Mid Hospital cover

Mid Hospital is our intermediate hospital product, providing cover for all services covered by Medicare that are not listed as ‘restricted’. Mid Hospital has a choice of excess levels available to lower your contributions.  This level of cover is ideal for those who don’t think they will need comprehensive cover but still want to be covered for more than just the basics.

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.
Removal of tonsils & adenoids
Knee & shoulder investigations & reconstructions
Appendicitis treatment
Hernias
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 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 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.
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 Mid Hospital 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

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.