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1300 367 906
Currently closed, opens 08:00 AM-08:00 PM AEST

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Suggested cover for you

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Legend

Covered
Not Covered
Restricted

Scope of cover

Additional Information

Hospital Cover

See below for more on some of the key terms in your quote.

Restricted services

A restricted service is one with limited cover.

You can choose your specialist but are likely to have significant out-of-pocket costs if they treat you at a private hospital.
With a public hospital admission (if you’re a private patient), it depends on what the hospital charges private patients.

Learn more about restricted cover

Waiting periods

To keep health insurance fair for everyone, you may need to wait before you can claim – it’s called a waiting period. They apply:
• to anyone new to private health insurance
• if you upgrade your cover to include things that weren’t covered before
• if you upgrade your cover when you join from another health fund.

If you leave another fund, join us within 60 days to avoid re-serving any applicable waiting periods.

Hospital waiting periods

Pre-existing conditions 12 months
Pregnancy & birth related services 9 months
Psychiatric, rehabilitation & palliative care 2 months
All other hospital services 2 months
Emergency ambulance transport 1 day
Non-emergency ambulance transport 1 day

Pre-existing condition

A pre-existing condition is an illness, ailment or condition where the signs or symptoms existed at any time during the six months before you got your Hospital cover, or transferred to a higher level of cover.

Where relevant, we appoint a medical practitioner to determine whether you have a pre-existing condition, based on information provided by your treating doctor or specialist.

The waiting period for a pre-existing condition is 12 months (the Mental Health Waiver is one exception – see below).

Mental Health Waiver

The Mental Health Waiver helps members with Hospital cover – who aren’t on a Gold-level product – access in-hospital (inpatient) psychiatric treatment.

Top Hospital (Gold) is the only level of Teachers Health Hospital cover on which the hospital psychiatric services clinical category is ‘covered’ (rather than ‘restricted’).

The waiver allows you to upgrade to Top Hospital (Gold) and get inpatient treatment right away, without serving the usual two-month waiting period.

You can access the waiver once in a lifetime, provided you’ve had Hospital cover for at least two months before you use it.

Extras Cover

Here are some explainers to shed light on more the complex stuff. 

Waiting periods

To keep health insurance fair for everyone, you may need to wait before you can claim – it’s called a waiting period. They apply:
• to anyone new to private health insurance
• if you upgrade your cover to include things that weren’t covered before
• if you upgrade your cover when you join from another health fund.

If you leave another fund, join us within 60 days to avoid re-serving any applicable waiting periods.

Extras waiting periods

General Dental, Therapies, Artificial Aids 2 months
Optical, Healthy Lifestyle 6 months
Major Dental, Orthodontia, Medical Appliances, Hearing Aids 12 months
Wheelchair purchase 24 months
Emergency Ambulance transport 1 day

Providers

Dental & optical

You can access a range of quality dental and optical services at Teachers Health Centres.

If you can’t get to one of our centres, there are plenty of other providers in our network .
Other Extras

You can find providers for other Extras by using the Healthshare tool. It allows you to search by specialty or name and location.
Choosing a provider
We can only pay claims for treatment from qualified and registered providers in a private practice. Luckily most meet this description, but if you’re unsure ask them if they’re a recognised provider with Teachers Health.

Limits on Extras benefits

For each service that’s included in your Extras cover you’ll see a maximum amount (dollars and/or a percentage) that you can claim – this is the benefit.

In most cases there are annual limits on Extras services – the total amount you can claim in a calendar year.

A note on Orthodontia, it has a lifetime limit rather than an annual limit – calculated across any health fund a member has belonged to.

Some services also have sub-limits, the maximum you can claim per year for a specific sub-category of that service (like group therapy on a physio limit).

Benefits and limits vary on each level of cover. When choosing, consider which Extras you’re likely to use, and how often. If there’s more than one person covered, check for per person or per family limits that may apply.

Pharmaceuticals

Under the Pharmaceutical benefit, you may be able to claim for medication that’s prescribed by a doctor but isn’t already subsidised by the government’s Pharmaceutical Benefits Scheme (PBS).

The medication does need to be approved by the Therapeutic Goods Administration (TGA) though. That will rule out medication that’s in a clinical trial, for instance.

We recommend that Teachers Health members call us to check whether they can claim for a given medication (if they’re unsure).

Your Cover

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Updating your quote
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