A - F
Access Gap Cover
The Fund's Scheme to eliminate or reduce out-of-pocket expenses for medical services (doctors, diagnostic imaging/radiology, and pathology) during hospital stays. If the medical practice is not yet aware of us, ask them to contact our office on 1300 703 703, we are here to help.
Accident & Emergency Facility 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.
The maximum benefit payable for services received during any calendar year for particular services or groups of services per person unless stated otherwise. The Annual Maximums start new on the 1st of January each year.
The amount payable by the Fund 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.
Our hospital cover has no benefit limitation periods. Other funds may apply benefit limitations which pay reduced benefits on one or more services for a set period of time that is no longer than normal waiting periods, then pay full benefits after this period.
From January 1 to December 31.
A request submitted by a member to the Fund for the payment of benefits for hospital treatment, in-patient medical treatment or extras treatment. All claims must be made within two years of receiving treatment.
A Contributor in the 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 and/or electronic communications and is responsible for premiums of the policy.
A co-payment is an amount that a member agrees to pay towards the cost of each day spent in hospital. Emergency Services Health does not have co-payments on its hospital coverage. However, if you transfer to Emergency Services Health and your previous cover had a co-payment component, you’ll 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 child;
Emergency Services Health’s literature refers to a number of different types of dependents.
Our Fund Rules refer to the Contributor and dependents. Dependents are any spouse/partner and any child of the Contributor eligible to be covered under your policy.
The Fund Rules collectively refers to your children eligible to be covered under your policy as “dependent persons” and are made up of the following types:
- Non-classified dependent person;
- Dependent student;
- Dependent non-student; and
- Dependent person with a disability.
A dependent child is where your child is aged under 18 and a non-classified dependent person is when your child is aged 18 and over but under 21.Together, we refer to these two types of dependent persons as younger dependent children (that is, where the child is aged less than 21 years).
A dependent student is a child of the Contributor who is 21 years and over, but under 32 years of age, who is considered to be a full time student of a school, college, or university recognised by our Fund.
A dependent non-student is a child of the Contributor who is 21 years and over but under 25 years of age, and not eligible to be a student dependent.
A dependent person with a disability is a child of the Contributor and the child is participating in the National Disability Insurance Scheme (NDIS) and hence holds an active NDIS plan. The child may be any age 18 years and over, but would only be registered as a dependent person with a disability if they do not meet any of the other dependent person types.
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.
Other than for a dependent person with a disability, a child ceases to be eligible as a dependent on a policy if they are married or in a defacto relationship.
An excess is an amount that a member agrees to pay upfront before a health insurance benefit is paid towards hospital accommodation as set out under a health insurance policy, similar to a motor insurance policy. Emergency Services Health does not have excesses on any of its hospital products. However, during waiting periods you may be required to pay an excess if you were subject to one under your previous policy.
Generally refers to non-hospital and non-medical health services such as dental, optical, or physiotherapy. Also sometimes referred to as Ancillary cover or General Treatment.
G - L
This most 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 our Fund (and Medicare if applicable), in effect your out-of-pocket cost. It can also refer to the uninsured difference between the fee charged for a service and the benefit paid by our Fund (and Medicare if applicable), in effect your out-of-pocket cost.
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
A person who has been admitted to a hospital. This does not include a person being treated in the out-patient or accident & emergency sections of a hospital.
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.
M - R
Medicare Benefits Schedule (MBS)
A list of medical services and fees recognised by the Australian Government.
The use of the words “membership” and “member” in this website relates to the policyholder (Contributor) and all dependents under the policy of the Fund. It does not imply member voting rights as described in the constitution of Police Health Limited ABN 86 135 221 519 .
When a member is not up-to-date with policy payments, the membership will be in arrears and no benefits will be paid to or on behalf of the member. The policy may be cancelled by the Fund if in arrears greater than two months.
The Fund operates on a not-for-profit basis. This means we do not pay dividends to shareholders, and any surpluses are retained to benefit members.
Prostheses Out-of-pocket Expenses
The portion of charges you incur that is not covered by Medicare or health fund benefits.
A person receiving treatment at a hospital but not admitted to hospital.
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 they are supplied while an in-patient of a hospital.
Private Health Information Statements (PHIS)
PHIS are available on all private health insurance products in Australia. These are designed to assist you in reviewing and comparing different health insurance policies.
This is a Federal Government initiative and all health insurers are required to provide such statements by law. Emergency Services Health as brought to you by Police Health Limited ABN 86 135 221, PHIS are available on request.
For further information on PHIS and other detailed information on private health insurance in Australia visit the Federal Government's private health website.
Our Fund's reference to a policyholder refers to the contributor of the policy (not everyone covered under the policy).
This refers to a health insurance policy with the Fund and the treatment you’re insured for in exchange for a set premium. The policy is governed by the Fund Rules.
Where signs or symptoms of an ailment, illness or condition (in the opinion of a medical practitioner appointed by us) existed at any time during the six months before you purchased your policy or upgraded to a higher level of cover.
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 include screws and plates, intraocular lenses, replacement joints, cardiac stents, defibrillators and other devices that are surgically implanted during your stay in hospital.
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 us. We only pay benefits for services by these providers. If you wish to ensure that your provider is covered please speak to us prior to treatment.
Restricted Membership Access
Emergency Services Health as brought to you by Police Health Limited ABN 86 135 221 is a restricted membership private health insurer, meaning that people must meet certain criteria to be eligible to become a member.
S - Z
State of Residence
The state or territory where the Contributor of the policy lives.
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).
A ‘waiting period’ in the context of private health insurance means the period of time from the commencement of cover or increase in cover, to when the benefit or new benefit can be claimed by the member under their chosen cover (excludes accidents).