Start with the basics

Are you young, fit and healthy – but want to have some level of hospital cover just in case? Our Basic Hospital cover should tick a few boxes. You’ll be covered for your choice of doctor in a public hospital – but might still need to jump on a waiting list.

Best of all, you won’t be paying higher premiums for services you might not need for a while yet.

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

Removal of wisdom teeth

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

Psychiatric, rehabilitation & palliative care

Restricted

Sterilisation & reversal of sterilisation

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

Emergency Ambulance Transport

Non-emergency Ambulance

Exemption from Medicare levy surcharge

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-of-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.

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,
  • 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 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, 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