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CoreElect

CoreElect is an intermediate level of Hospital and Extras cover, designed for those who don’t think they need comprehensive cover, but want to be covered for more than just the basics.

Hospital cover

Public and Private Hospitals (Agreement Private Hospital and same day surgeries)
Choice of Agreement Private Hospital
Accommodation – shared and private room (when available in a private hospital)
Theatre fees
Intensive care fees
Labour ward fees (only in a public hospital)Cover for pregnancy & birth related services is restricted. You are only covered for these services in a shared room of a public hospital. Charges associated with labour ward fees are included in the accommodation charge that is paid by Teachers Health Fund.If you choose to go to a private hospital for pregnancy & birth related services you will have significant out-of-pocket expenses.
Medical services
Choice of doctor
Access Gap CoverAccess Gap Cover (AGC) is a billing scheme that aims to reduce or eliminate
out-of-pocket expenses to members for doctor and specialist services received in hospital. Doctors may choose to participate in AGC on a patient by patient basis, so you should discuss this with your doctor.
More about AGC
Government approved surgically implanted prosthesesSome prostheses may have out-of-pocket expenses. Please call us on 1300 728 188 for more information.
Other
Excess $300 or $500 per person/per calendar yearYou will be required to pay an excess of $300 or $500 (depending on level of cover chosen) when admitted to a private or public hospital. This excess is paid once per person, per calendar year to a maximum of twice per membership, for couple, family and single parent memberships.
Emergency Ambulance transportEmergency Ambulance means an ambulance service that consists of transporting a seriously ill person to the nearest hospital by a State Government Ambulance Service or by a private ambulance service recognised by Teachers Health Fund in order to receive urgently needed treatment. This includes transportation from the scene of an accident or the scene of a medical event such as a heart attack or stroke, but does not include transportation to hospital for the routine management of an ongoing medical condition or transportation between Hospitals.
Exemption from Medicare Levy SurchargeThe Medicare Levy Surcharge is an additional 1% surcharge of taxable income imposed on higher income earners who are eligible for Medicare but do not have private Hospital cover. If the surcharge applies to you, your Medicare Levy increases from 1.5%, that is paid by most Australian tax payers, to 2.5% of your taxable income.
Services Private Hospital Public HospitalThese services are covered in a shared room of a public hospital. If you choose to go to a private hospital for any of these services you may be significantly out-of-pocket.
Whilst you can still choose your own doctor, you will not be able to avoid public hospital waiting lists for these services.
Pregnancy & birth related services RestrictedYou are only covered for a rate of a shared room of a public hospital for services that are restricted whilst in a private hospital. There are no benefits payable towards theatre and labour ward fees.
Infertility investigations & treatments RestrictedYou are only covered for a rate of a shared room of a public hospital for services that are restricted whilst in a private hospital. There are no benefits payable towards theatre and labour ward fees.
Hip, knee, shoulder & ankle replacements RestrictedYou are only covered for a rate of a shared room of a public hospital for services that are restricted whilst in a private hospital. There are no benefits payable towards theatre and labour ward fees.
Coronary care & cardiothoracic procedures RestrictedYou are only covered for a rate of a shared room of a public hospital for services that are restricted whilst in a private hospital. There are no benefits payable towards theatre and labour ward fees.
Dialysis procedures & treatments RestrictedYou are only covered for a rate of a shared room of a public hospital for services that are restricted whilst in a private hospital. There are no benefits payable towards theatre and labour ward fees.
Major eye & eye lens surgery RestrictedYou are only covered for a rate of a shared room of a public hospital for services that are restricted whilst in a private hospital. There are no benefits payable towards theatre and labour ward fees.
Bariatric surgery RestrictedYou are only covered for a rate of a shared room of a public hospital for services that are restricted whilst in a private hospital. There are no benefits payable towards theatre and labour ward fees.
Sterilisation & reversal of sterilisation RestrictedYou are only covered for a rate of a shared room of a public hospital for services that are restricted whilst in a private hospital. There are no benefits payable towards theatre and labour ward fees.
Psychiatric, rehabilitation & palliative care RestrictedYou are only covered for a rate of a shared room of a public hospital for services that are restricted whilst in a private hospital. There are no benefits payable towards theatre and labour ward fees.
All other services where Medicare pays a benefitThese services will be listed on the Medicare Benefits Schedule . This is a list of services for which Medicare pays a benefit and the rules that apply to the payment of those benefits. Each service has a fee that has been set by the Federal Government for the purpose of calculating the Medicare benefit payable for that service.
Services that do not attract a Medicare benefitSome services, such as laser eye surgery and cosmetic surgery to enhance appearance, do not attract a benefit from Medicare. Teachers Health Fund will not pay benefits for hospital or medical services where Medicare pays no benefits for the procedure. This will result in significant out-of-pocket expenses, regardless of your level of cover. Not covered

Restricted Services

You are only covered for a rate of a shared room of a public hospital for services that are restricted whilst in a private hospital. There are no benefits payable towards theatre and labour ward fees.

Excess

With CoreElect you will be required to pay an excess of $300 or $500 when admitted to a private or public hospital. This excess is paid once per person, per calendar year to a maximum of twice per membership, for couple, family and single parent memberships.

Waiting periods

Hospital waiting periods
Pre-existing conditionsA pre-existing condition is an illness, ailment or condition where the signs or symptoms existed at any time during the six months before taking out private health insurance or transferring to a higher level of cover. This rule applies to new members to private health insurance and existing members who are upgrading their level of cover.If you are a new member to private health insurance you will have to wait 12 months before you can receive benefits for items or services related to a pre-existing condition. If you change to a higher level of cover, you may have to wait 12 months to receive benefits, including benefits for services not previously covered. A 12 month waiting period applies to all pre-existing conditions except pregnancy & birth related services, which is a 9 month waiting period and psychiatric, palliative care and rehabilitation, which is a two month waiting period. 12 months
Pregnancy & birth related services 9 months
Psychiatric, rehabilitation & palliative care 2 months
All other hospital services 2 months
Emergency Ambulance transport 1 day

A waiting period is a period of time you need to wait after taking out your cover before you can receive benefits for services or items covered. Benefits are not payable for services or items received during the waiting period.

Waiting periods apply to:

  • New members to private health insurance.
  • Existing Teachers Health Fund members who upgrade to a higher level of cover or reduce their level of excess – in this case you will need to serve the relevant waiting period for the higher benefit entitlement.
  • Members who transfer from another health fund who have not already completed the required waiting periods, or who are transferring to a higher level of cover.

Extras cover

Services Benefit  (up to $) Overall limit
Dental
General Dental – 2 month waiting period
Comprehensive oral examination (012) – limit of 2 services per person/year $40

$500 per person
$1,000 per family

Bitewing x-ray (022) $28
Removal of calculus (114) – limit of 2 services per person/year $63
Topical application of remineralising agent (121) – limit of 2 services per person/year $25
Removal of tooth (311) $78
Filling: 1 surface metallic (511) $63
Filling: 3 surface metallic (513) $90
Filling: 1 surface adhesive restoration (531) $74
Filling: 3 surface adhesive restoration (533) $97
Major Dental – 12 month waiting period
Inlays/onlays – tooth coloured – 1 surface (551) $250 Included in Elect Extras – $250 per category per person $500 per category per family
Inlays/onlays – tooth coloured – 2 surfaces (552) $250
Bridge pontic – indirect (642) $250
Crown – veneered (615) $250
Dentures – upper and lower (719) $250
Optical – 6 month waiting period
Frames $90 $165 per person
$330 per family
Single vision lens – pair $95
Bifocal lens – pair $95
Multifocal lens – pair $95
Contact lenses – rigid or soft $165
Contact lenses – disposable $165
Repair of frames $70
Body and Mind Therapies – 2 month waiting period (except 12 month waiting period for psychology)
Chiropractic & Osteopathy – 1-4 visits $40 Included in Elect Extras – $250 per category per person $500 per category per family
Chiropractic & Osteopathy – 5+ visits $32
Chiropractic & Osteopathy – group therapy $20
Physiotherapy – 1-4 visits $40
Physiotherapy – 5+ visits $32
Podiatry – 1-4 visits $40
Podiatry – 5+ visits $32
Psychology consultation $72
Psychology assessment $100
Complementary therapies – 2 month waiting period
Acupuncture $32Benefits are for consultation only. No benefits for remedies, medicines or food preparations. Included in Elect Extras – $250 per category per person $500 per category per family
Remedial massage
Naturopathy
Reflexology
Chinese herbal consultations
Alexander Technique
Aromatherapy
Feldenkrais method
Homeopathy
Kinesiology
Myotherapy
Shiatsu
Western herbal medicine consultation
Healthy lifestyle – 12 month waiting period
Weight managementTo receive benefits towards your weight management program, you must provide a letter from your GP confirming that weight loss will help prevent or ameliorate a specific medical condition. Benefits are only available for recognised programs. There are no benefits available for meal replacement products / food.Programs currently recognised by Teachers Health Fund are:
– Weight Watchers
– GutBusters
– Jenny Craig.
75% $150 per person
$300 per family
Gym membershipTo receive benefits towards your gym membership, you must provide a letter from your GP confirming that attending the gym will help prevent or ameliorate a specific medical condition.
PilatesTo receive benefits towards your Pilates classes, you must provide a letter from your GP confirming that attending Pilates classes will help prevent or ameliorate a specific medical condition.
YogaTo receive benefits towards your yoga classes, you must provide a letter from your GP confirming that yoga classes will help prevent or ameliorate a specific medical condition.
Disease management subscriptions / membershipsWe will pay a benefit towards your annual subscription / membership to organisations of the following conditions:
Asthma
Diabetes
Heart
Arthritis
Coeliac
Crohns
Colostomy / Ileostomy
Health screening services / preventative screeningWe will pay a benefit for the following procedures where there is no benefit claimable from Medicare:
Mammograms (excludes 3D and thermal image mammograms)
Skin cancer screenings / Mole Maps
Bowel cancer tests / scans
Bone mineral density tests
Thin Prep
HEAL – Healthy Eating Activity Lifestyle Program. More
Medical health – 2 month waiting period
Pharmaceuticals (non PBS requiring prescription by law) $60 $400 per person
$800 per family

Elect-ExtrasElect-Extras is an addition to the core Extras services covered under CoreElect. You can elect how you can use your Extras benefits from this range of additional services covered under CoreElect. You can elect how you use your Extras benefits for, this range of additional services.

Elect-Extras services Sub-limit per service Overall limits
Major dental $250 per person $500 per family Single  Family
Physiotherapy Yr 1  $800  $1,600
Chiropractic & Osteopathic Yr 2  $950  $1,900
Podiatry (including orthotics) Yr 3+  $1,100  $2,200
Complementary therapies
Psychology

Extras services not covered in CoreElect

Orthodontic treatment – 24 month waiting period
Benefits are paid once in a lifetime
Orthodontia
Body and Mind Therapies – 2 month waiting period (except 12 month waiting period for psychology)
Exercise physiology
Physiotherapy & exercise physiology – group therapy
Ante or post natal physiotherapy course
Speech therapy
Orthoptist (eye therapist)
Occupational therapy
Audiology consultation
Dietician
Hypnotherapy
Psychology consultation
Medical health – 2 month waiting period
Home nursing
Medical Appliances – 12 month waiting periodThese services/prgrams must be approved by Teachers Health Fund and received as part of a health management program intended to prevent or
ameliorate a specific health condition, with written medical recommendation every 12 months.
Sleep apnoea monitor
Artificial aids – 2 month waiting period
Blood pressure monitor
Blood glucose monitor
Compression garments
Wigs
Allergy cover for mattress and pillow
Crutches – purchase
Crutches and wheelchair – hire
Nebuliser – 1 per calendar year
Surgical corsets/braces/trusses
Surgical shoesSurgical shoes must be custom made by a surgical shoe maker and prescribed by a podiatrist or medical practitioner. Any ‘off-the-shelf’ products are not eligible for a benefit. See more
TENS machine – 1 per calendar year
Wheelchair hire
Wheelchair repair (including batteries)
Hearing aids – 12 month waiting period
Hearing aids
Wheelchair – 24 month waiting period
Wheelchair purchase
Miscellaneous – 2 month waiting period
TravelTravel must be for a serious medical condition where the distance travelled is more than 200km return and the
treatment is not available closer to home. Proof of attendance is required from the treating provider.

If you wish to be covered for any of these services please see Top Extras cover.
 

Recognised providers

Benefits are only paid where the provider of the service or product is recognised by Teachers Health Fund at the time the service is received or the product is purchased.  Please refer to our FAQs section under Benefits for more information.  To check if your provider is recognised by Teachers Health Fund, please contact us on 1300 727 538.

Related Resources

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Your Rebate

All Australian residents, who are entitled to Medicare, are able to claim an income tested rebate on their private health insurance; would you like to apply your rebate?

For individuals earning between $88,001 - $102,000 (or $176,001 - $204,000 for families*).
*For families with children, the thresholds are increased by $1,500 for each child after the first.

How rebate tiers workX

Most Australians with private health insurance currently receive a rebate from the Australian Government to help cover the cost of their premiums. The private health insurance rebate is income tested. The table below details the different rebate amounts and Medicare Levy Surcharge levels.

The rebate applies to hospital, general treatment and ambulance policies. It does not apply to overseas visitors cover. The rebate levels applicable for 1 July 2013 to 30 June 2014 are:

Singles
Families
≤$88,000
≤$176,000
≤$88,001-102,000
≤$176,001-204,000
≤$102,001-136,000
≤$204,001-272,000
≤$136,001
≤$272,001
Rebate
< Age 6530%20%10%0%
Age 65-6935%25%15%0%
Age 70+40%30%20%0%

Single parents and couples (including de facto couples) are subject to family tiers. For families with children, the thresholds are increased by $1,500 for each child after the first. http://www.privatehealth.gov.au/healthinsurance/incentivessurcharges/insurancerebate.htm