Benefit Changes 2016
Why have you reduced some benefits on dental?
After reviewing all of our dental benefits and feedback from an external independent dental review, we have realigned a number of benefits to ensure that the majority of members receive more value on their extras cover whilst ensuring our benefits continue to remain appropriate and competitive.
We have increased the benefit on numerous regularly used services such as a scale and clean and fillings and invested approximately $2 million to improve our dental benefits. To help cover the cost of improving these benefits, we've decreased the benefit paid on a small number of less frequently used benefits.
When are the changes effective?
For increasing dental benefits, the change is effective for all services received on or after 1 April 2016.
For decreasing dental benefits, the change is effective for all services received on or after 1 May 2016.
What happens if I've received these services prior to 1 April (or 1 May for dental decreases) but haven't claimed them yet, will I receive the lower benefit?
All services are assessed based on the date of service. If you are claiming for a service received prior to 1 April 2016 (or 1 May for dental decreases), the benefits will be paid based on what was applicable at the date of service.
Major Dental on Essential Extras
From 1 April 2016, THF will pay benefits for Major Dental on Essential Extras up to a limit of $300 per person per calendar year.
Will I have to serve an additional waiting periods for the new major dental limit?
If you have had Essential Extras for 12 months or more, you can claim for Major Dental services received from 1 April 2016.
If you have had Essential Extras for less than 12 months, you will need to wait until you have had that cover for 12 months before you can claim on Major Dental.
All new members who take out Essential Extras on or after 1 April 2016 will need to serve a 12 month waiting period before they are eligible to claim for those services.
Removal of Family Limits
When are these changes effective?
Family limits will be removed from all Essential Extras services and Top Extras Healthy Lifestyle and Ambulance services from 1 April 2016.
What does this mean for me?
For most services, the current family limit is double the per person limit. This means if there are more than 2 people on your policy, not everyone will be able to claim up to the full per person limit when a family limit applies.
By removing the family limits on Essential Extras and Top Extras, everyone on a policy will be able to claim up to their individual per person limit regardless of claims made by other family members.
Artificial Limbs and Eyes benefits
What are the new benefits?
From 1 April 2016 Teachers Health Fund will pay a benefit of 75% up to a maximum of $1,000 per calendar year for artificial limbs and eyes for members with Top Extras cover. The benefit will be paid from the existing Artificial Aids limit.
Is there a new limit where these benefits will be paid from?
Artificial limbs and eyes will each have an overall limit of $1,000 per person per calendar year. The $1,000 is a sublimit of the overall calendar limit for Aids and Appliances which is $1,200 per person per calendar year.
What do I need to do to make a claim for an artificial eye or limb?
Any claim for an artificial eye or limb must be supported by an Aids and Appliances Supporting Documentation form completed by your specialist.
Where possible you must use any available government benefits before submitting a claim to Teachers Health Fund for the remaining cost.
Teachers Health Fund is unable to pay benefits for a member who is entitled to compensation from another party eg WorkCover.
We are replacing the lifetime limit from our wheelchair benefit with a 5 year limit. This means that members can receive a benefit if they need to update their wheelchair after 5 years.
Is the benefit/limit changing?
The benefit remains at 50% up to $1900 (a sublimit applies for manual wheelchairs). The only thing changing is that the overall limit of $1900 can be claimed once every five years, rather than once in a lifetime.
What if I've already claimed for a wheelchair?
If you had reached your lifetime limit prior to 1 April 2016, you will be able to make a claim for new purchases made on or after 1 April 2016. Once you reach your limit you won't be able to claim again until 5 years after the limit has been reached.
Can I claim for any purchases made prior to 1 April 2016?
The new five year limit only applies to claims for new purchases made on or after 1 April 2016. Unfortunately we cannot apply the new limit to purchases made prior to 1 April 2016.