How can you benefit from taking out cover with UniHealth Insurance?
UniHealth Insurance is a member-owned health fund that provides a range of health insurance cover options to the higher education community. UniHealth is a part of Teachers Health Fund, Australia’s largest industry-based fund with more than 60 years of experience offering health cover.
With a range of products and services tailored to the higher education community and their families, UniHealth is well worth a look if you’re after hospital, extras or combined cover.
UniHealth Insurance cover options and levels of cover
As a mutual organisation owned by its members, UniHealth invests all profits back into the organisation to provide improved products and services to members. It offers the following cover options:
- Top Hospital. This is UniHealth’s most comprehensive hospital product, providing high-level peace of mind for unexpected emergencies and health problems. It covers private and public hospital accommodation, theatre and labour ward fees, doctors’ and specialists’ fees, Access Gap Cover and all hospital services that are covered by Medicare. Emergency ambulance transport and non-emergency medically necessary ambulance transport are also covered and the policy is available with the choice of a nil, $300 or $500 excess.
- Mid Hospital. UniHealth Mid Hospital is an intermediate hospital cover product that provides private hospital cover for all services that Medicare covers that are not listed as restricted. It covers private and public hospital accommodation, theatre and labour ward fees, doctors’ and specialists’ fees, Access Gap Cover and emergency ambulance and non-emergency medically necessary ambulance transport. You also have a choice of excess ($300 or $500) to lower your premiums, but high-cost services such as pregnancy, major eye surgery and hip replacements only receive cover for a shared room in a public hospital.
- Basic Hospital. UniHealth Basic Hospital is the lowest level of hospital cover available from the fund. It provides private hospital cover for your choice of doctor and for the following key services: removal of tonsils and adenoids, knee and shoulder investigations and reconstructions, appendicitis treatment and hernias. Emergency ambulance cover is included but all other services where a Medicare benefit is payable only receive restricted cover. A $300 excess applies.
If you want an extras policy, UniHealth offers two choices:
- Top Extras. This comprehensive policy provides generous benefit limits on a wide range of extras services. It covers general and major dental, orthodontics, optical, chiro, osteo, physio, speech and occupational therapy, psychology, pharmaceuticals, artificial aids and emergency ambulance transport. A range of Healthy Lifestyle benefits are also offered, including cover for gym memberships, weight management programs and health screening services.
- Essential Extras. This entry-level policy provides cover for a range of core, everyday general treatment options. It covers general and major dental, optical, chiro, osteo, physio, podiatry, acupuncture, natural therapies, pharmaceuticals and emergency ambulance transport. A range of Healthy Lifestyle benefits are also offered, including cover for gym memberships, weight management programs and health screening services.
Combined hospital and extras
If you’re after a combined hospital and extras policy there’s the StarterPak. StarterPak covers a range of essential hospital services and procedures (including removal of tonsils and wisdom teeth, knee and shoulder reconstructions and investigations, hernias, appendicitis and accidents that require immediate treatment) but excludes services such as joint replacements, coronary care and pregnancy. It also covers essential extras such as dental, optical, chiro, physio, natural therapies and emergency ambulance.
Finally, UniHealth also provides Emergency Ambulance Cover to cover 100% of the cost of emergency ambulance provided by state government services, including air ambulance. This policy provides up to $6,000 of cover per person per year, or $12,000 of cover for a family. However, transportation between hospitals or transportation to a hospital for the routine management of an ongoing condition is not covered.
General exclusions, waiting periods and excesses
There are specific situations where UniHealth will not pay a benefit. Under hospital cover, no benefit will be paid if:
- No Medicare benefit is payable for the service or procedure
- Your claim is for telephone charges or TV hire while in hospital
- You receive a surgically implanted prosthesis not on the government-approved prostheses list
- Your claim is for pharmaceuticals not covered in the agreement with the hospital
There are also circumstances when your extras claim will not be paid, including:
- If it is lodged more than two years after the service date
- If you have the right to recover costs from a third party or authority
- If you received the service while your membership was unfinanced or suspended
- If you do not provide the official receipt
- If the provider is not recognised by UniHealth Insurance
- If you were treated by a provider related to you
- If the services were not provided face-to-face
- If it is for treatment received or goods purchased overseas
Waiting periods apply to all hospital, extras and combined policies offered by UniHealth. The following waiting periods apply to hospital cover:
- Pre-existing conditions: 12 months
- Pregnancy and birth-related services: 9 months
- Psychiatric, rehabilitation and palliative care: 2 months
- All other hospital services: 2 months
- Emergency ambulance transport: 1 day
- Non-emergency ambulance transport: 1 day
The following waiting periods apply to extras cover:
- Orthodontics: 24 months
- Wheelchair purchase: 24 months
- Major dental, medical appliances: 12 months
- Optical, healthy lifestyle: 6 months
- All other services: 2 months
- Emergency ambulance transport: 1 day
It’s also important to be aware of the excess payable under a hospital cover policy when you are admitted to hospital. The excess is paid once per person per calendar year, up to a maximum of twice per policy for couple and family policies. The excesses payable on UniHealth hospital policies are as follows:
- Top Hospital: $0, $300 or $500
- Mid Hospital: $300 or $500
- Basic Hospital: $300
Are there any additional benefits?
UniHealth members can also take advantage of the following additional benefits:
- Health management programs and services. Members can access a range of programs and services to help them improve their health and wellbeing. These include:
- New family program
- Rehabilitation at home
- Hospital care at home
- Weight loss/management
- Diabetes management
- Chronic disease management
- Mental wellness
- Transitioning from home to residential care
- Health support. UniHealth members can access a wealth of online information and resources to help them better manage their health.
- Teachers Health Centres. UniHealth members are able to access discounted dental, optical and physio treatment at Teachers Health Centres around Australia.
- Insurance. Members can also access a wide range of travel, home and contents, landlord and motor vehicle insurance through Teachers Health.
Making a claim
If your hospital policy includes an excess, you’ll need to pay this amount when you are admitted to hospital. If your doctor’s or specialist’s fees exceed the MBS fee and you need to cover the gap, what you need to do depends on whether or not the doctor participates in UniHealth’s Access Gap Cover scheme. If they do, send the bill to UniHealth. If they don’t, you’ll need to visit Medicare first.
There are four ways you can lodge an extras claim with UniHealth:
- On the spot. Swipe your UniHealth membership card on the spot for instant claims processing.
- Via a mobile app. UniHealth’s mobile claiming app is compatible with Apple and Android smartphones.
- Online. You can claim online by logging into UniHealth’s online member service.
- By completing a claim form. Forms can be submitted via post, email or in person.
Q. Can anyone join UniHealth?
- A. No, membership is restricted to members of the higher education community and their families. Contact UniHealth to determine whether or not you satisfy these criteria.
Q. Is there a cooling-off period?
- A. Yes, you can choose to cancel cover within 30 days of joining the fund and receive a full refund of your premium.
Q How long can my children be included under my health insurance policy for?
- A. UniHealth allows you to cover a child dependant up until they turn 21 and a student dependant up until they turn 25.
Q. How can I change my level of cover?
- A. You can upgrade or downgrade your level of cover at any time by phoning or emailing UniHealth, or logging into the online member service area.