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Submitting a Pre-Existing Condition (PEC) Certificate is a critical step for accessing your private health insurance benefits for hospital treatment. This form helps Teachers Health determine whether your condition is subject to waiting periods under Australian law. This guide will walk you through the process of correctly completing and submitting the THF-MPC-07/17 Pre-Existing Condition Certificate.

Download the Form: Teachers Health Pre-Existing Condition Certificate (GP & Specialist)

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Before You Start: Key Information & Preparation

What is a Pre-Existing Ailment?

Under the Private Health Insurance Act 2007, a pre-existing ailment is defined as:

“an ailment, illness or condition, the signs and/or symptoms of which… existed at any time during the six months preceding the day on which the contributor (patient) began contributions to their current hospital table.”

In simple terms, if you had signs or symptoms of the condition requiring hospital treatment in the six months before you joined or upgraded your current hospital cover, it may be classified as pre-existing. This can affect your benefits.

Document Checklist

Gather this information before visiting your doctors:

• Your Teachers Health member number
• Dates of your proposed hospital admission
• Details of the principal condition and proposed operation (if any)
• The date you first saw a doctor for this illness
• Details of all treating practitioners (GP and Specialist/Surgeon)

Critical First Step: Understand the Process

This is not a single-form task. You must obtain two separate, completed certificates:

1. Medical Practitioner Certificate – GP or Referring Practitioner
2. Medical Practitioner Certificate – Treating Specialist / Surgeon

⚠️ Warning: Both certificates must be completed, signed, and submitted together. Leaving a section blank or submitting an incomplete form will cause significant delays.

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Section-by-Section Filling Instructions

The PDF contains two nearly identical certificates. Follow this guide for each.

Part A: Patient Consent & Declaration

This section must be completed by the patient (or parent/guardian).

1. Read the Consent Statement: It explains that your medical information will be used solely to determine if your condition is pre-existing.
2. Fill in Your Details:
   • Member number: Enter your Teachers Health membership number.
   • Date of birth: Use the format DD / MM / YYYY.
   • Patient’s name: Your full legal name.
   • Date: The date you are signing the form.
3. Sign the Declaration: The patient (or legal guardian) must sign here. This consent allows your doctors to share relevant medical information with Teachers Health.

Part B: Certification by Medical Practitioner

This section must be completed by your doctor (GP for one form, Specialist for the other).

🔹 For the GP/Referring Practitioner Form:

• The GP who first saw you for this condition should complete this.
• If your GP referred you to a specialist, they are the “referring practitioner.”

🔹 For the Treating Specialist/Surgeon Form:

• The specialist or surgeon who will be performing or overseeing the hospital treatment completes this.

How to Guide Your Doctor Through Part B:

1. Hospital Admission Dates: Provide the known or proposed admission dates (From/To).
2. Condition & Operation Details:
   • 2a. Principal condition: The main medical reason for hospitalisation (e.g., “Severe Osteoarthritis, Right Knee”).
   • 2b. Nature of operation: The planned procedure (e.g., “Total Knee Replacement”).
   • 2c. Associated conditions: Any other related health issues.
3. First Attendance Date: The exact date you first consulted this doctor for the condition in 2a.
4. Signs & Symptoms (The Most Critical Section):
   • 4a. Consisted of: A clear description of your initial symptoms (e.g., “Persistent localised pain, swelling, and reduced mobility”).
   • 4b. Had commenced on: The date those specific symptoms began.
   • 4c. Had been present for: The duration (days, weeks, etc.) before you first saw the doctor.
5. Referral Information (Specialist Form Only): If the doctor completing the form is a specialist, they must state who referred you (your GP) and the date of referral.

Part C: Doctor’s Declaration

This final section is for the medical practitioner to complete and sign.

• The doctor fills in their name, practice address, phone number, and the date.
• The doctor must sign the declaration.

✅ Pro Tip: Before leaving your appointment, double-check that:

• Every field in Parts A, B, and C is filled.
• Dates are in the correct DD/MM/YYYY format.
• The doctor has signed Part C.
• You have signed the Patient Consent in Part A.

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Submission Process: How to Send Your Forms

You must submit both completed certificates together. Choose one of the following official methods:

Method	Instructions	Best For
Member App	1. Download the Teachers Health app. 2. Use the claims or document upload function.	Fastest, most convenient tracking.
Email	Send scanned copies of both forms and any supporting documents to: preexistingcertificate@teachershealth.com.au	Quick digital submission.
Mail	Post the original forms to: GPO Box 9812 Sydney NSW 2001	If you or your doctor prefer physical post.

⚠️ Important: Do not submit forms directly to your hospital. They must go to Teachers Health for assessment.

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After Submission: What Happens Next?

1. Acknowledgement: You may receive an automatic confirmation if submitting via app or email.
2. Assessment: A medical practitioner appointed by Teachers Health will review the information from both certificates.
3. Decision: Teachers Health will determine if your condition is considered pre-existing under the Act and inform you of the outcome and what benefits you are entitled to.
4. Timeframe: Allow time for processing. Incomplete forms are the most common cause of delay.

Your Rights & Privacy

• The information is used only for the PEC assessment.
• You can request to see the evidence considered in your assessment.
• If you disagree with the outcome, you can complain to the Private Health Insurance Ombudsman.
• Teachers Health manages your data under strict Australian privacy legislation. You can view their Privacy Policy online.

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Important Notes & Tips for a Smooth Process

• Start Early: Begin this process as soon as hospital treatment is planned. Do not leave it until the last minute.
• One Condition Per Episode: This form is for the specific condition leading to this hospital admission. Future admissions for other conditions may require new forms.
• Be Accurate and Consistent: Ensure the details (condition names, dates) match exactly on both the GP and Specialist certificates. Inconsistencies cause delays.
• Attach Supporting Documents: If you have relevant test results, referrals, or reports, attach them to your submission. This can help the assessor.
• Keep Copies: Always make photocopies or scans of the fully completed forms for your own records before submitting.
• Common Mistake to Avoid: The biggest error is forgetting the patient signature in Part A. You must sign both certificates.

Need More Help?

• For general claiming information, visit: teachershealth.com.au/using-your-cover/claiming-hospital-and-extras/
• For specific questions about the PEC process, contact Teachers Health via their official contact channels.

Completion of this form is a necessary step to ensure your private health insurance benefits are correctly applied. By following this guide, you can navigate the process confidently and help avoid unnecessary delays in your healthcare journey.