Teachers Health Fund Review

Established in 1954 by the NSW Teachers Federation, Teachers Health is now Australia's largest industry-based health fund.

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by Gary Andrews

Last update 15 Apr 2021

Overview

This not-for-profit fund is part of the Members Own Network.

It covers over 350,000 teachers, education employees and their families.

The Teachers Health fund has a strong focus on corporate social responsibility and runs a number of sponsorships, scholarships, and programs to care for the health and wellbeing of those in the education community.

Key Points

Australia's only health fund exclusive to the education sector.
Nine month waiting period for pregnancy and birth services.
Extra support for pregnancy, mental health and weight loss.

Teachers Health isn't on our panel but we're confident we can get you a great deal on your health cover.

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Hospital cover

Nobody chooses to go to hospital.

But when you do, hospital cover will help you get the treatment you need, where and when you want it.

It also helps to pay the bills, as fees for hospital rooms and specialists can add up.

Think about what services you're likely to need, in line with your budget.

If you earn over $90,000 individually or $180,000 as a couple, you could avoid paying the Medicare Levy Surcharge.

Teachers Health offers five hospital plans. Each level of cover, from Basic Plus to Gold, builds on the level before it.

StarterPak (Basic Plus)

This entry-level policy offers combined hospital and extras cover.

It allows you to choose your doctor and covers a few services in a private hospital.

It also includes the most commonly used extras, and offers $500 annual limits per person on major and general dental.

Key inclusions:

  • Dental surgery
  • Hernia and appendix
  • Tonsils, adenoids and grommets
  • Extras such as dental, physio and optical

Basic Hospital (Basic Plus)

This hospital-only policy is designed for the budget-conscious.

It covers you for all the same hospital services as the StarterPak, plus a few more with restricted cover.

The excess is $300.

Key inclusions:

  • Joint reconstructions
  • Dental surgery
  • Avoids Medicare Levy Surcharge

Mid Hospital (Basic Plus)

Cover for everyday health needs that doesn't exclude any services.

It covers a large number of services, while others -- like pregnancy and joint replacements -- have restricted cover (meaning you are limited to public hospital cover).

Choose a $300 or $500 excess.

Key inclusions:

  • Kidney and bladder
  • Insulin pumps
  • Podiatric surgery
  • Medically necessary breast surgery

Mid Classic (Silver Plus)

A broad, mid-level cover option that includes many services usually offered in Top Hospital, but excludes items such as pregnancy and weight loss surgery to lower the cost.

Choose a $300 or $500 excess.

Key inclusions:

  • Palliative care
  • Heart and vascular system
  • Lung and chest
  • Rehabilitation

Top Hospital (Gold)

This is the top tier cover option with no exclusions or restrictions.

It comes with a range of family planning services and, unusually, a nine month waiting period for pregnancy and birthing (most funds have a 12 month waiting period).

Excess options are $0, $300 or $500.

Key inclusions:

  • Pregnancy and birth
  • Cataracts
  • Join replacements
  • Assisted reproductive services

Ambulance Cover

All Teachers Health plans include emergency ambulance cover.

If you don't want to take out hospital or extras cover, you can purchase emergency ambulance cover separately.

Queensland and Tasmanian residents won't need to do this as they're covered by their state schemes.

Extras cover

From dental, to optical, to chiro and more, extras insurance helps cover the bills for routine treatments with rebates of up to 100%.

While we've summarised the key points of each plan below, it's always worth digging a little deeper into any gap fees, how much you can claim back, and whether your preferred healthcare provider, such as your local dentist, has an agreement with the health fund.

Take the time to work out what you need and what you're prepared to pay.

If this feels a bit overwhelming, you can speak to one of our experts who can talk you through what's included in each extras policy.

Teachers Health offers three levels of extras cover: StarterPak, Essential Extras and their most expensive Top Extras policy.

The first can only be purchased with hospital cover and the other two can be purchased on their own.

StarterPak (Basic Plus)

This entry-level policy offers combined hospital cover with the most commonly used extras like dental, optical, physio and more.

Essential Extras

Covers everyday items such as dental, optical and physio, plus a range of other services including healthy lifestyle programs like weight management and health screening.

Top Extras

Teachers Health's most comprehensive extras cover option comes with higher benefits and annual limits on common services like dental, physio, optical and more.

The policy also covers items such as speech therapy or diet, and devices such as hearing aids and blood pressure monitors, as well as including the healthy lifestyle programs.

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Waiting periods

To stop people signing up, claiming, then cancelling their health insurance, all insurers apply waiting periods.

Generally, the more expensive the treatment, the longer you'll wait. But keep an eye out for special deals with waiting periods reduced or waived.

StarterPak (Basic Plus)

  • 1 day -- ambulance transport
  • 2 months -- psychiatric, rehabilitation and palliative care (restricted, not pre-existing conditions)
  • 12 months -- pre-existing conditions
  • 2 months -- all other hospital services

Basic Hospital (Basic Plus) Mid Hospital (Basic Plus)

  • 1 day -- ambulance transport
  • 2 months -- psychiatric, rehabilitation and palliative care (not pre-existing conditions)
  • 9 months -- pregnancy and birth (restricted)
  • 12 months -- pre-existing conditions
  • 2 months -- all other hospital services

Mid Classic (Silver Plus)

  • 1 day -- ambulance transport
  • 2 months -- psychiatric, rehabilitation and palliative care (not pre-existing conditions)
  • 12 months -- pre-existing conditions
  • 2 months -- all other hospital services

Top Hospital (Gold)

  • 1 day -- ambulance transport
  • 2 months -- psychiatric, rehabilitation and palliative care (not pre-existing conditions)
  • 9 months -- pregnancy and birth (restricted)
  • 12 months -- pre-existing conditions
  • 2 months -- all other hospital services

Extras

  • 1 day -- ambulance transport
  • 2 months -- general dental, pharmaceuticals, childbirth education, home nursing, allied health services like chiro, osteo and podiatry, most artificial aids and appliances.
  • 6 months -- optical, healthy living programs.
  • 12 months -- major dental and orthodontics, hearing aids, CPAP machine and accessories purchases.
  • 24 months -- wheelchair.

Member benefits

All Teachers Health members can access:

  • Support programs through Teachers Healthcare Services.
  • Teachers Health Centres, with discounted dental and optical services.
  • Health Lifestyle programs included in all extras policies.
  • Health and fitness discounts on exercise equipment, weight management programs and nutrition programs.
  • Discounts on shopping, groceries, travel and more through the Teachers Health Shopping portal.

How to claim

Claim on the spot through HICAPS at a provider.

You can also claim through the Teachers Health app and online, or by email or post.

Hospital agreements

Teachers Health has agreements with many private hospitals and day surgeries across Australia.

When comparing policies, it's worth checking if your local hospitals and clinics are covered.

Our specialists can do this for you.

Customer service

Teachers Health received 6 complaints from 1 January to 30 March 2020.

That's 2% of complaints vs 2.4% market share, indicating customer service may be above average.

Source: Private Health Ombudsmans

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FAQs

Is Teachers Health a not-for-profit fund?

Yes, it’s part of the Members’ Own Network.

Who can apply? Are there any restrictions?

Teachers Health is exclusively for members of the education community and their families.

This includes current and former primary, secondary and tertiary teachers, teachers’ aides, lecturers and support and administration staff from public, private and independent institutions around Australia.

A member’s spouse or partner, and other family members can join the fund too. This includes siblings, adult children and grandchildren.

Is it easy to switch to Teachers Health?

Teachers Health isn’t on our panel but we’re confident we can find you a great deal on your health insurance.

You’ll need to contact Teachers Health directly if you’re interested in switching to one of their policies.

Do I need to re-serve waiting periods?

You can switch to an equivalent or lower level of cover without re-serving waiting periods.

You will only be required to serve waiting periods if you have upgraded to a higher level of cover.

Can I change my level of cover?

Yes, you can choose a lower or higher level of cover to suit your different life stages.

If you move to a higher level of cover, you will usually need to serve waiting periods on the extra services and/or higher benefits.

Do I get the government rebate?

For every dollar of private health insurance premiums, the Australian Government provides eligible Australians with a rebate of up to 33.4% (depending on your age and income).

Do I have to pay the Lifetime Health Cover loading?

If you're joining for the first time and you're 31 or over, you usually need to pay 2% loading for each year you've gone without health cover since your 31st birthday.

You can find out more here.

When do extras reset?

Extras reset on 1 January each year.

What age are children covered up to?

Teachers Health will cover children up to the age of 21.

If they're studying full time, dependents can be covered as a student under a family policy up to the age of 25.

Children must not be married or living in a de facto relationship. 

Read our guide to learn more.

How do I contact Teachers Health Fund?

You can call Teachers Health on 1300 727 538.

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This guide is opinion only and should not be taken as medical or financial advice. Check with a financial professional before making any decisions.