StarterPak

Our StarterPak combined cover is designed to suit young people who want value for money health insurance, but don’t want to pay for services that they may not use. It offers outstanding value and coverage for a range of Hospital and Extras services.

We've included a list of the most commonly claimed items. Call us on 1300 727 538 to check if you're covered for an item number that is not listed below. 

Hospital Cover

Private Hospital (Agreement private hospital and same day surgeries)

Choice of Agreement private hospital

Only 5 services are covered in a private hospital on this cover. Please see “private Hospital services” below for details

Accommodation – shared and private room (when available)

Only 5 services are covered in a private hospital on this cover. Please see “private Hospital services” below for details

Theatre fees, intensive care fees

Only 5 services are covered in a private hospital on this cover. Please see “private Hospital services” below for details

Labour ward fees

Private Hospital Services

Removal of tonsils and adenoids

Knee and shoulder investigations and reconstructions

Appendicitis treatment

Hernias

Removal of wisdom teeth

Dental surgeon fees do not attract benefits under Hospital cover. Benefits are payable from relevant Extras cover. Please contact us for details.

Pregnancy & birth related services

Infertility treatments

Hip, knee, shoulder & ankle replacements

Coronary care & cardiothoracic surgery

Dialysis procedures & treatments

Major eye & eye lens surgery

Glaucoma and excimer laser eye surgery are excluded
Restricted

Bariatric surgery

Restricted

Sterilisation & reversal of sterilisation

Psychiatric, rehabilitation & palliative care

Restricted

All other services where Medicare pays a benefit

Hip and knee are excluded
Restricted

Services that do not attract a Medicare benefit

Medical services

Choice of doctor

Access Gap Cover

Access Gap Cover (AGC) is a billing scheme that aims to reduce or eliminate out-of-pocket expenses to members for doctor and specialist services received in hospital. Doctors may choose to participate in AGC on a patient by patient basis, so you should discuss this with your doctor.

Government approved surgically implanted prostheses

Some prostheses may have out-of-pocket expenses. Please call us on 1300 727 538 for more information.

Public Hospital

Shared room

Private room (where available)

Only for services listed as covered under Private Hospital Services

Theatre fees, intensive care fees

Charges associated with these services are included in the accommodation charge that is paid by Teachers Health Fund

Labour ward fees

Other

Excess

Non-emergency Ambulance

Non-emergency ambulance is all ambulance services provided by a state government ambulance service or a private ambulance service recognised by Teachers Health Fund, other than those defined under emergency ambulance transport and not including inter-hospital transfers. Examples of services payable include: call out or attendance fee where no transport occurs and admission or discharge between hospital and home where transport is deemed medically necessary. Non-emergency ambulance transport deemed medically necessary must be supported by a letter from the treating doctor explaining the medical requirement for ambulance transport.

Emergency Ambulance Transport

Emergency Ambulance means an ambulance service that consists of transporting a seriously ill person to the nearest hospital by a State Government Ambulance Service or by a private ambulance service recognised by Teachers Health Fund in order to receive urgently needed treatment. This includes transportation from the scene of an accident or the scene of a medical event such as a heart attack or stroke, but does not include transportation to hospital for the routine management of an ongoing medical condition or transportation between Hospitals.

Exemption from Medicare levy surcharge

The Medicare Levy Surcharge is an additional 1.0%-1.5% surcharge of taxable income imposed on higher income earners who are eligible for Medicare but do not have private hospital cover. If the surcharge applies to you, your Medicare Levy increase from 2%, which is what most Australians pay, to 3.0%-3.5% of your taxable income.

Extras Cover

Dental

Service Benefit (up to $)

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)

$170

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 $)

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 $)

2 month waiting period

Acupuncture

$32

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

Remedial Massage

$32

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

Shiatsu

$32

Western Herbal Medicine Consultations

$32

Body & Mind Therapies

Service Benefit (up to $)

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

$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 $)

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 $)

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 $)

12 month waiting period

CPAP machine (purchase)

N/A

Artificial Aids

Service Benefit (up to $)

2 month waiting period

Blood pressure monitor (purchase)

N/A

Blood glucose monitor

N/A

Compression garments~

N/A

Wigs - chemotherapy / alopecia

N/A

Hearing Aids

Service Benefit (up to $)

12 month waiting period

Hearing aids

N/A

Restricted services

You are only covered at the rate of a shared room in a public hospital for services that are restricted while in a private hospital. If you attend a private hospital for these services you will have significant out-of-pocket expenses.

Excluded services

You will not receive benefits for pregnancy and birth related services, infertility treatments, joint replacement, coronary care and cardiothoracic surgery, dialysis procedures and treatment, glaucoma and eximer laser eye surgery, cosmetic surgery, sterilisation or reversal of sterilisation.

Excess

There is no excess payable on StarterPak.

Waiting Periods

A waiting period is the time you need to wait after taking out your cover before you can receive benefits for those services or items and apply to:

  • new members to private health insurance
  • existing Teachers Health Fund members who upgrade to a higher level of cover or reduce their level of excess
  • members who transfer from another health fund who have not already completed the required waiting periods, or who are transferring to a higher level of cover
If you have cancelled your health insurance membership with another health fund, you need to join Teachers Health Fund within 60 days to make sure you receive continuity of 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 Fund, 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.

^Teachers Heath Fund pays a benefit towards non-PBS prescriptions only medication supplied to treat a medical condition. You pay a co-payment equal to the current non-concessional PBS co-payment amount. Benefit is not payable for contraceptive prescribed in the absence of a medical condition. Evidence of this is required once per 12 months. No benefit for erectile dysfunction medication.


Extras Waiting Periods

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


Recognised Providers

Benefits are only paid where the provider of the service or product is recognised by Teachers Health Fund at the time the service is received or the product is purchased. To check if your provider is recognised by Teachers Health Fund please call 1300 727 538.

Frequently Asked Questions