Teacher’s Health Review

Overview

Teacher’s Health is a restricted health fund exclusively for current and former members of the Australian education industry and their families.

The fund was established in 1954 by the NSW Teachers Federation to provide affordable health care to educators and had a foundation membership base of 2,600.

Today they are the largest industry-based health fund in Australia and have over 330,000 members.

Teacher’s health Insurance is Not-For-Profit, Gender Neutral, and part of Members Own, a group of 19 like-minded, mutual health funds that invest their dividends back into their members through higher benefits and paid claims.

Teacher’s Health Key Facts

Founded: 1954

For-Profit or Not-For-Profit? Not-For-Profit

Private Hospital Agreements Nationwide: 287

Day Hospital Agreements Nationwide: 269

Health Deal Represented? No

Headquarters: Sydney, NSW

Teacher’s Health Hospital Cover

Teacher’s Health has a range of hospital covers to suit all ages and medical needs. These range from Basic Hospital all the way up to Top Hospital Gold. Here is a list of the current available hospital covers:

Basic Hospital (Basic Plus)
Mid Classic (Silver Plus)
Mid Hospital (Basic Plus)
Mid Classic (Silver Plus)
Top Hospital (Gold)

Teacher’s Health Extras Cover

Extras Cover takes care of the everyday healthcare service expenses that are not generally covered under Medicare such as dental services, prescription glasses, and physiotherapy. Here is a list of the current extras covers available:

Essential Extras
Top Extras

Teacher’s Health Combined Cover

Teacher’s Health currently has one combined cover:

StarterPak (Basic Plus)

Teacher's Health waiting periods

Teacher’s Health recognises the waiting periods you have already served with a previous health fund if you switch, this is called “portability”. For first-timers taking out a hospital cover, members who may have lapsed in hospital coverage and those upgrading their level of cover, the waiting periods below will have to be served before members can claim on services:

Teacher’s Health Hospital Waiting Periods

Ambulance services: 1 day

Accidental Injury: None

New Conditions: 2 Months

Pregnancy and birth-related services: 9 months

Pre-existing conditions: 12 months

Rehabilitation & Palliative care: 2 months

Weight Loss Surgery: 12 months

How Do You Claim Extras with Teacher’s Health?

Teacher’s Health offer several easy and convenient ways to claim on your extras. Here’s how you can do this:

On the spot: Swipe your membership card at a health provider that uses the HICAPS system to have your claim processed immediately.

Via a mobile app: You can lodge a claim using the Teacher’s Health app by submitting a photo of your original receipt.

Online: You can log into https://online.teachershealth.com.au/ and lodge your claim by providing the details on your receipt.

In-person: You can walk into a Member Care Centre at a Teachers Health Centre and submit your claim with your completed claims form and receipts.

Email: Scan a completed claims form attached with the relevant invoice or receipt to submitclaim@teachershealth.com.au

By Mail: You can lodge your claim by posting relevant accounts and receipts to:

Teacher’s Health

GPO Box 9812,

Sydney NSW 2001

Teacher’s Health Gap Cover

Teacher’s Health’s gap cover is called the Access Gap Cover. If your doctor charges you more than the standard MBS fee, this is known as the ‘gap’ and can leave you with an out-of-pocket expense. Access Gap can help to minimise or eliminate personal expense but it is the choice of the physician to participate in any given gap scheme.

Gap Cover Ratings by State

To determine how beneficial a gap scheme will be, we suggest comparing health funds in the same state or territory to show which of the funds offer a greater proportion of medical services covered with no gap. While it is more likely that a medical service covered under your health fund can be utilized at no personal cost to you, it is entirely the choice of the physician whether or not to participate in the gap cover scheme.

Medical Services with No Gaps — The percentage of claims that were fully refunded.

Medical Services with No or Known Gaps — The percentage of claims that were fully refunded, or where the policy holder knew the cost before the surgery was performed.

ACT

T.H medical services with No Gap: 82%

Industry Average: 79.1%

T.H medical Services with No or Known Gap: 95.1%

Industry Average: 90.5%

NSW

T.H medical services with No Gap: 90.5%

Industry Average: 89.5%

T.H medical Services with No or Known Gap: 97.2%

Industry Average: 95.7%

VIC

T.H medical services with No Gap: 90.7%

Industry Average: 86.7%

T.H medical Services with No or Known Gap: 98.7%

Industry Average: 95.1%

QLD

T.H medical services with No Gap: 92.7%

Industry Average: 89.2%

T.H medical Services with No or Known Gap: 97.9%

Industry Average: 94.5%

T.H medical services with No Gap: 89.9%

Industry Average: 89.5%

T.H medical Services with No or Known Gap: 99.2%

Industry Average: 96.6%

T.H medical services with No Gap: 86.1%

Industry Average: 84.4%

T.H medical Services with No or Known Gap: 95.9%

Industry Average: 96.2%

TAS

T.H medical services with No Gap:92.8%

Industry Average: 90.2%

T.H medical Services with No or Known Gap: 98.9%

Industry Average: 96.7%

T.H medical services with No Gap: 89.8%

Industry Average: 84.2%

T.H medical Services with No or Known Gap: 98.1%

Industry Average: 93.8%

Renee handled my call with empathy, product knowledge, and skill. She listened to my needs and prior experiences and came up with a result that was very satisfactory to me.

My consultant Mark was absolutely brilliant, he did all the research, asked and met my personal circumstances and was great to chat with. I will definitely be contacting again when or if I ever need any more help in this area. Thank you again!

Great service, explained very clearly and easy to understand