Do you work for a university or a higher education institution? Discover if UniHealth is the fund for you.
Restricted health funds are exclusive health insurance providers that are typically run as not-for-profit organisations for the benefit of their members. Because the health funds are restricted, it often means more similarities between members, which can help restricted funds offer more focused products to deliver better value for money. This guide goes through the different UniHealth cover types available and looks at how it compares to other health funds and the fine print to consider before signing up.
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Who can join?
Eligibility requirements
Higher education institutions
Universities
TAFEs
RTOs
Eligible staff members
Lecturers
Tutors
Management
Support
Administration staff
Maintenance workers
Anyone else working in a higher education institution
Eligible family members
Spouses and partners
Any immediate family member
Not a university, TAFE or RTO employee but still work in education? You and your family may be eligible to join Teachers Health. UniHealth is an offshoot of Teachers Health, which is built on 60 years of health expertise, with a more specialised focus in order to deliver more benefits to its members.
What are the key features of UniHealth policies?
Comprehensive ambulance cover with all policies. It’s generally unusual to find a health fund that includes cover for non-emergency ambulance services in its hospital policies, especially at its most basic level of cover. UniHealth includes a $3,000 annual limit for non-emergency ambulance services and unlimited cover for emergency ambulance services.
Full private room cover. You will receive cover for private hospital accommodation when available for all eligible in-hospital procedures. For restricted procedures you can still get covered for a private room in a public hospital. Many other health funds will only cover a shared room in a public hospital.
No outright excluded treatments. The services covered by the Basic Hospital policy are similar to what you’ll find with many other health funds, but it doesn’t outright exclude cover for any specific procedures. Although out-of-pocket costs may be incurred as a private patient (regardless of whether you’re in a public or private hospital) it still gives you more flexibility if you do need any of those procedures.
What policies does UniHealth offer?
You can take out either hospital or extras cover alone. If you want both, you can also take out both hospital and extras, either by picking your own cover level for each or picking the package option:
Hospital. Covers you for Medicare services in private hospitals and delivers other benefits. The three levels of hospital cover are Basic, Mid and Top.
Extras. Covers a range of ancillary health services that aren’t covered by Medicare, like dental work, optical, physiotherapy and many other out-of-hospital health services. The two levels of extras cover are Essential and Top.
Package. UniHealth has a single package option known as the StarterPak, designed for those who want basic value-for-money cover for more commonly used services.
What’s covered by each level of hospital cover?
Covered in private hospitals
Minimally covered in private hospitals, largely covered as a private patient in a public hospital
Not covered
Treatments and features
Basic Hospital
Mid Hospital
Top Hospital
Excess options
$300
$300 or $500
$0, $250 or $500
Access Gap Cover
Yes
Yes
Yes
Choice of doctor
Yes
Yes
Yes
Private room where available
Yes
Yes
Yes
Emergency ambulance transport
Yes
Yes
Yes
Non-emergency ambulance transport
Yes
Yes
Yes
Tonsil and adenoid removal
Partial
Yes
Yes
Knee and shoulder investigation and reconstruction
Knee and shoulder investigations and reconstructions
Yes
Appendicitis
Yes
Hernias
Yes
Wisdom teeth removal
Yes
Pregnancy and birth-related services
No
Infertility treatments
No
Hip and knee replacements
No
Shoulder and ankle replacements
Partial
Coronary care and cardiothoracic surgery
No
Dialysis
No
Major eye and lens surgery
Partial
Bariatric surgery
Partial
Sterilisation and reversals
No
Psychiatric, rehabilitation and palliative care
Partial
Extras services
Benefit amounts
General dental (specifics below)
$500 per person per year, $1,000 per family per year
Oral examinations
$40
Bitewing X-rays
$30
Calculus removal
$70
Remineralising agents
$25
Tooth removal
$90
Metallic fillings
$69 for a single filling, up to $109 for multiple
Surface adhesive restorations
$80 for a single restoration, up to $115 for multiple
Major dental (specifics below)
$500 per person per year, $1,000 per family per year
Wisdom teeth removal requiring removal of bone
$120
Wisdom teeth removal requiring removal of bone and tooth division
$150
Veneered crown
Not covered
Upper and lower dentures
Not covered
Orthodontics
Not covered
Other extras (specifics below)
Chiropractic, osteopathy, physiotherapy and exercise physiology have a combined benefit of $300 per person per year, $600 per family per year
Optical
Yes
Chiropractic
Yes
Osteopathy
Yes
Exercise physiology
Yes
Speech therapy
No
Podiatry
No
Psychology
No
Dietician
No
How many members does UniHealth service?
Along with Teachers Health, UniHealth provides health insurance policies to over 290,000 people. This gives Teachers Health a market share of 2.2%.
Is UniHealth nonprofit?
Yes.
Does UniHealth get many complaints?
Teachers Health, the not-for-profit fund that runs UniHealth accounts for:
2.2% of the Australian health insurance market
2.2% of all complaints about benefit payments
1.2% of all complaints about service
0.9% of all complaints that require investigation
Source: Private Health Insurance Ombudsman, State of the Health Fund Report 2016
How many hospital agreements does UniHealth have in my state and in total?
There are two important factors that determine the benefit your health fund pays for hospital services:
The level of hospital cover you purchase
Whether your health fund has an agreement with the hospital where you are treated
The table below details the number of hospital agreements Teachers Health (UniHealth’s parent fund) has in place across each Australian state and territory. You can check this figure against the industry maximum for all health funds to see how UniHealth compares.
Private hospital agreements
Day hospital agreements
NSW
97 (industry maximum: 101)
90 (industry maximum: 96)
ACT
6 (industry maximum: 7)
7 (industry maximum: 9)
VIC
78 (industry maximum: 84)
75 (industry maximum: 75)
QLD
53 (industry maximum: 57)
45 (industry maximum: 51)
SA
26 (industry maximum: 29)
25 (industry maximum: 27)
WA
21 (industry maximum: 23)
23 (industry maximum: 26)
TAS
6 (industry maximum: 8)
3 (industry maximum: 5)
NT
2 (industry maximum: 2)
1 (industry maximum: 1)
Are there any additional benefits to being a member?
Access Gap Cover. All UniHealth policies include Access Gap Cover. This billing scheme helps reduce your out-of-pocket expenses for hospital treatments with participating doctors.
QBE home and car insurance discounts. Members receive a multi-policy discount with QBE home and car insurance.
Allianz Global Assistance travel insurance discounts. They also get 10% off Allianz Global Assistance travel insurance
New family program. Practical information and support for early parenting matters.
Rehabilitation at home. Professional rehabilitation services in the comfort and privacy of your own home.
Weight loss and management. Assistance in reaching and then maintaining your weight goals.
Chronic disease management. Professional, evidence-based support and assistance for a range of chronic diseases.
Diabetes management. Assistance for members with diabetes or pre-diabetes.
Residential care support. Receive assistance in making well-informed decisions on residential aged care facilities.
Hospital care at home. Early discharge and hospital care in your own home to help reduce the chance of hospital-acquired infections and to get home sooner.
Paying your UniHealth premiums
Premiums for your UniHealth health insurance policy can be paid using the following methods:
BPAY. Contact your bank and quote UniHealth’s BPAY reference number (266155) and your BPAY member reference number.
Phone. You can make an over-the-phone credit card payment by calling 1300 345 876, or (02) 8072 9282 if calling from a mobile phone or from overseas.
Credit card. You can log into your UniHealth account and pay your premium by credit card through the UniHealth Online Member Services area.
Direct debit. You can also set up a direct debit from your nominated bank account or credit card for premiums to be automatically paid at your desired frequency.
Premiums can be paid fortnightly, monthly, quarterly, half-yearly or yearly.
How do I lodge a UniHealth claim?
There are several ways you can lodge a health insurance extras claim with UniHealth:
On the spot. Simply swipe your UniHealth membership card on the spot when you visit your health care provider to claim your benefit instantly.
Via mobile app. The UniHealth member app makes it easy to submit extras claims by uploading a photo of your receipt. The app is available for Apple and Android devices.
Online. You can lodge a claim for the following extras services through the UniHealth Online Member Services area: Acupuncture, chiropractic, complementary therapies, remedial massage, optical, physiotherapy and podiatry.
By mail. You can download a claim form from the UniHealth website. Once the form has been completed, you can send it along with your invoice or receipt to UniHealth, GPO Box 9812, Sydney NSW 2001.
In person. Completed claim forms and invoices or receipts can be lodged in person at a Member Care Centre located at a Teachers Health Centre.
Via email. Finally, you can also send your completed claim form and invoice via email to submitclaim@teachershealth.com.au
If you receive a bill for hospital services from your doctor or specialist:
If the doctor or specialist participates in UniHealth’s Access Gap Cover scheme, the bill will be sent directly to UniHealth
If the doctor or specialist does not participate in the Access Gap Cover scheme, you will need to take the bill to Medicare for processing before UniHealth can pay a benefit.
More useful information about UniHealth
A restricted service offers you a lot more options than an outright excluded service. For example, if you’ve taken out a Basic Hospital policy with UniHealth and you need knee surgery, you can receive time and cost estimates for how long you will have to wait and how much it will cost you to have the surgery done either under Medicare as a public patient or as a partially-covered private patient in a public or private hospital.
In many cases, you might be able to get a considerable portion of the costs covered for a restricted treatment as a private patient in a public hospital.
With restricted treatments, you’re in a position to consider all of the available treatment options, balancing the out-of-pocket costs and the benefits of each. If the treatment was simply excluded rather than restricted, as it typically is with most basic hospital policies, you’d have no choice but to get it done as a public patient or pay potentially extreme out-of-pocket costs as a private patient.
In general, the Basic Hospital policy delivers a higher level of cover than you might find with many equivalent basic policies, while the Top Hospital policy is generally equivalent to most comprehensive hospital policies, but at a more competitive price. And don’t forget about the exclusive UniHealth bonuses.
The Mid Hospital policy is also noteworthy. With a $500 excess option and private hospital cover for a practical range of services, it could be a suitable choice for people who want more than the Basic cover but don’t feel the need to get the full range of services included in the Top cover.
UniHealth’s set dental benefits are fairly generous compared to other health funds and the benefits are the same for all general, and even some major, dental treatments under both the Essential and the Top Extras plans. Essential Extras is a suitable option for people who want cost-effective access to major dental cover, especially compared to the many health funds that won’t offer any major dental cover under a basic extras policy.
Most of the benefits are prescribed as a set amount that is reimbursed, which varies depending on the type of service you receive. This means you can receive exceptionally cost-effective ancillary health services even with the most basic extras policy. For example, you might only be a few dollars out of pocket for a chiropractic visit. By contrast, a more typical basic extras policy might see you paying a flat 40-50% of the cost out-of-pocket.
The services covered by Essential Extras are limited and may not be as varied as many other providers. However, it’s worth noting that Essential Extras does cover useful services that are not always available at a basic cover level, including non-PBS pharmaceuticals and healthy living benefits. This means you may be able to get cover for the cost of non-PBS prescription medications, gym memberships, weight management programs, pilates and yoga classes, disease management programs and health screening services.
You are not covered for orthodontics with the Essential Extras policy or the StarterPak combined package, but the Top Extras policy does include a lifetime orthodontics limit that grows over time. This is typical of most health insurance providers. A lifetime limit is the most you can ever claim under that policy, in contrast to the usual annual limits.
When you first join, there is a 24-month waiting period for orthodontics. However, once your cover begins in the third year, you will receive a $1,500 lifetime limit. This limit grows by $500 each year, up to $2,500 in the fifth year. For example, you might be able to claim $1,500 on orthodontics in your third year of cover and then a further $1,000 in the fifth year of your cover. Between these two claims, you will have used up the $2,500 lifetime limit. Note that the growing limit only applies to years of continuous cover.
The lower benefit amount is for wisdom teeth removal that requires the removal of bone alone. The higher benefit amount is for wisdom teeth removal that requires the removal of bone and tooth division. The latter procedure is more intensive and may be more likely to require anaesthetic or incur other costs. As such, higher benefits are payable.
Although costs can vary widely between different dentists (and depending on the situation), the $240 benefit payable towards this procedure should typically be enough to cover most of the costs of this procedure.
Switching is generally as easy as signing up with a new provider and leaving your old policy behind. The health funds are able to handle the transfer of information between themselves and you can access the appropriate cover right away, depending on the applicable waiting periods.
If you the policy you switch to includes equivalent cover for the same services as your previous policy, any waiting periods already served will be recognised.
The excess is an amount payable if you are admitted to hospital. It generally needs to be paid directly to the hospital. By picking a higher excess, you can get lower premiums, but you may have larger out-of-pocket expenses in the event of hospitalisation.
The excess payable per year is limited, although these limits can vary between health funds. With UniHealth, the excess is payable up to once per year for a singles policy and up to twice per year for couples and family policies.
The excess you choose is entirely your choice. Generally, however, someone who has no reason to expect hospitalisation in the near future might favour a higher excess and lower premiums, while someone who is more likely to experience serious health issues may want to opt for no-excess hospital cover. As such, it can be useful to look for a policy that offers a range of different excess options.
Yes. All hospital and extras products from UniHealth include emergency ambulance cover, while a standalone Emergency Ambulance policy is also offered.
Yes. Dental cover is included in all UniHealth extras policies and the StarterPak combined policy.
Yes. Optical cover is included in all UniHealth extras policies and the StarterPak combined policy.
Yes. Physio cover is included in all UniHealth extras policies and the StarterPak combined policy.
Yes. Yes. Cover for chiropractic services is included in all UniHealth extras policies and the StarterPak combined policy.
Yes. Pharmacy cover is included in all UniHealth extras policies and the StarterPak combined policy.
Yes. Natural therapies cover is included in all UniHealth extras policies and the StarterPak combined policy.
Yes. Acupuncture cover is included in all UniHealth extras policies and the StarterPak combined policy.
Yes. Cover for psychology is included in the UniHealth Top Extras policy.
Yes. Preventative cover is included in the Healthy Lifestyle Benefits offered by all UniHealth extras policies and the StarterPak combined policy. These benefits help cover the cost of weight management programs, gym membership, pilates, yoga, disease management memberships and health screening services.
Yes. Cover for hearing aids is included in the UniHealth Top Extras policy.
No. UniHealth does not offer any overseas student health cover (OSHC) policies for international students.
No. UniHealth does not offer any OVHC policies for overseas visitors.
Are you looking for health cover but can’t decide which policy to choose? This article can help you take a look at the health insurance options available with ahm and help you decide whether any of its policies are right for you.
Health Partners offers three levels of standalone hospital and extras cover to suit different budgets and cover needs, as well as options designed for different life stages.
CUA Health Insurance offers private health cover options to suit people with a range of budgets and cover requirements. Its policies are designed to be both comprehensive and easy to understand.
CBHS offers private health insurance to present and former employees of the CBA Group and their families. It offers a wide range of cover options to provide everything from basic cover to comprehensive protection.
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