Let's take a look at the different levels of Private Hospital cover.
Private Health Insurance – The Basics
Private health insurance plays a crucial role in providing individuals and families with the necessary financial coverage for healthcare expenses. With various health funds available in Australia, it is essential to understand their structures, areas of cover, and costs to make an informed decision about your healthcare needs. In this article, we will delve into the world of health funds, focusing on TUH (Teachers Union Health), its different Hospital cover tiers, customisation options, and key terms like "gap payment" and "excess."
What is a Health Fund?
A health fund is a private health insurance provider that can offer hospital and extras cover. Hospital cover is aimed at helping its members with access to private hospital treatment - avoiding public hospital system waiting times and allowing choice of doctor. Private Health Insurance Extras Cover helps to fund a number of out-of-hospital preventative or rehabilitation health services that are not covered by the public health system, like physiotherapy. Health funds typically offer various tiers of coverage to cater to diverse needs and budgets.
Why TUH?
When it comes to private health insurance, TUH is a leading provider that offers a range of affordable health insurance options. As a health fund formed for the education community, TUH understands the unique needs of teachers and their families, providing tailored coverage and exceptional service. With over 50 years of experience, TUH has established itself as a trusted provider in the sector.
Health Insurance Tiers
TUH offers different tiers of health insurance, allowing individuals to choose the level of coverage that best suits their requirements. The tiers for hospital cover fall into four categories and come with varying costs. Let's explore the different tiers offered by TUH.
Basic Hospital Cover
The basic tier is legislated to provide essential coverage for 3 restricted hospital treatments only. The cost of the basic tier is lower compared to higher tiers, making it an affordable option for those on a budget. TUH provide a Basic+ Hospital policy, which covers an additional 4 treatment categories, as outlined in the table below:
| Minimum Product Requirements | TUH Basic+ Hospital Product |
|---|---|
| Rehabilitation (R) | Rehabilitation (R) |
| Hospital psychiatric services (R) | Hospital psychiatric services (R) |
| Palliative care (R) | Palliative care (R) |
| Dental surgery | |
| Hernia and appendix | |
| Joint reconstructions | |
| Tonsils, grommets and adenoids |
(R) = Restricted services are treatments or services that attract only partial benefits, which means you will only be partially covered for these items or services in a private hospital.
Bronze Hospital Cover
A Bronze health insurance policy covers the same 3 restricted benefits as the Basic tier as well as cover for an additional 18 treatments and services. TUH have chosen to include an additional 5 treatment categories to this list, bringing the total number of services covered by the policy to 26. These additional categories are outlined below:
| Minimum Product Requirements | TUH Bronze+ Hospital Product |
|---|---|
| Hospital psychiatric services (R) | Hospital psychiatric services (R) |
| Rehabilitation (R) | Rehabilitation (R) |
| Palliative care (R) | Palliative care |
| Brain and nervous system | Brain and nervous system |
| Kidney and bladder | Kidney and bladder |
| Miscarriage and termination of pregnancy | Miscarriage and termination of pregnancy |
| Eye (not cataracts) | Eye (not cataracts) |
| Bone, joint and muscle | Bone, joint and muscle |
| Gastrointestinal endoscopy | Gastrointestinal endoscopy |
| Breast surgery (medically necessary) | Breast surgery (medically necessary) |
| Joint reconstructions | Joint reconstructions |
| Gynaecology | Gynaecology |
| Tonsils, adenoids and grommets | Tonsils, adenoids and grommets |
| Hernia and appendix | Hernia and appendix |
| Skin | Skin |
| Diabetes management (excluding insulin pumps) | Diabetes management (excluding insulin pumps) |
| Male reproductive system | Male reproductive system |
| Chemotherapy, radiotherapy and immunotherapy for cancer | Chemotherapy, radiotherapy and immunotherapy for cancer |
| Ear, nose and throat | Ear, nose and throat |
| Digestive system | Digestive system |
| Pain management | Pain management |
| Lung and Chest | |
| Dental Surgery | |
| Blood | |
| Plastic and Reconstructive surgery (medically necessary) | |
| Sleep studies |
(R) = Restricted services are treatments or services that attract only partial benefits, which means you will only be partially covered for these items or services in a private hospital.
Silver Hospital Cover
Silver tier builds on the Bronze tier and adds eight additional clinical categories, providing cover for 29 clinical categories in total. In addition to this, TUH provides cover for 5 clinical categories across a suite of three Silver Hospital products. TUH provides Silver+ Hospital Essentials, Silver+ No Pregnancy and Silver+ Family in its suite of Silver Hospital products. The below table outlines the additional clinical categories covered and whether they are specific to a particular product.
| Minimum Product Requirements | TUH Silver Hospital Products |
|---|---|
| Rehabilitation (R) | Rehabilitation |
| Palliative care (R) | Palliative care (R) Unrestricted on Silver+ No Pregnancy and Silver+ Family |
| Hospital psychiatric services (R) | Hospital psychiatric services (R) |
| Tonsils, adenoids and grommets | Tonsils, adenoids and grommets |
| Hernia and appendix | Hernia and appendix |
| Skin | Skin |
| Heart and vascular system | Heart and vascular system |
| Blood | Blood |
| Podiatric surgery (by a registered podiatric surgeon) | Podiatric surgery (by a registered podiatric surgeon) |
| Male reproductive system | Male reproductive system |
| Chemotherapy, radiotherapy and immunotherapy for cancer | Chemotherapy, radiotherapy and immunotherapy for cancer |
| Ear, nose and throat | Ear, nose and throat |
| Digestive system | Digestive system |
| Pain management | Pain management |
| Plastic and reconstructive surgery (medically necessary) | Plastic and reconstructive surgery (medically necessary) |
| Implantation of hearing devices | Implantation of hearing devices |
| Brain and nervous system | Brain and nervous system |
| Kidney and bladder | Kidney and bladder |
| Miscarriage and termination of pregnancy | Miscarriage and termination of pregnancy |
| Eye (not cataracts) | Eye (not cataracts) |
| Lung and chest | Lung and chest |
| Back and spine | Back, neck and spine |
| Bone, joint and muscle | Bone, joint and muscle |
| Gastrointestinal endoscopy | Gastrointestinal endoscopy |
| Breast surgery (medically necessary) | Breast surgery (medically necessary) |
| Joint reconstructions | Joint reconstructions |
| Gynaecology | Gynaecology |
| Diabetes management (excluding insulin pumps) | Diabetes management (excluding insulin pumps) |
| Dental surgery (in hospital) | Dental surgery (in hospital) |
| Sleep Studies | |
| Dialysis for chronic kidney failure (Silver+ No Pregnancy and Silver+ Family) | |
| Insulin pumps (Silver+ No Pregnancy and Silver+ Family) | |
| Pregnancy and Birth (Silver+ Family) | |
| Assisted Reproductive Services (Silver+ Family) | |
| Cataracts (Silver+ No Pregnancy) | |
| Joint Replacements (Silver+ No Pregnancy and Silver+ Family) | |
| Pain management with device |
(R) = Restricted services are treatments or services that attract only partial benefits, which means you will only be partially covered for these items or services in a private hospital.
Gold Hospital Cover
The top tier is the most comprehensive option providing coverage for a wide range of hospital treatments. While the cost of the top tier is higher, it offers extensive coverage for those who want comprehensive protection and access to a broader range of healthcare services. All clinical categories must be unrestricted on Gold hospital cover.
Gap Payment and Excess
When it comes to private health insurance, it's important to understand terms like "gap payment" and "excess."
Gap Payment
A gap payment refers to the out-of-pocket expenses that may arise when the cost of an inpatient healthcare service exceeds the amount covered by your health fund and Medicare. It is the difference between the fee charged by the healthcare provider and the amount reimbursed by your health fund and Medicare. TUH provides a "No Gap" or "Known Gap" scheme with partner specialists, reducing or eliminating the gap payment for certain treatments.
Excess
The excess is the amount you agree to pay towards hospital treatment before your health fund starts covering the remaining costs. TUH offers different excess amounts for some policies, allowing you to choose an excess level that suits your budget and expected healthcare needs. A higher excess usually results in lower premium costs. An excess does not get charged by TUH for a hospital admission of a dependent and an excess is only to be paid once per person per calendar year.
Private health insurance is an essential investment to ensure you receive timely and quality healthcare. TUH stands out as a trusted provider, offering different tiers of coverage to meet various needs and budgets. By understanding terms like gap payment and excess, you can make informed decisions about your health insurance plan. Customise your policy to strike a balance between coverage and affordability, ensuring you have the right protection for you and your family's health.
Whether you are looking for top-level comprehensive cover for the whole family, or more affordable basic couples cover, TUH provides comprehensive options tailored to your needs. Choose TUH for reliable and affordable private health insurance coverage that prioritises your well-being.
