Annual Maximum 

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

 

Calendar Year

A calendar year is from January 1 to December 31.

 

Claim

A claim refers to a request submitted by a member to Police Health 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. Making a claim is easy see the many options on how to submit a claim here.

 

Co-payment

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 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.

 

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 and/or electronic communications and is responsible for premiums of the policy.

 

Dependent

Police 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:

  • Dependent child;
  • 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.

 

Excess

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.

Police 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.

 

Gap

The Gap 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

An in-patient is 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.

 

Extras/Ancillary Cover

Extras cover 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.

 

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.

 

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 Polices Health insurance. It does not imply member voting rights as described in the constitution of Police Health Pty Ltd ABN 86 135 221 519.

 

Membership arrears

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 members. 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-patient

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

 

Out-of-pocket expense

Out-of-pocket expenses are the portion of charges you incur that is not covered by Medicare or health fund benefits.

 

Palliative Care

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

 

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.

 

Policy Holder

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

 

Police/Product

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

 

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.

 

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 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.

 

State of residence

The state or territory where the Contributor of the policy lives.

 

Restricted member access

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

 

Helpguide

Optical Benefits

Optical Benefits

Enhancements to your cover, effective 1 April 2022

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Helpguide

FAQ: Will you pay for my Pilates treatment?

Police Health has never had a benefit structure for Pilates, either as a separate category or under our Complementary Therapy category.
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