| Ancillary |
Services that are not classed as Medical or Hospital.
(e.g. Dental/Optical/Physio etc.) |
| Access Gap Scheme |
Gap Cover arrangements with Medical Specialists
to pay benefits for in-patient medical services above the Medicare
Schedule Fee. |
| Base Rate |
Under
Lifetime
Health Cover legislation, health funds must charge up
to 70% loading on their hospital contribution rates.
The lowest premium
payable for each fund table is called the "Base Rate".
To be eligible for
the Base Rate persons must commence Hospital cover before
1 July following their 31st birthday.
Lifetime Health Cover loading applies to Hospital cover only.
Members with combined
cover will only pay loading on the Hospital component (if
a loading is applicable). |
| Day Facility |
A private hospital where patients are admitted
and discharged on the same day and is approved by the Department
of Health to provide such services. |
| Defacto |
A person who is living with a member on a bonafide
domestic basis although not legally married to that other person.
|
| EFTPOS |
E lectronic F unds
T ransfer at P oint O
f S ale. Electronic method of paying
for goods and services without the need for cash. |
| Eligibility Checking System |
Method for Hospitals to electronically confirm
the membership details and benefits for a patient that is to
be admitted to Hospital for treatment. This system is available
on-line 24 hours a day,
7 days a week. |
| HICAPS |
H ealth I ndustry
C laims A nd P ayment
S ervice. Allows you to make your claim at
the point of service via an EFTPOS style transaction
using your LPC membership card. |
| Hospital |
Services provided in a private or public hospital
approved by the Department of Health. |
| Informed Financial Consent
|
The
procedures that Hospitals and Doctors should have in place
to inform a patient, in writing, of what Hospital and Doctors
fees and charges, health fund benefits and out-of-pocket costs
(where applicable) exist in respect of Hospital and In Hospital
Medical treatment.
This information
should be provided in writting prior to the patient agreeing
that the hospital admission take place. |
| Inpatient |
A patient who has been formally admitted to a
Hospital or Day Facility. |
| Medical |
Services provided by a doctor, specialist, radiologist,
pathologist or anaesthetist. |
| Medical Gap |
The difference between the Benefit paid by Medicare
and the Doctors Fee for a medical service. |
| Membership |
A membership is comprised of the Member and all
other persons covered (who are classed as dependants.) |
| PBS |
P harmaceutical B enefits
S cheme. A scheme run by the Government which
subsidises the price of some pharmacy items. |
| Person Covered |
The Member's eligible spouse, dependant child
or student dependant who is listed on the membership at the
time when their health expense is incurred. |
| Portability |
Term used to describe entitlements for contributors
to transfer from one Health Fund to another without the imposition
of a waiting period or with reduced waiting periods where the
waiting period has been served in whole or in part. |
| Provider |
A Qualified Person who supplies services that
are eligible for benefits from LPC. |
| Restricted Benefits |
Specific in-hospital treatments that only attract a minimum
level of benefits. These are services that do not attact a Medicare
benefit (e.g. cosmetic surgery services and some prescription
drugs). Benefits paid are shared ward accomodation costs in
a Public Hospital as defined by the Minister for Health and
Ageing. |
| Spouse |
The members husband, wife, or defacto. |
| Student Dependant |
A child of a member who is a full-time student
at a tertiary institution. E.g. College or University. |
| Treatment Exclusions |
Services that are not eligible for fund benefits but are listed
on the Medicare Benefits Schedule. Lysaght Peoplecare does not
offer any Private Hospital Insurance products with Major Treatment
Exclusions as all items listed in the Medicare Benefits Schedule
are eligible for benefits. |
