Teachers Health fund

Teachers Health Hospital Cover

Are you a teacher, or related to one? Discover if Teachers Health is right for you.

Teachers Health was established by the NSW Teachers Federation in 1954 to bring cost-effective private healthcare to one of Australia’s most important industries.

Today, it covers more than 290,000 people all around Australia. You can join Teachers Health if you are a current or former member, or associate member, of an eligible education union. You can also join if you are a current or former staff member employed by a specified organisation. Membership is also open to family members of eligible people.

finder.com.au does not currently have access to this health insurance brand. You may wish to compare options available on the health insurance homepage.

What levels of hospital cover are available?

  • Basic. This plan is for the young and healthy and focuses on low costs and on the procedures that they are most likely to use. Private room costs in public hospitals are only covered for the specific procedures highlighted in the basic plan. For other treatments, you will generally be put in a shared room.
  • Mid. This is a flexible plan providing a balance of wide-ranging cover and affordable premiums. All Medicare services will be reimbursed to some extent, but many are restricted with limited benefits payable. You are able to get a private room in a public hospital, where available, for all Medicare procedures instead of just the ones covered under your plan.
  • Top. This is the most popular plan. It provides comprehensive cover of all Medicare services, including pregnancy, for cost-effective and high quality private hospital healthcare. You can get private rooms and private hospital treatments for all Medicare procedures.
BasicMidTop
Private room public hospital accommodationPrivate room only for covered procedures
  • Yes
  • Yes
Choice of doctor
  • Yes
  • Yes
  • Yes
Access Gap Cover
  • Yes
  • Yes
  • Yes
Non-emergency ambulance
  • Yes
  • Yes
  • Yes
Emergency ambulance
  • Yes
  • Yes
  • Yes
Public hospital theatre and intensive care fees
  • Yes
  • Yes
  • Yes
Private hospital theatre and intensive care feesFor covered procedures onlyFor covered procedures only
  • Yes
Tonsil and adenoid removal
  • Yes
  • Yes
  • Yes
Knee and shoulder investigation and reconstruction
  • Yes
  • Yes
  • Yes
Appendicitis
  • Yes
  • Yes
  • Yes
Hernias
  • Yes
  • Yes
  • Yes
Wisdom teeth removal
  • Yes
  • Yes
  • Yes
Pregnancy and birth-related servicesRestrictedRestricted
  • Yes
Labour ward feesRestrictedRestricted
  • Yes
Infertility treatmentsRestrictedRestricted
  • Yes
Hip, knee, shoulder and ankle replacementsRestrictedRestricted
  • Yes
Cardiothoracic surgery and coronary careRestrictedRestricted
  • Yes
Dialysis treatment and proceduresRestrictedRestricted
  • Yes
Major eye and lens surgeryRestrictedRestricted
  • Yes
Bariatric surgeryRestrictedRestricted
  • Yes
Sterilisation and reversal of sterilisationRestricted
  • Yes
  • Yes
Psychiatric, rehabilitation and palliative careRestrictedRestricted
  • Yes
Approved prostheses
  • Yes
  • Yes
  • Yes
All Medicare servicesRestrictedRestricted
  • Yes
Any non-Medicare services?
  • No
  • No
  • No

What are the extra advantages of Teachers Health Fund?

As a restricted community health fund, Teachers Health reinvests its surplus back into the fund and its services. It’s also Australia’s largest industry-based health fund which means it’s always looking at ways to evolve in order to make sure it can keep meeting the needs of all its members.

  • New family program. Practical information and support for early parenting matters
  • 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
  • Mental wellness support. Access a range of industry-leading organisations for mental wellness support
  • Residential care support. Assistance with informed decision-making to help find the right residential aged care facility
  • AOK. You can get 15% off functional exercise equipment like heart rate monitors, yoga mats, kettlebells and much more from AOK.
  • Jen4Men. You get 25% off the price of any new Jen4Men membership for programs to help you not only lose weight, but keep it off. This program includes meal plans that don’t involve giving up chips, chicken parma, beef pies and the other foods you love.
  • Step Into Life. Members, and up to five other people they choose to bring along, can get three free sessions with Group Outdoor Personal Training in Australia.
  • Great Ideas in Nutrition. You can get free postage when getting healthy meals delivered by this healthy eating specialist.
  • Voice Care for Teachers DVD. Up to 20% of teachers suffer voice problems each year. You can get a 10% discount on the DVD for easier access to information on how to look after your voice.

All Teachers Health plans let you use the Access Gap Scheme to reduce or eliminate out-of-pocket expenses for hospitalisation with participating doctors. Doctors are free to choose whether they want to participate on a patient-by-patient basis, and it’s worth asking whether they will be participating before undergoing treatments.

Teachers Health also focuses on childcare and family planning as evidenced by wide-ranging cover for pregnancy and related costs. With the Basic and Mid plans, you’re covered for giving birth at public hospitals, while the Top plan automatically includes pregnancy and related cover for private hospitals. The Mid plan also includes cover for private hospital sterilisations and reversals, which you can often find only with comprehensive plans.

The pregnancy waiting period with Teachers Health is only 9 months instead of the 12 months usually found with other health funds. For obvious reasons, this is a much more practical number and reflects the real commitment of Teachers Health to its members, instead of to its own bottom line.

With Teachers Health, your ambulance cover also covers callouts even if you did not receive emergency services. For example, you can still get cover when you call an ambulance just to be on the safe side or for things like a broken leg. It also covers medically necessary transport between homes and hospitals, such as in the event of severely limited mobility. However, it does not cover patient transport between hospitals.

What limitations, restrictions and waiting periods are there?

It’s important to be aware of the services that are restricted under the Basic and Mid hospital plans. With these, you are only covered at the rate of a shared room in a public hospital, and you will incur significant out-of-pocket expenses when attending a private hospital for these. However, you can still access public health facilities and choose your own doctor when getting these covered.

Waiting periods also apply as follows:

  • 12 months. Pre-existing conditions (except psychiatric, palliative care and rehabilitations, which are only 2 months)
  • 9 months. Pregnancy and birth-related services
  • 2 months. All other hospital services
  • 1 day. Emergency and non-emergency ambulance services

How to make payments

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 your credit card

How to make claims

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.

Any applicable excess will need to be paid directly to the hospital.

 

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