healthslips.com.au Policy Information

Teachers Health

Top Hospital 500 (Gold) & Top Extras

Restricted Insurer

$854.83 / month

(Before Rebate, Discount & Loading)

Available in SA

You may be entitled to an Australian Government Rebate on the above premium. Your premium may also include a Lifetime Health Cover Loading or an insurer discount. Check with your insurer for details.

This policy covers: Two adults & dependants, including non-student dependants (3 or more people, only 2 of whom are adults).

Children (0 - 17), non-classified* dependant (18 - 20), students (21 - 31) and non-students (21 to 31), as well as persons with a disability who qualify as a child, non-classified* dependant, student and non-student in these age ranges. *Non-classified dependant: A non-classified dependant is a dependent child over the age of 17 and under the age of 21.

Restricted insurer: Membership of this insurer is restricted to education union members and their families

Policy ID: NTF/H2/SART2Y

Source: Private Health Information Statement (PHIS)

Hospital Cover

  • This policy exempts you from the Medicare Levy Surcharge.
  • This policy provides accident cover - check with insurer for details.
  • This policy does not provide benefits for travel or accommodation outside of hospital.
Covered
Restricted Cover
Not Covered
This policy includes cover for
Assisted reproductive services
Back, neck and spine
Blood
Bone, joint and muscle
Brain and nervous system
Breast surgery (medically necessary)
Cataracts
Chemotherapy, radiotherapy and immunotherapy for cancer
Dental surgery
Diabetes management (excluding insulin pumps)
Dialysis for chronic kidney failure
Digestive system
Ear, nose and throat
Eye (not cataracts)
Gastrointestinal endoscopy
Gynaecology
Heart and vascular system
Hernia and appendix
Hospital psychiatric services
Implantation of hearing devices
Insulin pumps
Joint reconstructions
Joint replacements
Kidney and bladder
Lung and chest
Male reproductive system
Miscarriage and termination of pregnancy
Pain management
Pain management with device
Palliative care
Plastic and reconstructive surgery (medically necessary)
Podiatric surgery (provided by a registered podiatric surgeon)
Pregnancy and birth
Rehabilitation
Skin
Sleep studies
Tonsils, adenoids and grommets
Weight loss surgery

The benefits paid for hospital treatment will depend on the type of cover you purchase and whether your fund has an agreement in place with the hospital in which you are treated. See ‘Agreement Hospitals’ on privatehealth.gov.au for which hospitals have arrangements with your insurer – https://privatehealth.gov.au/dynamic/agreementhospitals.

Under this policy, you may have to pay out-of-pocket costs above what you get from Medicare or your private health insurer. Before you go to hospital, you should ask your doctors, hospital and health insurer about any out-of-pocket costs that may apply to you.

The following payments may also apply for hospital admissions

Excess: You will have to pay an excess of $500 per admission. This is limited to a maximum of $500 per person and $1000 per policy per year.

Co-payments: No co-payments

The following waiting periods for hospital admissions apply to new or upgrading members

Waiting periods:

  • 2 months for palliative care, rehabilitation and hospital psychiatric treatments, even if pre-existing
  • 12 months for other pre-existing conditions
  • 9 months for pregnancy and birth (obstetrics)
  • 2 months for all other treatments

Gap Cover

This provider offers 'known gap' or 'no gap' cover for medical bills for this product. The Medical Costs Finder (https://www.health.gov.au/resources/apps-and-tools/medical-costs-finder) lets you find out more about the cost of specialist medical services.

Other features of this hospital cover

If your doctor or specialist participates in our Access Gap Cover scheme, you may be able to reduce or eliminate your out-of-pocket medical costs. In addition, through Teachers Healthcare Services eligible members can connect with dedicated care coordinators to support them with hospital treatment, having a baby, or managing their physical and/or mental health.

Extras Cover

We’ve partnered with a network of optical and dental providers Australia-wide to give members greater access to high quality treatment and exclusive discounts, including 'no gap' offers. See https://www.teachershealth.com.au/members/find-a-provider/member-wellbeing-network/.

This policy includes General treatment (Extras) cover for

Treatment & waiting period (months)
Benefit limits per 12 months unless otherwise stated
Examples of maximum benefits
Acupuncture 2

$600 per person

combined limit for acupuncture, chinese medicine, remedial massage & other services

  • Initial visit: $38
  • Subsequent visit: $38
Ante-natal/Post-natal classes 2

$300 per person

  • Initial visit: $300
Audiology 2

No annual limit

  • Initial visit: $45
  • Subsequent visit: $45
Blood glucose monitors 2

$160 per person

  • Per monitor: $160
Chinese medicine 2

$600 per person

combined limit for acupuncture, chinese medicine, remedial massage & other services

  • Initial visit: $38
  • Subsequent visit: $38
Chiropractic 2

$480 per person

combined limit for chiropractic, osteopathy & other services

sub-limits apply

  • Initial visit: $55
  • Subsequent visit: $40
Dietetics/dietary advice 2

$400 per person

  • Initial visit: $60
  • Subsequent visit: $40
Endodontic* 12

$1,300 per person

combined limit for endodontic & major dental

  • Filling of one root canal: $160
Exercise physiology 2

$800 per person

combined limit for exercise physiology, eye therapy (orthoptics), physiotherapy & other services

  • Initial visit: $55
  • Subsequent visit: $40
Eye therapy (orthoptics) 2

$800 per person

combined limit for exercise physiology, eye therapy (orthoptics), physiotherapy & other services

  • Initial visit: $40
  • Subsequent visit: $35
General dental 2

No annual limit

sub-limits apply

  • Fluoride treatment: $27
  • Scale & clean: $70
  • Periodic oral examination: $40
Health management / Healthy lifestyle 6

$250 per person

sub-limits apply

  • Health management: $250
Hearing aids* 12

$1,200 per person

  • Hearing aid: $600
Home nursing 2

$800 per person

  • Initial visit: $95
  • Subsequent visit: $33
Major dental* 12

$1,300 per person

combined limit for endodontic & major dental

  • Surgical tooth extraction: $135
  • Full crown veneered: $750
Non PBS pharmaceuticals 2

$800 per person

combined limit for non pbs pharmaceuticals & vaccinations

sub-limits apply

  • Per eligible prescription: $60
Occupational therapy 2

$500 per person

sub-limits apply

  • Initial visit: $70
  • Subsequent visit: $44
Optical 6

$260 per person

  • Multi-focal lenses & frames: $260
  • Single vision lenses & frames: $260
Orthodontic* 12

$2,500 per person

$2,500 lifetime limit

  • Braces for upper & lower teeth, including removal plus fitting of retainer: $2500
Orthotics (podiatric orthoses) 2

$200 per person

  • Orthotics supply & fit: $100
Osteopathy 2

$480 per person

combined limit for chiropractic, osteopathy & other services

  • Initial visit: $55
  • Subsequent visit: $40
Physiotherapy 2

$800 per person

combined limit for exercise physiology, eye therapy (orthoptics), physiotherapy & other services

sub-limits apply

  • Initial visit: $55
  • Subsequent visit: $40
Podiatry 2

$400 per person

sub-limits apply

  • Initial visit: $55
  • Subsequent visit: $40
Psychology 2

$600 per person

  • Initial visit: $100
  • Subsequent visit: $72
Remedial massage 2

$600 per person

combined limit for acupuncture, chinese medicine, remedial massage & other services

  • Initial visit: $38
  • Subsequent visit: $38
Speech therapy 2

$600 per person

  • Initial visit: $80
  • Subsequent visit: $45
Vaccinations 2

$800 per person

combined limit for non pbs pharmaceuticals & vaccinations

  • Per service: $60

Acupuncture

Waiting period:  2 months

Benefit limits per 12 months unless otherwise stated

{$600 per person}

{combined limit for acupuncture, chinese medicine, remedial massage & other services}

Examples of maximum benefits

{Initial visit: $38}

{Subsequent visit: $38}

Ante-natal/Post-natal classes

Waiting period:  2 months

Benefit limits per 12 months unless otherwise stated

{$300 per person}

Examples of maximum benefits

{Initial visit: $300}

Audiology

Waiting period:  2 months

Benefit limits per 12 months unless otherwise stated

{No annual limit}

Examples of maximum benefits

{Initial visit: $45}

{Subsequent visit: $45}

Blood glucose monitors

Waiting period:  2 months

Benefit limits per 12 months unless otherwise stated

{$160 per person}

Examples of maximum benefits

{Per monitor: $160}

Chinese medicine

Waiting period:  2 months

Benefit limits per 12 months unless otherwise stated

{$600 per person}

{combined limit for acupuncture, chinese medicine, remedial massage & other services}

Examples of maximum benefits

{Initial visit: $38}

{Subsequent visit: $38}

Chiropractic

Waiting period:  2 months

Benefit limits per 12 months unless otherwise stated

{$480 per person}

{combined limit for chiropractic, osteopathy & other services}

{sub-limits apply}

Examples of maximum benefits

{Initial visit: $55}

{Subsequent visit: $40}

Dietetics/dietary advice

Waiting period:  2 months

Benefit limits per 12 months unless otherwise stated

{$400 per person}

Examples of maximum benefits

{Initial visit: $60}

{Subsequent visit: $40}

Endodontic*

Waiting period:  12 months

Benefit limits per 12 months unless otherwise stated

{$1,300 per person}

{combined limit for endodontic & major dental}

Examples of maximum benefits

{Filling of one root canal: $160}

Exercise physiology

Waiting period:  2 months

Benefit limits per 12 months unless otherwise stated

{$800 per person}

{combined limit for exercise physiology, eye therapy (orthoptics), physiotherapy & other services}

Examples of maximum benefits

{Initial visit: $55}

{Subsequent visit: $40}

Eye therapy (orthoptics)

Waiting period:  2 months

Benefit limits per 12 months unless otherwise stated

{$800 per person}

{combined limit for exercise physiology, eye therapy (orthoptics), physiotherapy & other services}

Examples of maximum benefits

{Initial visit: $40}

{Subsequent visit: $35}

General dental

Waiting period:  2 months

Benefit limits per 12 months unless otherwise stated

{No annual limit}

{sub-limits apply}

Examples of maximum benefits

{Fluoride treatment: $27}

{Scale & clean: $70}

{Periodic oral examination: $40}

Health management / Healthy lifestyle

Waiting period:  6 months

Benefit limits per 12 months unless otherwise stated

{$250 per person}

{sub-limits apply}

Examples of maximum benefits

{Health management: $250}

Hearing aids*

Waiting period:  12 months

Benefit limits per 12 months unless otherwise stated

{$1,200 per person}

Examples of maximum benefits

{Hearing aid: $600}

Home nursing

Waiting period:  2 months

Benefit limits per 12 months unless otherwise stated

{$800 per person}

Examples of maximum benefits

{Initial visit: $95}

{Subsequent visit: $33}

Major dental*

Waiting period:  12 months

Benefit limits per 12 months unless otherwise stated

{$1,300 per person}

{combined limit for endodontic & major dental}

Examples of maximum benefits

{Surgical tooth extraction: $135}

{Full crown veneered: $750}

Non PBS pharmaceuticals

Waiting period:  2 months

Benefit limits per 12 months unless otherwise stated

{$800 per person}

{combined limit for non pbs pharmaceuticals & vaccinations}

{sub-limits apply}

Examples of maximum benefits

{Per eligible prescription: $60}

Occupational therapy

Waiting period:  2 months

Benefit limits per 12 months unless otherwise stated

{$500 per person}

{sub-limits apply}

Examples of maximum benefits

{Initial visit: $70}

{Subsequent visit: $44}

Optical

Waiting period:  6 months

Benefit limits per 12 months unless otherwise stated

{$260 per person}

Examples of maximum benefits

{Multi-focal lenses & frames: $260}

{Single vision lenses & frames: $260}

Orthodontic*

Waiting period:  12 months

Benefit limits per 12 months unless otherwise stated

{$2,500 per person}

{$2,500 lifetime limit}

Examples of maximum benefits

{Braces for upper & lower teeth, including removal plus fitting of retainer: $2500}

Orthotics (podiatric orthoses)

Waiting period:  2 months

Benefit limits per 12 months unless otherwise stated

{$200 per person}

Examples of maximum benefits

{Orthotics supply & fit: $100}

Osteopathy

Waiting period:  2 months

Benefit limits per 12 months unless otherwise stated

{$480 per person}

{combined limit for chiropractic, osteopathy & other services}

Examples of maximum benefits

{Initial visit: $55}

{Subsequent visit: $40}

Physiotherapy

Waiting period:  2 months

Benefit limits per 12 months unless otherwise stated

{$800 per person}

{combined limit for exercise physiology, eye therapy (orthoptics), physiotherapy & other services}

{sub-limits apply}

Examples of maximum benefits

{Initial visit: $55}

{Subsequent visit: $40}

Podiatry

Waiting period:  2 months

Benefit limits per 12 months unless otherwise stated

{$400 per person}

{sub-limits apply}

Examples of maximum benefits

{Initial visit: $55}

{Subsequent visit: $40}

Psychology

Waiting period:  2 months

Benefit limits per 12 months unless otherwise stated

{$600 per person}

Examples of maximum benefits

{Initial visit: $100}

{Subsequent visit: $72}

Remedial massage

Waiting period:  2 months

Benefit limits per 12 months unless otherwise stated

{$600 per person}

{combined limit for acupuncture, chinese medicine, remedial massage & other services}

Examples of maximum benefits

{Initial visit: $38}

{Subsequent visit: $38}

Speech therapy

Waiting period:  2 months

Benefit limits per 12 months unless otherwise stated

{$600 per person}

Examples of maximum benefits

{Initial visit: $80}

{Subsequent visit: $45}

Vaccinations

Waiting period:  2 months

Benefit limits per 12 months unless otherwise stated

{$800 per person}

{combined limit for non pbs pharmaceuticals & vaccinations}

Examples of maximum benefits

{Per service: $60}

Ambulance cover

In SA this policy provides:

Emergency: Unlimited with a waiting period of 1 day.

Non-emergency: Transport with a waiting period of 1 day, or 1 day for pre-existing conditions, limited to $3,000 per person per year.

Call-out fees: Will be paid for each attendance, including emergency treatment without transport to hospital.

For further information about this policy see: https://www.teachershealth.com.au/health-insurance/our-products/emergency-ambulance/

Insurer Details

Teachers Health

Top Hospital 500 (Gold) & Top Extras

Restricted Insurer

$854.83 / month

(Before Rebate, Discount & Loading)

Available in SA

Disclaimer: This document is not a Private Health Information Statement (PHIS), and it is not intended to replace that document. The details contained in the healthslips.com.au Policy Information was provided by the insurer to the Australian Government. It is intended as general information. It may not take into account your circumstances. For further information contact the insurer. Information used is Licensed from the Commonwealth of Australia under a Creative Commons 3.0 licence.Private Health Information Statement is available from the Private Health Insurance Ombudsman website at https://privatehealth.gov.au/dynamic/Premium/PHIS/NTF/H2/SART2Y

Read our Terms of Use and Privacy Policy