Glossary

When you are admitted to hospital, there are 2 types of costs: fees charged by your Doctor or Specialist, and fees charged by the hospital.

Access Gap Cover is a scheme aiming to help eliminate or reduce your out-of-pocket costs for medical or Doctors' fees. If your Doctor or Specialist chooses to participate in our Access Gap Cover scheme you will have lower or no out-of-pocket expenses.

A Doctor or Specialist can choose to participate in the scheme on a per claim, per treatment and per patient basis. It is important to confirm with your Doctor or Specialist directly prior to treatment to confirm if they will participate in the scheme for your procedure.

Access Gap Cover does not apply to diagnostic services, out of hospital medical services or services not included on your cover.

Excess and Co-Payments will still apply.

Access to a list of Doctors and Specialists participating in the Access Gap Cover Scheme is available using the find a provider search.

An unforeseen event, occurring by chance and caused by an unintentional and external force or object resulting in involuntary hurt or injury to the body, which requires Treatment by a Medical Practitioner or a Hospital Emergency department within 48 hours.

This definition excludes unforeseen Conditions attributable to medical causes. Some see-u hospital covers may provide a temporary increase in coverage for services that are normally Restricted or Excluded if hospital treatment is required for injuries that are sustained in an Accident.

Please refer to your Product Summary for more information.

The Medicare Benefits Schedule (MBS) lists all the medical services subsidised by the Australian Government through Medicare. This includes thousands of in-hospital services that we pay benefits towards if this item is included on the cover.

An annual limit is the maximum amount of benefits payable towards services, items or groups of services/and or items within a calendar year.

Annual limits are calculated for a calendar year i.e. 1 January to 31 December each year.

If you have changed your cover (or insurer), limits that have been used under your previous level of cover will be carried over and considered when determining the first year limit on your see-u policy.

Treatment provided to an admitted patient in hospital to assist with becoming pregnant. Includes the retrieval and implantation of eggs and collection of semen.

In Vitro Fertilisation (IVF) treatment and Gamete Intra Fallopian Transfer (GIFT) are two of the most common procedures.

Please note that major portion of these treatments is provided as an outpatient and does not attract any benefits. Benefits are only paid for the inpatient portion of the treatment.

Hospital treatment for the investigation and treatment of the back, neck and spinal column.

For example, sciatica, prolapsed or herniated disc and spine curvature disorders such as scoliosis, kyphosis and lordosis.

A Benefit Replacement Period may apply to Extras items payable under some of our covers. It is a set period you need to wait from the date of purchase for an item before you can receive another benefit to replace the item.

This is separate to any waiting periods you may have to serve.

Please refer to your Product Summary to check what Benefit Replacement periods apply to your policy.

Hospital treatment for the investigation and treatment of blood and blood-related conditions.

Hospital treatment for the investigation and treatment of diseases, disorders and injuries of the musculoskeletal system.

For example, carpal tunnel, fractures, hand surgery joint fusion, bone spurs, osteomyelitis and bone cancer.

Hospital treatment and investigation and treatment of the brain, or spinal cord and peripheral nervous system.

For example, stroke, brain or spinal cord tumours, head injuries, epilepsy and Parkinson’s disease.

Hospital treatment for the investigation and treatment of breast disorders and associated lymph nodes, and reconstruction and/or reduction following breast surgery or a preventative mastectomy.

For example, breast lesions, breast tumours, asymmetry due to breast cancer surgery and gynecomastia.

No benefits are paid for cosmetic breast surgery that is not medically necessary.

Hospital treatment for surgery to remove a cataract and replace with an artificial lens

Hospital treatment for chemotherapy, radiotherapy and immunotherapy for the treatment of cancer or benign tumours.

Not included in this category:

Surgical treatment of cancer is listed separately under each body system.

Chiropractic treatment involves manipulation-based therapy to treat conditions related to the nerves, skeleton and muscles.

Osteopathic treatment includes manipulation of the body to promote mobility and balance.

Chiropractors and osteopaths are useful for:
• back and neck pain
• sciatica
• frequent headaches
• joint pains and muscle strains
• work-related, repetitive strain & sports-related injuries

A combined annual limit is the maximum amount of benefits you can claim, distributed across a group of services.

Some Dental surgery services are not fully covered under see-u Hospital covers, for example, wisdom teeth removal and dental implant surgery.

Where Dental surgery is covered on your hospital cover, we'll pay a benefit towards the hospital accommodation and theatre, however we're unable to pay a benefit for the oral surgeon's fees.

You may be able to receive a benefit for these services if you hold an eligible Extras cover, provided you have served the applicable waiting periods and have not already reached your annual limit. Members who do not hold Extras cover will not be able to receive benefits for the dentists’ fees. Contact us before your treatment to understand what out-of-pocket costs may apply.

Hospital treatment for the investigation and management of diabetes. For example, stabilisation of hypo- or hyperglycaemia, contour problems due to insulin injections.

Not included in this category:

Provision and replacement of insulin pumps is listed separately under insulin pumps.

Hospital treatment for dialysis treatment for chronic kidney failure.

For example, peritoneal dialysis and haemodialysis.

Dietitians and Nutritionists educate people on appropriate diet, menu planning and preparation of food to enhance and maintain optimum health.

Hospital treatment for the investigation and treatment of the digestive system, including the oesophagus, stomach, gall bladder, pancreas, spleen, liver and bowel.

For example, oesophageal cancer, irritable bowel syndrome, gall stones and haemorrhoids.

Hospital treatment for the investigation and treatment of the ear, nose, throat, middle ear, thyroid, parathyroid, larynx, lymph nodes, and related areas of the head and neck.

For example, damaged ear drum, sinus surgery, removal of foreign bodies, stapedectomy and throat cancer.

Use of exercise (as prescribed by an Exercise Physiologist) as a treatment strategy in the physical rehabilitation of a patient.

Exercise physiologists may assist with:
• disease prevention
• injury rehabilitation
• establishing and maintaining functional independence

The amount you get back when you claim for a service provided by a recognised provider. This could be a dollar amount or a percentage of cost amount depending on your level of cover.

Hospital treatment for the investigation and treatment of the eye and the contents of the eye sockets.

For example, retinal detachment, tear duct conditions, eye infections, and medically damaged trauma to the eye.

Hospital treatment for the diagnosis, investigation and treatment of the internal parts of the gastrointestinal system using an endoscope.

Diagnostic and other preventative procedures (not covered under Preventative dental) completed to help you keep on top of your oral health.

This is routine dental that includes:
• fillings
• basic extractions (excluding surgical extractions)
• x-rays

This does not include more complex treatments or procedures such as orthodontic work, most endodontic treatment (root canal therapy), crowns or bridges

Surgical insertion of ventilation tubes in the ear drum to treat chronic ear infection.

Hospital treatment for investigation and treatment of the female reproductive system.

For example, endometriosis, polycystic ovaries, female sterilisation and cervical cancer.

Includes benefits for Aids and appliances that help to maintain good health and diagnose and prevent medical conditions including Hearing Aids, Blood Glucose monitors, Blood Pressure pumps, pressure therapy garments, braces, splints, orthoses, post- mastectomy brassieres and external mammary prostheses amongst others.

Hospital treatment for the investigation and treatment of the heart, heart related conditions and vascular system.

For example, heart failure and heart attack, monitoring of heart conditions, varicose veins and removal of plaque from arterial walls.

Hospital treatment for the investigation and treatment of a hernia or appendicitis.

It is best to contact us prior to any procedure as treatments for some hernias fall under Digestive System.

Hospital treatment and care of patients with psychiatric, mental, addiction or behavioural disorders.

For example, psychoses such as schizophrenia, mood disorders and addiction therapy.

Hospital treatment to correct hearing loss, including implantation of a prosthetic hearing device.

Hospital treatment for the provision and replacement of insulin pumps for treatment of diabetes.

Hospital treatments for surgery for joint reconstructions.

For example, torn tendons, rotator cuff tears and damaged ligaments.

Hospital treatment for surgery for joint replacements, including revisions, resurfacing, partial replacements and removal of protheses.

For example, replacement of shoulder, wrist, finger, hip, knee, ankle or toe joint.

Hospital treatment for the investigation and treatment for the kidney, adrenal gland tumour and incontinence.

A lifetime limit is the total benefit you can claim for this service in a lifetime.

If you have changed your cover (or insurer), lifetime limits that have been used under your previous level of cover will be carried over and considered when determining the lifetime limit on your see-u policy.

As a way of rewarding our members for staying with see-u, some of our products include loyalty limits.

The annual limit will increase over the first three years by a set amount.

The loyalty limits are calculated using the anniversary of you joining the policy.

Hospital treatments for the investigation and treatment of the lungs, lung-related conditions, mediastinum and chest.

For example, lung cancer, respiratory disorders such as asthma, pneumonia and treatment of trauma to the chest.

Complex dentistry procedures including but not limited to:
• crowns and bridges
• root canal therapy
• removal of wisdom teeth
• dentures
• implants

Hospital treatment for the investigation and treatment of the male reproductive system including the prostate.

For example: male sterilisation, circumcision and prostate cancer.

The Medicare Levy Surcharge (MLS) is a levy paid by Australian tax payers who don’t have Hospital cover and who earn above a certain income.

All of our see-u hospital policies qualify as an appropriate level of cover to exempt you from the Medicare Levy Surcharge.

For further information regarding the MLS and the income thresholds that apply, visit the Australian Taxation Office at ato.gov.au

The waiver of the 2-month waiting period on Psychiatric Services for an upgrade to a higher level of Hospital cover for an eligible member.

This can only be used once in a member’s lifetime across any private health insurer.

Hospital treatment for the investigation and treatment of a miscarriage or for termination of pregnancy.

Treatments that work on the physical and emotional body to relieve pain and improve health and wellbeing.

Some services include:
• Remedial massage
• Acupuncture
• Chinese Herbalism

Surgery to any part of the nervous system and can include Insertion of a device or injection to manage severe movement disorders or chronic pain, also includes carpal tunnel release surgery.

A nursing home type patient is a patient who is in hospital, but not in need of acute hospital care.

Benefits for these types of patients are set by the Federal Government.

If you’re admitted to hospital for more than 35 successive days, you’ll be regarded as a ‘nursing home type patient’, unless your Doctor certifies your need for ongoing acute care.

This means lower benefits will be paid towards the daily hospital accommodation charge which could result in significant out-of-pocket expenses.

Therapy which assists people to overcome limitations caused by injury or illness, emotional or psychological difficulties, developmental delay or the effects of aging.

This can include:
• rehabilitation in skills of self-care
• physical rehabilitation
• cognitive and memory assessment
• stress management and relaxation

Correction of visual impairment such as long or short sightedness.

Examples of treatment include:
• prescription glasses
• contact lenses

A form of specialty dentistry focusing on realigning teeth and bites as well as procedures to help with the correction & alignment of the teeth and jaw.

Hospital treatment for pain management that does not require the insertion or surgical management of a device.

For example: treatment of nerve pain and chest pain due to cancer by injection of a nerve block.

Hospital treatment for the implantation, replacement or other surgical management of a device required for the treatment of pain.

For example: treatment of nerve pain, back pain, and pain caused by coronary heart disease with a device (for example an infusion pump or neurostimulator).

Hospital treatment for care where the intent is primarily providing quality of life for a patient with a terminal illness, including treatment to alleviate and manage pain.

Each person on your cover can claim up to the ‘per person’ limit, except where a policy limit applies and has already been reached by the other members on the policy.

This is the total amount that can be claimed by all members on your policy. This applies to any Single Parent, Couple or Family policy.

No benefits will be payable where the cost of the PBS listed drug is less than the current PBS copayment. Benefits are only payable per script.

Benefits are only payable for scripts that are not available under the Pharmaceutical Benefits Scheme (PBS) and are approved by Therapeutic Goods Administration (TGA) for the condition being claimed for and are usually classified as S4 or S8 type medication.

Any other Pharmacy items, including any clinical trials are not claimable under any of the Extras policies offered by see-u.

Hospital treatment which is medically necessary for the investigation and treatment of any physical deformity, whether acquired as a result of illness or accident, or congenital.

For example, burns requiring a graft, cleft palate, club foot and angioma.

Provided by a registered Podiatric Surgeon, the hospital treatment for investigation and treatment of conditions affecting the foot and/or ankle, but limited to cover for; accommodation and the cost of a Prosthesis as listed in the Prescribed List set out in the Private Health Insurance (Protheses) Rules, as in force from time to time.

Diagnosis, treatment and prevention of conditions affecting the toe, foot and ankle to help with good foot hygiene and posture. Orthotics are devices prescribed by a podiatrist that are placed into the shoe to control or correct abnormal lower limb motions and alignment.

Conditions treated by a podiatrist include amongst other treatments:
• complications with arthritis affecting the legs and feet
• skin and nail disorders
• corns and calluses
• ingrown toenails

Hospital treatment for investigation and treatment of conditions associated with pregnancy and child birth.

Group or individual consultations with a psychologist.

Psychology services are commonly sought for:
• marital, family or relationship problems
• stress or pain
• fears, phobias, anxiety and panic attacks
• sexual difficulties
• eating and weight control problems