Going to Hospital

Being admitted to hospital is something that most of us will experience at least once in our lifetime and for many people it can be a stressful and confusing time. We are committed to ensuring that you don’t have to worry about hospital costs or whether you are covered for certain procedures, allowing you to focus on getting better as quickly as possible.

Our Hospital Guide is designed to help you better understand the benefits available to you based on the level of Hospital cover you have or are considering.

Understand your cover

  • What type of procedure you will be receiving?
  • What is your level of Hospital Cover?
  • Will you be covered?
  • Do you have an excess?
  • Have you served all waiting periods?

Get a Quote

  • Get a quote from your doctor, specialist or other medical service provider involved in your hospitalisation to avoid unexpected costs.
  • Ask your treating doctor or specialist if they will participate in the Access Gap Cover (AGC), 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 option with your doctor to potentially reduce or eliminate any out-of-pocket expenses.
  • Contact Teachers Health Fund to confirm what you will be covered for.

Check if your Hospital has an Agreement with Teachers Health Fund

Teachers Health Fund has agreements with a network of private hospitals and day surgeries in Australia which outline hospital charges for accommodation, theatre, labour ward, coronary care and intensive care. It is important that you check if your hospital has an agreement with Teachers Health Fund so that you can avoid significant out-of-pocket expenses.

Determine the Benefits Available

Ask your doctor or specialist for an Informed Financial Consent document so that you can fully understand the overall costs and any potential out-of-pocket expenses. Please contact us to confirm what benefits you will be entitled to and discuss any excess you may be required to pay on admission to hospital.

Claiming Benefits

Hospital bills will be sent directly to Teachers Health Fund for payment. If your doctor/specialist has participated in the Access Gap Cover scheme, the bill should be sent directly to Teachers Health Fund for payment. If your doctor/specialist has not participated in the Access Gap Cover scheme, you should take any doctor/specialist bills you receive to Medicare to receive any benefits that are payable.

Refer to the Making a Claim section for more information.