New for 2020
No excess for kids on your cover
Who: Families on:
What: You won’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
If a specialist agrees to treat you under the scheme, the maximum gap they can charge you is $400. This sounds simple, but these charges can apply to each Medicare item number involved in your inpatient hospital treatment. If your treatment consists of multiple item numbers, your costs could escalate.
From 1 July 2020
The maximum gap a specialist can charge will be $500, but it has to cover all the item numbers that feature in your treatment. One gap; a $500 cap.
Closing the loop(hole)
If a specialist is treating you under Access Gap, they should only charge fees that are related to a Medicare item number. But some add extra charges – like ‘booking’ or ‘admin’ fees. Not ok.
From 1 July
The Access Gap rules are being 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 of your Extras benefits will increase on 1 April 2020 – find out what that means for you.
Teachers Healthcare Services helps eligible members* with Hospital cover access a range of support services.
For more on the annual premium and benefits review, 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.