New for 2020
No excess for kids on your cover
Who: Families on:
- Top Hospital (Gold) $300 or $500 excess
- Mid Classic (Silver Plus)
- Mid Hospital (Basic Plus)
What: You don't have to pay an excess if your kids are admitted to hospital (child dependants on your cover aged under 25)
When: From 1 April 2020
Simpler Access Gap scheme
Who: Anyone on Hospital cover or Starterpak (Basic Plus)
What: Simplifying the scheme to make it easier for you to control your costs
When: From 1 July 2020
How Access Gap works
If you haven’t used it before, Access Gap Cover is a billing scheme that can help you minimise your out-of-pocket expenses for in-hospital (inpatient) care.
It works by restricting the amount a specialist can ask you to pay. Before you’re treated, you know you’ll be charged either an agreed amount (known gap), or nothing at all (no gap) – even better!
The gap cap
Before 1 July 2020
If a specialist agreed to treat you under the scheme, the maximum gap they could charge you was $400. These charges could apply to each Medicare item number involved in your inpatient hospital treatment. If your treatment consisted of multiple item numbers, your costs could escalate.
Now
The maximum gap a specialist can charge under the scheme is $500, but it has to cover all the item numbers that feature in your treatment. One gap; a $500 cap.
Closing the loop(hole)
Before 1 July 2020
If a specialist treated you under Access Gap, they should've only charged fees that were related to a Medicare item number. But some added extra charges – like ‘booking’ or ‘admin’ fees. Not ok.
Now
The Access Gap rules were tightened up so this doesn’t happen. If a specialist treats you under the scheme, they can only charge you for services that are linked to a Medicare item number. No miscellaneous fees for you!
Mid Classic (Silver Plus)
Changes specific to members on Mid Classic (Silver Plus) Hospital cover.
Have Extras cover?
Some Extras benefits increased on 1 April 2020 – some good news to celebrate!
Additional support
Teachers Healthcare Services helps eligible members* with Hospital cover access a range of support services.
FAQs: October 2020
For info on 1 October 2020 premium increases, check out these Frequently Asked Questions.
*These programs are brought to members through Teachers Healthcare Services, an initiative of Teachers Health to support members’ health and wellbeing through quality, evidence-based health management programs and services. To be eligible for a program you must be a member of Teachers Health and have Hospital cover with all relevant waiting periods served. Additional eligibility criteria may apply. Eligible members are connected with a dedicated Teachers Healthcare Services care coordinator who supports them on their personal journey.