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For the well-being of teachers & their families.

How to claim

Claiming with Teachers Health Fund is easy and can be done a number of ways- depending on the claim.

Claiming Extras services

  • With your membership card on the spot
  • Online
  • Complete a claim form
  • On the spot – Fast and convenient

    You can conveniently claim on the spot after you have received your treatment. Simply present your membership card to be swiped and the claim will be processed automatically. You will only be required to pay the balance remaining after the fund benefit has been paid.

    On-the-spot claiming can be done at a vast number of Optometrists, Dentists, Physiotherapists, Podiatrists and many more. Just ask your service provider beforehand or check here.

  • Claiming online – Computer or Smart phone

    Simply log on to your Online Member Services account and enter the details found on your receipt under the ‘claim’ section. Payment of benefits will be transferred into your nominated bank account within 3 business days.

    You can claim the following range of extras services online:

    • Complementary therapies
    • Chiropractic
    • Dental
    • Optical
    • Physiotherapy
    • Podiatry

    You are still required to submit your invoice or receipt within 7 days from the day you submitted the claim. This can be done in the following ways:

    Computer – scan and email, copy and post or fax

    Smart phone – take a photo and send to us via email

    More information about claiming online.

    Make sure you copy, scan or photograph both sides of the invoice or receipt if there are details on both sides. When you send it over to us, be sure to include your full name and online claim number.

  • Complete a claim form

    Complete a claim form, attach your invoice or receipt and submit to us. We will make payment directly into your nominated account.

    Mail

    Teachers Health Fund
    GPO Box 9812
    Sydney NSW 2001

    In person

    at a Member Care Centre

    Email

    claims@teachershealth.com.au

For more information, see the Benefits section of our FAQ

Claiming hospital and doctor/specialist expenses

Sometimes with Hospital or Medical claims it can get a little confusing – especially when Medicare is involved.

We are here to help you every step of the way. You will also find that the staff working with your treating doctor or specialist will provide some guidance to you.

Teachers Health Fund will pay benefits for your treatment when admitted to hospital (depending on your level of Hospital cover), but does not pay for visits to your specialist before or after your hospital stay.

  • Hospital bills

      • If you are required to pay an excess upon admission, you will need to pay this directly to the hospital. You may need to make this payment when you are admitted or the hospital may bill you at a later date– be sure to ask the hospital.
      • Hospitals will usually bill the remainder of your account to Teachers Health Fund directly.

    For treatment in hospital:
    Medicare pays 75% of the Medicare Benefits Schedule and Teachers Health Fund pays 25% of the Medicare Benefits Schedule.

  • Doctor and specialist bills

      • My doctor has participated in the Access Gap Cover scheme Access 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. –  Generally Access Gap Cover bills will be sent from your doctor or specialist directly to Teachers Health Fund for direct payment. If the doctor sends the bill to you, please forward it to us. Please do not take it to Medicare. We will forward your claim to Medicare on your behalf and will pay your doctor or specialist directly.
      • My doctor did not participate in the Access Gap Cover scheme – Please take the bill directly to Medicare. Medicare must process the claim before we can provide any benefit.

    For visits to your specialist before and after you go to hospital:
    Medicare pays 85% of the Medicare Benefits ScheduleThe Medicare Benefits Schedule 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. and you pay the remainder of the account.

Doctors and specialists may charge above the Medicare Benefits Schedule (MBS) fee for a service, which is at their own discretion. This will leave you to pay the ‘gap’ which will be your out-of-pocket expense. The ‘gap’ is the difference between the fees charged by the doctor or specialist and the MBS fee for the service.

Join NowX

Membership Type

You

Tell us a little about yourself to get started:

Tell us a little about yourself and your partner to get started:

Tell us a little about yourself, your partner and family to get started:

Tell us a little about yourself and your family to get started:

Your Cover

Select your desired level of cover:

or

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