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Home » Our products » Hospital cover » Top Hospital

Top Hospital

Top Hospital is our most comprehensive Hospital product covering you for a wide range of services such as pregnancy, heart procedures and hip and knee joint replacements – giving you the peace of mind needed if the unexpected was to occur.

In addition to covering your hospital accommodation and theatre expenses at any Agreement Private or public hospital, you can rest assured that you won’t have an excess or co-payment when you are admitted into hospital.

Top Hospital can be taken out on its own or combined with Extras cover. Over 50% of our members currently have Top Hospital and Top Extras.

If you would like to reduce your contribution rates by paying an excess when admitted to hospital check out Private Hospital Saver.

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
Government approved surgically implanted prosthesesSome prostheses may have out-of-pocket expenses. Please call us on 1300 728 188 for more information.
Other
Excess
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.
Private hospital & public hospital services Private Hospital Public Hospital
Pregnancy & birth related services
Infertility investigations & treatments
Hip & knee replacements
Coronary care & cardiothoracic procedures
Dialysis procedures & treatments
Cataract & eye lens procedures
Psychiatric, rehabilitation & palliative care
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.
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

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.

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You

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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