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| A |
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Means any injury inflicted as a result of unintentional, unexpected actions or events which require
treatment by a registered healthcare practitioner but excluding accidental illness, surgical procedures,
pregnancy, injuries or illnesses induced by alcohol, drug dependence or aggravation of a pre-existing
condition.
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| B |
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Australian Unity health benefit fund members may be eligible to become a member of Australian Unity Limited ABN 23 087 648 888 after completing 2 years of continuous membership. Australian Unity Health benefit fund members joining through a corporate group membership are generally ineligible to become members of Australian Unity Limited. |
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| C |
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Benefits are not payable for periods during which a membership is unfinancial or suspended, nor are they payable on claims submitted more than two years after the date of service. |
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Australian Unity benefits are not payable where a member has a right to claim damages, compensation or benefits from any other source. Please contact the Claims Analysis section for advice concerning compensation claims. |
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A couple membership covers the member and one other person who is not a dependant child of the member. |
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| D |
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In respect of a family membership means any person who is related to a member who contributes at the family rate being the member's spouse or defacto;
that member's eligible child who has not attained the age of 23 years; or that member's eligible child who has not attained the age of 25 years and is not married
or living in a defacto relationship; who is pursuing a full time course of study approved by the Fund.
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Dental Maximums - Current available Combination Covers / Extras Covers. Please note that the dental benefit maximums under these covers are different and can affect your dental entitlement when transferring from one cover to another. Additional waiting periods can apply when transferring between covers E7, E2, E3, E5, LPP, LPX, LCC, LCX or a Smart table for crowns, bridges, etc. and for overall dental maximums. |
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| E |
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For singles, the excess is applied once per calendar year if admitted into hospital, with the exception of the Smart Start® product, where the excess only applies to overnight hospital admissions that are not as a result of an accident. For couples and families, the excess is applied at the single rate up to a maximum of twice per calendar year.
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| F |
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A family membership covers the member, spouse / defacto and their dependant children up to the age of 23 years. Children continue to be included under the family membership while they remain unmarried and continue to attend an Australian Unity approved full-time course of study up to the age of 25 years. If they join their own membership within three months of ceasing to be included under the family cover, they receive continuity of benefits. |
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If you would like to discuss any aspect of your experience with us just call 13 23 39 (8.30am - 8.30pm EST, Monday - Saturday). |
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| L |
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Australian Unity will not be liable should an application or claim form contain false or inaccurate information or where the member is unfinancial. |
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| M |
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Years of membership and benefits paid with another fund will be taken into account in calculating Australian Unity waiting periods and benefits payable if the member joins an Australian Unity health insurance cover within 30 days of ceasing membership with their previous Registered Health Fund. |
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All contributions are payable in advance. Failure to pay contributions within two months of the expiration of the member’s last contribution period will result in cessation of both the membership and entitlement to benefits. |
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| P |
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Means any illness or ailment, the signs or symptoms of which were known or which a medical or para-medical practitioner appointed by the Company considers
after examining information furnished by the member's practitioner, and other material relevant to a claim for benefits, were in existence in the member or his
dependant at any time during the six months preceding the commencement or transfer date, irrespective of whether the member or dependant was aware of the pre-existing
illness or ailment and includes all proposed elective or cosmetic procedures.
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| R |
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Australian Unity’s rate guarantee policy ensures that contributions paid in advance are protected against the rate change. Once contributions are due again, they will be payable at the new rate. |
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Benefits are only payable for ancillary (extras), dental and nursing services provided by practitioners recognised by Australian Unity and in private practice. Recognition is subject to change without notice. Recognition by Australian Unity is for benefit payment purposes only and should not be taken or construed in any way as sponsorship, approval of, or any recommendation as to the qualifications and skills of, or services provided by, a practitioner or therapist. Members should check that their practitioner is recognised by Australian Unity before commencing treatment. |
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| S |
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A single membership covers one person (the member) only. |
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This glossary is only a summary of the fund rules. The complete rules of the health benefits fund set out in full the terms and conditions of membership and liability under the fund. These rules are available for inspection at Australian Unity Head Office in South Melbourne. |
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To assist members, provision exists for members with Hospital and Combined Hospital and Extras cover to apply for suspension of membership for a minimum of three months up to two years if they are traveling overseas. |
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| W |
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Australian Unity gives you immediate cover, except as listed below.
Please note that if you are transferring from an equivalent level of cover with another fund, you will not have to re-serve any completed waiting periods.
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| Y |
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All yearly maxima, excesses and limits are calculated from 1st January each calendar year. (January - December) |
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A member’s year of entitlement is calculated on the number of calendar years of membership with Australian Unity less any applicable 12 month waiting periods, e.g. major dental. |
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