Teachers Health Fund Review – Eligibility and Coverage

Published: September 11, 2018

Australians in the education community looking for health insurance coverage might be wondering whether Teachers Health fund is any good.

The not-for-profit organisation has been providing private health insurance to teachers for over 60 years and is Australia’s largest industry-based health fund.

We review what they have to offer, who is eligible to join and for those of you who are already a member, we invite you to re-affirm whether this health insurer still provides you with the level of cover you need.

ComparingExpert does not currently have access to this provider. Visit www.teachershealth.com.au to request a quote and compare their price and benefits to the Australian private health insurance companies we have access to.

A health insurer for the education community

In 1954, the NSW Teachers Federation was established with the aim of providing cost-effective private health insurance to people in the education industry, including their families.

Today, Teachers Federation Health provides coverage to over 320,000 teachers, education staff and their families in all states and territories, including NSW, Victoria, QLD, SA, WA, NT, ACT and Tasmania.

Because they are a not-for-profit organisation, the private health insurer gives back to the education community investing any surplus generated back into the Fund in the form of sponsorships, scholarships and programs to improve its members’ health and wellbeing.

Who can join the Teachers Health fund Australia?

The health fund is restricted to Australians formerly and currently working in public, private and independent primary and secondary schools, as well as tertiary institutions who have a membership to a relevant union, including:

  • NSW Teachers Federation
  • Institute of Senior Education Administrators NSW (SEANSW)
  • Australian Education Union (AEU) and affiliated unions
  • Independent Education Union (IEU) and related unions
  • National Tertiary Education Union (NTEU)
  • State School Teachers Union of Western Australia (SSTUWA)
  • Other appropriate education workplace unions

Australians eligible to join the Teachers Health fund

  • Teachers: Including teachers’ aids and lecturers.
  • Administration and support staff: Members of SEANSW, current and former staff of NSW Teachers Federation or Teachers Mutual Bank, and persons currently or formerly employed by the NSW Department of Education & Training, The Office of the NSW Board of studies or the Institute of Teachers in the TAFE Commission who is, or was, a member of an appropriate union.
  • Family members: Current or former spouse/partner, dependent and adult children (including their partner and dependent kids), siblings (including their partner and dependent children), parents and grandchildren.

Benefits of Teachers Health insurance

  • A range of products specifically created for people in the education industry, to suit your lifestyle and budget.
  • Easily request a quote online using the Fund’s live quote tool.
  • The Teachers Health member app can be used to view your cover details, check your remaining annual benefits and make claims.
  • Access to Teachers Health Centres, including state-of-the-art eye care and dental services.
  • The Healthy Lifestyle Benefits available under Extras cover provides cost savings on approved gym memberships, recognised weight management programs (Weight Watchers, GutBusters, Jenny Craig etc.), and yoga & pilates.
  • Helping people with asthma with free coaching services delivered over the phone.
  • New family program for eligible members requiring additional support in their journey to parenthood.
  • Diabetes management for eligible members with either pre-diabetes, gestational diabetes, type 1 or 2 diabetes wanting help managing their health and lifestyle.

Above are just some of the advantages. For more information, please visit their website.

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Need help? Call us on 1300 795 560

Packages offered by the Teachers Federation Health

Teachers Health insurance provides a range of health cover products for singles and families, including standalone hospital or extras cover, combined options and their pre-packaged SarterPak. Select the option you’d like to know more about by clicking the link below:

Hospital cover only

Your choice of hospital cover usually depends on how much protection you want, whether you’re single or have a family and how much you can afford. Of course, your current health status and medical history should also be considered before making a decision.

The below tables are based on a single person living in NSW applying for hospital cover only with an excess of $300, as at September 2018. Please review the Standard Information Statement (SIS) for a full list of benefits covered.

Basic hospital

What to compare Basic hospital specifics
Description Limited number of services
Price per month $113.62
What’s fully covered
  • Doctor’s bills in hospital
  • Choice of agreement hospital
  • Accommodation – shared and private room when available
  • Non-emergency & emergency ambulance services
  • Investigations & reconstruction of knee and shoulder
  • Appendicitis treatment
  • Hernias
  • Removal of wisdom teeth

Mid hospital coverage

What to compare Mid hospital specifics
Description An intermediary product which includes all services covered in the Basic hospital plan, plus more
Price per month $146.68
What’s fully covered
  • Sterilisation & reversals
  • All other services for which Medicare pays a benefit

Teachers Health Top hospital cover

What to compare Top hospital specifics
Description Comprehensive hospital coverage without restrictions or benefit limitation periods.
Price per month $182.61
What’s fully covered
  • Coronary care and cardiothoracic surgery
  • Labour ward fees
  • Sterilisation & reversals
  • Pregnancy and birth related services
  • Infertility treatments
  • Hip, knee, shoulder and ankle replacements
  • Major eye and eye lens surgery/li>
  • Bariatric surgery
  • Psychiatric, rehabilitation and palliative care

Extras cover

Extras health insurance refers to the protection provided for services such as Teachers Health dental, physio, and optical. Below we’ve compared the two Extras options currently available from the private health insurer.

Please note; The price refers to cover for a single person living in NSW purchasing stand-alone general treatment services (Extras) at September 2018. For a full list of Extras provided by the Teachers fund, please visit their website.

Essentials extras vs Top extras

Essential extras Teachers Health fund Top extras
Budget-friendly Extras providing services at a yearly limit of $500 per person. Top of the range Extras providing a comprehensive list of services.
$49.01 monthly premium $76.05 monthly premium
  • General dental: $500 limit
  • Major dental: $300 limit
  • Orthodontics: $300 limit
  • General dental: No annual limit
  • Major dental: $1,300 limit
  • Orthodontics: $1,500 limit
$165 Optical limit per 12 months $260 for Teachers Health Optical
Physiotherapy: $300 yearly limit Physiotherapy: $800 annual limit
  • Chiropractic
  • Podiatry
  • Psychology
  • Acupuncture
  • Naturopathy
  • Remedial massage
  • Blood glucose monitors
  • Ambulance
  • Hearing aids
  • Chiropractic
  • Podiatry
  • Psychology
  • Acupuncture
  • Naturopathy
  • Remedial massage
  • Blood glucose monitors
  • Ambulance
  • Hearing aids
Healthy Lifestyle limit of $150 per year $200 Healthy Lifestyle annual limit

Please use the below legend to indicate which Extras services are covered and which are restricted.

  • Fully covered
  • Limits apply
  • Not covered

Combined cover

If you want both Hospital and Extras services, you can choose to either purchase a combined Top Hospital & Top Extras policy at $252.94 per month with a $500 excess, or the more affordable StarterPak which will cost you about $125.36 per month.

Teachers Health StarterPak

This pre-packaged offer combines a limited number of Hospital services with Extras cover in one policy. Designed specifically for young, healthy individuals who are looking for affordable coverage.

Hospital cover includes full benefits for:

  • The removal of tonsils and adenoids
  • Appendicitis treatment
  • Hernias
  • Knee and shoulder investigations and reconstructions
  • Accidentals
  • The removal of wisdom teeth.

Extras cover available:

  • General and major dental: $500 each per year
  • Optical: $165 annual limit
  • Non-PBS Pharmaceuticals: $400 per year
  • Physiotherapy and chiropractic: Combined limit of $300 annually
  • Acupuncture, naturopathy and remedial massage: $200 combined yearly limit
  • Ambulance cover: No annual limit

Claiming from Teachers Federation Health

In-hospital bills will usually be sent directly to Teachers Health with Medicare generally paying 75% and the fund paying 25% of the Medicare Benefit Schedule fees. However, you might need to pay an excess payment when being admitted to the hospital or the hospital may bill you at a later date.

Claiming options for Extras usually include:

  • Submitting a Teachers Health claim form via post, email or in person at a Teachers Health Centre
  • Swiping your membership card on the spot at participating providers. This is called Health Industry Claims and Payment Service (HICAPS):
  • Claiming online through the membership service.

Take note; receipts provided with your claim form should be on official letterhead or stamped with a provider stamp that has the practitioners name, address and contact details.

Frequently Asked Questions

How do I join the Teachers Health fund?

You can join this private health insurer by visiting their website or calling them directly on 1300 727 538. Alternatively, you can print the application form that’s available online and post or email it to the insurer.

Does Teachers Health insurance cover counselling?

Generally, counselling services are only available when purchasing a Top Extras policy:

  • Psychology assessments and consultations up to $600 per year.
  • Hypnotherapy consultations up to $300 per annum

Can substitute teachers get health insurance?

If the substitute teacher belongs to one of the education unions mentioned above and works as a primary, secondary or tertiary substitute teacher or lecturer, then they should be able to get health coverage from the insurer.

How much is Teachers Health basic hospital cover?

As at September 2018, Basic Hospital cover from this private health fund can cost about $113.62 with an excess of $300 when living in NSW. However, this is subject to your unique circumstances and where in Australia you live.

Does Teachers Health fund cover IVF?

Infertility treatments are usually only covered by their Top Hospital policy option, which also provides coverage for pregnancy and birth-related services.

Does Teachers Health do travel insurance?

Yes, you can purchase travel insurance from this health fund. The cover is underwritten by Allianz Australia Insurance Limited (Allianz).

When does my benefit limit refresh?

Limits are refreshed every calendar year, on the 1st of January.

Does Teachers Health cover gym membership?

You can claim Healthy Lifestyle benefits for programs and services, like gym memberships, approved by the health fund.

Compare Health Insurers

Request your quote today
Need help? Call us on 1300 795 560
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Thanks for reaching out!

We will review your comment and get back to you as soon as possible. If your inquiry is urgent, please use the phone number listed at the top of this page.

Talk to you soon.

Ask an Expert?

12 Comments

  • Kelly |

    Is Ambulance cover included anywhere other than just in Extras? (Victorian resident).

    • SPECIALIST
      Anneke Van Aswegen |

      Hi Kelly,

      Generally, you can obtain Ambulance services on either a Hospital only, Extras only or Combined policy. Select insurers also offer Ambulance only coverage. The level of ambulance services covered will vary depending on the policy and insurer you choose.

      On Teachers Health, you can generally get comprehensive ambulance cover on their Hospital policies or Extras policies.

  • Ruth Wong |

    How much can I claim for a tooth crown?
    Thanks.

    • SPECIALIST
      Anneke Van Aswegen |

      Hi Ruth,

      Crowns are generally covered under Major dental and usually requires a higher level of Extras cover. So, your choice of Extras plan will typically dictate how much you can claim for a tooth crown. Please carefully read through your health insurance Standard Information Statement to get clarity on how much you can claim.

      If you do not yet have Extras cover, you might want to start by comparing policies and choose one best suited to your requirements.

  • Tim Waley |

    Hi

    My wife and I are teaching overseas currently and return to Australia in December. Whether we continue teaching will depend on how we settle back to life in Australia. Can we join the fund? What is the waiting period for specific coverage? Can I engage with someone over email or skype to agree to the best coverage with the fund so that I can get everything in place prior to returning to Australia?

    Obviously there are other questions

    • SPECIALIST
      Anneke Van Aswegen |

      Hello Tim.

      To join the Teachers Health Fund you need to be a current or former member of one of the below.
      – NSW Teachers Federation
      – Institute of Senior Education Administrators NSW (SEANSW)
      – Australian Education Union (AEU) and affiliated unions
      – Independent Education Union (IEU) and related unions
      – National Tertiary Education Union (NTEU)
      – State School Teachers Union of Western Australia (SSTUWA)
      – Other appropriate education workplace unions

      You can call 1300 795 580 for a specialist to assist you in finding a health insurance policy suited to your requirements.

  • Colin Prosper |

    My granddaughter and my Grandson both are school teachers in NSW schools. Am I eligible to join this insurance fund?

    • SPECIALIST
      Anneke Van Aswegen |

      Hello Colin.

      You might be eligible to join if either your grandson or granddaughter is a member of a relevant union. It’s best to contact the insurer directly, be sure to have your grandchildren’s details at hand.

  • Colin Hampson |

    I have been a member of teachers health for 42 years. For the last two years I have taken out extended family cover as my daughter is 22 and can not afford top cover at this stage of her life.
    What exactly is she covered for, are there any restrictions and her coverage?

    • SPECIALIST
      Anneke Van Aswegen |

      Hi Colin.

      For specifics on what your daughter is and is not cover for, it’s best to contact the insurer directly. Give them a call on 1300 727 538 or visit their website and submit an enquiry when navigating to their ‘Contact Us’ page.

  • Mary |

    I am currently covered with Medibank but am about to lose some of my coverage, due to the recent government changes.

    I am a single mum and a member of AEU in Canberra. My children are 18 and 16. My oldest child is studying full time, as is the younger one.

    I want to be covered for joint replacements and have Extra cover (probably top extras).

    Medibank advise I must change my plan prior to the 1st of November, they have suggested one of their plans, but it doesn’t cover joint replacement, and the cost is higher.

    Can you please advise the following:
    1. If I change my plan to you do waiting periods apply, and when would I get credit in my extra coverage?
    2. What cost for top cover and extras?
    3. How long can my children be covered on this policy as adults? Both as students and as working adults.
    4. Am I still eligible for this health fund if at any point I am no longer a member of the union?

    • SPECIALIST
      Anneke Van Aswegen |

      Hi Mary.

      Teachers Health Fund is not one of the funds we currently compare. It’s always best to reach out to them directly.

      However, to answer some of your questions as per the general terms of private health insurance:
      1. If you’ve already served your waiting periods and switch to a similar policy from another health funds, you generally do not need to reserve your waiting period. Unless it’s benefits you did not previously have access to or for upgraded cover, in which case you’ll usually serve a waiting period for the increased amount of coverage and new benefits.
      2. According to the privatehealth.gov.au a Combined Top Hospital (500 Excess) & Top Extras for yourself and student children will cost you about $487.80. Again, it’s best to contact the fund directly.
      3. Adult children that are full-time students can generally stay on your policy up until their age 25. However, it varies from insurer to insurer.
      4. Yes, membership is open to current and former members of education unions.