Access Gap Cover. For inpatient medical services with participating doctors, you will have either nothing to pay, or in most cases you will know your out-of-pocket expense before treatment begins.

Benefit. The amount you receive from a health fund.

Contracted Hospital. At TUH Contracted Hospitals there is 100% cover for hospital accommodation and theatre fee charges for members with Total Care Hospital.

Co-payment. An amount you pay towards your treatment expenses after you have received your entitled benefit from the health fund. The amount still owing is called a co-payment.

Emergency ambulance. Emergency is defined as an event that is unplanned, non-routine, and which requires immediate medical attention. The member is not covered for transportation from a hospital to: their home, a nursing home, or another hospital (where the member has been admitted to the transferring [first] hospital). The member is also not covered for transportation from the member's home, a nursing home or hospital for ongoing medical treatment, e.g. chemotherapy or dialysis

Excess. An amount you agree to pay towards your hospital treatment. Once you have paid this amount in a Calendar Year, no further excess will apply for that year. The higher the excess, the lower your premium.

General. Provides benefits for services such as physiotherapy, dental, and optical treatment.

HICAPS. On the spot claims using your Teachers’ Union Health card at participating service providers.

Lifetime Health Cover. A Federal Government initiative designed to encourage people to join a health fund before the age of 31 and maintain membership throughout life.

Limit. The maximum amount payable per Calendar Year for a general benefit. The annual limit is renewed on 1 January each year.

Non-Contracted Hospital. Hospitals without a contract with Teachers’ Union Health, reduced benefits will apply.

Out-of-pocket expenses. Amount you owe after all benefits have been received. This varies depending upon the Government’s schedule fees for medical services you receive, the practitioner you see, the particular treatment you have, and if applicable, the hospital you go to.

Sub-limit. A limit which is applied annually (or another specified period of time) on the benefit paid for a particular item or service within an overall annual limit.