Working in education and seeking private health insurance? You might want to consider Teachers Health Fund's range of policy options.
Established in 1954 by the NSW Teachers Federation, this industry-based fund now offers a range of affordable health insurance products exclusively to those who are a current or former member of an education union and their immediate family members.
- What are the main features of Teachers Health Fund policies?
- Are there any additional benefits from becoming a member?
- What will Teachers Health Fund not pay a benefit for?
- What factors can affect my health insurance premium?
- How does excess work?
- How do I submit a claim to Teachers Health Fund?
- Benefit amounts you can expect for specific treatments
- Answers to questions that may not have been covered
Teachers Health Fund offers health insurance designed to suit everyone, from the budget conscious to those who want the highest level of cover available. Currently you can choose from:
- Hospital cover. Teachers Health Fund offers three levels of hospital insurance which are Top Hospital, Mid Hospital and Basic Hospital.
- Extras cover. Teachers Health Fund offers three types of extras insurance which are Top Extras, Essential Extras and Emergency Ambulance Cover.
- Combined cover. The StarterPak hospital and extras policy is designed specifically for young people, offering cover for vital services at an affordable price. Additionally, you are free to mix and match any hospital and extras cover to tailor a policy that suits your insurance needs and price point.
Now that you have a general idea of what is offered by Teachers Health Fund, you may want to know more about what each policy offers. Simply select the type of health insurance you are interested in to view the features and services included.
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 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.
Members of Teachers Health Fund are also able to take advantage of the following extra 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.
- Other discounts. Members can also access discounts from health providers including Voice Care for Teachers, AOK Health and Jenny Craig.
- Discounted travel insurance. A range of travel insurance products are available for fund members at discounted rates.
If you are 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.
- Procedures that Medicare does not pay a benefit for.
- If the claims is more than two years old.
- The provider is not recognised by Teachers Health Fund.
- Hospital or general treatment received overseas.
- Hospital expenses such as telephone charges or TV hire.
- Pharmaceuticals not covered by your hospital.
- Ambulance transport between hospitals.
- Ambulance transport for a patient requiring day treatment.
- Non-government approved surgically implanted prostheses.
- Ambulance transport to and from a nursing home.
- If the claimant is also receiving damages from a third party.
- For services received free of charge.
- Any period during which your membership is suspended.
- Have not served a relevant waiting period.
- If no official receipt can be provided.
- If the claimant was treated by a relative.
- For services that were not provided face-to-face.
- The level of cover you choose. Top tier policies will cost more than ones that only offer a basic level of cover.
- Standalone or combined cover. Hospital or extras only policies will be cheaper than a combined hospital and extras policy.
- If you opt for an excess. The excess amount you choose will influence the cost of your premiums.
- Your age when you take out cover. Taking out cover before your 31st birthday will avoid the Lifetime Health Cover loading.
- Your income level. This can affect your eligibility for a private health insurance rebate.
- If you are a single parent. Single parent pricing is available on some Teachers Health Fund products.
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. The payment of this lump sum will result in your premium rate being reduced.
Depending on the hospital cover option you choose from Teachers Health Fund, you can take advantage of a choice of excesses:
- Top Hospital cover lets you choose an excess between $0, $300 or $500 per calendar year.
- Mid Hospital cover offers a choice between $300 or $500 per calendar year.
- Basic Hospital cover offers an excess limit of $300 per calendar year.
Making a claim with Teachers Health Fund is a simple process:
- Extras cover claims. On-the-spot electronic claiming is offered by many providers for extras cover claims. 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.
- Hospital cover claims. 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. Payments can be made online or over the phone using credit card, debit card and BPAY.
Get the Teachers Health Fund claims app
Teachers Health Fund
The dollar amount you receive will depend on the type of medical service you claim for. The seriousness of the condition and the complexity of the procedures required to treat it will determine the corresponding benefit amount.
For example, if a claim is successful Teachers Health Fund will pay a benefit payment of $2,563 for knee reconstruction surgery, 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||$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 a 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|
|Tonsil and adenoid removal||$295.70||$513.90|
|Uncomplicated delivery of a baby||$693.95||$1,484.50|
Will I be covered if I'm treated at my doctor's clinic?
No, only procedures performed in a day surgery or hospital will be covered by Teachers Health Fund. Services received from your doctor 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.