Fund Name: Address: UniHealth Insurance (brought to you by Teachers Health Fund.) Level 4, 260 Elizabeth Street SYDNEY NSW 2000 Postal Address: GPO Box 9812 SYDNEY NSW 2001 Telephone: Ph: 1300 367 906 Facsimile: Fax: 1300 728 388 Email : Chief Executive Officer: info@unihealthinsurance.com.au Brad Joyce Claims Enquiries: 1300 367 906 Membership Enquiries: 1300 728 188 Patient Eligibility Checks: Patient eligibility and membership level of cover should be confirmed prior to patient admission. UniHealth Insurance is Eclipse enabled. All eligibility checks should be conducted through Eclipse using identification code NTF Where a hospital is not eclipse enabled, eligibility and member level of cover can be confirmed at https://echeck.hambs.com.au Patient Eligibility Checks: Pre-existing Conditions - 12 months Pregnancy and Related Conditions - 9 months
Psychiatric/Rehabilitation/ Palliative Care - 2 months All other hospital services - 2 months Excluded Benefits: No benefits are payable for any services which no Medicare benefit is payable including cosmetic surgery and Laser Eye Surgery. This applies to all levels of cover. The only exception is psychiatric care, rehabilitation and palliative care. Restricted Benefits: Prostheses Benefits: Services listed as Restricted, when provided in a private hospital, are eligible for Minimum Default Benefits prescribed by Private Health Insurance Legislation. These benefits relate to hospital bed charges and are unlikely to cover the fees charged for a private hospital admission. Members may incur large out of pocket expenses for theatre fees together with the difference between Minimum Default Benefit and the bed charge raised by the hospital. Benefits for Prostheses are payable for non-cosmetic surgically implanted items that are Government approved up to the listed benefit specified by the Prostheses List.
Table Top Hospital, Top Hospital 300 and Top Hospital 500 (K,X,I,N &S) Description Private Hospital Covers Top Hospital Top Hospital 300 $300 per person per admission up to a maximum of $600 for a family per calendar year No excess payable for dependants under 21 No excess payable for public hospital admission Top Hospital 500 $500 per person per admission up to a maximum of $1000 for a family per calendar year No excess payable for dependants under 21 No excess payable for public hospital admission Table Mid Hospital 300 and Mid Hospital 500 (G & F) Description Private Hospital Cover (with Minimum Benefits in a private hospital for some treatments) see attached for more details Mid Hospital 300 Apply refer attached product table below $300 per person per admission up to a maximum of $600 for a family per calendar year Mid Hospital 500 Apply refer attached product table below $500 per person per admission up to a maximum of $1000 for a family per calendar year
Table Description Basic Hospital (H) Private Hospital Cover (with Minimum Benefits in a private hospital for some treatments) see attached for more details $300 per person per admission up to a maximum of $600 for a family per calendar year Table StarterPak (P) Description Private Hospital cover (with Minimum Benefits in a private hospital for some treatments and benefits in public and private hospital for some treatments) see attached for more details All services not excluded are treated as restricted with the exception of items actually covered and listed on attached product schedule below Nil
Top Hospital, Top Hospital 300 and Top Hospital 500 (K,X,I,N &S) Top Hospital excess for Top Hospital Top Hospital 300 $300 per person per admission up to a maximum of $600 for a family per calendar year No excess payable for dependants under 21 No excess payable for public hospital admission Top Hospital 500 $500 per person per admission up to a maximum of $1000 for a family per calendar year No excess payable for dependants under 21 No excess payable for public hospital admission Excluded Services (No benefits available) Services for which a Medicare Benefit is not payable receive benefits for Teachers Health fund in a private or public hospital Claims subject to a COMPENSABLE injury Hospital Admissions for Accidents or Injuries MUST have the relevant form completed on admission and sent to Teachers Health Fund with the hospital claim. Payment delays may be experienced where this does not accompany the claim submitted. For compensable services where liability has been accepted by another party, please direct claim to relevant party.
Mid Hospital 300 and Mid Hospital 500 (G&F) Mid Hospital 300 $300 per person per admission up to a maximum of $600 for a family per calendar year Mid Hospital 500 $500 per person per admission up to a maximum of $1000 for a family per calendar year Excluded Services (No benefits available) Services for which a Medicare Benefit is not payable receive benefits for Teachers Health fund in a private or public hospital Claims subject to a COMPENSABLE injury Hospital Admissions for Accidents or Injuries MUST have the relevant form completed on admission and sent to Teachers Health Fund with the hospital claim. Payment delays may be experienced where this does not accompany the claim submitted. For compensable services where liability has been accepted by another party, please direct claim to relevant party. The below services are RESTIRCTED on Mid Hospital and only attract the MINIMUM DEFAULT BENEFITS as specified in the Private Health Insurance (Benefit Requirement) Rules Pregnancy & Related Services Infertility Treatment Coronary Care & Cardiothoracic Dialysis Joint replacement Major Eye Surgery Glaucoma Bariatric Surgery Psychiatric Rehabilitation / Palliative Care Sterilisation & Reversal of Sterilisation 16400 16590 13200 11700 30551 38218 38312 38441 38485 38562 38673 38766 55117 60015 63388 13100 47522 49515 49715 48915 42506 42590 42673 42744 42812 42746 14215 170 2958 37616 16401 16600 13201 11701 30553 38220 38315 38446 38487 38565 38677 38800 55118 60018 63391 13103 49315 49517 49716 48918 42509 42593 42680 42758 42815 42749 31441 171 2972 37619 16404 16603 13202 11702 30696 38222 38318 38447 38488 38568 38680 38803 55119 60021 63401 13106 49318 49518 49717 48921 42510 42596 42683 42761 42818 42752 31569 172 2974 37622 16406 16606 13203 11708 30710 38225 38350 38448 38489 38571 38700 38806 55120 60060 63404 13109 49319 49519 21486 48924 42512 42599 42686 42764 42833 42755 31572 297 2978 37623 16500 16609 13206 11709 33103 38228 38353 38449 38490 38572 38703 38809 55121 60063 63443 13110 49321 49521 21638 42515 42602 42692 42767 42836 42770 31575 320 2984 35687 16501 16612 13209 11710 33109 38231 38356 38450 38493 38577 38706 38812 55122 60066 21930 13112 49324 49524 42518 42605 42695 42773 42839 31578 322 2988 35688 16502 16615 13212 11711 33145 38234 38358 38452 38496 38588 38709 40345 55123 60069 21936 34500 49327 49527 42521 42608 42698 42776 42842 31581 324 2992 35691 16504 16618 13215 11712 33148 38237 38359 38453 38497 38600 38712 40348 55125 61302 21941 34503 49330 49530 42527 42610 42701 42779 42845 31584 326 2996 35694 16505 16621 13218 11713 34136 38240 38362 38455 38498 38603 38715 41889 55130 61303 21942 34506 49333 49533 42530 42611 42702 42782 42848 31587 328 3000 35697 16508 16624 13221 11718 34139 38241 38365 38456 38500 38609 38718 41892 55131 61306 22051 49336 49534 42533 42623 42703 42783 42851 31590 342 3005 35700 16509 16627 13251 11721 35003 38243 38368 38457 38501 38612 38721 41895 55135 61307 22055 49339 49554 42536 42626 42704 42785 42854 20791 344 3010 16511 16633 13290 11722 35006 38246 38371 38458 38503 38613 38724 41898 55136 61310 22060 49342 21402 42539 42629 42707 42786 42857 346 3014 16512 16636 13292 11724 35303 38256 38384 38460 38504 38615 38727 41901 59903 61313 22070 49345 21403 42542 42632 42710 42788 42860 348 3032 16514 18226 11727 35330 38270 38387 38462 38505 38618 38730 41904 59912 61314 49346 42543 42635 42713 42789 42863 350 3040 16518 18227 13400 35331 38272 38390 38464 38506 38621 38733 41905 59925 61316 21214 42545 42638 42716 42791 42866 352 3044 16519 20850 30532 35360 38275 38393 38468 38507 38624 38736 43900 59970 61317 21216 42548 42641 42719 42792 42869 855 3051 16520 20855 30533 35361 38285 38415 38469 38508 38627 38739 43903 59971 61320 42551 42644 42725 42801 43021 857 3055 16522 20956 30535 35362 38286 38418 38470 38509 38637 38742 43906 59972 61328 42554 42647 42731 42802 43022 858 3062 16525 20958 30536 38200 38287 38421 38473 38512 38640 38745 43909 59973 61340 42557 42653 42734 42805 43023 861 3069 16528 20960 30538 38203 38290 38424 38475 38515 38643 38748 43912 59974 61348 42563 42656 42737 42806 20142 864 3074 16564 30539 38206 38293 38427 38477 38518 38647 38751 43915 60000 61523 42569 42659 42738 42807 866 3078 16567 30545 38209 38300 38430 38478 38550 38650 38754 55113 60003 61529 42572 42662 42739 42808 14224 3083 16570 30547 38212 38303 38436 38480 38553 38653 38757 55114 60006 61577 42574 42665 42740 42809 3088 16571 30548 38213 38306 38438 38481 38556 38654 38760 55115 60009 61580 42581 42667 42741 42810 3093 16573 30550 38215 38309 38440 38483 38559 38656 38763 55116 60012 63385 42584 42672 42743 42811
Basic Hospital (H) Basic Hospital excess $300 per person per admission up to a maximum of $600 for a family per calendar year Excluded Services (No benefits available) Services for which a Medicare Benefit is not payable receive benefits for Teachers Health fund in a private or public hospital Restricted Services (Minimum Benefits) AL MBS items NOT LISTED below receive Minimum Default Benefits only as specified in the Private Health Insurance (Benefit Requirements) rules for accommodation in a private hospital. Benefits for prostheses are payable for noncosmetic surgically implanted items that are Government approved up to the minimum specified by legislation The below services are COVERED in a Private Hospital or Day Surgery that has an agreement with Teachers Health Fund Tonsils and Adenoids Knee Investigations and Reconstructions Shoulder Investigations and Reconstructions Appendicitis Treatment Hernias Removal of Wisdom Teeth 41788 49500 49560 48900 30394 30403 D001* 41789 49503 49561 48903 30571 30405 D002* 41792 49506 49562 48906 30572 30609 D042* 41793 49509 49563 48909 30574 30612 D043* 41796 49512 49564 48912 30614 41797 49534 49566 48915 30615 41800 49536 49569 48930 30616 41801 49539 48933 30617 41807 49542 48936 30620 20170 49545 48939 30621 49548 48942 43837 49551 48945 43840 49554 48948 43939 49557 48951 49558 48954 49559 48957 48960 Claims subject to a COMPENSABLE injury Hospital Admissions for Accidents or Injuries MUST have the relevant form completed on admission and sent to Teachers Health Fund with the hospital claim. Payment delays may be experienced where this does not accompany the claim submitted. For compensable services where liability has been accepted by another party, please direct claim to relevant party. * Removal of Wisdom Teeth(cover for hospital charges only no cover for dental items).
StarterPak (P) StarterPak excess Nil Restricted Services (Minimum Benefits) AL MBS items NOT LISTED below receive Minimum Default Benefits only as specified in the Private Health Insurance (Benefit Requirements) rules for accommodation in a private hospital. Benefits for prostheses are payable for noncosmetic surgically implanted items that are Government approved up to the minimum specified by legislation The below services are COVERED in a Private Hospital or Day Surgery that has an agreement with Teachers Health Fund Tonsils and Adenoids Knee Investigations and Reconstructions Shoulder Investigations and Reconstructions Appendicitis Treatment Hernias Removal of Wisdom Teeth 41788 49500 49560 48900 30394 30403 D001* 41789 49503 49561 48903 30571 30405 D002* 41792 49506 49562 48906 30572 30609 D042* 41793 49509 49563 48909 30574 30612 D043* 41796 49512 49564 48912 30614 41797 49534 49566 48915 30615 41800 49536 49569 48930 30616 41801 49539 48933 30617 41807 49542 48936 30620 20170 49545 48939 30621 49548 48942 43837 49551 48945 43840 49554 48948 43939 49557 48951 49558 48954 49559 48957 48960 * Removal of Wisdom Teeth (cover for hospital charges only limited cover for dental items ADA item 323 pays $70 for Tooth IDs 18 and 28 only, ADA item 324 pays $100 for Tooth IDs 38 and 48 only).
Excluded Services (No Benefits available) The services LISTED below and all services for which a Medicare Benefit is not payable receive benefits from Teachers Health fund in a private or public hospital Pregnancy & Related Services Infertility Treatment Coronary Care & Cardiothoracic Dialysis Glaucoma Joint Replacement Hip Joint Replacement Knee 16400 16590 13200 11700 30551 38218 38312 38441 38485 38562 38673 38766 55117 60015 63388 13100 42746 47522 49515 37616 Sterilisation & Reversal of Sterilisation 16401 16600 13201 11701 30553 38220 38315 38446 38487 38565 38677 38800 55118 60018 63391 13103 42749 49315 49517 37619 16404 16603 13202 11702 30696 38222 38318 38447 38488 38568 38680 38803 55119 60021 63401 13106 42752 49318 49518 37622 16406 16606 13203 11708 30710 38225 38350 38448 38489 38571 38700 38806 55120 60060 63404 13109 42755 49319 49519 37623 16500 16609 13206 11709 33103 38228 38353 38449 38490 38572 38703 38809 55121 60063 63443 13110 42770 49321 49521 35687 16501 16612 13209 11710 33109 38231 38356 38450 38493 38577 38706 38812 55122 60066 21930 13112 49324 49524 35688 16502 16615 13212 11711 33145 38234 38358 38452 38496 38588 38709 40345 55123 60069 21936 34500 49327 49527 35691 16504 16618 13215 11712 33148 38237 38359 38453 38497 38600 38712 40348 55125 61302 21941 34503 49330 49530 35694 16505 16621 13218 11713 34136 38240 38362 38455 38498 38603 38715 41889 55130 61303 21942 34506 49333 49533 35697 16508 16624 13221 11718 34139 38241 38365 38456 38500 38609 38718 41892 55131 61306 22051 49336 49534 35700 16509 16627 13251 11721 35003 38243 38368 38457 38501 38612 38721 41895 55135 61307 22055 49339 49554 16511 16633 13290 11722 35006 38246 38371 38458 38503 38613 38724 41898 55136 61310 22060 49342 21402 16512 16636 13292 11724 35303 38256 38384 38460 38504 38615 38727 41901 59903 61313 22070 49345 21403 16514 18226 11727 35330 38270 38387 38462 38505 38618 38730 41904 59912 61314 49346 16518 18227 13400 35331 38272 38390 38464 38506 38621 38733 41905 59925 61316 21214 16519 20850 30532 35360 38275 38393 38468 38507 38624 38736 43900 59970 61317 21216 16520 20855 30533 35361 38285 38415 38469 38508 38627 38739 43903 59971 61320 16522 20956 30535 35362 38286 38418 38470 38509 38637 38742 43906 59972 61328 16525 20958 30536 38200 38287 38421 38473 38512 38640 38745 43909 59973 61340 16528 20960 30538 38203 38290 38424 38475 38515 38643 38748 43912 59974 61348 16564 30539 38206 38293 38427 38477 38518 38647 38751 43915 60000 61523 16567 30545 38209 38300 38430 38478 38550 38650 38754 55113 60003 61529 16570 30547 38212 38303 38436 38480 38553 38653 38757 55114 60006 61577 16571 30548 38213 38306 38438 38481 38556 38654 38760 55115 60009 61580 16573 30550 38215 38309 38440 38483 38559 38656 38763 55116 60012 63385 Claims subject to a COMPENSABLE injury Hospital Admissions for Accidents or Injuries MUST have the relevant form completed on admission and sent to Teachers Health Fund with the hospital claim. Payment delays may be experienced where this does not accompany the claim submitted. For compensable services where liability has been accepted by another party, please direct claim to relevant party.
NOTES Table K & X (Top Hospital): No front end deductible Tables I, N (Top Hospital 300) are equal to tables K & X minus the front end deductible. The front end deductible for tables I & N is $300 per member or dependant with a maximum of $600 per family, per calendar year. Tables S (Top Hospital 500) are equal to tables K & X minus the front end deductible. The front end deductible for tables S is $500 per member or dependant with a maximum of $1000 per family, per calendar year Table P (StarterPak) allows benefit equal to tables K & X for a limited number of services. They are: Accidents, Removal of Wisdom Teeth, T s & A s, Knee investigations & reconstructions, Shoulder investigations and reconstructions, Appendix treatments and Hernias. Table P excludes any benefit being paid for services or procedures relating to: Pregnancy and related birth, Infertility investigations and treatments (including IVF), Coronary and cardiothoracic, Dialysis, Glaucoma, Hip and Knee Joint replacements, Cosmetic treatments or procedures designed to enhance appearance. Table P pays a benefit equal to the Government prescribed Default Benefit for all other services eligible for benefit under this agreement. Table M (CoreElect $300)- : The following services attract default public hospital benefits: Pregnancy and related services, Infertility investigations and treatments, Joint replacement (hip, knee, shoulder and elbow), Cataract and eye lens procedures, Cardiothoracic surgery, Obesity surgery, Dialysis, psychiatric, rehabilitations and palliative care. All other services that are covered by Medicare are covered at AHSA negotiated private hospital rates. Please note that a private room benefit is payable. An excess of $300/ person/ $600 max under a couples/family/single parent policy per calendar year applies for private and public hospital inpatient treatment. Table R (CoreElect $500) - : The following services attract default public hospital benefits: Pregnancy and related services, Infertility investigations and treatments, Joint replacement (hip, knee, shoulder and elbow), Cataract and eye lens procedures, Cardiothoracic surgery, Obesity surgery, Dialysis, psychiatric, rehabilitations and palliative care. All other services that are covered by Medicare are covered at AHSA negotiated private hospital rates. Please note that a private room benefit is payable. An excess of $500/ person/$1000 max under a couples/family/single parent policy per calendar year applies for private and public hospital inpatient treatment. Table F (Mid Hospital 300)- : The following services attract default public hospital benefits: Pregnancy and related services, Infertility investigations and treatments, Joint replacement (hip, knee, shoulder and elbow), Cataract and eye lens procedures, Cardiothoracic surgery, Obesity surgery, Dialysis, psychiatric, rehabilitations and palliative care. All other services that are covered by Medicare are covered at AHSA negotiated private hospital rates. Please note that a private room benefit is payable. The front end deductible for tables F is $300 per member or dependant with a maximum of $600 per family, per calendar year. Table G (Mid Hospital 500)- : The following services attract default public hospital benefits: Pregnancy and related services, Infertility investigations and treatments, Joint replacement (hip, knee, shoulder and elbow), Cataract and eye lens procedures, Cardiothoracic surgery, Obesity surgery, Dialysis, psychiatric, rehabilitations and palliative care. All other services that are covered by Medicare are covered at AHSA negotiated private hospital rates. Please note that a private room benefit is payable. The front end deductible for tables G is $500 per member or dependant with a maximum of $1000 per family, per calendar year. Table H (Basic Hospital) allows benefit equal to tables K & X for a limited number of services. They are: Accidents, Removal of Wisdom Teeth, T s & A s, Knee investigations & reconstructions, Shoulder investigations and reconstructions, Appendix treatments and Hernias.
Table H pays a benefit equal to the Government prescribed Default Benefit for all other services eligible for benefit under this agreement The front end deductible for tables H is $300/ person/ $600 max under a couples/family/single parent policy per calendar year applies for private and public hospital inpatient treatment.