We are committed to complying with the requirements of the Privacy Act (Cth 1988) the Australian Privacy Principles (APPs) and the APRHA Board Code of Conduct for Registered Health Practitioners when we collect, hold and manage a Client’s personal information, that is, information that allows others to identify an individual.
When will I receive my membership card?
Your card will arrive within 14 days of the date of your application, even if your policy doesn't start right away.
What is an excess?
An excess is the amount you agree to pay towards the cost of your hospital treatment when you're admitted to hospital, in exchange for a lower regular premiums.
When you choose private hospital cover, you can choose the level of excess you want to pay. The higher the level of excess, the lower your premium will be, as you agree to pay a larger sum towards your hospital costs.
At Territory Health Fund, you can choose an excess of $250 or $500 per person within any one Membership Year, regardless of the number of times you’re admitted to hospital.
Even on a family membership, regardless of the number of people covered, you’ll only pay the excess once per individual, to a maximum of two excess payments, for the entire family within your membership year. This means a maximum of $500 on a $250 excess option, or $1,000 for a $500 excess option.
|Excess level||Maximum excess per Membership yYear|
Also, under our Top Hospital cover, we don’t charge any excess on children aged 12 years or under if they need to be admitted to hospital for medical treatment.*
Your chosen excess applies to the full cost of hospitalisation at a public, private or day hospital facility. Once the excess has been paid, we take care of the rest, so you can enjoy the full benefits of your private health insurance.
Please note that if you do not have extras cover and physiotherapy, for example, is required in hospital as part of your treatment, then you will not be covered for these services if they are invoiced separately by the physiotherapist. This is also the case for any allied services (exercise physiology, dietetic etc.) covered under one of our extras products.
*The excess exemption for children 12 years and under is NOT applicable under our Intermediate Hospital cover.
Who's covered by my policy?
Each of our cover options has different levels of cover depending on who is included in the policy.
Here is a summary of who is covererd under each policy type.
|Cover Type||Who's covered|
|Single||An individual adult aged over 18.|
|Couple||Two adults over 18, usually in a de facto relationship or married.|
|Family||Two adults and their dependant children aged up to 21, or up to 25 if the dependent is a full time student or low income earning apprentice*|
|Single parent family||One adult and their dependant children aged up to 21, or up to 25 if the dependent is a full time student or low income earning apprentice*|
|Extended family||One or two adults with dependant children aged up to 25, who are NOT full time students or apprentices^.|
*Full time students and low income earning (under $30,000 p.a.) apprentice dependants who do not have a partner are included on the policy at no extra cost.
^Dependants aged 21 to 25 who aren’t full time students or apprentices and do not have a partner can be covered under Extended Family cover, which attracts an additional cost.
What happens if I'm going overseas?
If you’re heading out of the country for more than four weeks, but less than two years, have a chat to us about whether or not you’re eligible to apply for a suspension to your membership.
Suspending your membership means you’ll be able to put your payments on hold while you’re out of the country. We’ll still recognise you as a Member and honour all of the waiting periods you’ve served, and once you come back you can pick up right where you left off.
When travelling overseas and aplying to suspend your policy the only information you wil now be required to submit to us with your suspension aplication is a copy of your itinerary. This should specify your intended date of return to Australia. What this change will also allow us to do is automatically reactivate your policy upon your return to Austrlaia without you doing anything further.
Now we also know money can be tight after a return from an overseas holiday so to ensure your policy reactivation can automatically take effect on your return date to Australia, we will now require you to be paid a minimum of one month in advance from the date of your policy suspension. This way you can come home and not have to immediately find the money to kick-start your health cover. A minimum of six months must be served between reactivation and suspension for overseas travel.
While your membership is suspended, you won't be able to make any claims, but once your peyments recommence, you'll be god to go!
Whether your trip is a short one or a long one, your health insurance won't cover you for injury, treatment or surgery while you're overseas, so don’t forget to approach your preferred insurer about travel insurance to cover you while you’re away. Travel insurance will cover any medical expenses that may crop up during your travels.
To find out more about suspending your membership, contact us when you’re making your travel plans.
What's my membership year?
Your Membership Year is the anniversary date of when you first joined Territory Health Fund.
Your yearly limits and excesses are calculated from this date, and reset each year on that date.
So, if you first signed up with us on October 25, your limits and excess will reset each year on October 25.
When do my limits reset?
We're a little different from some other health funds. Your yearly limits reset each year on your anniversary date - the date you first joined our health fund.
This applies to benefit limits and excesses.
What happens if my payments aren't up to date?
If your payments aren't up to date, we won't be able to pay any claims for treatments or services.
Please note that it is the policy holder’s responsibility to make sure that payment amounts are correct and are paid in advance, to avoid any claims being rejected due to having an un-financial status.
If you're experiencing financial difficulty, please contact us on 1800 623 893 to discuss your options.
What is Online Member Services?
Online Member Services (OMS) our online self-service portal which gives you control over your policy, allowing you to update your details, view your benefits and make payments by credit card.
If you don't have access yet, you can register and login straight away.
What can I do in OMS?
Online Member Services (OMS) gives you control over your policy. Normally, you’d need to call us to make changes to your details or policy, but with OMS, you simply need to login (or register) to access everything you need.
Here's what you can do in OMS:
- Update your personal details
- Make a credit card payment
- Change your cover level (conditions apply if you upgrade your level of cover)
- Access tax statements
- View your claims history
- View your limits and remaining benefits
- Update payment details
- Add student or apprentics dependants
- Add Medicare card details
How can I add or remove a person from my membership?
The best way to add or remove a person from your membership is to give us a call. If you're adding a person, they may need to serve waiting periods for benefits, depending on their previous health insurance history.
We'll make sure you continue to have the best level of cover for your needs if you make any changes to your policy.
Can I upgrade my cover?
If you're on one of our lower or medium levels of cover, you can choose to upgrade at any time by contacting us on 1800 623 893.
Upgrading could include:
- Increasing the level of cover - for example, going from Intermediate to Top Hospital
- Adding a new cover - for example, adding Extras cover
- Reducing your excess - that is, going from $500 excess to $250
If you're upgrading, you may need to serve waiting periods on the upgraded portion of your cover. While you're waiting, we'll still honour the benefits of your previous cover. Conditions also apply to hospitalisation if you're changing your excess.
Can I downgrade my cover?
If things are a bit tight financially, or if you want to change to a level of cover that's more practical, you can choose to downgrade your cover.
Downgrading may include:
- Reducing the level of cover - for example, going from Top Hospital to Intermediate Hospital cover
- Removing a current cover - for example, dropping extras cover
- Increasing your excess - going from a $250 to $500 excess
If you choose to downgrade, you won't need to serve additional waiting periods, and your new excess applies to inpatient hospital services immediately.
What happens if my partner and I have separated?
In the unfortunate case that you and your partner have separated, there are a few options available.
We can separate your policy where one partner, usually the primary policy holder, keeps the same Member number but we change it to a single policy or single parent policy. We then create a new policy for the other partner, and they can keep the same level of cover (even if it's a closed product). Your kids can be covered under one policy or both, but please be aware that it's illegal to claim for the same treatment under both policies.
If the separation is amicable, some people choose to stay on the same policy, especially where there are kids involved.
It's best to give us a call on 1800 623 893 to discuss your policy.