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Top Extras Essential Extras
Service Benefit
(up to $)
Overall limit Overall limit
Dental
General Dental – 2 month waiting period
Periodic oral examination (012 – limit of 2 services per person/year $40 Unlimited
(unless otherwise stated)
$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) $273 Increasing limits
Inlays/onlays – tooth coloured – 2 surfaces (552) $432 Year 2 $1,100
Bridge pontic – direct (642) $520 Year 3 $1,600
Crown – veneered direct (615) $650 Year 4 $2,100
Dentures – upper and lower (719) $830 Year 5 $2,600
Dentures – upper and lower (719) $830 Year 6+ $2,800
Orthodontial treatment – 24 month waiting period. More information.
Benefits are paid once in a lifetime Increasing limits
Orthodontia – year 3 $1,500 Year 3 $1,500
Orthodontia – year 4 $2,000 Year 4 $2,000
Orthodontia – year 5 $2,500 Year 5+ $2,500
Optical – 6 month waiting period
Frames $90 $250 per person $165 per person
$330 per family
Single vision lens – pair $120
Bifocal lens – pair $135
Multifocal lens – pair $165
Contact lenses – rigid or soft $175
Contact lenses – disposable $175
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 $450 per person
($300 sub-limit for group therapy)
$250 per person
$500 per family
Chiropractic & Osteopathy – 5+ visits $32
Chiropractic & Osteopathy – group therapy $20
Physiotherapy – 1-4 visits $40 $800 per person
($300 sub-limit for group therapy)
$300 per person
$600 per family
Physiotherapy – 5+ visits $32
Exercise Physiology – 1-4 visits $40
Exercise Physiology – 5+ visits $32
Physiotherapy & Exercise Physiology – group therapy $20
Ante or post natal physiotherapy course $78 per confinement
Orthoptist (eye therapist) – initial $40
Orthoptist (eye therapist) – subsequent $32
Speech therapy – 1-4 visits $70 $600 per person
Speech therapy – 5+ visits $40
Occupational therapy – 1-4 visits $70 $500 per person
Occupational therapy – 5+ visits $44
Podiatry – 1-4 visits $40 $400 per person
($60 sub-limit for orthotic repair)
$200 per person
$400 per family
Podiatry – 5+ visits $32
Audiology consultation $45 Unlimited
Dietician – 1-4 visits $60 $400 per person
Dietician – 5+ visits $40
Hypnotherapy $30 $300 per person
Psychology consultation $72 $500 per person
Psychology assessment $100
Complementary therapies – 2 month waiting period
Acupuncture $32 $600 per person $400 per person
$800 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% $200 per person
$400 per family
$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
Medical health – 2 month waiting period
Pharmaceuticals (non PBS requiring prescription by law)Teachers Health Fund pays a benefit towards non-PBS prescription only medication supplied to treat a medical condition.
You pay a co-payment equal to the current non-concessional PBS co-payment amount. Benefit is not payable for
contraceptives prescribed in the absence of a medical condition. Evidence of this is required once per 12 months.
$60 $800 per person (sub-limits apply)$280 sub-limit for erectile dysfunction and vaccines
Home nursing < 6 hours $33 $800 per person
Home nursing > 6 hours $95
Medical Appliances – 12 month waiting period
Sleep apnoea monitor 75% $800
1 monitor every 3 calendar years
Artificial aids – 2 month waiting period
Blood pressure monitor 75% up to $85 $1,200 per person (sub-limits apply)
Blood glucose monitor 75% up to $160
Compression garments 75% up to $400 (includes $130 sub-limit for surgical stockings)
Breast pump 75% up to $150
Wigs 75% up to $350
Allergy cover for mattress and pillow 75% up to $240
Crutches – purchase 75% up to $140
Crutches – hire 75% up to $140
Nebuliser – 1 per calendar year 75% up to $170
Surgical corsets/braces/trusses 75% up to $500
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. http://www.mgfregister.com.au/mgf_register.htm 75% up to $400
TENS machine – 1 per calendar year 75% up to $160
Wheelchair hire 75% up to $140
Wheelchair repair (including batteries) 75% up to $75
Hearing aids – 12 month waiting period
Hearing aids Increasing limitsIncreasing limits are calculated on years of continuous membership of Teachers Health Fund Top Extras cover. Single Pair
Years 1-2 $300 $600
Years 2-5 $600 $1,200
Years 5+ $900 $1,800
Wheelchair – 24 month waiting period
Wheelchair purchase 50% $1,900
(sub-limit applies for a manual wheelchair)
1 wheelchair per person/lifetime
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.
15c/km $400 per person
Emergency Ambulabce transport – 1 day waiting period
Emergency Ambulance transport 100% $6,000 per person
$12,000 per family
$6,000 per person
$12,000 per family

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Your Cover

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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