HAPPY DAYS HEALTHY FUTURES

PREGNANCY GUIDE 03 Thinking about having a baby? 05 Step 1 Choose the right product for you 09 Step 2 Choose an obstetrician 11 Step 3 Access Gap Cover scheme

13 Other information 14 Frequently asked questions 17 New Family Program 19 Did you know?

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2 | PREGNANCY GUIDE THINKING ABOUT HAVING A BABY?

Does your current policy cover pregnancy Your private Hospital cover kicks in and birth-related services? Will you have once you are admitted into hospital. to pay an excess on your current cover? Out-of-hospital medical expenses When you start planning a family, you incurred throughout your pregnancy need to think about your health cover. (scans, obstetrician appointments, blood tests etc) will not be covered by your If you want to be covered for obstetrics private health insurance – although (pregnancy and birth-related services) they may be covered to some extent in a private hospital with an obstetrician by Medicare. of your choice, you need to take out private Hospital cover or upgrade Check if you are eligible for additional your existing cover well before you are Medicare benefits with the Medicare pregnant, as waiting periods will apply. Safety Net (see page 15).

3 | PREGNANCY GUIDE A new class of health

4 | PREGNANCY GUIDE CHOOSE THE RIGHT PRODUCT FOR YOU

TOP HOSPITAL

STEP 1 Top Hospital is an appropriate level of Check if your hospital has an cover for pregnancy and birth-related agreement with Teachers Health at services. If you are on Top Hospital and teachershealth.com.au or call us your chosen hospital has an agreement on 1300 728 188. with Teachers Health, you will be covered If your chosen hospital does not have in a private hospital for: an agreement, you will be covered • accommodation, labour ward, theatre up to the minimum default benefit rate and intensive care fees as set out by the Federal Government and will incur significant out-of-pocket private (subject to availability) or • expenses. shared room • obstetrician / surgeon / specialist fees (for services provided in hospital as an admitted patient) • Access Gap Cover - if your doctor charges you under this scheme, your out-of-pocket expenses may be reduced or eliminated (see page 11) • emergency ambulance transport.

5 | PREGNANCY GUIDE MID HOSPITAL & BASIC HOSPITAL WILL I HAVE WAITING If you have Mid Hospital or Basic Hospital PERIODS TO SERVE? cover you will be covered in a public There is a nine month waiting period for hospital for: all pregnancy and birth-related services. • accommodation, labour ward, theatre This means you need to have held an and intensive care fees up to the appropriate level of Hospital cover for minimum default benefit rate as set at least nine months before you are out by the Federal Government admitted to hospital to have your baby. a shared room Check your waiting period status by • logging into your membership via • obstetrician / surgeon / specialist Online Member Services at fees (for services provided in hospital teachershealth.com.au/members as an admitted patient) or calling 1300 728 188. • Access Gap Cover - if your doctor charges you under this scheme, your WILL I HAVE TO out-of-pocket expenses may be PAY AN EXCESS? reduced or eliminated (see page 11) If you have Top Hospital nil excess, • emergency ambulance transport. no excess is payable. If you have Top Hospital 300 or 500, Mid Hospital or See teachershealth.com.au for coverage Basic Hospital, you will have an excess details. to pay towards your admission (see page 7). STARTERPAK If you have StarterPak, you will not be covered for pregnancy and birth-related services in a private or public hospital.

6 | PREGNANCY GUIDE HOSPITAL COVER EXCESS PAYABLE PRIVATE HOSPITAL COVER TOP HOSPITAL No excess. TOP HOSPITAL 300 $300 per person, per calendar year. The excess is paid once per person, per calendar year to a maximum of twice per membership, for Family and Couple memberships. This excess is only payable when admitted to a private hospital. Please note: excess does not apply to child dependants under the age of 21. TOP HOSPITAL 500 $500 per person, per calendar year. The excess is paid once per person, per calendar year to a maximum of twice per membership, for Family and Couple memberships. This excess is only payable when admitted to a private hospital. Please note: excess does not apply to child dependants under the age of 21. PUBLIC HOSPITAL COVER MID HOSPITAL 300 $300 per person, per calendar year. The excess is paid once per person, per calendar year to a maximum of twice per membership, for Family and Couple memberships. This is payable when you are admitted to a private or public hospital. Excess does not apply to child dependants under the age of 21. Please note: If you choose to deliver in a private hospital, significant out-of-pocket expenses will be incurred. Mid Hospital only provides pregnancy cover in a public hospital. MID HOSPITAL 500 $500 per person, per calendar year. The excess is paid once per person, per calendar year to a maximum of twice per membership, for Family and Couple memberships. This is payable when you are admitted to a private or public hospital. Excess does not apply to child dependants under the age of 21. Please note: If you choose to deliver in a private hospital, significant out-of-pocket expenses will be incurred. Mid Hospital only provides pregnancy cover in a public hospital. BASIC HOSPITAL $300 per person, per calendar year. The excess is paid once per person, per calendar year to a maximum of twice per membership, for Family and Couple memberships. This is payable when you are admitted to a private or public hospital and applies to all people on the policy. Please note: If you choose to deliver in a private hospital, significant out-of-pocket expenses will be incurred. Basic Hospital only provides pregnancy cover in a public hospital. NO COVER STARTERPAK Pregnancy and birth-related services are not covered.

7 | PREGNANCY GUIDE You’re all about them, we’re all about you

8 | PREGNANCY GUIDE CHOOSE AN OBSTETRICIAN

HOW DO I CHOOSE CONTACT US AND ASK:

STEP 2 AN OBSTETRICIAN? • If the hospital your obstetrician works Ask your GP for a list of obstetricians in at has an agreement with Teachers your area. We recommend that you give Health. If you elect to have your baby them a call and ask them the following in a hospital that does not hold an questions: agreement with us, you will have significant out-of-pocket expenses. 1. Are you taking any more patients? • Whether your obstetrician has 2. At which hospitals do you deliver? participated in AGC before (see page 3. Is that a public or private hospital? 11 for more details on AGC). If they have, they may consider charging 4. Can you provide me with a rough you under the AGC scheme which will guide as to the fees you charge for eliminate or significantly reduce your managing my pregnancy? out-of-pocket expenses. 5. Do you participate in the Access Gap Cover (AGC) scheme? ASK YOUR OBSTETRICIAN 6. What arrangements do you have in FOR A QUOTE place if you are away at the time of Obtain a quote (known as Informed the delivery? Financial Consent) from your obstetrician so you are aware of the charges payable throughout your pregnancy. Remember that any services received while you are not admitted in hospital may only be partially covered by Medicare. You should discuss with your obstetrician if they will bill you under the AGC scheme for services received when you are admitted to hospital to give birth.

9 | PREGNANCY GUIDE Healthy minds, happy hearts

10 | PREGNANCY GUIDE ASK ABOUT THE ACCESS GAP COVER SCHEME

Access Gap Cover (AGC) is a billing If your obstetrician chooses to participate scheme that aims to reduce or eliminate in AGC, they must provide you with a STEP 3 out-of-pocket expenses for medical written estimate of fees for the cost of the services received in hospital as an services throughout your pregnancy. in-patient. If you have any questions about AGC, AGC allows us to pay above the scheduled contact us on 1300 728 188. fee for services provided to you as an in-patient. Doctors can choose to participate in AGC on a patient-by-patient basis so contact your doctor to discuss if they are willing to treat you under this arrangement. If your doctor or specialist agrees to bill you under this arrangement, you will experience either reduced or nil out-of- pocket expenses for in-patient medical charges. If they charge above the AGC fee you will be able to establish the ‘known gap’ that you will have to pay before you receive treatment.

11 | PREGNANCY GUIDE QUESTIONS TO ASK YOUR OBSTETRICIAN ABOUT THE ACCESS GAP COVER SCHEME

• Will the fee you charge me be covered • Will any assisting doctors involved under Access Gap Cover (AGC) or will I in helping me give birth, including have to pay a ‘known gap’? anaesthetist, assistant surgeon, paediatrician and pathologist, treat If there is a gap amount, can you • me under AGC? What out-of-pocket provide me with an Informed Financial expenses, if any, will there be for their Consent document so I know exactly services? how much I will be out-of-pocket? Can you send the bill directly to Can you provide me with the relevant • • Teachers Health, so that they can Medicare Benefits Schedule (MBS) claim the Medicare benefit on my item numbers, so I can discuss behalf and send the payment these with Teachers Health and/or back to you? Medicare?

12 | PREGNANCY GUIDE OTHER INFORMATION

WHAT OUT-OF-POCKET FOR TREATMENT IN HOSPITAL EXPENSES MIGHT I HAVE? WHEN AN ADMITTED PATIENT: • A hospital excess paid upon admission • Medicare pays 75% of the MBS fee, to hospital (depending on your level of Teachers Health pays 25% of the cover). MBS fee. • Anaesthetist (if you have an epidural You pay the remainder of the account or a caesarean section) if they do not (unless the specialist providing the participate in the Access Gap Cover treatment participates in AGC). (AGC) scheme. It’s important to note that there is still AFTER THE BABY ARRIVES potential for out-of-pocket expenses When you are settled in, give us a call even if you are billed under the AGC on 1300 728 188 or log in to Online scheme. Member Services at teachershealth. com.au/members and add your baby • Any assisting specialists (e.g. to your cover. We will need your baby’s assisting surgeon if you require a name, date of birth and sex for them to caesarean) who do not participate in be covered with no waiting periods. All the AGC scheme. waiting periods will be waived for your • If your baby receives treatment in baby if you add them to your membership the hospital and is not an admitted within two months of their birth. patient (e.g. paediatric check-up). • Pharmaceuticals that are not covered in the agreement with the PLEASE NOTE: hospital or that are listed under the If you are on a Single membership, you Pharmaceutical Benefits Scheme. will need to upgrade to a Family or Single Parent membership within two months of FOR VISITS TO YOUR OBSTETRICIAN the birth of your baby, to add them to your AND ANY TESTS OR SCANS cover and avoid any waiting periods. BEFORE AND AFTER YOU GO TO HOSPITAL: • Medicare pays 85% of the Medicare Benefits Schedule (MBS) fee, you pay the remainder of the account.

13 | PREGNANCY GUIDE FREQUENTLY ASKED QUESTIONS

1. What happens if I am considering 3. What if my baby is premature and I getting pregnant but I’m on a am required to give birth in a public Hospital cover that excludes or hospital, even though I am booked restricts pregnancy or birth-related to give birth in a private hospital? services, and I want to give birth in a You may be admitted as a private private hospital? patient in a public hospital. You will It’s important you have Hospital cover not be guaranteed a private room, that includes pregnancy and birth- but if a private room is available or related services, such as Top Hospital. becomes available during your stay, A nine month waiting period applies you may be relocated to the available for all services relating to pregnancy room. This decision is dependent on and childbirth. This means you will the hospital and is not controlled or need to have held Top Hospital well in influenced by Teachers Health. advance of your pregnancy. 4. What happens if I have Hospital 2. What happens if my baby is cover that includes pregnancy, but premature and I have not served my I become pregnant while I am on a waiting periods? Single membership? If your baby comes early and you are If you have a Single membership, still within the nine month waiting you will still be covered during your period you will not be entitled to pregnancy and at the birth of your benefits under your private hospital baby. Once your baby is born, you cover. For this reason, Teachers will need to upgrade to a Family or Health recommends taking out or Single Parent membership. This is upgrading to a cover that includes particularly important if your baby is pregnancy well in advance of your admitted to hospital. pregnancy. For more information, or to upgrade your membership, please contact us on 1300 728 188. You will need to advise us of the name, date of birth and sex of your baby.

14 | PREGNANCY GUIDE 5. When is my baby an 8. Does Teachers Health pay benefits admitted patient? for physio? Babies born without complications Physio conducted outside of a are generally not admitted to hospital, hospital may be covered if you have but treated as an out-patient. Extras cover. Please contact us on A newborn baby is classified as an 1300 728 188 for further information. in-patient when one or more of the Some hospitals offer postnatal classes following criteria are met: in conjunction with your hospital admission and accommodation costs. the baby is admitted to an approved • These costs are covered by Teachers neo-natal intensive care facility Health if you have private Hospital • the baby is the second or subsequent cover. Eligibility criteria applies. born in a multiple birth situation (i.e. twins or triplets) 9. What is the Medicare Safety Net? The Medicare Safety Net provides the baby is more than 10 days old • families and individuals with financial when still in hospital. assistance for high out-of-pocket 6. What do I need to do if my baby is expenses for out-of-hospital MBS admitted to hospital? fees. Once you meet a Medicare Safety Net threshold, you may be After giving birth, your main focus eligible for additional Medicare will be on your own recovery and benefits for out-of-hospital MBS the health of your newborn baby. services for the rest of the calendar However, if your baby is admitted year. You can register for the to hospital, they will need to be added Medicare Safety Net for free at to your cover as soon as possible . This (within two months) to ensure that medicareaustralia.gov.au allows Medicare to track your out- a claim can be made for the costs of-hospital, out-of pocket expenses incurred during that time. and advise you when you are nearing 7. What happens if my baby is not the threshold. admitted to hospital but still 10. Why won’t my doctor participate receives treatment? in the Access Gap Cover (AGC) Benefits will only be available through scheme? Medicare. Medicare will cover 85% It is up to your doctor to decide whether of the Medicare Benefits Schedule to charge you under the AGC scheme. (MBS) fee. Benefits are not available Even if the doctor has previously from Teachers Health when your participated in this scheme, it does not baby is not an admitted patient in the guarantee that the doctor will hospital. participate for your treatment. Doctors are free to choose on a patient-by- patient basis. This decision remains solely with the doctor.

15 | PREGNANCY GUIDE 11. What might I have to pay for during 12. Can I receive benefits towards my hospital stay? home nursing after There are services that you may a hospitalisation? receive in hospital that are not If you have Top Extras cover you may covered by us. These include: receive benefits towards home visits by a registered nurse in a private telephone and internet • practice. usage charges • TV hire or other items of 13. Does Teachers Health pay a a non-medical nature benefit for one-on-one lactation consultations? pharmaceuticals that are not • If you have Top Extras cover you may covered in the agreement with the receive benefits towards one-on-one hospital or that are listed under the lactation consultations received from Pharmaceutical Benefits Scheme a recognised provider. (PBS).

16 | PREGNANCY GUIDE NEW FAMILY PROGRAM

Teachers Health provides more than simply Members participating in the program health insurance to our members. We also receive access to telephone understand that starting a family can be consultations with a trained Safe Sleep challenging, so we developed the New Space consultant. Based on individual Family Program to further support your circumstances, the consultations will health and wellbeing. support members through any early parenting challenges, particularly The New Family Program has been developed concerning infant sleep and settling. in collaboration with early childhood experts, Safe Sleep Space & Nourish Perinatal Wellness with the aim of helping our This program is brought to members members to navigate the first few months through Teachers Healthcare Services, of life with a newborn. The innovative and an initiative of Teachers Health to specialised program provides practical support our members’ health and information and support on a range wellbeing through quality, evidence- of early parenting matters, including based health management programs sleep and settling routines. Members and services. To be eligible for this participating in the program receive: program you must be a member of • Safe Sleep Space/Nourish video Teachers Health and have Hospital programs – a USB flash drive containing Cover with all waiting periods served. six video segments which offer useful, Additional eligibility criteria may apply. common sense ante- and post-natal To find out more, contact Teachers information, plus tips to gently prepare Health on info@teachershealth. your baby for sleep. Topics include com.au or call 1300 728 188. Eligible childbirth preparation, breastfeeding, members will then be connected with understanding your baby and settling. a dedicated Teachers Healthcare Services care coordinator who will Safe Sleep Space book – this easy to • support members on their personal read book presents information on journey. This program is not intended infant development, including what to replace the clinical advice of are realistic expectations and gentle your doctor or healthcare provider. approaches to sleep. You should consult your doctor for • Soothing Sounds for Sleep CD – based specialist medical advice if you have on the meditative effect of the multiple any concerns about your pregnancy. sound layers found within nature, this CD creates ‘white noise’ using the movement of ocean waters fused with the rhythm of powerful binaural heartbeats.

17 | PREGNANCY GUIDE From A to Z... we’ve got you covered

MORE INFORMATION Contact us on 1300 728 188

18 | PREGNANCY GUIDE DID YOU KNOW?

DENTAL OPTICAL • A pregnant woman’s unique diet It is recommended to have a during pregnancy can sometimes comprehensive eye examination during cause dental diseases. The frequency pregnancy, especially for women with of meals and gastric acids (due to conditions such as diabetes (including vomiting when experiencing morning gestational diabetes), high blood pressure, sickness) can cause erosion of the or a family history of glaucoma. tooth surface. A diet low in sugar and During pregnancy, women can experience acidity is recommended to reduce the the following changes to their vision: risk of tooth decay. prescription changes – this can A pregnant woman runs an increased • • be temporary or permanent. If your risk of gingivitis during pregnancy. prescription changes during your This is caused by an excess of bacterial pregnancy, we recommend that you plaque compounded by hormonal be re-examined at some point after changes. Good oral hygiene is highly the delivery of your baby or once you recommended to prevent this. finish breastfeeding So if you have Extras cover, have a dental dry eyes – especially if you wear check-up before you are planning to have • contact lenses. This can be treated a baby or after you conceive. with eye drops. Don’t forget to tell your dentist if you’re pregnant, or planning to be, as x-rays may not be safe at this time.

19 | PREGNANCY GUIDE MASSAGE Acupuncture Remedial or pre-natal massages are Consult a qualified practitioner such as great for back pain. There are some a member of the Australian Acupuncture essential oils that are beneficial during and Chinese Medicine Association pregnancy, however, there are some (AACMA). which should be avoided for their contraction stimulating properties. Be Reflexology sure to check with a qualified therapist Reflexology can help to reduce stress before using any essential oils during a and anxiety, which can cause conditions massage while you are pregnant. in pregnancy, labour and in the post natal period. DEALING WITH MORNING SICKNESS There are several remedies you can try If you have further questions, to help relieve morning sickness - some or are unsure of anything you of which are listed. It is important that you have read in this brochure, please talk to your obstetrician or midwife before trying them. Also ensure that the service contact us on 1300 728 188. providers are experienced in dealing with pregnant women. You may be able to claim a benefit for these services from your Teachers Health Extras cover.

20 | PREGNANCY GUIDE Inspiring good health

MORE INFORMATION For more information, visit teachershealth.com.au

21 | PREGNANCY GUIDE IT DOESN’T HURT TO ASK

Your pregnancy should be an enjoyable Alternatively, you can direct your experience. Please contact us if you questions to your obstetrician or the have any questions - we are here hospital where you are scheduled to have to help you. Call 1300 728 188 your baby. They will be able to tell you or email [email protected] what paperwork to take to Medicare and what to give Teachers Health.

Here for all your firsts

22 | PREGNANCY GUIDE NOTES:

23 | PREGNANCY GUIDE teachershealth.com.au Phone: 1300 728 188 Mail: (Monday – Thursday 8am – 8pm, GPO Box 9812 Friday 8am – 6pm, Sydney NSW 2001 Saturday 8.30am – 12.30pm AEST) Email: Mobile and overseas callers: [email protected] +61 2 8346 2111

The information contained within this brochure is current at the time of printing. Membership of Teachers Health is available to current and prior education union members and their families. Fund policyholders and those covered under a policy are subject to the rules and conditions of Teachers Health as well as applicable government legislation and laws. Fund policyholders are encouraged to review the Teachers Health Privacy Policy, available at teachershealth.com.au. Teachers Health is a signatory to the Private Health Insurance Code of Conduct. © Teachers Federation Health Ltd ABN 86 097 030 414 trading as Teachers Health. A Registered Private Health Insurer. THF-PG-04/17