TUH Health Fund

Discover which TUH Health Fund policy is best for you with this handy guide.

Founded in 1972 by the Queensland Teachers’ Union, TUH Health Fund provides affordable healthcare for teachers in Queensland. Covering all current and former union members and their families Australia-wide, the not-for-profit fund ensures premiums are returned to members in the form of improved benefits. In the last year alone, TUH returned 90% to its members.

What are the different levels of cover?

TUH offers:

• Hospital Only health cover. Budget, Advantage No Pregnancy, Family and Total Care.
• Extras Only health cover. Basic, Mid Range, Healthy Options (60%), Family and Comprehensive.
• Hospital & Extras packages. Young Choice, Easy Choice and Ultimate Choice.

What do these options cover?

The following summarises what each level of cover includes:

Hospital Only cover

• Budget Hospital. Medically necessary treatment (restrictions and exclusions apply), accommodation, theatre fees, intensive care, cardiac care, industry approved prostheses and hospital medication in almost all private hospitals in Australia. There’s a $500 excess per adult on the policy.
• Advantage No Pregnancy. Includes cover for brain and brain-related, cataracts, chemo and radiotherapy for cancer, cochlear implants, related admissions and replacements, dialysis for chronic kidney disease, digestive system & endoscopies, eye lens, glaucoma and macular degeneration, heart and heart-related, insulin pumps, related admissions and replacements, joint investigations & reconstructions, joint replacements and revisions, medically necessary plastic and reconstructive surgery, palliative care, psychiatric services (restricted benefit), rehabilitation, robotic surgery, spinal surgery and related admissions, sterility reversals, stroke, surgery by a podiatrist, tonsils, grommets and adenoids, and all other in-hospital services where a Medicare benefit is payable. There’s a $400 excess per adult on the policy.
• Family. Includes cover for all the benefits as Advantage No Pregnancy, with the exception of cataracts. Additionally, the Family policy covers congenital defects and conditions, infertility investigations, assisted reproductive services, labour ward, newborn/neonatal care and pregnancy and birth-related costs. There’s a $400 excess per adult on the policy.
• Total Care Hospital. Total Care covers all of the benefits covered by the other Family, with no restrictions placed on psychiatric services and additional cover for cataracts and gastric banding and bariatric/obesity-related surgery (incl. reversal). There’s a $0 excess per adult on the policy.

Extras Only cover

• Basic Extras. Affordable, no-frills cover including general dental and selected therapies (chiropractic, physiotherapy, homeopathy, massage therapy, naturopathy and osteopathy).
• Mid Range Extras. Mid range cover including general and major dental, orthodontics, optical and other therapies, plus a Health & Wellness benefit (provides up to 80% on health screenings and access to health management programs for a specific chronic health or medical condition up to overall annual limit).
• Healthy Options (60%) Extras. Tailored to young singles and couples for general and major dental, orthodontics, optical and other therapies, plus a Health & Wellness benefit (provides up to 60% on health screenings and access to health management programs up to overall annual limit).
• Family Extras. General and preventive dental cover with no annual limit plus a Health & Wellness benefit (provides up to 80% on health screenings and access to health management programs).
• Comprehensive Extras. Cover for services with higher benefits including dental, orthodontics, optical, physiotherapy, massage, podiatry, health appliances and more. Plus a Health & Wellness benefit (provides up to 80% on health screenings and access to health management programs) and a bonus to spend on extras out-of-pocket expenses when combined with any Total Care Hospital cover. Annual limits increase with years of membership.

Hospital & Extras packages

• Young Choice. Budget hospital and basic extras cover with a $250 excess per adult.
• Easy Choice. Mid range hospital cover and a wide range of extras including dental and optical, plus other health care services such as physiotherapy, acupuncture and massage. Includes a bonus of $75 for singles or $150 for families to put towards your extras out-of-pocket expenses, with an excess of $300.
• Ultimate Choice. Top hospital cover with no excess to pay and the highest and most comprehensive level of extras. Includes unlimited general dental, major dental (high benefit), optical, physiotherapy and other therapies, plus a bonus of $125 for singles and $250 for families towards extras out-of-pocket expenses. Limits increase with years of membership for selected services.

What other benefits are available?

As a not-for-profit health fund, TUH provides value for money wherever possible for its members. The range of additional benefits includes:

• No excess for dependants
• An Active Health Bonus for extras on some products
• Access Gap Scheme
• Health management programs with some products
• A travel benefit for regional members to access healthcare on selected covers
• Discounts at OPSM, OPSM Direct, Laubman & Pank and Budget Eyewear
• Brisbane Health Hub offering members dental, optical and allied health services
• Cardiac and cardiac-related treatments covered in all hospital products
• A $100 EFTPOS gift card if you refer a friend or family member who joins TUH

What are the waiting periods and other limitations?

Waiting periods apply to both Hospital and Extras cover and can be summarised as follows:

Hospital cover

• No waiting period. Accidents.
• 2 months. All hospital and general services (unless otherwise specified), palliative care, psychiatric services, rehabilitation and home care programs.
• 6 months. Disease management programs.
• 12 months. Obstetrics (pregnancy and birth-related treatment) and pre-existing conditions (excluding palliative care, psychiatric services and rehabilitation).

Extras cover

• 2 months. All extras services (unless otherwise specified)
• 6 months. Active Health bonus (for Comprehensive Extras when combined with any Total Care Hospital cover), optical (for Family Extras, Mid Range Extras and Healthy Options 60% Extras) and midwifery services (outpatient).
• 12 months. Hearing aids, major dental, orthodontia, prostheses (non-implanted, custom made), orthotics and mechanical/health appliances.

Other limitations include maximum amounts payable per service, excesses on some services and exclusions on services where a benefit will not be paid (eg, cosmetic surgery).

What types of costs are covered?

Other costs you may incur include any gap between the fee charged for a service and the amount covered by Medicare and TUH, unless you have Access Gap Cover. You’ll also have to pay the fee portion not covered by Medicare for out-of-hospital services such as GP visits.

Depending on your level of cover, costs that are covered by TUH include ambulance, in-hospital services and fees for treatment as a private patient in a public or private hospital.

How to make a claim

There are two separate processes for claiming on your TUH Hospital and Extras cover:

Hospital claims

If you receive a hospital account, send it to TUH with a completed claim form via one of the following methods:

• Email onlineclaims@tuh.com.au with copies of accounts/receipts attached.
• Upload to the TUH smart phone app with photos of accounts/receipts.
• Snail mail to TUH, PO Box 265, Fortitude Valley Q 4006, with the original accounts/receipts enclosed.

Extras claims

You can claim your Extras benefits in any of the following ways:

• Electronically. If your healthcare provider has an electronic terminal such as HICAPS or Health Point, simply swipe your membership card and your claim will be processed on the spot.
• Online. Log in to Member Services on the TUH website and follow the instructions to submit your claim (no need to include receipts).
• Smartphone app. Upload photos of your receipts and other documents and instantly submit them via the TUH smartphone app.
• Manually. Download, print out and complete a claim form and submit it manually with copies of your receipts via email or post.

In both instances, once received and processed, your claim will be paid directly into your bank account allowing up to two weeks for postage and processing.