Private Hospital Saver
Private Hospital Saver is designed for those who want comprehensive Hospital cover but are willing to reduce their contribution rates by paying an excess of $300 or $500 when admitted to a private hospital.
Private Hospital Saver covers you for the same comprehensive range of services as Top Hospital such as pregnancy, heart procedures and hip and knee joint replacements – giving you the peace of mind needed if the unexpected occurs.
Private Hospital Saver can be taken out on its own or combined with Extras cover.
If you would like to avoid paying an excess when admitted to hospital check out Top 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) | |
| Theatre fees | |
| Intensive care fees | |
| Labour ward fees | |
| 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 |
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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. | |
| Other | |
|---|---|
| Excess (excess is waived for any children under the age of 21) | $300 or $500 per person/per calendar yearYou will be required to pay an excess of $300 or $500 (depending on level of cover) when admitted to a private hospital. This excess is paid once per person, per calendar year to a maximum of twice per membership, for couple 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. | |
| Services | Private Hospital | Public Hospital |
|---|---|---|
| Pregnancy & birth related services | |
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| Infertility investigations & treatments | |
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| Hip, knee & elbow replacements | |
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| Coronary care & cardiothoracic procedures | |
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| Dialysis procedures & treatments | |
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| Cataract & eye lens procedures | |
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| Psychiatric, rehabilitation & palliative care | |
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| All other services where Medicare pays a benefitsThese 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 | |
Excess
With Private Hospital Saver you will be required to pay an excess of $300 or $500 (depending on level of cover) when admitted to a private 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.
