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 dependent 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.
|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 or use the Medical Costs Finder tool to find and understand costs for medical specialist services across Australia.
*With all of our hospital covers you won’t be charged an excess if your dependent 12 years and under, is admitted to hospital for medical treatment.
** Only available on Vital Hospital (Bronze+) 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 covered under each policy type.
|The policy holder.
The policy holder and their partner.
The policy holder, their partner and any of their child dependents and/or student or apprentice dependents.
|Single parent family
|The policy holder and any of their child dependent and/or student or apprentice dependents.
|Covers the policy holder, their partner and any of their dependents (at least one of whom is an adult dependent)^.
^Dependents aged 21 up to and including 31 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.
To ensure your policy reactivation can automatically take effect on your return date to Australia, we require you to be paid a minimum of one month in advance from the date of your policy suspension. 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.
Can I change the way I pay my premiums?
Yes. If you'd like to change the way you pay your premiums or the frequency, call us on 1800 623 893 to update your payment method.
You can choose to pay weekly, fortnightly, monthly, six monthly or yearly, as long as you're paid up in advance if you switch your payment frequency. There’s no hidden fees for paying more or less frequently – the overall premium price will be exactly the same, regardless of weekly or yearly payments. If you switch to paying quarterly, six monthly or yearly, we’ll send you a reminder notice as a courtesy.
You can pay by credit card, direct debit or BPAY.
You can make an immediate payment by credit card through our Mobile App or Online Member Service Portal. Alternative you can call 1800 623 893 and speak to one of our friendly staff to arrange payment over the phone.
Direct debit facilities are available if you'd prefer to have your payment amount automatically deducted from an account or credit card. If you’d like to set up a direct debit, you can do this via Online Member Services or you can contact our friendly team who can update your membership.
The BPAY biller code and your reference number appears on all statements. If you don’t receive regular statements (for example, if you pay weekly, fortnightly or monthly), just give us a call or email and we’ll be happy to supply you with our biller code and your reference number. You can also set up recurring BPAY payments so you never have to worry about missing a payment – just ask your financial institution.
All contributions are payable in advance. If you don't pay your contributions within two months (63 days) of the contribution due date, this may result in cancellation of both your membership and your entitlement to benefits.
What is Online Member Services?
Online Member Services (OMS) is 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. OMS gives you control to make changes to your details or policy without having to contact the Fund directly; 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 dependents
- 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 Value Plus Hospital
- Adding a new cover - for example, adding extras cover
- Reducing your excess - that is, going from $750 (Vital Hospital (Bronze+)) or $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 Better Hospital (Silver +) to Vital Hospital (Bronze+) cover
- Removing a current cover - for example, dropping extras cover
- Increasing your excess - going from a $250 to $500 excess or $750 for Vital Hospital (Bronze+)
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 dependents 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 dependents involved.
It's best to give us a call on 1800 623 893 to discuss your policy.