New for 2020
No excess for kids on your cover
Who: Families on:
What: You don't have to pay an excess if your kids are admitted to hospital (child dependants on your cover aged under 25)
When: From 1 April 2020
Simpler Access Gap scheme
Who: Anyone on Hospital cover or Starterpak (Basic Plus)
What: Simplifying the scheme to make it easier for you to control your costs
When: From 1 July 2020
How Access Gap works
If you haven’t used it before, Access Gap Cover is a billing scheme that can help you minimise your out-of-pocket expenses for in-hospital (inpatient) care.
It works by restricting the amount a specialist can ask you to pay. Before you’re treated, you know you’ll be charged either an agreed amount (known gap), or nothing at all (no gap) – even better!
The gap cap
Before 1 July 2020
If a specialist agreed to treat you under the scheme, the maximum gap they could charge you was $400. These charges could apply to each Medicare item number involved in your inpatient hospital treatment. If your treatment consisted of multiple item numbers, your costs could escalate.
The maximum gap a specialist can charge under the scheme is $500, but it has to cover all the item numbers that feature in your treatment. One gap; a $500 cap.
Closing the loop(hole)
Before 1 July 2020
If a specialist treated you under Access Gap, they should've only charged fees that were related to a Medicare item number. But some added extra charges – like ‘booking’ or ‘admin’ fees. Not ok.
The Access Gap rules were tightened up so this doesn’t happen. If a specialist treats you under the scheme, they can only charge you for services that are linked to a Medicare item number. No miscellaneous fees for you!
Some Extras benefits increased on 1 April 2020 – some good news to celebrate!
Teachers Healthcare Services helps eligible members* with Hospital cover access a range of support services.
For info on 1 October 2020 premium increases, check out these Frequently Asked Questions.
*These programs are brought to members through Teachers Healthcare Services, an initiative of Teachers Health to support members’ health and wellbeing through quality, evidence-based health management programs and services. To be eligible for a program you must be a member of Nurses & Midwives Health and have Hospital cover with all relevant waiting periods served. Additional eligibility criteria may apply. Eligible members are connected with a dedicated Teachers Healthcare Services care coordinator who supports them on their personal journey.