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    StarterPak

    StarterPak is designed specifically for those who are young and healthy, just starting out in health insurance, who want value Hospital and Extras cover, but don’t want to pay top dollar for services they don’t think they will need.

    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 in a private hospital)
    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.
    Services Private Hospital Public Hospital
    Accidents An accident is an injury inflicted as a result of unintentional, unexpected actions or events caused by an external force that requires immediate inpatient hospital treatment by a registered Medical Practitioner or Dentist, but excludes pregnancy.
    If ongoing treatment is required past the initial inpatient admission, this treatment will no longer continue to be classed as an ‘accident’.
    that require immediate attention
    Removal of tonsils & adenoids
    Hernias
    Appendicitis treatment
    Shoulder & knee investigations & reconstructions
    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.
    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.
    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.
    Glaucoma and eximer laser eye surgery Not covered
    Pregnancy & birth related services Not covered
    Infertility investigations & treatments Not covered
    Sterilisation & reversal sterilisation Not covered
    Hip & knee joint replacements Not covered
    Coronary care & cardiothoracic procedures Not covered
    Dialysis procedures & treatments Not covered
    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. 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.
    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.

    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
    Not covered under StarterPak
    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.

    Extras cover

    Service Benefit (up to $) Overall limit
    Dental
    General Dental – 2 month waiting period
    Comprehensive oral examination (012) – limit of 2 services per person/year $40 $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
    Optical – 6 month waiting period
    Frames $90 $165 per person
    $330 per family
    Single vision lens – pair $95
    Bifocal lens – pair $95
    Multifocal lens – pair $95
    Contact lenses – rigid or soft $165
    Contact lenses – disposable $165
    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 $300 per person
    $600 per family
    Chiropractic & Osteopathy – 5+ visits $32
    Chiropractic & Osteopathy – group therapy $20
    Physiotherapy – 1-4 visits $40
    Physiotherapy – 5+ visits $32
    Complementary therapies – 2 month waiting period
    Acupuncture $32Benefits are for consultation only. No benefits for remedies, medicines or food preparations. $200 per person
    $400 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% $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
    HEAL – Healthy Eating Activity Lifestyle Program. More
    Medical health – 2 month waiting period
    Pharmaceuticals (non PBS requiring prescription by law) $60 $400 per person
    $800 per family

    Extras services not covered in StarterPak

    Major Dental – 12 month waiting period
    Inlays/onlays – tooth coloured (551, 552)
    Bridge pontic – indirect (642)
    Crown – veneered (615)
    Dentures – upper and lower (719)
    Orthodontic treatment – 24 month waiting period
    Benefits are paid once in a lifetime
    Orthodontia
    Body and Mind Therapies – 2 month waiting period (except 12 month waiting period for psychology)
    Exercise Physiology
    Physiotherapy & Exercise Physiology – group therapy
    Ante or post natal physiotherapy course
    Speech therapy
    Orthoptist (eye therapist)
    Occupational therapy
    Podiatry
    Audiology consultation
    Dietician
    Hynotherapy
    Psychology consultation
    Medical health – 2 month waiting period
    Home nursing
    Medical Appliances – 12 month waiting periodThese services/prgrams must be approved by Teachers Health Fund and received as part of a health management program intended to prevent or
    ameliorate a specific health condition, with written medical recommendation every 12 months.
    Sleep apnoea monitor
    Artificial aids – 2 month waiting period
    Blood pressure monitor
    Blood glucose monitor
    Compression garments
    Wigs
    Allergy cover for mattress and pillow
    Crutches – purchase
    Crutches – hire
    Nebuliser – 1 per calendar year
    Surgical corsets/braces/trusses
    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. See here. 
    TENS machine – 1 per calendar year
    Wheelchair hire
    Wheelchair repair (including batteries)
    Hearing aids – 12 month waiting period
    Hearing aids
    Wheelchair – 24 month waiting period
    Wheelchair purchase
    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.

     

    If you wish to be covered for any of these services please see Top Extras cover.

     

    Recognised providers

    Benefits are only paid where the provider of the service or product is recognised by Teachers Health Fund at the time the service is received or the product is purchased.  Please refer to our FAQs section under Benefits for more information.  To check if your provider is recognised by Teachers Health Fund, please contact us on 1300 727 538.

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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