Looking for a private health fund? Teachers Health may be the right choice
Private Health insurance has two main benefits: covering medical and hospital costs not included under Medicare and giving you the freedom of choice when it comes to doctors and hospitals. If you’re in the market for private health insurance for yourself or your family, you may wish to consider the policy options available from Teachers Health Fund.
Established in 1954 by the NSW Teachers Federation, this industry-based fund now offers its products and services to more than 130,000 Australians. With membership available to anyone working in education and their immediate family members, Teachers Health Fund offers a range of affordable cover options to choose from.
What policies are available?
Teachers Health Fund offers hospital and extras cover options designed to suit everyone from people on a tight budget to those who want the highest level of cover available. You can choose standalone hospital or extras cover or mix and match your cover options to tailor a policy that suits your insurance needs and how much you’re willing to pay.
In terms of hospital cover, Teachers Health Fund offers Top Hospital, Mid Hospital and Basic Hospital. These options can then be paired with your choice of extras cover from Top Extras, Essential Extras and Emergency Ambulance Cover.
Finally, Teachers Health Fund also offers StarterPak, an option especially designed for young people. It offers basic cover at an affordable price, while at the same time excluding a range of services they are unlikely to need.
Teachers Health Fund hospital cover options
- Top Hospital. This comprehensive product is designed to offer complete peace of mind. It covers an extensive range of procedures including pregnancy, heart procedures, joint replacements (including hip and knee), hospital accommodation and theatre expenses. Members get their choice of Agreement private hospital and can choose an excess of $0, $300 or $500.
- Mid Hospital. This mid-level cover option provides cover for all services covered by Medicare that are not restricted. Members get their choice of private hospital, a choice of either $300 or $500 excess and cover for shared and private room accommodation, theatre fees, intensive care fees and their choice of doctor.
- Basic Hospital. Basic Hospital is an entry-level health insurance option that offers your choice of doctor in a public hospital but does not allow you to avoid hospital waiting lists. Designed for young and healthy applicants, it covers essentials like hernias, tonsil removal, appendicitis, and knee and shoulder reconstructions.
Teachers Health Fund extras cover options
- Top Extras. Enjoy generous benefit limits for a wide range of treatments including major dental, optical, psychology, chiropractic, physio, speech therapy, and occupational therapy.
- Essential Extras. This offers affordable cover for a mid-level range of services, including general and preventative dental, physio, optical, podiatry and naturopathy.
Teachers Health Fund hospital and extras option
- StarterPak. Designed for young people and offering a range of essential benefits, this policy excludes a range of treatments and services that members are unlikely to need. It offers cover for your choice of Agreement private hospital and choice of doctor, as well as procedures like hernias, knee reconstructions, appendix removal and tonsil removal.
Teachers Health Fund emergency ambulance options
- Emergency Ambulance. While all Teachers Health Fund hospital cover options include Emergency Ambulance cover, this can also be taken out on its own to cover air ambulance and emergency ambulance transport when you are ill or involved in an accident.
What won’t I be covered for?
Your Teachers Health Fund Health Insurance claim will not be paid if:
- It is for hospital expenses such as telephone charges or TV hire.
- It is for surgically implanted prostheses not on the government approved list.
- It is for pharmaceuticals not covered in the agreement with your hospital.
- It is for ambulance transport between hospitals.
- It is for ambulance transport for a patient requiring day treatment.
- It is for ambulance transport to and from a nursing home.
- Your claim is lodged more than two years after the date of service.
- You have the right to recover costs, for example damages or compensation, from a third party or authority.
- It is for service received free of charge.
- It is for any period during which your membership is suspended.
- You have not served a relevant waiting period.
- You do not provide an official receipt.
- The provider is not recognised by Teachers Health Fund.
- You have been treated by a provider related to you.
- The service you are claiming was not provided face-to-face.
- It is for hospital or general treatment received overseas.
- It is for a procedure where Medicare does not pay a benefit.
How much does cover cost?
The following factors will affect your Teachers Health Fund Health Insurance premium:
- The level of cover you choose. A top-level policy will obviously cost more to fund than one that only offers basic cover.
- Standalone or combined cover. Choosing a single hospital or extras cover option will be cheaper when compared to a combined hospital and extras policy.
- The excess you choose. Some policies, for example Top Hospital Cover offer you three choices of excess: $0, $300 and $500. The excess you choose will influence the cost of your premiums.
- The age when you take out cover. If you’re over the ae of 30, a premium loading may apply under the Lifetime Health Cover scheme.
- Your income level. This can affect your eligibility for a private health insurance rebate.
- If you’re a single parent. Single parent pricing is available on some Teachers Health Fund products.
What excess is charged for claims?
When you are admitted to hospital, the excess is the amount you will have to pay to contribute towards the cost of your private health insurance claim. Depending on the hospital cover option you choose from Teachers Health Fund, you can take advantage of a choice of excesses. For example, Top Hospital Cover lets you choose an excess between $0, $300 and $500, while Mid Hospital Cover offers a choice between $300 and $500. These amounts are the maximum excess you will have to pay per calendar year, and Basic Hospital Cover offers an excess limit of $300 per calendar year.
How can I reduce the cost of my cover?
- Choose a higher excess. This will result in cheaper premiums.
- Choose a lower level of cover. Don’t want to pay top dollar for the highest level of cover? Downgrade to a mid- or entry-level cover option to save money.
- Choose standalone hospital or extras cover. This will be much cheaper than a combined policy.
- Avoid premium loadings. Under the Lifetime Health Cover scheme, you’ll need to pay an additional premium if you sign up for cover after you have turned 30.
How do I claim?
Making a claim with Teachers Health Fund is a simple process. For extras claims, on-the-spot electronic claiming is offered by many providers. All you have to do is swipe your card and then pay any remaining balance not covered by Teachers Health Fund. Where electronic claiming isn’t available you can claim online, via the Teachers Health fund app, or by filling out and submitting a claim form in person, via email or by post.
When it comes to your hospital bills, some hospitals will require you to pay your excess upon admission. The hospital will then, in most cases, send the remained of your bill directly to Teachers Health Fund.
Get the Teachers Health Fund claims app
Teachers Health Fund
I’ve just received services in my doctor’s room – will this be covered?
No, only procedures performed in a day surgery or hospital will be covered by Teachers Health. Services received in your doctor’s room will be covered by Medicare.
What pharmaceuticals are covered by Teachers Health Fund?
Pharmaceuticals that are approved by the Therapeutic Goods Administration but not covered under the Pharmaceutical Benefits Scheme will be covered by Teachers Health Fund.
At what age will my children stop being covered as dependants?
Your children will no longer be considered dependants on your single parent or family policy once they reach their 21st birthday, although student dependants can remain on your policy until their 25th birthday.
How can I join Teachers Health Fund?
You can join Teachers Health online or by downloading and completing an application form.
What payment options are available?
Teachers Health Fund payments can be made online or over the phone. Payment options include credit card, debit card and BPAY.
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Any additional benefits?
Teachers Health Fund members can also enjoy the following benefits:
- Free access to health support programs. These include HealthMeasures, an online tool to help you develop a tailored diet, exercise and healthy lifestyle program.
- Access to Teachers Health Centres. Teachers Health Fund runs specialist centres where members can access discounted optical and dental services.
- Discounted Travel Insurance. A range of travel insurance products are available for fund members at discounted rates.
- Other Discounts. Members can also access discounts from health providers including Voice Care for Teachers, AOK Health and Jenny Craig.
If you’re eligible to become a member of Teachers Health Fund, consider the benefits and features offered by its range of policies. You should also compare these cover options with those from other health insurance providers to ensure that you find the right cover for you and your family.
How are benefit amounts determined?
The dollar amount you receive will depend on the type of medical service you claim for. The process follows a logical path of assessing the seriousness of the condition and subsequent procedures required to treat it, and then allocating a corresponding benefit amount. To use Teachers Health Fund Insurance as an example; A successful claim for knee reconstruction surgery will result in a benefit payment of $2,563, while a claim for varicose vein treatment only merits a payment of $164.
These figures were taken from the Australian Medical Association's 2016 report card on health insurers, and the results of both the Teachers Health Fund and Medicare (MBS) can be viewed in full below. Please note that the Teachers Health Fund is part of the Australian Health Service Alliance (AHSA), and is listed under that organisations name in the table:
|Basal Cell Carcinoma or Squamous Cell Carcinoma removal from nose, eyelid, lip, ear, digit or genetalia||$221.35||$366.10|
|Breast, benign lesion surgical biopsy of excision||$260.05||$356.40|
|Carpal Tunnel Release||$276.80||$440.20|
|Complicated Delivery (of baby)||$1,629.35||$1,855.90|
|Coronary Artery Bypass||$2,200.00||$3,783.30|
|Femoral on Inguinal Hernia||$464.50||$909.70|
|Overnight investigation for sleep apnoea||$588.00||$682.20|
|Tonsils or Tonsils and Adenoid||$295.70||$513.90|
|Uncomplicated Delivery (of baby)||$693.95||$1,484.50|
I recognise most of these funds except for the AHSA, what is that?
The funds represented by the ASHA are:
- ACA Health Benefits Fund
- Australian Unity Health Limited
- CBHS Health Fund Limited
- CUA Health Limited
- Defence Health
- GMF Health
- Budget Direct Health Insurance
- Frank Health Insurance
- GU Health
- HBF Health Ltd
- Health Care Insurance Limited
- Health Insurance Fund of Australia Limited
- Health Partners
- Navy Health
- Peoplecare Health Insurance
- Phoenix Health Fund
- Police Health Limited
- Queensland Country Health Fund Limited
- Reserve Bank Health Society Ltd
- rt health fund
- Teachers Health Fund > UniHealth Insurance
- Teachers Union Health
- The Doctors' Health Fund Pty Ltd
- Transport Health