Hospital cover changes

Hospital cover changes

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* 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.

Now

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.

Now

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.