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My husband and I recently switched from Australian Unity to Teachers Health Fund. One of the reasons for the change was the refund of non-PBS medication with TH. As stated online and in the members’ guide for top extras: Pharmaceuticals - Benefits towards non-PBS prescription: $800 yearly limit per person. However, after trying to make a claim, I was told by a customer service officer that TH did not refund non-PBS medication. This was confirmed today by the TH Business Development Officer who sold us the policy: non-PBS medication are only covered if they are listed on the TH list. However, there is no mention of such a disclaimer on the TH site or in the membership contract and information. Therefore, we have now joined a fund on the basis of false/incomplete information. What other surprises are in store when we next attempt to make a claim?
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Hi @Anne2119 and welcome to the Community.
I moved your post to an already existing topic about consumer experiences with Teachers Health. Thank you for sharing your experience and knowledge of the product.
On searching their site for the information as explained to you. What I could find was a reference to the TGA approved drugs list but not the TH list. Was the drug you were trying to claim for a TGA approved prescription non PBS medication? The following come from various parts of their site and included is the Product Information document in regards to the Pharmaceutical benefits (second screenshot). Did they actually refer to the TH list? If they did this appears to be inconsistent with their Product Disclosure document and could be a grounds for complaint. The complaint can be made to the Commonwealth Ombudsman (a free service) and at the bottom of this post I have included a link to the relevant page about Private Health Insurance and how to contact the Ombudsman.
Commonwealth Ombudsman
We’re with Teachers Health and have been since 1991. We find it to be an excellent Health Fund. Our dental is carried out by a Teachers Health Dentist and for general checkup and clean is free. We also have eye checks and cover done by Teachers Health Opticians. Again, excellent. We’ve both had lens replacements done by the Doctor to whom we were referred by Teachers Health. Again, excellent and Teachers Health covered the cost.
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Thank you for your response and the screen shots you sent. I did see those on the TH website, but like you, I cannot find a list. Yes, my prescription has received TGA approval.
My intention is to make a complaint to the Ombudsman. Thank you for the information.
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It will be the TGA list:
The wording on the Teachers Health website ’ treat a medical condition’ is likely to mean than it needs to be used to treat something which is diagnosed by a doctor and approved (registered) by the TGA to treat such conditions.
It won’t apply to any over the counter products which can be bought through self diagnosis nor purchases which aren’t supported by a medical diagnosis and not shown to be effective for the condition.
The number of non-PBS prescribed medicines would be limited as most would be prescribed by a doctor would be PBS subsidised where necessary to treat a condition.
Edit: thinking further, it might only be treatments which are prescribed by a doctor but not subsidised under the PBS. There are often reports of patients or advocacy groups asking for medicines to be included on the PBS to save patients, using the medicines, money. Such medicines can be extremely expensive. These aren’t over the counter type medicines but are prescribed based on the unique requirements of the patient.
If this benefit was the deciding criteria which persuaded change to Teachers Health, it may have been prudent to confirm what the benefit is and if it is useful to one’s own circumstances before making the change.
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If you want to, please let us know here how the complaint went when you receive your answer/outcome. Your feedback will help others if they encounter this issue.
