Compare Hospital cover
| Comprehensive Cover | Mid Cover | Basic Cover | |
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| Service | Top HospitalPrivate Hospital Saver | Mid Hospital | Basic Hospital |
| Private Hospital (Agreement Private Hospital and same day surgeries) | |||
| Choice of Agreement Private Hospital |  |
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| Accommodation – shared and private room (when available) | |
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| Theatre fees, intensive care fees | |
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| Labour ward fees | |
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| Public Hospital | |||
| Shared room | |
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| Private room (where available) | |
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| Theatre fees, intensive care fees | #Charges associated with these services are included in the accomodation charge that is paid by Teachers Health Fund. | #Charges associated with these services are included in the accomodation charge that is paid by Teachers Health Fund. | #Charges associated with these services are included in the accomodation charge that is paid by Teachers Health Fund. |
| Labour ward fees | #Charges associated with these services are included in the accomodation charge that is paid by Teachers Health Fund. | #Charges associated with these services are included in the accomodation charge that is paid by Teachers Health Fund. | #Charges associated with these services are included in the accomodation charge that is paid by Teachers Health Fund. |
| Medical services |
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| Choice of doctor | |
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| 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 |
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| Government approved surgically implanted prosthesesSome prostheses may have out-of-pocket expenses. Please call us on 1300 728 188 for more information. | |
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| Private Hospital services |
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| Removal of wisdom teeth | LimitedDental surgeon fees do not attract benefits under Hospital cover. Benefits are payable from relevant Extras cover. Please contact us for details. | LimitedDental surgeon fees do not attract benefits under Hospital cover. Benefits are payable from relevant Extras cover. Please contact us for details. | LimitedDental surgeon fees do not attract benefits under Hospital cover. Benefits are payable from relevant Extras cover. Please contact us for details. |
| 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. | 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 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. | 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. | 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 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. | 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. | 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. | 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. | 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. | 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. | 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 benefits These 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. | |
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| 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 | ||
| Other |
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| Excess | Top Hospital: $0 | $300 or $500 per person/per calendar year This excess (depending on level of cover chosen) is payable upon admission to a pulic and private hospital. This excess is paid once per person, per calendar year to a maximum of twice per membership, for couple, single parent and family memberships. |
$300 per person/per calendar year This excess (depending on level of cover chosen) is payable upon admission to a pulic and private hospital. This excess is paid once per person, per calendar year to a maximum of twice per membership, for couple, single parent and family memberships. |
| Private Hospital Saver: $300 or $500 per person/per calendar year Excess will be waived for any children under the age of 21. This excess (depending on level of cover chosen) is payable upon admission to a private hospital. This excess is paid once per person, per calendar year to a maximum of twice per membership, for couple, single parent and family 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. |
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| 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. | |
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Waiting periods
| Hospital waiting periods | |
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| 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 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. |
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.