Basic Hospital Basic +
Start with the basics
If you’re looking for a more affordable option, but want to be able to choose your doctor, Basic Hospital could work for you. You’ll be able to go to a private hospital for a few services, and a public hospital for many more (on restricted cover). The Basic Hospital excess is $300.
Scope of cover
What you need to know about restricted services, waiting periods and choosing an excess.
Here’s an overview of what we’ll pay for and what you’ll have to pay for if going to hospital for treatment for a service that’s restricted. Note that scheduling of treatment will be up to the treating specialist and/or hospital.
In a public hospital:
- We pay – accommodation in a shared room (as long as the hospital doesn’t charge above the default rate set out by the Federal Government), and medical costs.
- You pay – any excess (if applicable), and any gap if your hospital charges above the default rate.
In a private hospital:
- We pay – accommodation in a shared room (at the default rate set out by the Federal Government), and medical costs.
- You pay – any excess (if applicable) and the balance of accommodation costs, plus any theatre costs. This could be costly, so ensure the hospital provides you with the potential costs upfront.
You should make sure you have a breakdown of all out-of-pocket costs you’ll need to pay before agreeing to treatment. This is called informed financial consent.
To keep health insurance fair for everyone, you may need to wait for a while before you can claim.
This can happen if you:
- are new to private health insurance
- upgrade your cover to include things that weren’t covered before
- upgrade your cover when you join from another health fund.
If you’re switching to Teachers Health from another fund, join us within 60 days to avoid re-serving any applicable waiting periods.
Standard waiting periods:
|Pre-existing conditions*||12 months|
|Pregnancy & birth related services||9 months|
|Psychiatric, rehabilitation and palliative care||2 months|
|All other hospital services||2 months|
|Emergency ambulance transport||1 day|
|Non-emergency ambulance transport||1 day|
The excess is an agreed amount that you pay directly to the hospital on your admission. You’ll only pay the total excess once per person, per calendar year (if you claim on your Hospital cover that year).
*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.