Acupuncture
Alternative therapy – Acupuncture is a form of evidence-based Chinese medicine that involves the stimulation of the body’s energy pathways to encourage normal flow of energy (or Qi) through the body. Acupuncture is used in the treatment of long and short-term conditions.
Acute
Refers to illnesses that are rapid in their onset, short in duration and require urgent care. Duration and care will depend on the illness, for example a broken leg and a sore throat may both be classified as ‘acute’.
Acute care certificate
Required for acute hospital stays that are over 35 continuous days. Long-term acute accommodation is mostly for patients requiring nursing-home type care. The certificates are submitted by the hospital to the health fund as these services are paid at a different rate to other acute care patients.
Ambulance
Emergency ambulance services are covered on all Frank hospital policies and on eligible Frank extras with a recognised provider Australia-wide. See our ambulance cover explainer to understand what you need to be covered in your state or territory for non-emergency ambulance trips, which include transportation from a hospital to your home, or another hospital, and call-out fees.
Ancillary cover
Also known as extras cover, this can be taken out on its own or combined with a hospital cover. Extras covers pay a benefit towards agreed services that are generally not covered by Medicare.
Ancillary services
Also known as extras services, includes cover for treatments like dental, optical, physio, chiro and other therapies. These services are not generally covered by Medicare.
Annual limit
The total amount in a year you can claim on an extras service. Frank’s annual limits reset at the beginning of each calendar year.
Antenatal
Services relating to care pre-pregnancy or during pregnancy; before birth.
Appliance
Medical appliances are devices used on the body that have a physical or medical effect, or are used for monitoring. Appliances can range from simple bandages to blood pressure monitors.
APRA
The Australian Prudential Regulation Authority (APRA) oversees private health insurance, banks, credit unions, building societies, general insurance and reinsurance companies, life insurance, friendly societies and most members of the superannuation industry.
Artificial aids
Items to help someone manage an illness or condition such as splints, casts, supportive wear, monitoring devices or protective items.
Assisted reproductive services
Pregnancy-related service provided by a participating private hospital relating to egg retrieval and implantation.
Benefit
The amount your fund will pay for a service or treatment included on your cover.
Blood glucose monitors
A blood glucose monitor is a device for monitoring your blood glucose level in order to reduce the chances of developing complications from diabetes.
Branch
A health insurance branch is a physical store or location where you can visit your insurer. As an online fund, Frank doesn’t have branches, which helps us keep prices down. You can view and manage your cover and submit claims in the Frank app or member area, or get in touch with us during business hours.
Calendar year
A period of 12 months from 1 January to 31 December. Frank operates on a calendar year and our benefits reset on 1 January each year.
Cataracts
Eye surgeries including cataract surgery, eye lens procedures and corneal transplants. Check with Frank if you require these services.
Certified age of entry (CAE)
Your CAE is based on the age you were on 1 July prior to you first taking out hospital cover. This is used to calculate your Lifetime Health Cover (LHC) loading.
Change of cover
When you transfer to Frank from another fund, we will contact your old fund on your behalf. We’ll request the cancellation of your previous cover and ask them to send us a transfer certificate. Also called a clearance certificate, this is a record of your health insurance cover and is needed to confirm if waiting periods or LHC loading will apply to your new cover, based on your history.
Chiropractic
Chiropractic care uses manual treatments (including spinal manipulations – termed ‘adjustments’) to treat disorders of the musculoskeletal system.
Closed policy
A policy that's no longer available to new members.
Community Rating
A system developed by the Australian Government to make sure that everyone is entitled to access the same health insurance policies, for the same price, regardless of their health status, history or previous claims.
Contributor
A financial member of a health fund.
Cosmetic surgery
Limited benefits may apply on hospital covers for cosmetic surgery, depending on the medical justification for the surgery. We recommend you contact us prior to any planned surgery to confirm your cover and benefits.
Dental
Broken down into three categories for extras cover, dental includes:
- General and preventative dental: preventative dental includes routine dental check-ups, cleaning and fluoride treatments while x-rays, fillings and basic extractions fall under general dental.
- Major dental: includes treatment for more complicated fillings, crowns, bridgework, dental implants, root canal treatment, indirect restorations, occlusal therapy and surgical extractions, including wisdom teeth.
- Orthodontics: includes a course of corrective treatment for teeth and bite alignment.
Refer to your fact sheet to see which dental categories are included on your cover.
Dependant
A person who is included on a membership as a child or student dependent.
Endodontic services
Endodontic treatments (such as a root canal) are for teeth that are diseased or have nerve damage. These services may be covered under major dental treatments.
Excess
An excess is the amount you pay upfront when you are admitted into hospital. Excess fees allow us to keep membership costs low.
Exclusions
Exclusions are services or benefits not included in your cover. Some things are excluded because we are not legally allowed to cover them and some are excluded on certain covers to keep prices down. A product fact sheet will explain what is excluded from a cover.
Extras
Also known as ancillary or general treatment services, includes cover for treatments like dental, optical, physio, chiro and other therapies. These services are not generally covered by Medicare.
Frank
Frank Health Insurance aims to make private health insurance easy as. We’re an online fund and we focus on health insurance and nothing else.
We’re part of GMHBA Limited, a not-for-profit health fund that has been around since 1934.
Fund type
There are for profit, not-for-profit, member-owned and mutual health insurers in Australia. Frank is a not-for-profit fund, and we are part of GMHBA Limited.
Gap cover arrangements
All of Frank's hospital covers come with Access Gap Cover through our partnership with the Australian Health Service Alliance (AHSA).
Providing you choose a doctor that participates in the program you can reduce or even eliminate any gap for medical fees when treated as an inpatient in hospital.
General treatment policy
Also known as extras policy, includes cover for treatments like dental, optical, physio, chiro and other therapies. These services are not generally covered by Medicare.
General dental
General and preventative dental includes dental treatments like check-ups, cleaning and fluoride treatments, x-rays, fillings and basic extractions.
Health fund
Frank Health Insurance is part of the GMHBA Limited health fund.
Heart and vascular system
Surgeries related to the treatment of the heart and blood vessels. Includes cardiac surgery and coronary care.
HICAPS
HICAPS is an on-the-spot claims processing system for health funds, Medicare and WorkSafe claims. If your provider does not have HICAPS, you can make your claim in the Frank app or member area.
Home nursing
Home nursing may be part of a hospital substitution program such as Hospital in the Home and Rehab in the Home.
Hospital costs
The costs of services provided by the hospital. These can include things such as the hospital accommodation and meals, operating theatre fees and dressings and bandages.
Joint replacements
A joint replacement surgery removes an impaired joint and replaces them with an artificial joint (known as a prostheses).
Major dental
Major dental includes treatment for things like more complicated fillings, surgical extractions (including wisdom teeth), crowns, bridgework, dental implants, root canal treatment, indirect restorations and occlusal therapy.
MBS payable item
A procedure covered by Frank Health Insurance. See also Medicare Benefits Schedule below.
Medical costs
The cost of receiving your treatment as a private patient while admitted to hospital. Medicare and Frank pay benefits towards your inpatient medical costs. Medical providers can set their own fees, which determines your out-of-pocket costs for medical treatment.
Medical gap
A medical gap is the difference between what your doctor charges and what’s covered by Medicare and your hospital cover. If there’s a medical gap for your treatment, you’ll have an out-of-pocket expense.
Medicare Benefits Schedule (MBS)
Items with an MBS number are used to identify procedures. Request an MBS item from your doctor during consultation and Frank can check your level of cover and provide an estimate of any benefits payable to you.
Medicare Levy Surcharge (MLS)
The MLS is a tax set by the Australian Government. It applies to individuals and families on higher incomes who don’t have eligible private hospital cover. It goes directly to funding the national public health system Medicare.
Medicare Levy Surcharge exemption
If your annual taxable income falls within the MLS range you can avoid the tax altogether by taking out hospital cover. Read more here.
Optical
Includes prescription glasses, prescription sunglasses and prescription contact lenses.
Orthodontics
Orthodontic treatment includes a course of corrective treatment to align the teeth, jaws and bite and may involve braces, a plate or removal retainers. See Dental above and read more about claiming orthodontics.
Palliative care
Palliative care is designed to relieve pain and suffering of patients with life-limiting illnesses.
Participating Private Hospital
Hospitals that have an agreement with Frank for what they will charge our members. If you're admitted to a Participating Private Hospital (for a procedure that is included on your Frank cover), you'll pay any applicable excess and we'll pay for your hospital bill. You may still have out-of-pockets for things such as medication when you are discharged, wi-fi, or any incidentals during your stay.
PHIS
Private Health Information Statements (PHIS) are available on all private health insurance policies available in Australia. They can be used to compare health insurance products between funds. There are three types of PHIS; hospital, general treatment (extras) and combined (packaged hospital and extras).
Physiotherapy
Physiotherapy is concerned with the assessment, diagnosis, and treatment of disease and disability through physical means.
Podiatric surgery
Podiatry treats disorders of the feet and lower limbs. If you have podiatric surgery in a hospital performed by a registered podiatric surgeon, benefits are limited to only cover hospital accommodation and the cost of a prosthesis per the prosthesis list, as laid out in the Private Health Insurance (Prosthesis) Rules. Medical services such as the anaesthetist or surgeon’s account, pathology or radiology are not covered under hospital products.
Podiatry
Podiatry treats disorders of the feet and lower limbs including orthotics which are custom-made foot supports designed to support the feet and correct any lower limb problems.
Portability
The Private Health Insurance Act 2007 includes 'portability' rules to protect consumers who want to change to another hospital policy with the same insurer or with another insurer. This means that you will not have to wait the normal waiting periods again before benefits can be paid to you.
Pre-existing condition
Pre-existing conditions are classed as any ailment, illness or condition with any signs or symptoms in the 6 months before signing up for hospital cover or upgrading existing cover.
Pregnancy and birth-related services
Hospital products with pregnancy and birth included as a clinical category cover services and treatment relating to childbirth or complications during pregnancy.
Premium
This is the amount you pay to be a member of Frank Health Insurance. You can pay your premiums weekly, fortnightly, monthly. quarterly, half-yearly or yearly.
Private Health Insurance Ombudsman
The Private Health Insurance Ombudsman protects the interest of and provides free independent advice for private health insurance consumers.
Private hospital
Unlike public hospitals, which are funded by the state and federal governments, private hospitals are funded by a combination of private and government sources including private health insurance, Medicare, the Pharmaceutical Benefits Scheme, third party insurers, and patients. See Participating Private Hospital.
Psychiatric services
Psychiatric services cover the in-hospital treatment of a mental illness or addiction.
Psychology
Psychologists work with patients to gain an understanding of their mind and how it impacts their behaviour. Generally this is done through group or one-on-one discussions.
Remedial massage
Remedial massage is a combination of massage techniques used to treat injuries of the muscles, tendons, ligaments or connective tissues.
State
There are instances where your state of residence may affect your cover and requirements. If you move states, ensure you update your details in the member area. We also recommend checking that you're covered for all ambulance trips for your state or territory.
State of the Health Funds Report
A Commonwealth Ombudsman report that provides comparative information on health funds.
Waiting period
A waiting period is simply the period of time you have to wait between taking out health insurance or upgrading your cover and being able to claim. Waiting periods apply to both hospital and extras cover.
Suspension of private health cover
If you’re heading overseas for more than two months, you may be eligible to suspend your Frank cover for a maximum of three years without affecting your CAE and LHC.
