Hospital Cover
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Extras Cover
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From
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Payment
* Based on an Australian Government Rebate of {{quotePanel.value.rebatePercent}}%, {{quotePanel.value.lhcPercent}}% LHC loading, ${{quotePanel.value.excess}} excess for a {{quotePanel.value.coverType}} Extended in {{model.state}}.
Please note that the amount quoted will change on 1 April 2017 due to private health insurance premium increases.
Hospital Cover
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Extras Cover
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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.
| 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 |
| 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 |
| 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. |
| 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. |
| 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. |
| 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. |
| Benefits are only paid for services received by Teachers Health recognised providers who are in a private practice. |
| 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 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 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. |
| 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. |
| *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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* Based on an Australian Government Rebate of {{quotePanel.value.rebatePercent}}%, {{quotePanel.value.lhcPercent}}% LHC loading, ${{quotePanel.value.excess}} excess for a {{quotePanel.value.coverType}} Extended in {{model.state}}.
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