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Home » Understanding Health Insurance » Going to hospital

Going to hospital

Things you should know before you go to hospital

Hospitalisation can be a stressful experience and understanding what you are and are not covered for under your Hospital cover can be confusing.

We aim to simplify your experience and encourage you to read the Hospital Guide to help you better understand the benefits available to you based on the level of Hospital cover you have chosen.

We are just a phone call away and are here to answer any questions you may have.

Please take the time to read through the Hospital Guide.

  • Understand your cover

    • What type of procedure you will be receiving?
    • What is your level of Hospital Cover? Will you be covered?
    • Do you have an excess?
    • Have you served all waiting periods?
  • Get a quote

    • Get a quote from your doctor, specialist or other medical service provider involved in your hospitalisation so there won’t be any unexpected costs.
    • Ask your treating doctor or specialist if they will participate in the 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
      .
    • Contact Teachers Health Fund to double check what you will be covered for.
  • Check your hospital has an agreement with Teachers Health Fund

    Teachers Health Fund has agreements with most Australian private and day hospitals. If your chosen hospital does not have an agreement with us, you will incur significant out of pocket expenses. Check now.

  • Determine the benefits available

    Ask your doctor or specialist for Informed Financial Consent so you understand the overall cost and how much you might be out-of-pocket. Please contact us to confirm what benefits you will be entitled to and discuss any excess you may be required to pay upon admission.

  • Claiming benefits

    • Hospital bills will be sent directly to Teachers Health Fund for payment.
    • Take doctors/specialist bills to Medicare to receive benefits payable. If your doctor/specialist has participated in the Access Gap Cover scheme, the bill should be sent directly to Teachers Health Fund for payment. Find out more.

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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