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?

As a result of the recent private health insurance reforms introduced by the government this year, Teachers Health have made some changes to their hospital cover. Their policies now include the required classifications: basic, bronze, silver and gold.

  • Basic Hospital (Basic Plus). With a $300 excess, this plan is for the young and healthy with an emphasis on low costs. It pays for your accommodation in a shared room in a private or public hospital with restrictions on most services. It covers you for services like dental surgery, hernia and appendix, joint reconstructions and tonsils, adenoids and grommets.
  • Mid Hospital (Basic Plus). Another basic policy, this also includes all the services required for a basic policy plus some more things. Ideal for healthy singles, couples and those on a budget, it pays towards the important things but doesn't include any major hospital cover services. There are no exclusions but many restrictions, meaning you will still have out of pocket expenses. It provides restricted cover for services including heart and vascular, pregnancy and birth and more. This policy comes with a choice of excess: $300 or $500.
  • Mid Classic (Silver Plus): Fairly comprehensive silver cover that still aims to keep costs low, this is good for families on a budget as well as young singles and couples. It does not include pregnancy and birth services, so is ideal for couples not planning on starting a family soon and completed families. Services include heart and vascular, diabetes management, sleep studies and more. You can choose between a $300 and $500 excess. You are able to get a private room in a private hospital, where available, as well as your own choice of doctor and access to gap cover.
  • Top Hospital (Gold). A very comprehensive plan that covers all 38 clinical categories as required for a gold rating. It provides comprehensive cover of all Medicare services, including pregnancy, so is suitable for couples looking to start a family as well as families wanting to have more children. With cover for heart procedures, hip or knee joint replacements, weight loss surgery and more, this policy also includes cover for labour ward fees. You can get private rooms and private hospital treatments for all Medicare procedures.

Hospital Cover Inclusions:

ServiceBasic HospitalMid HospitalMid ClassicTop Hospital
Back, neck and spine
Bone, joint and muscle
Brain and nervous systemRestricted
Breast surgery (medically necessary)Restricted
Chemotherapy, radiotherapy and immunotherapy for cancerRestricted

Dental surgeryRestricted
Diabetes management (excluding insulin pump)Restricted
Digestive systemRestricted
Ear, nose and throatRestricted
Eye (not cataracts)Restricted
Gastrointestinal endoscopyRestricted
Hernia and appendixRestricted
Implantation of hearing devicesRestricted
Insulin pumps
Joint reconstructionsRestricted
Kidney and bladderRestricted
Male reproductive systemRestricted
Miscarriage and termination of pregnancyRestricted
Pain managementRestricted
Pain management with deviceRestricted
Plastic and reconstructive surgery (medically needed)Restricted
Podiatric surgery (provided by a registered podiatric surgeon - limited benefits)Restricted
Sleep studiesRestricted
Tonsils, adenoids and grommetsRestricted
Assisted reproductive servicesRestrictedRestricted
Dialysis for chronic kidney failureRestrictedRestricted
Heart and vascular systemRestrictedRestricted
Hospital psychiatric servicesRestrictedRestricted
Joint replacementsRestrictedRestricted
Lung and chestRestrictedRestricted
Palliative careRestrictedRestricted
Pregnancy and birthRestrictedRestricted
Weight loss surgeryRestrictedRestricted

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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