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 Member’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 10 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 pay up front if you go to hospital or day surgery. The higher the excess, the less you pay for your regular premiums. The excess applies to all Members covered and is applied to the full cost of hospitalisation, including dependaent children (*excluding exempt children as provided below) in both public and private hospitals and day surgery facilities.
In addition to your agreed excess, you may have other out-of-pocket costs associated with your hospital treatment.
The calculation of the excess amount will apply to hospitalisations in the order they are processed by Territory Health Fund. If the excess contribution on your first visit is less than your chosen excess option, and you’re admitted to hospital again in the same Membership Year you will be required to pay the remainder of your excess obligation.
The most you’ll have to pay each Membership Year for your excess payment is outlined below.
|Excess level||Maximum excess per Membership Year|
Once the excess has been paid, the rest of the hospital accommodation charges will be sent to us, so you can enjoy the full benefits of your private hospital cover. Of course your medical costs will be determined by your doctors’ participation with our gap scheme. See Access Gap section for more information.
*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.
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 covered under each policy type.
|Cover Type||Who's covered|
|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 de facto 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 applying to suspend your policy the only information you will now be required to submit to us with your suspension application 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 Australia 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 payments recommence, you'll be good 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 dependants can be covered under one policy or both, but please be aware that it's fraudulent to claim for the same treatment under both policies. One service can only have benefits paid from one policy and funds will be recovered if it is found that a service has already received benefit entitlements elsewhere.
If the separation is amicable, some people choose to stay on the same policy, especially where there are kids dependants involved.
It's best to give us a call on 1800 623 893 to discuss your policy.