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Suggested cover for you
Hospital Cover
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Extras Cover
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EXCESS
PAYING
EXCESS
From
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PAYING
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Hospital Cover
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Extras Cover
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Yearly limits **
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** Sub-limits & benefit limits may apply.
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.
| 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 |
| 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. |
| 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 |
| 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). |
| 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.
| 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. |
| 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 |
| 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 . |
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| 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. |
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| 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. |
| 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. |
| 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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Payment
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*
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Updating your quote
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