Hospital cover changes

Hospital cover changes

Your Cover





* Based on an Australian Government Rebate of %, % LHC loading, $ excess for a in . Please note that our prices will increase from 1 April

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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!

Have Extras cover?
Have Extras cover?

Some Extras benefits increased on 1 April 2020 – some good news to celebrate!

Additional support
Additional support

Teachers Healthcare Services helps eligible members* with Hospital cover access a range of support services.

FAQs: October 2020
FAQs: October 2020

For info on 1 October 2020 premium increases, check out these Frequently Asked Questions.