Basic Hospital

Basic Hospital is our entry level Hospital product that provides cover for your choice of doctor in a public hospital, however you may be placed on a public hospital waiting list for your service.  It is designed specifically for those who are young and healthy and don't want to pay high premiums for services they feel they are unlikely to need in the near future.

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

Cover for pregnancy & birth related services is restricted. You are only covered for these services in a shared room of a public hospital. Charges associated with labour ward fees are included in the accommodation charge that is paid by Teachers Health Fund. If you choose to go to a private hospital for pregnancy & birth related services you will have significant out-of-pocket expenses.
Restricted

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

Restricted

Infertility treatments

Restricted

Hip, knee, shoulder & ankle replacements

Restricted

Coronary care & cardiothoracic surgery

Restricted

Dialysis procedures & treatments

Restricted

Major eye & eye lens surgery

Restricted

Bariatric surgery

Restricted

Sterilisation & reversal of sterilisation

Restricted

Psychiatric, rehabilitation & palliative care

Restricted

All other services where Medicare pays a benefit

These services will be listed on the Medicare Benefits Schedule. This is a list of services for which Medicare pays a benefit and the rules that apply to the payment of those benefits. Each service has a fee that has been set by the Federal Government for the purpose of calculating the Medicare benefit payable for that service
Restricted

Services that do not attract a Medicare benefit

Some services, such as laser eye surgery and cosmetic surgery to enhance appearance, do not attract a benefit from Medicare. Teachers Health Fund will not pay benefits for hospital or medical services where Medicare pays no benefits for the procedure. This will result in significant out-of-pocket expenses, regardless of your level of cover.

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

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

Other

Excess

This excess is payable upon admission to a public and private hospital. This excess is paid once per person, per calendar year to a maximum of twice per membership, for couple, single parent and family memberships.

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.

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.

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.

Frequently Asked Questions