Territory Health Fund prides itself on offering products with market-leading benefits. We review these benefits each year to ensure we maintain a very competitive and value for money product. We also want you to experience the genuine value we offer our Members thanks to our generous benefits that grow each year.

Below you'll find all of the details of the changes to our benefits which will take effect on 1 April 2020.

Positive changes to optical benefits

We understand that optical is one of the most valued extras benefits based on Member feedback. To ensure our benefits are very competitive we’ve made a couple of improvements.


1. The Annual Limit per person has been increased by $15 across all Extras products.


2. To ensure Territory Health Fund continues to deliver value to its Members and reflective of our Members’ needs, from 1 April 2020 we will be introducing an Optical Rollover Benefit. The introduction of this new benefit is in response to a common concern received from Members that they prefer to purchase a more expensive pair of glasses than the allocated benefit however they have significant out-of-pocket expenses.

The Optical Rollover Benefit allows Members to carry over any unused benefit entitlement that is not claimed during the previous membership year into the following Membership Year.

Claims will always be paid from the current Membership Year’s benefit entitlement up to the Annual Limit before a Rollover Benefit is accessed. The combined Rollover Benefit and the Annual Limit are shown as the “Rollover Cap”.

The Rollover Benefit allows you more flexibility when using your optical limit.

TYPE OF SERVICE

Single vision spectacles, bifocal spectacles, multifocal spectacles, contact lenses (hard or soft). Repairs to frames or frames only or replacement lenses.


 

LEVEL OF EXTRAS COVER

CURRENT BENEFIT

NEW BENEFIT

PREMIUM EXTRAS

$285 per person

Total benefits per person per Membership Year for optical items

 

 

 

$300 per person

Total benefits per person per Membership Year for optical items

 

ROLLOVER CAP $600 per person

ESSENTIAL EXTRAS

$200 per person

Total benefits per person per Membership Year for optical items

 

 

$215 per person

Total benefits per person per Membership Year for optical items

ROLLOVER CAP $430 per person

SELECT EXTRAS

$230 per person

Up to $460 per policy per Membership Year for optical items

 

 

 

 

 

$245 per person

Up to $490 per policy per Membership Year for optical items

 

ROLLOVER CAP

$490 per person

Up to $980 per policy

YOUNG EXTRAS

$210 per person

Up to $420 per policy per Membership Year for optical items

 

 

 

 

 

$225 per person

Up to $450 per policy per Membership Year for optical items

 

ROLLOVER CAP

$450 per person

Up to $900 per polic


Removal of percentage limits applied to some benefits i.e Mechanical Aids, orthodontics

We have six goods or services that are currently restricted by a percentage limit (as outlined in the following table). Currently we pay a percentage of the cost incurred by our Members up to the benefit limit. From 1 April 2020, we will no longer have percentage limits on these services (triennial, annual and sub-limits apply, please refer to your product brochure or summary for full details, including waiting periods).

It is important to note that for more expensive items, such as Orthodontic and Hearing Aids, Members may now reach their annual limit a little earlier however, they will have the opportunity to access their full available benefit entitlement in the first claim of their Membership Year.

TYPE OF SERVICE

PERCENTAGE OF COST FOR GOODS OR SERVICES UP TO BENEFIT LIMITS

(Pre 1 April 2020 and to be removed)

Cover level Percentage 
Mechanical Aids and Appliances









Top-level hospital covers* 85%
Premium Extras N/A
Essential Extras N/A
Select Extras N/A
Young Extras N/a
     
Hearing Aids










Top-level hospital covers* 85%
Premium Extras N/A
Essential Extras N/A
Select Extras N/A
Young Extras N/A
     
Orthodontics





Top-level hospital covers* N/A
Premium Extras 85%
Essential Extras 50%
Select Extras N/A
Young Extras N/A
     
Podiatry - approved appliances (orthotics)




Top-level hospital covers* N/A
Premium Extras 85%
Essential Extras 85%
Select Extras 85%
     
Podiatry - minor procedures





Top-level hospital covers* N/A
Premium Extras 75%
Essential Extras 75%
Select Extras 75%
Young Extras 75%
     
Foot Orthoses and Orthopaedic Shoes





Top-level hospital covers* N/A
Premium Extras 85%
Essential Extras 85%
Select Extras N/A
Young Extras  N/A

* * Our top-level hospital covers include Better Hospital Silver+ as well as Top Hospital Gold which is closed# product.

# Closed hospital covers are products that are no longer available for purchase.

Hearing Aids – Addition of subscription option

We recognise that there are some hearing aid distributors that now offer their products through a monthly subscription-based service. This allows consumers to avoid one large lump sum for the purchase of their hearing aids. Under our current Fund Rules, we do not pay a benefit on this option. Recent feedback has shown that more of our Members are now taking up this subscription-based service, so from 1 April 2020 we will commence paying a benefit on this service.

Members will need to provide invoices outlining their monthly payments and the available Hearing Aid benefit will be paid. Hearing Aid Benefits are paid under our highest levels of hospital cover and in accordance with the appropriate benefit limit based on the Member’s length of membership with Territory Health Fund. A benefit for hearing aids is provided to use over three Membership Years based on the date of which the purchase of a hearing aid/s is made.

Help for our changing families

Our Members’ families are changing and so are we. To accommodate these changes and suit our Members’ needs we are introducing Extended Family pricing across our range of covers, excluding Public Hospital Basic+ and Extras only covers. This will assist in making health insurance more affordable for our changing families.

Extended Family Covers

We are helping families with older children! Our Extended Family Covers have always represented a great way for older dependents^ to stay covered on their family cover longer.  This provides savings in comparison to the dependent taking out an equivalent level of cover on their own.

Up until now Extended Family Cover has been limited to our “top-level” Hospital covers as either a stand-alone product or packaged with one of our Extras covers.  To provide more flexibility for those families with older children we are introducing Extended Family Cover to our “mid-level” Hospital covers as either as a stand-alone product or packaged with any of our Extras covers. 

This change will provide more product flexibility and diversity for families with different budgets or cover requirements.

^^Please see below to determine our Top and Mid-level covers. 

Single Parent Pricing

Just like Extended Family Cover, Single Parent priced Cover** has been limited to our “top-level” covers as either a stand-alone product or packaged with one of our Extras covers.

For single parent families we are introducing Single Parent pricing to our “mid-level” Hospital covers as either a stand-alone product or packaged with any of our Extras covers. Single Parent pricing will also be introduced to our closed# combined product, Singles & Couples Cover.

This change will provide even greater product flexibility and diversity for families with different budgets or cover requirements.

^^Please see below to determine our Top and Mid-level covers. 

^A dependent child can remain covered under a family cover up to age 21 years. If a dependent child is single and studying full-time at a school, college or university; or an apprentice, single and earning less than $30,000 p.a.; or is unemployed and receiving a Centrelink benefit, they can remain covered under a family cover until aged 25 years. For student dependents if study ceases, defers or reduces to part-time, or in the case of an apprentice dependent their training ceases, or in the case an unemployed dependent becoming employed, they can no longer be covered on a family policy.

^^ Our “top-level” Hospital covers include Better Hospital Silver+ and Top Hospital Gold closed# cover.  Our “mid-level” Hospital covers include Vital Hospital Bronze+ and Intermediate Hospital Basic+ closed# covers. 

#Closed hospital covers are products that are no long available for purchase.

** Covers the policy holder as well as their dependent children up to 21 years. Full-time students, apprentices earning no more than $30,000 p.a. and unemployed dependents receiving a Centrelink benefit can be covered under the single parent family policy at no extra cost up to age 25 (As long as the dependent child is not married or living in a de facto relationship).

Thank you for your feedback!

Territory Health Fund prides itself on offering products with market-leading benefits. We review these benefits each year to ensure we maintain a very competitive and value for money product. We also want you to experience the genuine value we offer our Members thanks to our generous benefits that grow each year. If you’d like to learn more, contact our friendly team today for a chat.