Get off to a good start

StarterPak combines a big range of Hospital and Extras services – without a big price tag.

Below is a list of some commonly claimed items:

Hospital Cover

Private Hospital (Agreement private hospital and same day surgeries)

Choice of Agreement private hospital

Click here to search for an agreement hospital.

Accommodation – shared and private room (when available)

Theatre fees, intensive care fees

Labour ward fees

Private Hospital Services

Removal of tonsils and adenoids

Knee and shoulder investigations and reconstructions

Appendicitis treatment

Hernias

Accidents

Removal of wisdom teeth

Pregnancy & birth related services

Infertility treatments

Hip and knee replacements

Shoulder and ankle replacements

Restricted

Coronary care & cardiothoracic surgery

Dialysis procedures & treatments

Major eye & eye lens surgery

Restricted

Bariatric surgery

Restricted

Sterilisation & reversal of sterilisation

Psychiatric, rehabilitation & palliative care

Restricted

All other services where Medicare pays a benefit

Restricted

Services that do not attract a Medicare benefit

Medical services

Choice of doctor

Access Gap Cover

Click here for more information about Access Gap Cover.

Government approved surgically implanted prostheses

Public Hospital

Shared room

Private room (where available)

Theatre fees, intensive care fees

Labour ward fees

Other

Excess

Non-emergency Ambulance

Emergency Ambulance Transport

Exemption from Medicare levy surcharge

Extras Cover

Dental

Service Benefit (up to $) Yearly Limits

General Dental - 2 month waiting period

Periodic oral examination (012) - limit of 2 services, per person/year

$40

Yearly Limits:
$500 per person
$1,000 per family

Bitewing x-ray (022)

$30

Removal of calculus (114) - limit of 2 services, per person/year

$70

Topical application of remineralising agent (121) - limit of 2 services per year

$25

Removal of tooth (311)

$90

Filling: 1 surface metallic (511)

$63

Filling: 3 surface metallic (513)

$109

Filling: 1 surface adhesive restoration (531)

$80

Filling: 3 surface adhesive restoration (533)

$115

Major Dental -12 month waiting period

Removal of wisdom teeth requiring removal of bone (323)

$120

Yearly Limits:
$500 per person
$1,000 per family

Major Dental limit available for removal of wisdom teeth only.

Removal of wisdom teeth requiring removal of bone and tooth division (324)

$150

Crown - veneered (615)

N/A

Dentures - upper and lower (719)

N/A

Orthodontia Treatment - 24 month waiting period

Orthodontia - Year 3

N/A

Orthodontia - Year 4

N/A

Orthodontia - Year 5+

N/A

Optical

Service Benefit (up to $) Yearly Limits

6 month waiting period

Frames

$100

Yearly Limits:
$165 per person
$330 per family

Single vision lens - pair

$95

Bifocal lens - pair

$95

Multifocal lens - pair

$95

Contact lenses - rigid or soft

$165

Contact lenses - disposable

$165

Complementary Therapies

Service Benefit (up to $) Yearly Limits

2 month waiting period

Acupuncture

$32

Yearly Limits:
$200 per person, $400
per family

Benefits are for consultation only. No benefits for remedies, medicines or food preparation.

Alexander Technique

$32

Aromatherapy

$32

Bowen Therapy

$32

Chinese Herbal Medicine Consultations

$32

Feldenkrais Method

$32

Homeopathy

$32

Kinesiology

$32

Myotherapy

$32

Naturopathy

$32

Reflexology

$32

Remedial Massage

$32

Shiatsu

$32

Western Herbal Medicine Consultations

$32

Body & Mind Therapies

Service Benefit (up to $) Yearly Limits

2 month waiting period

Chiropractic & Osteopathy - 1-4 visits

$40

Yearly Limits:
$300 per person
$600 per family

Chiropractic & Osteopathy - 5+ visits

$32

Chiropractic & Osteopathy - group therapy

$20

Physiotherapy - 1-4 visits

$40

Combined limit - see Chiropractic

Physiotherapy - 5+ visits

$32

Physiotherapy - group therapy/class therapy

$20

Exercise Physiology - 1-4 visits

$40

Combined limit - see Chiropractic

Exercise Physiology - 5+ visits

$32

Exercise Physiology - group therapy

$20

Speech therapy - 1-4 visits

N/A

Speech therapy - 5+ visits

N/A

Podiatry - 1-4 visits

N/A

Podiatry - 5+ visits

N/A

Dietitian - 1-4 visits

N/A

Dietitian - 5+ visits

N/A

Psychology consultation

N/A

Psychology assessment

N/A

Healthy Lifestyle

Service Benefit (up to $) Yearly Limits

6 month waiting period

Weight management

75%

Yearly Limits:
$150 per person
$300 per family

For more information on programs and how to claim, click here.

Gym membership

75%

Pilates

75%

Yoga

75%

Disease management subscriptions / memberships

75%

Health screening services / prevention screening

75%

National Healthy Eating Activity and Lifestyle (HEAL) program

75%

Medical Health

Service Benefit (up to $) Yearly Limits

2 month waiting period

Pharmaceuticals (non PBS requiring prescription by law)

$60

Yearly Limits:
$400 per person
$800 per family

Medical Appliances

Service Benefit (up to $) Yearly Limits

12 month waiting period

Purchase of CPAP machine or accessories

N/A

Artificial Aids

Service Benefit (up to $) Yearly Limits

2 month waiting period

Blood pressure monitor (purchase)

N/A

Blood glucose monitor

N/A

Compression garments (includes $130 sub-limit for surgical stockings)

N/A

Wigs - chemotherapy / alopecia

N/A

Hearing Aids

Service Benefit (up to $) Yearly Limits

12 month waiting period

Hearing aids

N/A

Restricted services

We pay the Minimum Benefits for restricted services – including the minimum default benefit rate for a shared room as is set out by the government and for government-approved Prosthesis List items.

So if you decide to be looked after:

  • In a private hospital – you’ll be out-of-pocket, as the benefits we pay won’t cover all the hospital costs
  • In a public hospital as a private patient – you could still have out-pf-pocket expenses to pay, if the minimum benefit is less than what your hospital charges.

Either way, the hospital should let you know about any out-of-pocket expenses you’ll need to pay. This is called informed financial consent.


Excluded services
These are the services that you aren’t covered for – so if you use any of them, you’ll have out-of-pocket expenses.


Excess
You won’t need to pay an excess with StarterPak.


Waiting Periods
Like all health funds, we have a waiting period between when you take out your cover and when you can access the benefits of that cover.

Waiting periods apply to:

  • Members taking our health insurance for the first time
  • Current Teachers Health members who upgrade to a higher level of cover, or reduce their cover or excess
  • Members who come over to Teachers Health from another health fund who haven’t finished the waiting periods – or are transferring to higher cover.

If you’ve cancelled your membership with another health fund, you’ll need to join us within 60 days to keep up your cover.

Hospital Waiting Periods

Pre-existing conditions* 12 months
Pregnancy & birth related services 9 months
Psychiatric, rehabilitations & 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 of which, in the opinion of the Fund Medical Advisor or other relevant medical practitioner appointed by Teachers Health, existed at any time during the six months before taking out private health insurance or transferring to a higher level of cover. This rule applies to new members to private health insurance and existing members who are upgrading their level of cover. If you are a new member to private health insurance you will have to wait 12 months before you can receive benefits for items or services related to a pre-existing condition. If you change to a higher level of cover, you may have to wait 12 months to receive benefits, including benefits for services not previously covered. A 12 month waiting period applies to all pre-existing conditions except pregnancy & birth related services, which is a 9 month waiting period and psychiatric, palliative care and rehabilitation, which is a two month waiting period.


Extras Waiting Periods

Orthodontia 24 months
Wheelchair purchase 24 months
Major dental, medical appliances 12 months
Optical, healthy lifestyle 6 months
All other services 2 months
Emergency ambulance transport 1 day


Make sure you claim with a recognised provider

We can only pay benefits if you’ve taken up the service through a provider who’s recognised by Teachers Health at the time. To find out if your provider’s one of them, just call us on 1300 727 538.

Frequently Asked Questions