatment 16

Cover for extras 18

Manage your membership online 20

Things worth knowing 21

Glossary 30

The information contained in this brochure is current at the time of issue, January 2013, and supersedes all previously published material. Please ensure you readthis brochure thoroughly and retain a copy for future reference. Membership of Medibank is subject to our Fund rules and policies which are summarised in ourMembership guide. You will receive a Membership guide and Cover summary upon joining. Premium rates, and the Fund rules and policies, change from time to time.The information in this brochure only applies to Medibank branded products .

If you are unsure of any terms or phrases used in this brochure you can check the glossary on page 30.

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Keeping your healtha top priority while

in AustraliaHealth are systems vary greatly all aroundthe world and navigating your way throughAustralia’s an e onfusing.

As a visitor to Australia we believe it's important that youunderstand how the Australian health care system works andwhat options are available to ensure you and your family’shealth care needs can be met while you are here.

Like most countries in the world, health care costs in Australiacan be expensive. Even a few days in hospital for a routineoperation can cost thousands of dollars in hospital chargesand doctors’ fees.

The Australian health are system hastwo main omponents:

1.Medicare Medicare is our national health care system, which provideseligible Australian residents with access to free treatment aspublic patients in public hospitals and free or subsidisedtreatment by doctors and other health professionals.

2.Privatehealthinsurance Many Australians purchase private health insurance to helpcover the cost of going to a private hospital and receiving otherhealth services usually not covered by Medicare.

Some visitors to Australia have restricted access to Medicarefor medically necessary treatment because their country hasa reciprocal health care agreement with Australia. Refer topage 21 to see if this applies to you.

However, most visitors and temporary workers have no accessto Medicare. That’s why as a visitor to Australia, it’s worthconsidering private health insurance so you can keep your healtha top priority. Choose Medibank and you’ll be with one ofAustralia’s largest private health insurers.

It’s easy to joinCall us on 132 331 or +61 3 8622 5780(if calling from outside of Australia)

Visit medibank.com.au/visitors

Visit a Medibank store

Looking afteryour health

in Australia

5



Are you overed for amulane?Ambulance services are included under all coversdescribed in this brochure. Unless you’re already covered(e.g. under a state scheme), we’ll cover the cost ofeligible ambulance services if you need immediateprofessional attention and your medical condition issuch that you couldn’t be transported any other way.See page 24 for more details.

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Mediank – health overthat gives you more

Mi Health – a new levelof health support with ourhospital covers

You‘ll get even more value from your hospital cover with accessto Mi Health. It’s a range of health support ser vices includingaccess to Medibank nurses on our 24/7 Health Advice Line,

Hospital Support, an online health resource and smartphonehealth apps to help you make healthier decisions on the go.

For more about how Mi Health can benefit you, see pages 8-9.

Value at Members’ Choiceproviders

Our Members’ Choice network is one of the largest healthprovider networks in Australia, covering most private hospitalsand the widest range of extras services of any health fund.

See pages 10-11 for more information.

No hospital excessfor kids

With our hospital covers, you won’t be charged an excess if achild on your membership needs to go to hospital.

Managing yourmembership online

Online Member Services is an easy, secure way to manageyour membership details, claims and payments wheneverand wherever it suits you.

See page 20 for more information.

More than justhealth cover

As a member, you also get a 10% discount on the following products:

• travel insurance

• pet insurance.

For more information go to medibank.com.au

feelbetterrewards

At Medibank, we’ll take care of you even when you’re in perfecthealth. With our feelbetter rewards program you have access toa variety of offers which have been tailored towards health andwellbeing, leisure and lifestyle, entertainment and everyday living.

Special offers include discounts on:

• movie tickets

• magazine subscriptions

• hotel accommodation and car hire.

Like to know more?Take a look at Things worth

knowing on page 21Visit medibank.com.au

Call us on 132 331Visit a Medibank store

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Smartphone

Health AppsTo help you make healthier

decisions on the go

24/7 HealthAdvie Line

Medibank nurses can answerany health question

Hospital SupportPersonal advice and support

during your hospital stay

Health HuYour one-stop online resource

for a healthy lifestyle

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The Mi Health services are provided by Medibank Private Limited and its related companies. For details on how your personal(including sensitive) information is handled see the back cover of this brochure.

Mi Health – etter healthsupport for our memers

Mi Health is a new range of health supportservies, designed to help our memers managetheir health and lifestyle.

As a member with hospital cover, you’ll have access to theMi Health support services. If you choose to have extras only,you’ll have access to the online Health Hub and SmartphoneHealth Apps.

It’s our commitment to making health cover better for

our members.

24/7 HealthAdvice Line

Call a Medibank nurse with any health questions you and yourfamily may have, 24 hours a day, seven days a week.

Designed to complement the care given by general practitionersand other health professionals, Medibank nurses can give you

advice about your health, symptoms, diagnosed conditions anddiscuss treatment options. They can also help you find medicalcentres, child health services, dentists, mental health services,pharmacies and more.

If you call with a health problem that our nurses believe shouldbe seen by a doctor promptly, they’ll offer to ring your regularGP and help you make an appointment.

Translators for a range of languages are available if required.

Members can access the Medibank nurses by calling1800 Mi Health (1800 644 325)

HealthHub

Health Hub is an online health resource overseen andmaintained by doctors. It includes:

• tools to help assess your health age, calculate risk factorsand set personalised health goals

• informative videos about medical procedures andhealth conditions

• a range of coaching programs to help you manageyour health

• an extensive library of articles, exercises, healthy recipes,newsletters and more.

Members can access Health Hub by logging ontoOnline Member Services at medibank.com.au

HospitalSupport

Hospital Support is a growing service designed to give youpersonal support during a stay of one night or longer in aMembers' Choice hospital.

During your stay, one of our Hospital Liaison Representatives

can help you get the most out of your cover. They can answerquestions about your entitlements as a private patient,medical benefits covered, claiming procedures, out-of-pocketexpenses and more.

The Hospital Liaison Representative can also provide supportand assist you with reviewing your cover and seeing what othercovers may better suit your needs. They can refer you to healthinformation and coaching programs that may be of interest andif need be, even add a newborn to your membership.

Hospital Support is currently only available at selectedMembers' Choice hospitals.

Call us on 132 331 before you go to hospital.

SmartphoneHealth Apps

Access our health apps on your smartphone when you needhealth information on the go.

Symptom Checker*Check your everyday symptoms, find out what to do aboutthem including when to seek professional treatment.

* Only available on iPhone. iPhone is a trademark of Apple Inc.

Energy BalancerTo help you balance the foods you’re eating with exerciseand activities.

Like to know more?For more information about

Mi Health, call 132 331 orvisit medibank.com.au

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It’s pretty simple: visit a Memers’ Choie extrasprovider or hospital and you an save money.

Our Members’ Choice network is one of the largest healthprovider networks in Australia, covering most private hospitalsand the widest range of extras services of any health fund.

We’ve negotiated with many healthcare professionals, so you won’tbe charged more than the agreed price. We’ve also negotiateddiscounts off normal prices at optical retailers and for orthotics.

A Members’ Choice extras provider must agree to and meetMedibank’s customer service standards in addition to meetingany registration standards for practising that profession.

Hospitals

Visit a Members’ Choice hospital and you’ll get better valuefor money compared to a Non Members’ Choice private hospital,as long as the service you receive is covered by our agreementwith the hospital and is included under your cover.

What aout your out-of-poket expenses?

Even if you go to a Members’ Choice hospital, you’re still likelyto have out-of-pocket expenses. The hospital and doctorstreating you should tell you about their costs before you go tohospital – so it’s important to ask. Give us a call before you goto hospital so we can help you ask the right sort of questions.

See page 27 for more information.

Memers’Choie

Extrasproviders

This section applies to Intermediate 70 Visitors Health Insuranceor Top 85 Visitors Health Insurance covers.

Benefits of Memers’ Choie extras providers

• Capped charges*• Discounts at optical retailers and for orthotics

• % back of the charge. This could be 70% or 85%depending on your cover#

• Wider range of extras services than other insurers

• Generally lower out-of-pockets than Non Members’Choice providers.

* Excludes optical retailers# Subject to annual limits and waiting periods

What types of providers are inluded in

Memers’ Choie?Our Members’ Choice network covers more types of extrasservices than any other private health insurer and includesthe following:

• Dentists

• Dental prosthetists

• Optical retail outlets

• Chiropractors

• Physiotherapists

• Podiatrists

• Acupuncturists

• Naturopaths• Remedial massage therapists.

Go to medibank.com.au or call us on 132 331 to find yournearest Members’ Choice provider. Please note, Members’ Choiceextras providers may not be available in some areas.

Find a Memers'Choie provider

To find a Members' Choiceprovider use our smartphone appwww.medibank.com.au/mobile

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Memers‘ ChoieOptial Network

We’ve got the largest health fund optical network nationally andwe can provide you with access to discounted products andservices.

Glasses and ontats

We’ve negotiated great deals with our optical partners OPSM,Specsavers and VSP Neighbourhood Eyecare. With any of ourextras covers, you will get back 100% up to your annual limit andat least 20% off most frames and lenses and 15% off contactlenses from these optical partners.

Whether you’re looking for contact lenses, a wide range ofvalue-for-money glasses with no gap, the latest in designerbrand glasses or prefer to use an independent optometrist, we’vegot your optical needs covered.

Laser eye surgery

As part of our interest in your better health, Medibank has alsonegotiated a special agreement with Vision Eye Institute^.Members with Top Extras or Ultra Health Cover who have LASIKor ASLA surgery performed by a Vision Eye Institute surgeon willreceive a 15% reduction on their surgical fees*.

^ Only available for services in V IC, NSW and QLD

* Excludes initial assessment fees

To find out how to take advantage of these great offers, visit

medibank.com.au

More valuefrom extras

Enjoy greater value from ourMemers’ Choie network

We’ve also got some great deals available. With both ourIntermediate 70 Visitors Health Insurance and our Top 85 Visitors

Health Insurance covers, you’ll get one free dental check-up,scale and clean (excludes x-rays) per person, per calendar year– valued at over $130 – when you visit a Members’ Choice dentist.

To find out more call us on 132 331.

How does it work?

Here’s an example of how you can get the most outof Members’ Choice:

Marc has Intermediate 70 Visitors Health Insurance and livesin NSW. The table below shows typically how much he can savewhen he visits a Members’ Choice physiotherapist for asubsequent consultation.

* Most common charge in NSW for a subsequent physio consultationfor Non Members’ Choice providers for claims during November,December and January (processed on or before 31 January 2012)

# Subject to annual limits and waiting periods† Fixed benefit that can be claimed

Members’Choice provider

Non Members’Choice provider

Charge$58.00(capped charge)

$62.60*

Benefit payable# (% back or fixed benefit)

70% of chargeback ($40.60)

$33.40†

Out-of-pocket cost $17.40 $29.20

NeighbourhoodEyecare

TM

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YoungVisitorsHealthInsurance

Intermediate70VisitorsHealth

Insurance

Top85VisitorsHealthInsurance

Hospital

Helps with the cost of being treated in aprivate hospital or a public hospital as aprivate patient. It also allows you to chooseyour own doctor, as well as which hospitalyou would prefer to attend. See page 14for more information.

c c c

Medical

Helps to cover the cost of doctors’ servicesprovided in and out of hospital. See page 16for more information.

c c c

Extras

Helps you with the cost of services thatare not usually provided by hospitals such

as dental, physiotherapy, optical itemsand more. See page 18 for more information. b c c

Choosing the rightover is easy

Three key areas of health over that visitors should onsider when in Australia:hospital, medial and extras.

There are several options to choose from depending on your visa type, needs and budget. These range from basic cover,which is suitable for young and healthy, budget conscious visitors and students on bridging visas waiting for permanent residency,through to comprehensive cover designed for visitors on extended stays or retirement visas.

Suggested overs for popular visa ategories

The table below is a guide to the Medibank Visitors Health Insurance covers thatare most suited to some of the major Australian visa sub class classifications.

* Refer to our separate brochure for details on this cover.

The table above is not a complete list of visa sub class classificationsand visa sub class numbers and they are subject to change by theAustralian government from time to time. If your visa sub class is

not listed please call us.If your circumstances change (eg. you gain full access to Medicareentitlements or your visa status changes) you need to notif y Medibankas Visitors Health Insurance may no longer be suitable for you.

Visasubclass Visatype SuitableMedibankcover(s)

405 or 410 Retirement or InvestorRetirement

Top 85 Visitors HealthInsurance

416 Special Program Top 85 VisitorsHealth Insurance

Intermediate 70 VisitorsHealth Insurance

Young VisitorsHealth Insurance

417 Working Holiday

Various Bridging Visa

Various Tourist

570 to 576 Student Visa Overseas StudentHealth Cover*

For visitors working orstudying in Australia

Check out Working Visa Health Insuranceor Overseas Student Health Cover.

Download a copy of thesebrochures from:medibank.com.au/visitors or

medibank.com.au/oshc

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Cover for hospitaltreatment

What enefits are paid

For the services included under each of our covers,we’ll pay benefits (less any applicable excess) towards:

• private hospital accommodation

– overnight accommodation in a private or shared room

– same day admissions

– intensive care

– theatre fees

• public hospital accommodation as a private patient

– overnight accommodation in a private or shared room

– same day admissions (shared room only)

• doctors’ fees for in-hospital medical services when youare treated as a private patient

• surgically implanted prostheses and other items on theFederal Government’s Prostheses Schedule

• eligible ambulance services where immediate professionalattention is required (see page 24).

Please note that any charge above your benefit will formpart of your out-of-pocket expenses (see page 27 formore information).

Mi Health – etter healthsupport for our memers

When you take out any of our Visitors Health Insurance coversyou'll have access to the Mi Health range of support services.

Read more about Mi Health on pages 8-9.

Presription onlypharmaeutials – important information

You may incur significant out-of-pocket expenses if high costpharmaceuticals are required for your treatment when inhospital. This is because the Visitors Health Insurance covers

described in this brochure only pay limited benefits forpharmaceuticals. More information is available in our VisitorsHealth Insurance Membership guide.

Most international visitors to Australia are not eligible forsubsidised pharmaceuticals under the Pharmaceutical BenefitsScheme (PBS).

Pharmaceuticals used in oncology (cancer) and other treatmentscan be very expensive for people who do not have access tosubsidised pharmaceuticals.

For more information on the PBS visit health.gov.au

Like to know more?Go to Things worth knowing

for more information on waitingperiods and other benefitassessment information.

See pages 24-25.

What's an exess?An excess is an amount you must pay towards thecost of your hospital treatment. An excess applies perperson per calendar year and doesn’t apply to childrenon your membership.

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Key:

Services we pay benefits towards.

Services we don’t pay benefits towards.

Note: Cosmetic surgery/procedures are excluded on allMedibank covers.

Waiting periods may apply including the general 2 month waitingperiod, 12 months for pre-existing ailments and a 12 month waiting

period for obstetrics-related services. For more information includingother benefit assessment information, please refer to Things worthknowing on pages 24-26.

Item/ServiceYoung Visitors

Health Insurance*

Intermediate 70Visitors

Health Insurance

Top 85 VisitorsHealth Insurance

Ambulanceservices(see page 24 for more information) c c c

Kneereconstructionsurgery&investigations c c cShoulderreconstructionsurgery&investigations c c cAppendicitistreatment c c cRemovaloftonsils&adenoids c c cSurgicalremovalofwisdomteeth(for hospital charges only. See page 26) c c c

Heart-relatedservices b c cObstetrics-relatedserviceseg. pregnancy b c c

Plastic&reconstructivesurgery(excludes cosmetic surgery) b c c

Palliativecare b c cPsychiatrictreatment b c cRehabilitationtreatment b c cFertilitytreatmenteg. IVF & GIFT programs b b c

Majoreyesurgery–includingcataract&lens-relatedservices b b c

Hip&kneejointreplacementsurgery b b cRenaldialysis b b cAllotherin-hospitalservicesrecognisedforMedicarebenefitpurposes

c c c

Access to Mi Health support services24/7 Health Advice Line / Hospital Support / Health Hub /

Smartphone Health Apps

Your excess $300 $300 $300

* For Young Visitors Health Insurance, where treatment is required for injuries sustained in an accident, services which are normally excluded will be covered.

What's overed

15



Cover for medialtreatment

that's rightfor you

Choosethe over

The Mediare Benefits Shedule (MBS) lists astandard fee for most surgial and medialproedures (MBS fee). The amount of enefit youan expet to reeive from us is alulated as aperentage of the MBS fee. However, you’ll haveto pay any additional ost if the dotor hargesyou more than the enefits we pay you.

In-hospital medial enefits

We pay benefits towards medical services provided by adoctor or specialist that are included under your hospital cover,and listed under the MBS. For example, surgeon’s fees andanaesthetist’s fees. No benefits are payable for services thatare excluded under your cover.

Out-of-hospital medial enefits

We pay benefits towards medical services provided by adoctor or specialist that are listed under the MBS. For example,doctor’s visits and pathology. No benefits are payable for

services that are excluded under your cover.

Go to Things worth knowing for more information on waitingperiods, other benefit assessment information and benefitsfor pharmaceuticals, see pages 24-25.

The enefits you reeive for medial serviesinluded under your over

YoungVisitorsHealthInsurance

Intermediate70Visitors

HealthInsurance


100% of the MBS fee 100% of the MBS fee Generally higher than100% of the MBS fee

Top 85 Visitors Health InsuraneWith Top 85 Visitors Health Insurance you’ll generallyreceive a higher benefit payment than with YoungVisitors Health Insurance or Intermediate 70 VisitorsHealth Insurance.

It’s easy to join

Call us on 132 331 or +61 3 8622 5780(if calling from outside of Australia)

Visit medibank.com.au/visitors

Visit a Medibank store

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Cover forextras

Get a freedental hek-up

With Intermediate 70 VisitorsHealth Insurance and Top 85Visitors Health Insurance you

get a free dental check-up, scaleand clean (excludes x-rays) perperson per calendar year at a

Members’ Choice dentist.

Cover for everyday health servies,whether you’re fit and healthy or in needof some extra are.

Both Top 85 Visitors Health Insurance and Intermediate70 Visitors Health Insurance provide cover for a comprehensiverange of extras services. However, Top 85 Visitors HealthInsurance generally provides higher benefits. Young VisitorsHealth Insurance does not include an extras component.

Perentage ak at Memers’ Choie providers

When you visit a Members’ Choice extras provider foreligible services, you’ll get a percentage back of the charge(up to applicable limits). The percentage back you get willdepend on the level of cover you choose – the higher thecover, the higher the percentage back.

For more details, see the comparison table on page 19.

Fixed enefit at Non Memers’ Choie providers

A fixed benefit is the maximum amount we’ll pay for eachservice or item (up to applicable limits) and it may be less than

the provider’s charge. Generally, the higher the level of coveryou choose, the higher the fixed benefit which will help reduceyour out-of-pocket expenses.

Extras overomparison tale

We’ll pay benefits towards the items and services listed in thetable on page 19. It shows the annual limits that apply per personper calendar year.

Annual limits

This is the maximum amount we’ll pay for items or ser vicesin a calendar year.

The benefit we pay for a particular item or service may beless than the annual limit and less than your provider’s charge,which means you may have out-of-pocket expenses to pay.See page 27 for more information.

Orthodonti entitlement

You start with an opening balance in the first year and you’retopped up with an additional amount each full calendar yearof membership up to a maximum lifetime limit for your levelof cover. Once you’ve served your 12 month waiting period,you can claim up to 100% of your balance.

Benefit replaement period

Benefit replacement periods may apply for some items /services.See page 25 for more information.

Memers’ Choie extras providersWe’ve negotiated capped charges or discounts withthe following healthcare professionals so you can claima percentage back* of 70% or 85% depending on yourlevel of cover:

cDental cAcupuncture

cPhysio cRemedial Massage

cChiro cPodiatry

cNaturopathy

cOptical Items

Plus at all optical retailers, you can claim 100%* back on arange of glasses or contact lenses regardless of your levelof extras cover.

See page 10 for more information about Members’ Choice.

* Where eligible and subject to your annual limits and waiting periods.

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# The 2 month waiting period is waived when the service arises from an accident.

Item/Service Waiting period#

Intermediate70Visitors

HealthInsurance


Up to 70% backat a Members’

Choice provider

Up to 85% backat a Members’

Choice provider

Ambulance services 100% cover (see page 24 for more information) 2 months No annual limit No annual limit

General dental

Includes preventative treatment, dentalexaminations, scale & clean 2 months

No annual limit No annual limit

Surgical dental procedures 12 months

Optical items100% back up to your annual limit under bothcovers includes frames, prescription lenses &contact lenses

6 months $225 $250

Physiotherapy Includes consultations, group pilates& hydrotherapy sessions 2 months $600 $700

Chiropractic 2 months$400 $500

Osteopathy 2 months

Natural therapies

Consultations for naturopathy,acupuncture & remedial massage

2 months $300 $400Consultations for myotherapy, reflexology,kinesiology, Chinese & Western herbalism,exercise physiology, shiatsu, aromatherapy,

homeopathy, Bowen therapy, Alexandertechnique & Feldenkrais

Major dental

• Endodontic services (eg. root canal)• Periodontics (i.e. treatment of gum disease)• Crowns, dentures & bridges • Major restorative fillings (eg. veneers)

12 months $1,000 $1,200

Orthodontics eg. braces (see page 26 for more information) 12 months

$800 opening balancetop up of $400 peryear up to $2,400

lifetime limit

$1,000 openingbalance top up of

$500 per year up to$3,000 lifetime limit

PrescriptionPharmaceuticals (non-PBS)

For prescriptions only. Benefits will bepaid after a set charge has been deducted(see page 25 for more information)

2 months $400 $600

Dietetics 2 months $400 $500

Podiatry Includes specified orthotics 2 months $400 $500

Clinical psychology Consultations only 2 months $400 $500

Occupational therapy 2 months $400 $500

Speech therapy 2 months $400 $500

Eye therapy 2 months $400 $500

Breathing appliances Peak flow meters, nebulisers& spacing devices 12 months

$200 $250Blood glucose monitors& blood pressure monitors

100% back up to your annual limit 24 months

Hearing aids 36 months $800 $1,200

Health appliances &external prostheses

eg. insulin delivery pens 2 months $400 $500

19



Manage yourmemership online

Medibank Online Member Services is a convenient way of managing your membership online†. You can submit claims, makepayments and access health programs 24/7. By logging into Online Member Services you can make the most of your membership.

Manage your membership

Manage your mailbox and send secure mail to us

View membership details

Download brochures and forms

Order a replacement membership card

Request to suspend membership

Update contact details

Register your bank account details toreceive benefits for extras claims by EFT

Make an extras claim and view claiming history*

Acupuncture Eye therapy

Chiropractic Osteopathy

Dental Pharmaceuticals (non PBS)

Dietetics Physiotherapy

Myotherapy Podiatry

Naturopathy Clinical psychology

Occupational therapy Remedial massage

Optical items Speech therapy

Orthodontics Make a doctor's claim (GP only)^

Manage payments

Pay premiums or renew membership

Change payment type

View payment details

* Only available to members with Intermediate 70 Visitors Health Insurance and Top 85 Visitors Visitors Health Insurance covers.

^ Available to all members with Visitors Health Insurance covers.† Waiting periods may apply to some services.

Pleasenote:All current Medibank members aged 16 years and over can use Online Member Services. If you’re the contributor, you'll have access toall the features under your cover type. Access to some functions may be limited for your spouse/partner and dependants.

Online Health Hu

The Health Hub is an online resource you can rely on. It’s fullof tools, programs, videos and information to help you plan ahealthy lifestyle. Best of all, the Health Hub is maintained andoverseen by doctors. Just login to Online Member Services andstart a healthier lifestyle today. See page 9 for more information.

Mediank Moile App

The Medibank Mobile App is free for anyone with a compatibleiPhone or Android™ smartphone. If you've registered for OnlineMember Services you can use your login details to access theapp. You can download the app from the App Store on iPhoneor Android Market on Android™ smartphones. There are otherapps you can access as a Medibank member, see page 9 formore information.

Register and Login

You can register for Online Members Servicesat www.medibank.com.au/registerTo login visit www.medibank.com.au/login

If you're having trouble registering please callus on 132 331.

iPhone is a trademark of Apple Inc.Android is a trademark of Google Inc.

App store is a service mark of Apple Inc.

20



Things worthknowing

Understanding private health insurane ane ompliated. This setion is designed to helpmake things a little easier for you. It ontainssome important information aout our oversalong with explanations of ommonly usedterms you may not e familiar with. It alsogives you an overview of some of our key rules.

It’s important you have a good look through the VisitorsHealth Insurance Membership guide which is available atmedibank.com.au You’ll also receive a copy of this once you join. This contains a summary of the rules of your membership(known as our Fund rules) – things like your responsibilitiesas a member. It’s important to read the Cover summary whereyou’ll receive further details about your cover and entitlements.

Helping you choosethe right cover

Is Visitors Health Insurance right for me?

Medibank Visitors Health Insurance covers are designed forvisitors, temporary residents, residents of Norfolk Islandand other residents in Australia who are not eligible for full

Medicare entitlements.

Reciprocal Health Care Agreements

Australia has Reciprocal Health Care Agreements with theUnited Kingdom, New Zealand, Italy, Belgium, Malta, theNetherlands, Sweden, Finland, Norway and the Republic ofIreland. If you’re a resident of a country which has a ReciprocalHealth Care Agreement with Australia, you may be entitled torestricted access to Medicare, but only for medically necessarytreatment. Post-arrival time limits and other restrictions mayapply. So be sure to check what you’re covered for beforerelying on a Reciprocal Health Care Agreement. For furtherinformation, please contact Medicare on 132 011.

What if I’m an international student?

If you’re an international student with a valid student visa, ourVisitors Health Insurance covers will not meet your student visarequirements. We recommend you purchase Medibank OverseasStudent Health Cover (OSHC) which is specifically designed withthe needs and budgets of students in mind. You can purchaseyour OSHC online at medibank.com.au/oshc or visit aMedibank store.

What if I’m on a working visa?

If you’re in Australia on a working visa, our Visitors HealthInsurance may not meet any visa requirements you might have.We recommend you purchase one of our Working Visa HealthInsurance covers which meet the Australian Government’s457 working visa requirements. Refer to our separate brochurewhich you can download from medibank.com.au or visit a Medibankstore. You can also call us on 132 331 for more information.

What happens if I become a permanent resident?

When your residency status changes, remember to call us on132 331 or visit a store to review and discuss your cover options.

21



Helping you choose

the right coverCan I purchase cover before I arrive?

You can purchase your cover up to 12 months before you arrivein Australia. The maximum period of cover you can purchasein advance is 12 months. Medibank requires a minimum of onemonth's premium to be paid in advance, by direct debit, in whichcase the advance payment period may be shorter.

Can someone else purchase this cover for me?

A friend or relative can apply in advance for membership onyour behalf, so that your membership can start from the

moment you arrive.

When does my cover start?

If you join Medibank and pay your premiums in advance fromoutside Australia, your membership starts on the day you arrivein Australia. Waiting periods apply before you can claim benefits.

If you arrive on a date other than your expected date of arrival,please visit us at one of our stores so that our records can bechanged to reflect the appropriate commencement date.You will need to bring your passport and membership card(if you already have one) with you to make this change.

If you join in Australia, your membership starts on the day

you first pay your premiums, unless you have nominated alater date to be your commencement date, or on the date youtransfer from your current health fund. Once your membershipstarts, you'll then begin to serve your waiting periods.

About your membership

with usDo you have a ‘cooling-off’ period?

If you join but then decide you’d like to either cancel yourmembership or move to another cover, we have what is knownas a ‘cooling-off’ period. This also applies if you’re already amember and have recently changed your cover.

As long as you tell us within 30 days of your cover commencing,and no claims have been made against your cover there’s noproblem. We can either transfer you to a more suitable coveror refund your premium in full.

If you close your membership after the ‘cooling-off’ period we'llrefund any unused premium less an administration fee.

How often should I review my cover?

You may have different health needs at different stages of yourlife, so it makes sense to review your health cover regularly.This is especially important if your situation changes. For example,if you are granted permanent residency, if you’re planning to starta family, the kids have grown up or either you or someone in yourfamily has developed a health issue. Whatever your situation, it’sa good idea to call us to discuss your options on 132 331 or visitone of our stores.

What's the difference between a member,a membership and a contributor?

There are three terms we use when we’re talking aboutmembership: member, membership and contributor. As astarting point, it’s good to be clear on all three. A member issimply any person covered under a Medibank membership.

A membership is made up of one or more members and canconsist of:

• just one person (single membership)

• a couple membership which covers you (the contributor) andyour spouse/partner

• family membership, which covers you and your spouse/partnerand

– any of your child dependants and/or

– any of your student dependants.

The term contributor refers to the person who ‘owns’ themembership. This is the person we contact when we need tocommunicate important information.

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Can my partner manage my membership too?

Although you as the contributor ‘own’ the membership, yourpartner (if he or she is also covered by the same membership)can automatically manage most aspects of the membership too,including: making claims, adding or removing dependants,changing cover, suspending the membership and changingcontact and bank account details.

However, as the contributor you’re the only one who canremove yourself from the membership or cancel the membership.It’s important to be aware that this means we may disclose

registered membership details to both of you.

If at any time you want to be the only person who can managethe membership or you require further information about thehandling of personal information, please call us on 132 331.

If I transfer to Medibank from another Australianprivate health insurer, am I covered immediately?

In some cases yes, in other cases no. You’ll be covered forservices on your new cover from the date you join if: (i) thoseservices were also included on your cover with your formerhealth insurer (ii) you join us within two months of leaving yourformer health insurer and (iii) you’ve already served theapplicable waiting periods. So although we’ll recognise anywaiting periods you’ve served with your former fund, if youhaven’t fully served the applicable waiting periods, you’ll needto serve the balance with us before you’re eligible for benefits.

Additional waiting periods will also apply if you’ve switched to ahigher level of cover with Medibank or if you wait more than twomonths after leaving your former fund before you join Medibank.For more information see page 24.

Any loyalty bonus or other similar entitlements built up withyour former fund (eg. orthodontic entitlements) will not transferto Medibank.

If you transfer to Medibank or to another Medibank cover, any

benefits that may have been paid under your previous cover maybe taken into account in determining the benefits payable underyour new cover.

What if I want to add my partner to my singlemembership?

It’s easy to change from a single to a family membership,but you should be aware that higher premiums apply to afamily membership and additional waiting periods may applyto your partner.

Can I add a dependent child (including newborns)to my membership?

If you’re on a single membership:To add a dependent child to your membership you’ll need tochange from a single to a family membership. If you do thiswithin two months of the date of their birth or inclusion in yourfamily unit (eg. through marriage, adoption or fostering) yourchild won’t have to serve any additional waiting periods. Thechange will be backdated to the date of birth or inclusion in yourfamily unit. Also, this change of membership means you’ll payhigher premiums.

If you’re on a family membership:You can add a dependent child to your membership at any timeand they won’t need to serve any waiting periods already servedon the membership. Your premium doesn’t increase if you add adependent child to your cover.

What if I want more information on addinga dependent child or newborn?

Call us on 132 331 or visit a Medibank store.

What happens if my newborn baby needshospital treatment?

When a newborn baby is in hospital with its mother, noaccommodation charges apply for the baby unless the babybecomes an admitted patient in their own right. This happenswhen the baby requires admission to a neo-natal intensive careunit or it is the second or later child of a multiple birth. If yourbaby is admitted to hospital, please call us.

If I have children, how long can they be insuredon my cover?

As your children grow older they can still be covered at noadditional cost on your family membership until they turn 21 or,if they are full-time students, until they turn 25, provided they’re

not married or in a de facto relationship. This is because weconsider them to be your dependent children.

Adding adependent childIf you have a baby, don’t

forget to add them to yourmembership within 2 months

from the date of their birth.

23



Ambulance

servicesWhat’s covered

Where you need immediate professional attention and yourmedical condition is such that you couldn't be transportedany other way, you are covered for services provided by anambulance provider approved by Medibank, in the followingcircumstances:

• ambulance transportation to a hospital to receive immediateprofessional attention

• when an ambulance is called to provide immediateprofessional attention but transport by ambulance isnot needed

• when, as an admitted patient, the hospital requires youto be transferred from one hospital to another (excludingtransfers between public hospitals)

• transport by air ambulance, where pre-approval hasbeen obtained from Medibank by the air ambulance provider.

What's not covered

We don’t pay benefits for any ambulance service that hasnot been defined above under ‘What's covered’. This includesthe following circumstances:

• ambulance services where immediate professional attentionis not required (eg. general patient transportation)

• any ambulance transport required after dischargefrom hospital

• inter-hospital transfers when you’re transferred from onepublic hospital to another public hospital as an admitted patient

• any ambulance costs that are fully covered by a third partyarrangement, such as an ambulance subscription orfederal/state/territory ambulance transportation scheme,WorkCover or the Transport Accident Commission

• any air ambulance services that are fully subsidised,

such as South Care or NRMA Care Flight.

About

waiting periodsWhat is a waiting period?

All health funds have waiting periods. In short, a waiting periodis a period of time you need to wait after taking out your coverbefore you can receive benefits for services or items covered.

You’re not able to receive benefits for any items or services youmight have obtained while you’re serving a waiting period orbefore you joined Medibank.

How do I know if a waiting period applies to me?

Waiting periods will apply if you’re a new member, you’rerejoining Medibank after not having health cover for some timeor you’re changing to a higher level of cover (either withinMedibank or transferring from another fund).

If you’re changing to a higher level of cover, you’ll still be entitledto benefits at the level of your former cover while you’re servingany waiting periods on your new cover if:

• those services were included under your old cover; and

• you’ve already served the waiting periods that applied underyour old cover.

How long is the waiting period?

That depends on the types of ser vices or items included on yourcover. Have a look at the following table for a guide.

*If you have an accident after joining us or changing cover andrequire treatment, we’ll waive the 2 month waiting period.

Period Item/Service

2 months* All services (including ambulance services)– expect as specified below.

6 months Optical items

12 months

Pre-existing ailments

Obstetrics-related ser vices

Major dental services

Orthodontic treatment

Surgical dental procedures

Nebulisers

Peak flow meters

Spacing devices

24 months Blood glucose monitors& blood pressure monitors

36 months Hearing aids

24



Aout enefit

replaement periodsWhat’s a benefit replacement period?

It’s a period of time you need to wait after purchasing anitem covered by us before you can receive further benefitsto replace the item. For example, if you received benefits foran insulin delivery pen, purchased on 1 July 2011, you canonly receive benefits for another one purchased on or after1 July 2013.

How long is a benefit replacement period?

This varies from item to item and generally applies per member

unless specified in the table below. Under Intermediate 70Visitors Health Insurance and Top 85 Visitors Health Insurance,the following benefit replacement periods will apply.

Period Item/Service

12 months

External mammary prostheses

Repairs of external prosthesesand health appliances

2 years

Wigs

Hip protectors

Insulin delivery pens

3 years

Blood glucose monitors

& blood pressure monitorsBreathing appliances:- nebulisers- peak flow meters- spacing devices

Mouthguards (for members up to 18 years of age,benefits may be payable for a replacementmouthguard each calendar year)

Dentures, crowns and bridges

Other health appliances and external prostheses

5 years

Hearing aids

Sleep Apnoea – continuous pressure devicesand other similar approved appliances under ourhospital cover

Aout

pre-existing ailmentsIt’s standard pratie in the private healthinsurane industry to apply a waiting periodof 12 months efore enefits are payale fora pre-existing ailment.

What’s a pre-existing ailment?

By pre-existing ailment, we mean an ailment, illness or conditionwhere signs or symptoms existed at any time during the 6 monthsbefore you either took out your new cover, or transferred to a

higher level of cover. We’ll appoint a medical or health practitionerto determine whether you have a pre-existing ailment, based oninformation provided by the practitioner(s) treating you.

What if I have a pre-existing ailment?

If you’re a new member, you’ll have to wait 12 months beforeyou can receive benefits for items or services related to apre-existing ailment.

If you’re changing to a higher level of cover (either withinMedibank or from another fund), you may have to wait 12 monthsto receive the higher benefits, including benefits for ser vicesnot previously covered.

Aout enefits forpharmaeutials

Visitors to Australia are generally ineligible for benefits underthe Pharmaceutical Benefits Scheme (PBS) so you may havesignificant out-of-pocket expenses. Benefits are not payable fororal contraceptives or for pharmaceuticals prescribed forcosmetic purposes.

Before going to hospitalor ommening treatment

It's important you call usfirst on 132 331. We can help you

understand what's involved and thetypes of questions you should ask your

doctor or specialist. We can alsoprovide you with information onrecognised providers and the

benefits you're entitled to.

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How do orthodonti

enefits work?Your orthodontic entitlement starts with an opening balance,which you can access once your 12 month waiting periodis served. Your balance is then topped up with an additionalamount each 1 January following the completion of your waitingperiod up to a maximum lifetime limit.

OpeningBalance

Anytop ups

Anybenefits

everclaimed

The benefityou can claim(after waiting

period)

Orthodontic entitlements available on each relevant product:

Cover Openingbalance

Additionalannualtop ups

Lifetime limit

Intermediate 70Visitors HealthInsurance

$800 $400 $2,400

Top 85Visitors HealthInsurance

$1,000 $500 $3,000

Example of orthodontic entitlements

Intermediate70 Visitors Health

Insurance

Top 85 VisitorsHealth Insurance

Dates

Whatyougettowardsorthodonticseachyear

Youravailablebalanceifnoclaimhasbeenmade

Whatyougettowardsorthodonticseachyear

Youravailablebalanceifnoclaimhasbeenmade

Date joined30 Jun 2011

$800(openingbalance)

b

$1,000(openingbalance)

b

Waitingperiod ends30 Jun 2012

b $800 b $1,000

1 Jan 2013$400(top up) $1,200 $500

(top up) $1,500

1 Jan 2014 $400(top up) $1,600 $500

(top up) $2,000

1 Jan 2015$400(top up) $2,000 $500

(top up) $2,500

1 Jan 2016 $400(top up)

$2,400 (lifetimelimit)

$500(top up)

$3,000 (lifetimelimit)

Other rules for

paying enefitsAre there any other rules I need to know about?

Yes, there are some other important rules for you to be aware of.

• We only pay benefits for items and services delivered byMedibank-recognised providers.

• Restrictions may apply to the number of services you canclaim in a particular period.

• Some appliances may need to be ordered by a medicalpractitioner before benefits are payable eg. nebulisers.

• To claim for a Sleep Apnoea device or similar device approved

by Medibank, you’ll need Intermediate 70 Visitors HealthInsurance or Top 85 Visitors Health Insurance. You’ll alsoneed to undergo an overnight investigation for Sleep Apnoeawhich is listed in the Medicare Benefits Schedule. In additionthe device must also be requested by a medical practitionerand purchased or hired within 12 months of undergoingthe investigation.

• Limitations apply to some benefits. For example, for an initialconsultation for an extras service, we generally pay the higherbenefit (if any) per person, per provider, per calendar year onlyonce in a course of treatment.

• Limited benefits apply to hospital charges for podiatric surgery(performed by an accredited podiatrist) and dental procedures

that are performed in a Non Members’ Choice hospital.• If you no longer need acute care and stay in hospital for more

than 35 days, you’ll be classified as a nursing home type patient.If this happens, we’ll only pay a small portion of the daily hospitalcharges and you may need to pay the rest of the cost of your care.If you’re in a private hospital, these costs may be substantial.Your doctor and hospital will be aware of this rule which appliesto all health funds and they can advise you.

• We don’t pay benefits for services or treatments where you are,or may be, entitled to compensation and/or damages. For exampleState Government workers’ compensation schemes, trafficaccident schemes or public liability claims.

• We generally don’t pay benefits for hospital proceduresnot recognised for Medicare benefit purposes (such ascosmetic surgery).

• Benefits are not payable for treatment not considered medicallynecessary (eg. health screening services as required foremployment or visa renewal purposes).

• Benefits are not payable for treatment arranged pr iorto arrival in Australia.

• Benefits are not payable for services providedoutside Australia.

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Aout out-of-poket

expensesWhat’s an out-of-pocket expense?It’s any expense for a hospital, medical or extras service oritem for which you won’t be reimbursed by us.

What out-of-pocket expenses can I expect if I receivean extras service and how can I reduce them?

The out-of-pocket expense will be the difference betweenthe provider’s charge and the benefit we pay. To help reduceyour out-of-pocket expenses, visit a Members’ Choice extrasprovider where you can access capped charges and/or discountsand generally receive higher benefits than you would with a

Non Members’ Choice provider.

What kind of out-of-pocket expenses can I expect if I go to hospital?Although hospital cover helps reduce the cost of your privatehospital visit, you’ll still have out-of-pocket expenses for thingslike your excess and any difference between what the hospitalcharges and the benefit we pay for the hospital services.

You can also expect to pay the difference between the chargefor in-hospital medical services (eg. doctors’ services, pathologyand radiology) and what you receive from us. To explain it further,the benefits you’re entitled to for the medical services you receivewhile you’re in an overnight or day hospital facility are based onthe Medicare Benefits Schedule (MBS) fee. The MBS is a list of

all the services Medicare pays benefits for and the rules thatapply to payment of those benefits.

If you visit a doctor and they charge you more than the MBS fee,you may have out-of-pocket expenses. These can vary and may besignificant, especially for doctors’ visits when you’re in hospital.

Youshouldconfirmalllikelyout-of-pocketexpenseswithyourdoctorand/orhospitalbeforeadmission.

How can I reduce my hospital out-of-pockets?If possible, go to a Members’ Choice hospital where our agreementwith the hospital limits what you can be charged. This means yourout-of-pockets for hospital charges should be limited to things like:

• any excess you may have with your cover

• any difference between your doctors’ charges (includingpathology and radiology fees) and the benefits we pay you

• any difference between the amounts you are charged forpharmaceuticals (including drugs issued on discharge fromhospital) that are not covered by our agreement with thehospital and the benefits available to you under the extrascomponent of your cover for pharmaceutical prescriptions(excluding Young Visitors Health Insurance)

• any gap for surgically implanted prostheses and other itemson the Federal Government’s Prostheses Schedule

• costs for services not covered, or not fully covered, by ouragreement with the hospital or under your cover

• costs for treatment in an emergency department in a private hospital.

If you go to a Non Members’ Choice hospital, you’re likely to havesignificant out-of-pocket expenses.

Going to hospitalCall us first on 132331 so we can help you understand what’sinvolved and the types of questions you need to ask your doctoror specialist.

Aout my

premiumsIf I cancel my membership, will I get a refund?If you need to cancel your membership you may apply toclaim a refund of premiums paid in advance and we may applyan administration fee. Please refer to the Working Visa HealthInsurance Membership guide (available at medibank.com.au)for more information.

Are pre-paid premiums protected from rate increases?Where premiums have been paid in advance of the rate increase,the new rates will apply from your next payment. However, if youchange the level of your cover or membership category, the newrates will apply from the date of the change.

Aouttaxation

If you're an Australian resident for taxation purposes you maybe required to pay the Medicare Levy and the Medicare LevySurcharge (MLS).

The Medicare Levy is imposed by the Australian Government tofund the Medicare scheme. It is normally calculated at 1.5% of

your annual taxable income, but this rate may vary depending onyour circumstances.

The MLS is an additional amount (on top of the Medicare lev y)which is imposed on individuals or families who:

• have an annual income for surcharge purposes above therelevant threshold, and

• don't have an appropriate level of private hospital cover forthemselves and any of their dependents.

The rate of the MLS increases as your income increases - from1% to a maximum of 1.5%.

The surcharge applies proportionately for the period during thefinancial year when an appropriate level of hospital cover wasnot held.

Important:NoneoftheVisitorsHealthInsurancecoversmentionedinthisbrochurewillexemptyoufromtheMedicareLevySurcharge.

For more information on the Medicare Levy or MLS, please contactthe Australian Taxation Office on 132 861, or visit ato.gov.au

About Goods andServices Tax

Our Working Visa Health Insurance covers are subject to a Goodsand Services Tax (GST), which is included in the premium you pay.Under Medibank’s Fund rules, if you’re on any of our Working VisaHealth Insurance covers it is assumed you have no entitlement toclaim any part of the GST as an input tax credit. If you’re eligibleand intend to claim back part or all of the GST, you must notifyus in writing.

27



How to join

Whether you’re in Australia already or haven’tleft your home country yet, it’s easy to join.Simply complete the following relevant applicationforms and submit them to us for processing.You can get the following forms by calling us,visiting a Medibank store or downloading themfrom medibank.com.au

1. Application formComplete this form to:

• Join Medibank

• Transfer from another health fund membershipto Medibank

• Change your current Medibank cover

• Add or remove a spouse/partner or dependants.

2. Transfer certificate request

Complete this form if you're transferring to Medibank fromanother health fund and we can arrange to close your

membership at your existing health fund and obtain a TransferCertificate to show proof of your previous cover.

3. Authority form

Complete this form if you wish to nominate another personto act on your behalf.

How to pay

It’s entirely up to you which option you choose.

Direct debit

Medibank’s direct debit facility is a convenient and flexible wayto pay your premiums. Your premiums are automaticallydeducted from your Australian bank, building society or creditunion or a credit card* account. You also have the flexibility tochoose when you’d like your payments to be made – fortnightly,four-weekly, monthly, quarterly, half-yearly, or yearly.

* Please note direct debit deductions from a credit card account can onlybe made at monthly intervals on the 11th of each month.

1. Bank, building society or credit uniondirect debit request or

You must complete this form to have your premiumsautomatically deducted from your bank, building societyor credit union account.

2. Credit card payment form

Complete this form if you want your premiums automaticallycharged to your credit card each month. Only available forMasterCard or VISA.

Other payment methodsOf course, if direct debit doesn’t suit you, there are otherpayment options available. You can pay your premiums:

• at Medibank stores

• by ® (through your participating financial institution)

• or by calling Australia Post on 131 816 and registeringto pay through their Billpay service, or at any branch ofAustralia Post.

® Registered to BPay Pty Ltd ABN 69 079 137 518

Important points to note about payment methods

• EFTPOS, cheque or credit card payments made direct toMedibank must be a minimum of one month’s premium.

• Payment by credit card is available by VISAor MasterCard only.

For more information on payment methods, please call132331 or+61386225780(outside Australia), visit aMedibank store, or visit medibank.com.au

Once you've completed the forms you can drop them off at aMedibank store, fax them through to (07) 3026 0557 or mailthem to Medibank, GPO Box 9999 in your capital city.

28



Other important

informationWhat’s the best way for me to give feedback?

If you have any feedback on our products and services,or you’d like further explanation on anything to do with yourmembership, please contact us:

• call 132331

• email [email protected]

• visit any of our Medibank stores

• write to us at Medibank, GPO Box 9999 in your capital city.

What if I have a complaint?

We’ll try to resolve any complaint you may have the first timeyou raise it with us – please contact us with any issues throughthe contact points listed above. If you believe your complaint hasnot been satisfactorily dealt with, let us know and we’ll escalateyour complaint.

You can also write to our Customer Resolutions team atMedibank, GPO Box 9999, Melbourne, VIC 3000.

Free, independent advice is also available from thePrivate Health Insurance Ombudsman:

• call 1800 640 695• online phio.org.au

Private Patients’ Hospital Charter

The Private Patients’ Hospital Charter is a guide to what itmeans to be treated as a private patient in hospital. It sets outwhat you can expect from your doctors, the hospital and yourprivate health insurer. To download a factsheet please visithealth.gov.au

Private Health Insurance Code of Conduct

We’re proud to be a signatory to the Private Health Insurance

Code of Conduct. The code was developed by the private healthinsurance industry and aims to promote the standards of serviceto be applied throughout the industry. The code is designed tohelp you by ensuring that:

• information which we provide to you is written inplain language

• our employees are competently trained to deal withyour enquiries

• we protect the privacy of your information in line with theprivacy legislation

• you have access to a reliable and free system of addressingcomplaints with us.

A copy of the code is available online atprivatehealth.com.au/codeofconduct

Disclaimer

• Medibank encourages providers to offer high quality productsand services at competitive prices to its members.

• Where Medibank recognises a provider, advertises on behalfof a provider, or appears by reference or logo or otherwise inan advertisement of any provider, to the fullest extent allowedby the law, such advertising or reference should not beconstrued as:

– an endorsement by Medibank;

– an acknowledgment or representation by Medibank as tofitness for purpose; or

– a recommendation or warranty by Medibank;

of, for, or in relation to, the product and/or service of theprovider. Accordingly, to the fullest extent allowed by law,Medibank neither takes nor assumes any responsibility forthe product and/or service provided.

• Members should make and rely on their own enquiries andseek any assurance or warranties directly from the providerof the service or product.

Note

Policies of insurance issued under, or on the terms of, anyproducts described in this publication are referable to theMedibank Private Limited (ABN 47 080 890 259) healthbenefits fund.

29



AccidentAn unforeseen event occurring by chance and caused by anexternal force or object, resulting in involuntary injury to thebody which requires immediate treatment, but does not includeunforeseen conditions brought on by medical causes.

AmbulanceservicesAmbulance services are included under all covers described inthis brochure. Unless you’re already covered (e.g. under a statescheme), we’ll cover the cost of eligible ambulance services ifyou need immediate professional attention and your medicalcondition is such that you couldn’t be transported any other way.

See page 24 for more details.

AnnuallimitAn annual limit is the maximum amount of benefits payable forparticular extras items or services within a calendar year. Otherrestrictions may apply to the number of services you can claimin a particular period. Call us on 132 331 for more information.

BenefitThis is an amount of money we pay for an approved health-relatedexpense you’ve incurred. It can be paid to you or on your behalf.

CalendaryearA 12 month period commencing 1 January and ending 31 December.

Condition

A condition means any actual or perceived state of health forwhich treatment is sought. It includes but is not limited to statesvariously described as: abnormality, ailment, disability, disease,disorder, health problem, illness, impairment, impediment,infirmity, injury, malady, sickness or unwellness.

CosmeticsurgeryA service that is not clinically necessary and that can't be billedto Medicare. Under all Medibank covers, no benefits are payabletowards procedures or hospital costs associated with cosmeticsurgery or procedures not recognised by Medicare.

DependentchildThis 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.

DoctorA registered medical practitioner including a generalpractitioner, specialist, surgeon or anaesthetist.

EndodonticservicesTreatment to save an infected or damaged tooth. It involvesremoving the nerve and, where possible, restoring the structureof the tooth. A common example of an endodontic treatment is aroot canal.

ExcessAn amount you pay towards your hospital treatment. It onlyapplies to the hospital component of Visitors Health Insurancecovers. No excess applies to children on any of our VisitorsHealth Insurance covers.

ExcludedservicesThis is a service for which no benefits are payable.

ExternalprosthesesThese are manufactured items designed to replace externalparts of the body such as an arm or leg. Benefits for these areonly paid under certain Visitors Health Insurance covers.

FederalGovernment’sProsthesesScheduleThis is a list published by the Federal Government which sets outthe benefits for surgically implanted prostheses and other items.

FixedbenefitYou’ll receive a fixed benefit when you visit a Non Members’Choice provider. A fixed benefit is the maximum amount we’ll payfor each service or item (up to applicable limits). Usually it will beless than the provider’s charge, which means you may haveout-of-pocket expenses to pay.

FundrulesThese are the rules of your Medibank membership. Some of themore important Fund rules are summarised in your Membership

guide and Cover summary that is sent to all new members.You can view the Fund rules online at medibank.com.au or atany of our Medibank stores. All members are subject to theFund rules as varied from time to time.

GeneraldentalThis is routine dental work and includes things such as check-ups, x-rays, scale and cleans, fill ings and extractions. It doesn’tinclude more complicated treatments or procedures such asorthodontic work, gum disease, root canal treatment, crownsor bridges.

Heart-relatedservicesIncludes open heart and bypass surgery and invasive cardiacinvestigations and procedures such as angiograms,

angioplasties and stent insertions.HospitalchargesThese are amounts charged by a hospital for things likeaccommodation and nursing care, theatre fees and surgicallyimplanted prostheses. It may not include charges for extrasservices, such as physiotherapy, or fees charged by yourhospital doctor.

IncludedservicesWe pay benefits towards these services.

Glossary

30



MajordentalThis includes things like restorative fillings, dentures, crowns,bridges, and treatment for gum disease and root canals. It doesnot include orthodontic treatment.

MajoreyesurgeryThis includes cornea and sclera transplants and cataract surgery.

MedicalcostsThese are costs you incur in an overnight or day-hospital facilityfor things such as doctors’ fees, blood tests, scans and x-rays.

Medicare

Australia’s national health care system which providespermanent Australian residents with access to free treatmentin public hospitals and free or subsidised treatment by doctors.

MedicareBenefitsSchedule(MBS)This schedule lists all the services for which Medicare paysbenefits and the rules that apply to the payment of those benefits.Each service has a fee that’s been set by the Federal Governmentfor the purpose of calculating the Medicare benefit payable forthat service (called the MBS fee).

NonMembers'ChoiceHospitalA public or private hospital that is not par t of MedibankMembers' Choice network.

Obstetrics-relatedservices

This includes all treatment specified in the Medicare BenefitsSchedule (MBS) as ‘obstetrics’ including antenatal and post-natalcare and the management of labour and delivery.

OrthodontictreatmentThis involves the use of corrective appliances, such as bracesand plates, to bring the teeth and jaws into proper alignment.

PharmaceuticalBenefitsScheme(PBS)A Federal Government scheme which allows for manypharmaceuticals to be supplied to Australian residents atreduced or no cost. The PBS is generally not available to visitors,temporary residents or people not entitled to benefits underMedicare. As a result, you can incur significant out-of-pocketexpenses when purchasing prescription pharmaceuticals.

PlasticandreconstructivesurgeryPlastic surgery is a medical speciality concerned with theevaluation and treatment of any physical deformity that canbe corrected by surgery, whether acquired or congenital.Reconstructive plastic surgery is usually performed to improvefunction, but it may be done to approximate a normal appearance.

Examples of plastic and reconstructive surgery are skin graftsafter burns treatment, reconstruction after cancer surgery,surgeries on congenital abnormalities such as nasal deformitiescausing breathing problems, some surgeries that require repairof facial bone fractures and breaks and other plastic surgeryservices for which there is a Medicare benefit payable.

Prescriptionpharmaceuticals(non-PBS)These are prescription-only items not covered by thePharmaceutical Benefits Scheme. With Top 85 VisitorsHealth Insurance and Intermediate 70 Visitors HealthInsurance, we’ll pay benefits up to a set amount for eachprescription item after a set charge has been deducted.The set charge is equivalent to the current PBS patientcontribution. It’s important to note that we don’t pay benefitsfor oral contraceptives or for prescription pharmaceuticalsprescribed for cosmetic purposes.

Provider

A provider is any health or medical professional whoprovides you with a service and may include your doctor,dentist, anaesthetist or acupuncturist. It also includes peopleor organisations who provide you with health items or aids– things like hearing aids, mouthguards or nebulisers.

RecognisedproviderThis is a provider approved by Medibank for the purpose ofpaying benefits. To check if a provider is recognised, pleasecall us on 132 331.

SamedayadmissionThis is when you’re admitted to a hospital or day hospital facilityand discharged on the same day where the stay does not extendbeyond midnight.

SurgicallyimplantedprosthesisAn approved manufactured item or piece of equipment thatis surgically implanted or applied, generally during a hospitalsurgical procedure to replace or assist a body part or function.Examples include pacemakers, defibrillators, cardiac stentsand joint replacements.

31



Medibank alsooffers covers for

permanent Australianresidents, non-residents

working in Australia,overseas students and

access to pet andtravel insurance.

If you anticipate treatment for which you are expecting a benefit from Medibank, please contact us before commencing treatment to confirm that the benefit you expectwill be paid. In order to provide you with a range of health insurance and health related service s, Medibank and its related companies may share your per sonal (includingsensitive) information. Our Privacy Policy sets out how your personal (including sensitive) information is handled. You can view a copy of our Fund rules and Privacy Policyonline at medibank.com.au or at any Medibank s tore.

all 132 331 or +61 3 8622 5780(if alling outside Australia)visit mediank.om.au/visitorsor ask in store

The Private Health Insurance Code of Conduct logo isa trademark of, and is used under authorisation from,Private Healthcare Australia.

Medibank Private is a signatoryto the Private Health InsuranceCode of Conduct.

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