See what’s included in Teachers Health combined hospital and extras cover
Teachers Health Fund is dedicated to offering health insurance for teachers and others who work in Australia’s education industry at affordable prices. It was created to do exactly this in 1954 and has succeeded so well that it’s now the largest industry health fund in Australia, and still one of the fastest growing. You can join Teachers Health if you are a current or former member, or associate member, of an eligible education union and a current or former staff member employed by a specified organisation. Membership is also open to family members of these people.
What does the StarterPak combined hospital and extras cover include?
Teachers Health understands the health needs of education workers and offers cost-effective hospital and extras cover that can be combined as needed, as well as a single affordable combined cover option for people who want all-round cover at affordable prices. The StarterPak, as it’s known, is designed to cover young people without any special health needs but who still want affordable and effective all-round cover, and to be eligible for the tax and rebate benefits of private health insurance. It includes both basic-level hospital and extras cover, put together for affordability and usability.
The hospital cover
The package’s hospital cover is designed to let you access agreement private hospitals in the Teachers Health network, for some of the more common procedures. For more intensive and less common procedures you’ll still need to attend public hospitals, as either a private or public patient depending on the procedure, in order to minimise out-of-pocket expenses.
|Private hospital accommodation||For the 5 covered procedures only|
|Public hospital accommodation||Private rooms for the 5 covered procedures only Shared rooms for all procedures|
|Theatre and intensive care fees (private hospital)||For the 5 covered services only|
|Theatre and intensive care fees (public hospital)||Included in accommodation cover where applicable|
|Labour ward fees||Not covered at all in private or public hospitals|
|Choice of doctor||When attending as a private patient, at a public or private hospital, you can choose your own doctor|
|Access Gap Cover||Eliminates or caps your out-of-pocket expenses when getting treated by a participating provider for covered services|
|Government-approved prostheses||Covered up to the government-specified limits. Depending on the prosthesis you choose, it might be 100% covered or there might be a gap|
|Non-emergency ambulance cover||When medically necessary. No cover for inter-hospital transfers|
|Emergency ambulance cover|
|Removal of tonsils and adenoids|
|Knee and shoulder investigations|
|Wisdom teeth removal|
|Pregnancy, fertility and birth related|
|Hip, knee, ankle and shoulder replacements|
|Coronary care and cardiothoracic surgery|
|Major eye and lens surgery||Restricted|
|Psychiatric, rehabilitation and palliative care||Restricted|
|Any non-Medicare services?|
The extras cover
Some of the most important extras are covered under the StarterPak, while a lot of those less likely to be used are foregone in order to keep costs down.
|StarterPak general dental cover||$500 per person, $1,000 per family annual general dental limit|
|Removal of calculus||$70|
|Remineralising agent application||$25|
|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|
|StarterPak major dental cover||$500 per person, $1,000 per family annual major dental limit|
|Wisdom teeth removal requiring removal of bone||$120|
|Wisdom teeth removal requiring removal of bone and tooth division||$150|
|Upper and lower dentures|
|StarterPak optical cover||$165 per person, $330 per family annual optical limit|
|Single vision lens pair||$95|
|Bifocal lens pair||$95|
|Multifocal lens pair||$95|
|Disposable contact lenses||$165|
Physiology and psychology
|Chiropractics||$300 per person, $600 per family annual limit|
Natural and complementary therapies
The StarterPak lets you claim up to $32 per session, and up to $200 a year per person or $400 for families, for all of the following services:
- Remedial massage
- Alexander technique
- Bowen therapy
- Chinese herbal medicine (consultations only)
- Feldenkrais method
- Western herbal medicine (consultations only)
Healthy lifestyle benefits
Programs need to be approved before you can claim them and may need to have been recommended as part of a health management program. You can claim 75% of the cost of each, up to a limit of $150 per person or $300 per family, per year.
- Weight management programs
- Gym memberships
- Disease management subscriptions or memberships
- Health screening and prevention services
- National Healthy Eating Activity and Lifestyle (HEAL) program
Pharmaceuticals, health aids and appliances
You are covered for non-PBS prescription pharmaceuticals for up to $400 per year for singles, or $800 for families. No health aids or appliances are covered under the StarterPak. If you want cover for hearing aids, wheelchairs, wigs for alopecia, blood glucose monitors and similar health aids designed to support ongoing health needs, you may want to consider a more comprehensive standalone extras policy.
Why should I consider a Teachers Health combined plan?
The StarterPak is the only pre-made combined health plan offered by Teachers Health Fund. It is designed to be affordable, but only carries a basic level of cover. If you’re relatively young and healthy, without any specific ongoing health needs, it might be an effective way to get affordable cover, as well as a few other benefits available to members of this health fund. Some of the features worth noting include:
- Non-emergency ambulance cover. This can be difficult to find with many health funds, and may save you the cost of needing to purchase a state ambulance subscription or standalone ambulance cover.
- Limited dental cover, focused on prevention. The dental cover available with this plan is focused largely on prevention rather than treatments. You may not be covered for some of the relatively common major dental procedures offered by other plans, such as root canals, but ideally won’t need them.
- Public-hospital-focused cover. You are only covered for certain procedures at private hospitals, but these are the ones you’re more likely to use. For many of the more intensive procedures you’ll need to use public hospitals and the Medicare system.
- Set extras reimbursement. Instead of only getting reimbursed a percentage of extras costs you can claim a fixed amount back (except for healthy lifestyle benefits). By finding providers that charge within these amounts, you can eliminate out-of-pocket expenses for a range of extras health services.
- Access Gap Cover. A feature worth looking for in hospital cover, Access Gap Cover means the insurer may pay participating doctors and specialists more than the strict Medicare Benefits Schedule amount, with the agreement that prices will be limited and potential out-of-pocket expenses may be capped. This feature can make a significant difference in avoiding out-of-pocket costs, and here is available even with a basic-level plan.
Where needed, you may also be able to access a range of additional support services offered through Teachers Health Fund:
- Rehabilitation at home. Get these important services in the comfort and privacy of your own home.
- Weight loss and management. Support for achieving personal weight goals.
- Chronic disease management. Evidence-based support from health professionals for the management of ongoing health conditions, including a focused diabetes management program and an asthma management program.
- Residential care support. Assistance with informed decision-making to help find the right residential aged-care facility.
With the StarterPak combined health policy, Teachers Health Fund members can also access a range of other discounts to make staying in shape even easier, including:
- AOK. 15% off health, fitness and exercise equipment.
- Jen4Men. Get 25% off the price of new Jen4Men weight-loss program memberships.
- Step Into Life. Group outdoor personal training, with up to three free sessions for members and five friends or family members.
- Great Ideas in Nutrition. Free postage on healthy meals delivered by Great Ideas.
- And more. Whether it’s discounts on DVDs specially designed for teachers, or other health and fitness products and programs, Teachers Health is finding new ways to bring more benefits and savings to members.
What limitations, waiting periods and exclusions should I know about?
As a base-level package policy, the StarterPak is cost-effective but only covers a limited range of treatments. In the event of serious health issues or surgical needs, such as heart surgery, you will still need to use a public hospital as a public patient. The extras cover is similarly focused on essentials only, to keep costs down. You are also not covered for pregnancy or related services at all under this plan, and may still incur significant labour ward fees as a private patient at a public hospital, or fees for services that aren’t covered by Medicare. If you’re planning on starting a family, this package may not suit your needs. Waiting periods also apply:
- 12 months. Pre-existing conditions, major dental.
- 6 months. Optical and healthy lifestyle benefits.
- 2 months. All other hospital and extras services not otherwise specified.
- 1 day. Ambulance cover
How to pay premiums
You can pay your premiums in any one of three ways:
- BPAY. Set up a direct transaction through your bank.
- Phone. Pay with Visa and MasterCard over the phone.
- Online. You can pay premiums online with a credit card.
How to make a claim
Hospital bills should be sent directly to Teachers Health for payment when practitioners participate in the Access Gap Scheme. When they don’t, you can send bills to Medicare for payment. There is no excess with the StarterPak, so you won’t need to worry about paying it under this plan. When you’re claiming extras, you will be able to make claims simply by swiping your membership card when visiting the provider. Otherwise, you can do it online or through the Teachers Health app simply by taking a photo of your receipt and uploading it. Benefits are only paid when visiting providers recognised by Teachers Health Fund at the time the service is provided, and your extras claiming is limited to one patient per provider, per day.