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Extras Cover
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** Sub-limits & benefit limits may apply.

Legend

  • Service fully covered for all accommodation and associated costs in an agreement private hospital and all public hospitals.
  • Services not covered.
  • If you go to a private hospital for a restricted service you will only be covered for the rate of a shared room of a public hospital. If you choose to go to a private hospital for these services you will be significantly out-of-pocket. There are no benefits payable towards theatre and labour ward fees. These services are covered in a shared room of a public hospital. Whilst you will be able to choose your own doctor, you will not be able to avoid public hospital waiting lists.

Hospital waiting periods

Pre-existing condition 12 months
Pregnancy & birth related services 9 months
Psychiatric, rehabilitation & palliative care 2 months
All other hospital services 2 months
Emergency Ambulance transport 1 day

Extras waiting periods

General Dental, Body & Mind Therapies, Complementary Therapies, Artificial aids 2 months
Optical, Healthy Lifestyle 6 months
Major Dental, Medical Appliances, Hearing Aids 12 months
Orthodontia, Wheelchair purchase 24 months
Emergency Ambulance transport 1 day

What is a waiting period?

A waiting period is a period of time you need to wait after taking out your cover before you can receive benefits for services or items covered. Benefits are not payable for services received over the course of a waiting period.

Who does a waiting period apply to?

Waiting periods apply to:
- New members to private health insurance.
- Existing Teachers Health members who upgrade to a higher level of cover or reduce their level of excess – in this case you will need to serve the relevant waiting period for the higher benefit entitlement.
- 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.

All health funds have waiting periods.

Pre-existing condition

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
- existing members who are upgrading their level of cover.

A 12 month waiting period applies to all pre-existing conditions except psychiatric, palliative care and rehabilitation, which are covered by the normal two month waiting period.

Emergency ambulance transport

Teachers Health Extras cover provides you with 100% cover for emergency ambulance with state government services (including air ambulance) to the nearest hospital that can provide you with the care you require. This does not include transportation to a hospital for the routine management of an ongoing condition or transportation between hospitals.

Recognised provider

Benefits are only paid for services received by Teachers Health recognised providers who are in a private practice.

Benefit limits

Benefits are limited to one service per patient, per provider, per day. If a provider performs more than one consultation, the treatment that attracts the higher benefit will be paid. Where multiple visits/services are performed on the same day at different times by the same provider, then the visit/service that attracts the higher benefit will be paid.

Increasing limits

Increasing limits are calculated on years of continuous membership of Teachers Health Top Extras cover. Loyalty limits accrued for orthodontia at other health funds can be transferred to your Teachers Health membership when you change funds provided there is no break in cover when transferring. Other loyalty limits are not transferable.

Pharmaceuticals

Pharmaceuticals Benefit Scheme (PBS) pharmaceuticals are subsidised by Medicare and by law are not eligible for health fund benefits. Our Extras covers pay benefits towards non-PBS prescription only medication supplied to treat a medical condition. You pay a co-payment equal to the current non-concessional PBS co-payment amount.

Yearly limits

All per person and per family limits are based on a calendar year from 1 January each year, unless otherwise stated. Family yearly limits are based on a set amount across all members of the family.

Disclaimer & product information

*Note: The level of cover you select may include waiting periods, pre-existing conditions, exclusions, restrictions, limitations and excesses. Please see the Membership Guide for details. All brochures and forms should be read carefully and retained.
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