Singles, Couples & Families. Effective 1 October 2017 TAS

Transcription

1 Singles, Couples & Families Effective 1 October 2017 TAS

2 ii St.LukesHealth singles, couples and families

3 Welcome to St.LukesHealth If you have started to read this brochure you have already recognised that Medicare may not be sufficient to meet your health care needs. Medicare alone does not give you the freedom to choose where or by whom you wish to be treated. St.LukesHealth can give you that security. With St.LukesHealth you will have greater control and more choice to meet your health care needs. In this brochure, St.LukesHealth presents a range of hospital covers, extras covers and combined hospital and extras packages that are specifically designed to provide you with choices to meet your needs. Our friendly customer care team is trained to provide you with a personalised service to assist you in choosing the level of cover you require, so don t hesitate to call us. We ll make it easy for you! We know how busy life can be, so we would like to look after your interests by bringing our services to you. If you would like to discuss your health cover needs with one of our business development consultants either at home or at work, please contact us on the number below. Alternatively, information on St.LukesHealth is available at your fingertips by visiting our website or by downloading our app from the itunes App Store or Google Play. Telephone Visit general@stlukes.com.au or Download our app from the itunes App Store or Google Play facebook Find us on Facebook The information contained in this brochure should be read carefully and retained. St.LukesHealth singles, couples and families 1

4 2 St.LukesHealth singles, couples and families

5 Contents Why do you need private health cover 4 Product Features 6 Looking after your health and wellbeing 8 Packaged cover Packaged hospital & extras products Hospital cover Stand alone hospital products Extras cover Stand alone extras products Information about private health cover 30 Payment options 35 Claiming options 36 Online member services 37 St.LukesHealth on your phone 37 Complaints, compliments and suggestions 38 Important information you need to know 39 Premiums 46 Application forms 55 St.LukesHealth singles, couples and families 3

6 Why do you need private health cover? Private hospital care and choice of doctor Medicare provides you with access to emergency care in a public hospital. However, for elective surgery you will be placed on a waiting list and you may have to wait for a public bed to become available. As a public patient you won t have a choice of doctor as you will be allocated a doctor by the hospital. Private health cover gives you the freedom, to be treated by your doctor of choice, at a time that best suits your needs. It opens the door to the choices that the private health care system offers and helps you to protect both your health and your lifestyle too. Extra services not covered by Medicare In addition to private hospital treatment, there are many extra health care services that Medicare does not cover. These services include dental, optical appliances, physiotherapy, remedial massage, and natural therapies to name a few. St.LukesHealth offers benefits to help meet these additional costs. Avoid the Lifetime Health Cover loading Lifetime Health Cover (LHC) is an Australian Government initiative. Under LHC you may have to pay a loading on your premium depending on what age you or your partner first take out hospital cover. To avoid the loading you must take out private hospital cover by 1 July immediately following your 31st birthday. Any delay will result in a 2% loading for each year you are over the age of 30 up to a maximum loading of 70% and as from 1 July 2013, the Private Health Insurance rebate does not apply to any LHC loading applied to your policy. If a LHC loading is applied to your premium, it can be removed after you have held hospital cover for 10 continuous years. For more information on LHC see page 32. Receive an Australian Government Rebate on your Private Health Cover The Australian Government provides a rebate on private health cover to make private health care more affordable. The rebate is subject to an income test so the amount of rebate you are entitled to will depend on your level of income. All Australians eligible for Medicare may be entitled to receive a rebate depending on your level of income. Higher rebates are available for people aged over 65 and 70. If you are eligible for a rebate you can lower your health cover premium by applying to receive the rebate as a reduction in the premium you pay to St.LukesHealth, or you can claim the rebate in your annual tax return. On 1 July 2013, the Australian Government introduced a change to remove the rebate from any Lifetime Health Cover loading that may apply to a policy, meaning the rebate only applies to the base rate premium of a private health insurance product. For more information on the rebate see page St.LukesHealth singles, couples and families

7 You may avoid the Medicare Levy Surcharge The Medicare Levy Surcharge (MLS) is another Australian Government initiative. If your taxable income is above the defined income thresholds set by the Government, you will be required to pay an additional MLS of up to 1.5% if you don t hold an appropriate level of private hospital cover. An appropriate level of hospital cover is one which does not have an excess greater than $500 for single members or greater than $1000 for couples, single parent or family members. If you take out private hospital cover with St.LukesHealth you may be exempt from paying the MLS from the date the policy is effective on all hospital covers, with the exception of our high excess product Hospital For further information go to our website at or refer to our separate brochure entitled The Australian Government Rebate on Private Health Insurance. More information about the MLS is also available on the Australian Taxation Office (ATO) website or you can call the ATO on Medicare Levy Surcharge Income Tiers Income Base Tier Tier 1 Tier 2 Tier 3 Single Income $0 - $90,000 $90,001 - $105,000 $105,001 - $140,000 $140,001 + Families Income $0 - $180,000 $180,001 - $210,000 $210,001 - $280,000 $280,001+ Additional Medicare Levy Surcharge 0.0% 1.0% 1.25% 1.5% St.LukesHealth acknowledges that the opportunity to avoid paying the MLS, however, is limited in its scope to the proportionately few people, including individuals and families who fall into the Tier 1, Tier 2 and Tier 3 income tiers. But I m young and healthy! Even when you re young and healthy, you don t know when an unexpected illness or injury can hit. It s not just a sporting injury that may see you in hospital, it may be tonsillitis, appendicitis or your wisdom teeth, or it may be an unexpected illness that you thought would never happen to you. If you only have Medicare cover and you require hospital treatment, you may have a delay before a public hospital bed becomes available. With St.LukesHealth you can choose where or by whom you wish to be treated. St.LukesHealth offers you the flexibility and security you require to control your future health care needs. Why St.LukesHealth is your best choice Established in Tasmania, St.LukesHealth has been providing private health cover to Australians since Over this time, St.LukesHealth has built a strong reputation on its expertise and ability to supply top quality health cover and to provide exceptional customer service to its members. Our cover is Australia wide so regardless of where you live, doing business with St.LukesHealth is easy. St.LukesHealth is also an innovator in the industry with a number of standout product features including gap free preventative dental, no hospital excess for children on most hospital covers and a great range of no gap optical partnerships. Find out more on pages 6 and 7. St.LukesHealth singles, couples and families 5

8 Product features for you and your family: Great cover for you and your family. Gap free preventative dental for all the family at your choice of dentist Under gap free preventative dental, we offer cover options that pay 100% of your dentists regular fee* up to a maximum benefit for each eligible service. This means that for most dentists you will have no gap or out of pocket to pay for an examination, x-ray, scale and clean or fissure sealing. This will help you keep your teeth and gums healthy and help prevent the need for more extensive treatment later on. Importantly Gap Free Preventative Dental applies to all the family at your choice of dentist. Find out more on page 9. * regular fee refers to the average fee your dentist charges to all patients of his or her practice for each eligible service. Gap free preventative dental for children Our gap free preventative dental is even better for children who can enjoy gap free cover for fissure sealing on eligible products. Placement of sealants in children assessed as having a high risk of tooth decay, is a safe and effective way in preventing dental decay in permanent teeth. Find out more on page 9. Children are covered until they turn 23 Children are covered on their parent s policy until they reach the age of 23, provided they are not married or living in a defacto relationship. Single, full time students dependants can remain covered until they reach the age of 25, if fully dependent on their parents. Want to keep them protected? Non-student child dependants can now remain covered on their parent s policy until they reach the age of 25, provided they are not married or living in a defacto relationship. Our Dependant Extension option is available on selected hospital and package products for an additional premium. No hospital excess for children If you choose an excess you won t have to pay the excess on most hospital covers if a child covered on your policy needs to go to hospital. Save with no excess on same day treatment You can choose a hospital cover with no excess on same day treatment for adults and children. The excess will only apply to overnight hospital treatment. This represents a real savings, as two in three hospital procedures are now performed on the same day. 6 St.LukesHealth singles, couples and families

9 Get rewarded for staying a member At St.LukesHealth we value the relationship we have with our members and that s why we have introduced Member Rewards on selected covers. Member Rewards will reward each person who has held top extras cover with St.LukesHealth for five years or more with a 5% increase in their dental benefits and annual dental limits. Find out more on pages 14 and 25. Great service and great service options We pride ourselves on our customer service. You can experience our friendly face to face service at one of our many customer care centres or agents, or you can access your membership details and transact business over the Internet through our online member services. Claiming is easy with point of service electronic facilities (HICAPS) or mobile claiming from your iphone or Android phone and we have convenient methods of premium payments including direct debit, salary deduction, BPay and Internet. We have great partners too You can choose from a range of no gap* options and discounts from our optical partners, Eyelines, Look of Australia, Specsavers, OPSM, Sharpe and Fowler Eyecare, Total Eyecare and Laubman and Pank. * subject to your level of cover and policy conditions. Customers of MyState and Tasplan can take advantage of the discounts and benefits offered through our alliance partnerships. Ask us about our other partnerships that will add value to your membership! These features and more, establish St.LukesHealth as your best choice in health cover. Transferring from another fund without loss of benefits? If you have served all your waiting periods with another fund, you can transfer to equivalent or lower cover with St.LukesHealth without having to re-serve waiting periods on benefits common to both funds, providing you transfer within 2 months of ceasing to be covered by your previous fund. If you transfer to a higher level of cover, some waiting periods may apply for the higher benefits. For more information on waiting periods and pre-existing conditions, refer to page 30 and membership conditions 1 and 3 on page 39. Our guarantee We re certain you ll be satisfied with your St.LukesHealth membership so we offer you our membership guarantee. If within the first 30 days of joining St.LukesHealth you are not fully satisfied with the cover you have chosen, we will refund any premium paid by you providing there have been no claims made against your policy during that period. St.LukesHealth singles, couples and families 7

10 Looking after your Health and Wellbeing We know how busy life can be and how difficult it can be to dedicate the time you need to look after your health and wellbeing. We also know how important health cover is when you are unwell and need access to the best health care available. However, at St.LukesHealth we go one step further by helping you stay healthy with our health and wellbeing and preventative programs. You can now get so much more from your health cover, even when you re not sick. My Health Guardian Improving your health and wellbeing My Health Guardian is an online health and wellbeing program featuring a wide range of innovative online planning and monitoring tools that make it easier for you to improve your health and wellbeing. The health management tools available to you with My Health Guardian include: Your Wellbeing Assessment a simple, guided process to assess your lifestyle and overall health. Your Wellbeing Action Plan put together your online interactive wellbeing action plan, including focus areas to keep you on track. A resource library with hundreds of articles, exercises and recipes for you to access. Access to qualified health coaches online access to health coaches that can assist you with any diet, exercise and lifestyle questions you have. Personalised exercise and diet plans use the Get Fit and Eat Fit tools to put together your exercise and diet plans. There are exercise demonstrations and lots of healthy recipes to help you put your plans together. To access these tools you need to hold either hospital and/or extras cover and be 18 years of age or older. 8 St.LukesHealth singles, couples and families

11 Telephone support from nurses trained in chronic disease management is also available to members with chronic conditions who hold hospital cover. My Health Guardian is provided in conjunction with Healthways Australia, an independent health and wellbeing company. Any personal or medical information you provide through the program remains confidential and is not released to St.LukesHealth. Your participation is totally voluntary and does not in any way affect your health insurance premium or your eligibility to make a claim. For more information on My Health Guardian, go to our website at Gap Free Preventative Dental Another way in which we support your health and wellbeing is by encouraging regular dental check-ups to help keep your teeth and gums healthy. That s why we offer cover options with gap free preventative dental for both adults and children at your choice of dentist. Under gap free preventative dental we pay 100% of your dentist s regular fee* up to a maximum benefit for each eligible service. This means that for most dentists you will have no gap or out of pocket to pay for an examination, x-ray, scale and clean or fissure sealing. This will help you keep your teeth and gums healthy and hopefully prevent the need for more extensive treatment later on. Annual limits apply. Find out more on pages 13 and 24. * regular fee refers to the average fee your dentist charges to all patients of his or her practice for each eligible service. St.LukesHealth singles, couples and families 9

12 Packaged cover Packaged hospital & extras products If you require hospital and extras cover, then a packaged product is your best option. You can choose from one of the following packages, or you can create your own combined product by mixing and matching a stand alone hospital product from pages 20 and 21 with a stand alone extras product from page 24 and 25. The following packaged products provide a range of combined hospital and extras cover options offering a complete health cover package. Comprehensive options (if you want the best) Combined Plan Single policy Per calendar year Hospital Excess Couple & Family policies Per person per calendar year Maximum per policy per calendar year Level of Extras cover Packaged Platinum Plus nil nil nil our highest Packaged Platinum nil nil nil comprehensive Packaged Platinum Plus and Packaged Platinum are St.LukesHealth premium combined hospital and extras products. Both products give you top private hospital cover without the need to pay an excess. Both products also offer a comprehensive level of extras cover, with Packaged Platinum Plus members enjoying the highest level of extras benefit. Refer to page 12 for detail on the hospital benefits covered and refer to the extras benefit comparison on pages 15 to 19 for detail on the extras benefits covered. For a premium comparison refer to pages 46 to 50. Comprehensive with excess options (if you want to lower your premium) Combined Plan Single policy Per calendar year Hospital Excess Couple & Family policies Per person per calendar year (excluding children) Maximum per policy per calendar year Level of Extras cover Packaged Gold $300 $300 $600 comprehensive Packaged Silver $500 $500 $1,000 comprehensive Packaged Bronze Plus $500 $500 $1,000 basic Packaged Gold, Silver and Bronze Plus all give you top private hospital cover with your choice of excess. Packaged Gold and Silver also offer a comprehensive level of extras cover and with Packaged Bronze Plus you can save more by choosing a basic level of extras cover. The excess only applies to adults who are hospitalised overnight. It does not apply to same day hospital treatment or to children covered by the policy. Refer to page 33 for more detail on how the excess is applied. Refer to page 12 for detail on the hospital benefits covered and refer to the extras benefit comparison on pages 15 to 19 for detail on the extras benefits covered. For a premium comparison refer to pages 46 to St.LukesHealth singles, couples and families

13 Budget options (if you only need a basic cover) Combined Plan Packaged Budget 500 Level 1 Packaged Budget 500 Level 2 Restricted Services 5 restricted services (see list below) 8 restricted services (see list below) Single policy Per calendar year Level 1 Restricted services Joint replacement Cataract and eye lens procedures Bariatric procedures (weight loss surgery, including repair, replacement, removal and adjustment) Dialysis for chronic renal failure Psychiatric services (including drug and alcohol rehabilitation) Hospital Excess Couple & Family policies Per person per calendar year (excluding children) Maximum per policy per calendar year Level of Extras cover $500 $500 $1,000 basic $500 $500 $1,000 basic Level 2 Restricted services Joint replacement Cataract and eye lens procedures Bariatric procedures (weight loss surgery, including repair, replacement, removal and adjustment) Dialysis for chronic renal failure Psychiatric services (including drug and alcohol rehabilitation) Pregnancy and related services Assisted reproductive services Cardiac and cardiac related services Packaged Budget 500 Levels 1 and 2 offer private hospital cover with an excess for all services except for the restricted services listed above where the benefit is limited, once the excess is deducted, to the public hospital shared ward room rate if you elect to be treated as a private patient in a public hospital. There is very limited cover in a private hospital for the restricted services listed. So if you do elect to be treated in a private hospital for a restricted service, significant out of pocket costs will apply. A basic level of extras cover is also included in both products. The excess applies to overnight and same day hospital treatment for adults. The excess does not apply to children covered by the policy. Refer to page 33 for more detail on how the excess is applied. Refer to page 12 for detail on the hospital benefits covered and refer to the extras benefit comparison on page 15 to 19 for detail on the extras benefits covered. For a premium comparison refer to pages 46 to 50. St.LukesHealth singles, couples and families 11

14 Packaged cover Hospital Benefits Hospital Benefit Platinum Plus & Platinum Gold, Silver & Bronze Plus Budget 500 Level 1 & 2 Full cover for hospital accommodation and theatre fees in all contracted private hospitals and day hospital facilities within Australia (medical certification is required after 35 continuous days in hospital). Full cover for intensive and coronary care in all contracted private hospitals (medical certification is required). Benefits will be paid at no less than the minimum benefit when you elect to be treated as a private patient in all public hospitals within Australia. Benefits towards approved surgically implanted prostheses (see page 34 for more detail). The gap between the Medicare benefit and the Medicare Benefit Schedule (MBS) fee for medical services performed while you are an inpatient in hospital. Additional gap cover benefit for medical services provided by practitioners participating in St.Lukes Gap Cover (see page 34 for more detail). Benefits towards uncontracted private hospitals (patient gaps may apply, you should check with St.LukesHealth before being admitted to an uncontracted hospital). Restricted services (refer to page 11 and membership condition 5 on page 39). no no yes Cosmetic surgery and other surgical procedures not covered by Medicare (refer to membership conditions 6, 8 and 9 on pages 39 and 40). not covered not covered not covered Excess on overnight hospitalisation (see page 33 for more details). Excess on same day hospitalisation (see page 33 for more details). Excess on child dependants (see page 33 for more details). Waiting periods and benefit limitation periods apply (refer to page 30 and membership conditions 1, 2 and 3 on page 39 for more details). Exempts high income earners from having to pay the additional Medicare Levy Surcharge (refer to page 5 for more details). no yes yes no no yes no no no yes yes yes yes yes yes A full list of the private hospitals and day hospital facilities contracted with St.LukesHealth is available on request or by visiting our website at 12 St.LukesHealth singles, couples and families

15 Packaged cover Extras benefits In addition to the hospital benefits outlined on pages 10 and 11, St.LukesHealth Packaged cover also offers benefits towards the cost of an extensive range of other health care services. Examples of benefits are included in this extras benefit comparison and where applicable annual limits are per person covered per calendar year unless otherwise specified. A calendar year runs from January to December. Benefits are only payable when rendered by a practitioner in private practice who is recognised by this Fund. Contact the Fund on to check whether your practitioner is registered. For details on the extras benefits covered on our Packaged cover, refer to the extras benefit comparison on pages 15 to 19. Gap Free Preventative Dental A popular feature on Packaged Platinum Plus, Packaged Platinum, Packaged Gold and Packaged Silver is Gap Free Preventative Dental. Under gap free preventative dental we pay 100% of your dentist s regular fee* up to a maximum benefit for each eligible service. This means that for most dentists you will have no gap or out of pocket to pay for an examination, x-ray, scale and clean or fissure sealing. If your dentist charges above the maximum benefit a gap or out of pocket may apply. The stand out features of Gap Free Preventative Dental for St.LukesHealth members is that it applies to both adults and children and at your choice of dentist. We don t tell you which dentist you need to go to in order to receive the higher benefit for preventative dental as it applies to all dentists^. A great way to help you keep your teeth and gums healthy. An extra feature for children is gap free cover^ for fissure sealing. Placement of sealants in children assessed as having a high risk of tooth decay, is a safe and effective way in preventing dental decay in permanent teeth. * Regular fee refers to the average fee your dentist charges to all patients of his or her practice for each eligible service ^ Includes examination, x-ray, scale and clean and fissure sealing. Benefits of 100% of the dentist s regular fee* apply on selected products up to a maximum benefit per service. If your dentist charges above the maximum benefit, or in excess of the regular fee* he or she charges all patients, a gap or out of pocket may apply. Benefit applies to both adults and children who have served their two month waiting period. Other preventative services such as topical fluoride application and provision of mouthguard not included. Annual limits apply. Package bonus When you take out Packaged Platinum Plus, Packaged Platinum, Packaged Gold or Packaged Silver, you will also receive a bonus benefit towards approved health management programs. See the extras benefit comparison on page 19 for more detail on this benefit. St.LukesHealth singles, couples and families 13

16 Member Rewards At St.LukesHealth we value the relationship we have with our members and that s why we have introduced Member Rewards on selected covers. Member Rewards will reward each person who has held top extras cover with St.LukesHealth for five years or more with a 5% increase in their dental benefits and annual dental limits. Member Rewards applies to the following products, Packaged Platinum Plus, Packaged Platinum, Packaged Gold and Packaged Silver. To qualify for member rewards each individual person covered by an eligible product must meet the following conditions: You must have held membership of one of the eligible covers with St.LukesHealth for at least five continuous years; Qualification is based on the length of membership of the individual covered by an eligible product; The additional 5% increase in dental benefit applies to all dental services excluding preventative services paid under gap free preventative dental; and Previous membership of another health fund does not count towards the five years continuous membership as the reward is for your length of membership with St.LukesHealth. This is another great reason to maintain your top extras cover with St.LukesHealth. 14 St.LukesHealth singles, couples and families

17 Packaged cover Extras benefit comparison Service Category Platinum Plus Benefits Platinum, Gold & Silver Bronze Plus & Budget 500 Levels 1 & 2 General Dental 2 month waiting period Annual Limit per person per calendar year $1,250 $1,000 $500 preventative dental (examination, x-ray, scale and clean and fissure sealing) * Regular fee refers to the average fee your dentist charges to all patients of his or her practice for each eligible service. See page 13 for details on gap free preventative dental 100% of dentist s regular fee up to maximum benefit per service* limit of two general dental consultations per person per calendar year comprehensive oral examination see above $33 limit of two general dental consultations per person per calendar year scaling and cleaning see above $54 simple extraction $112 $97 $77 mouthguard $105 $90 $65 limit of one per person per calendar year 1 surface filling - posterior tooth $106 $91 $71 Major Dental 12 month waiting period Annual Limit per person per calendar year $2,000 $1,500 nil Periodontics course of non-surgical treatment 80% 70% nil fixed rebates apply to some periodontic services sublimit per person per calendar year $1,500 $1,000 nil Endodontics preparation of root canal 1 canal $185 $160 nil root canal obturation 1 canal $200 $170 nil sublimit per person per calendar year $1,500 $1,000 nil Crowns & Bridges full crown veneered indirect $1035 $805 nil sublimit per person per calendar year $1,500 $1,000 nil Procedures for Dental Implants full crown attached to implant veneered indirect $855 $630 nil sublimit per person per calendar year $1,500 $1,000 nil Dentures complete upper denture $630 $480 nil complete upper & lower denture $1,000 $800 nil limit of one upper and one lower denture per person payable every 2 calendar years sublimit per person per calendar year $1,000 $800 nil Orthodontics course of treatment 100% 100% nil fixed rebates apply to some orthodontic services sublimit per person per calendar year $1,200 $1,000 nil lifetime limit $3,000 $2,800 nil The overall limit for each service category is highlighted. Some categories have sub limits which are included within the overall limit for that service category. n/a St.LukesHealth singles, couples and families 15

18 Service Category Platinum Plus Benefits Platinum, Gold & Silver Bronze Plus & Budget 500 Levels 1 & 2 Optical 6 month waiting period Annual Limit per person per calendar year $350 $300 $200 frames 100% of fee up to annual limit $95 single vision lenses 100% of fee up to annual limit $105 bi-focal lenses 100% of fee up to annual limit $105 multi-focal lenses 100% of fee up to annual limit $105 soft contacts $350 $300 $200 hard contacts $350 $300 $200 disposable contacts (12 months supply) $350 $300 $200 repair to frames $30 $25 $20 * includes benefit towards hardening of lenses. Physiotherapy 2 month waiting period Annual Limit per person per calendar year $1,000 $850 $500 physiotherapy initial $55 $50 $40 subsequent $45 $40 $32 exercise physiology initial $45 $40 nil subsequent $36 $32 nil sublimit per person per calendar year $200 $200 nil approved group sessions (includes hydrotherapy) $25 $15 $15 sublimit per person per calendar year $500 $300 $150 ante natal/post natal $25 $25 $20 sublimit per person per calendar year $500 $400 included in physiotherapy limit lymphedema $45 $40 $32 sublimit per person per calendar year included in physiotherapy limit Pharmacy 2 month waiting period Annual Limit per person per calendar year $600 $600 nil per non PBS prescription $90 $70 nil for prescriptions not covered by the PBS, excluding contraceptives, anabolic steroids, items normally available without prescription and drugs not approved for sale in Australia. A co-payment applies to each prescription item equal to the current non-concessional PBS co-payment amount. The overall limit for each service category is highlighted. Some categories have sub limits which are included within the overall limit for that service category. 16 St.LukesHealth singles, couples and families

19 Service Category Platinum Plus Benefits Platinum, Gold & Silver Bronze Plus & Budget 500 Levels 1 & 2 Other Therapies 2 month waiting period Annual Limit per person per calendar year $1,000 $1,000 nil Podiatry initial $45 $40 nil subsequent $36 $32 nil sublimit per person per calendar year $500 $400 nil Occupational Therapy initial $73 $68 nil subsequent $52 $47 nil sublimit per person per calendar year $500 $400 nil Eye Therapy initial $50 $45 $25 subsequent $38 $33 $25 sublimit per person per calendar year $500 $400 included in physiotherapy limit Speech Therapy initial $85 $75 $30 subsequent $52 $47 $24 sublimit per person per calendar year $500 $400 included in physiotherapy limit Dietetics initial $80 $75 nil subsequent $50 $45 nil sublimit per person per calendar year $500 $200 nil Alternative Therapies 2 month waiting period Annual Limit per person per calendar year $1,000 $500 included in physiotherapy limit Chiropractic initial $45 $40 nil subsequent $33 $28 nil sublimit per person per calendar year $500 $400 nil Chiropractic X-rays $60 $60 nil sublimit per person per calendar year included in chiropractic limit nil Osteopathic initial $50 $45 nil subsequent $40 $35 nil sublimit per person per calendar year included in chiropractic limit nil Acupuncture initial $40 $35 $25 subsequent $35 $30 $25 sublimit per person per calendar year $500 $400 $200 Natural Therapies initial $37 $32 $29 subsequent $33 $28 $25 Includes chinese & western herbal consultations, homeopathy, naturopathy, myotherapy and remedial massage therapy. sublimit per person per calendar year $500 $400 $200 The overall limit for each service category is highlighted. Some categories have sub limits which are included within the overall limit for that service category. St.LukesHealth singles, couples and families 17

20 Service Category Platinum Plus Benefits Platinum, Gold & Silver Bronze Plus & Budget 500 Levels 1 & 2 Clinical Psychology 12 month waiting period Annual Limit per person per calendar year $500 $400 nil initial consultation $95 $90 nil subsequent consultation $90 $80 nil Diabetes Education 2 month waiting period initial consultation $60 $55 nil subsequent consultation $50 $45 nil sublimit per person per calendar year included in Dietetics limit Home Nursing 2 month waiting period Annual Limit per person per calendar year $500 $500 nil per service for services provided by a registered nurse in private practice. $55 $50 nil Health Appliances and Aids 12 month waiting period Annual Limit per person per calendar year $1,500 $1,000 nil foot orthotics (custom made) 90% 85% nil sublimit per person per calendar year $250 $200 nil repair to custom made foot orthotics $35 $30 nil sublimit per person per calendar year limit of one repair per person per calendar year nil other specified orthotics* eg. custom fitted spinal & knee braces. 90% 90% nil sublimit per person per calendar year limits apply to individual items nil specified prosthetic appliances* eg. breast prosthesis after mastectomy. 90% 90% nil sublimit per person per calendar year limits apply to individual items nil other specified health aids* eg. blood glucose monitor, nebuliser. 90% 90% nil sublimit per person per calendar year limits apply to individual items nil * A full list is available at any of our offices. Audiology 2 month waiting period Annual Limit per person per calendar year 2 per year 2 per year nil per consultation $45 $40 nil Only payable when service rendered by an Audiologist in private practice and approved by this Fund. Benefit will not be payable if the service is claimable from any other source. The overall limit for each service category is highlighted. Some categories have sub limits which are included within the overall limit for that service category. 18 St.LukesHealth singles, couples and families

21 Service Category Platinum Plus Benefits Platinum, Gold & Silver Bronze Plus & Budget 500 Levels 1 & 2 Member Rewards 5 year qualifying period 5% increase in dental benefits Yes Yes No (excluding preventative services paid under gap free preventative dental) 5% increase in annual dental limits Yes Yes No Member reward benefits are payable after 5 years continuous membership on an eligible St.LukesHealth product. See page 14 for qualifying conditions. Health Management Programs 3 month waiting period single policy per year 70% 70% nil annual limit per policy per calendar year $100 $100 nil couples & families policy per year 70% 70% nil annual limit per policy per calendar year $200 $200 nil Benefits are payable for approved health management programs. Limits apply to the policy, not to each person covered by the policy. Contact St.LukesHealth for more information on approved health management programs. The overall limit for each service category is highlighted. Some categories have sub limits which are included within the overall limit for that service category. St.LukesHealth singles, couples and families 19

22 Hospital cover Stand alone hospital products Our hospital covers provide top private hospital cover which can be taken on their own if you only need hospital cover, or you can tailor your own hospital and extras package by combining a hospital cover with a stand alone extras cover from pages 24 and 25. The following hospital products provide a range of options to help you choose the right cover for you and your family. Comprehensive options (if you want the best) Hospital Plan Single policy Per calendar year Hospital Excess Couple & Family policies Per person per calendar year Maximum per policy per calendar year Hospital Platinum nil nil nil Hospital Platinum gives you top private hospital cover without the need to pay an excess. Refer to page 22 for detail on the hospital benefits covered. For a premium comparison refer to pages 46 to 50. Comprehensive with excess options (if you want to lower your premium) Hospital Plan Single policy Per calendar year Hospital Excess Couple & Family policies Per person per calendar year (excluding children) Maximum per policy per calendar year Hospital 300 $300 $300 $600 Hospital 500 $500 $500 $1,000 Hospital 1000* $1,000 $1,000 $2,000 Hospital 300 and 500 gives you top private hospital cover with your choice of excess. The excess only applies to adults who are hospitalised overnight. It does not apply to same day hospital treatment or to children covered by the policy. Refer to page 33 for more detail on how the excess is applied. Hospital *High excess hospital cover Note: Hospital 1000 will not exempt high income earners from having to pay the additional Medicare Levy Surcharge. Refer to page 5 for more detail. An excess of $200 per admission applies to same day hospital treatment on Hospital 1000, up to the maximum excess of $1,000 per person. The full excess of $1,000 per person applies to overnight hospital treatment (less any excess that has already been applied to same day treatment for that person in the same calendar year). The excess applies to both adults and children covered by the policy. Refer to page 33 for more detail on how the excess is applied. Refer to page 22 for detail on the hospital benefits covered. For a premium comparison refer to pages 46 to St.LukesHealth singles, couples and families

23 Budget options (if you only need a basic cover) Combined Plan Budget 500 Level 1 Budget 500 Level 2 Restricted Services 5 restricted services (see list below) 8 restricted services (see list below) Single policy Per calendar year Level 1 Restricted services Joint replacement Cataract and eye lens procedures Bariatric procedures (weight loss surgery, including repair, replacement, removal and adjustment) Dialysis for chronic renal failure Psychiatric services (including drug and alcohol rehabilitation) Hospital Excess Couple & Family policies Per person per calendar year (excluding children) Maximum per policy per calendar year $500 $500 $1,000 $500 $500 $1,000 Level 2 Restricted services Joint replacement Cataract and eye lens procedures Bariatric procedures (weight loss surgery, including repair, replacement, removal and adjustment) Dialysis for chronic renal failure Psychiatric services (including drug and alcohol rehabilitation) Pregnancy and related services Assisted reproductive services Cardiac and cardiac related services Budget 500 Levels 1 and 2 offer private hospital cover with an excess for all services except for the restricted services listed above where the benefit is limited, once the excess is deducted, to the public hospital shared ward room rate if you elect to be treated as a private patient in a public hospital. There is very limited cover in a private hospital for the restricted services listed. So if you do elect to be treated in a private hospital for a restricted service, significant out of pocket costs will apply. The excess applies to overnight and same day hospital treatment for adults. The excess does not apply to children covered by the policy. Refer to page 33 for more detail on how the excess is applied. Refer to page 22 for detail on the hospital benefits covered. For a premium comparison refer to pages 46 to 50. St.LukesHealth singles, couples and families 21

24 Stand alone hospital cover benefits Hospital Benefit Hospital Platinum Hospital 300 & 500 Budget 500 Level 1 & Level 2 Hospital 1000 Full cover for hospital accommodation and theatre fees in all contracted private hospitals and day hospital facilities within Australia (medical certification is required after 35 continuous days in hospital). Full cover for intensive and coronary care in all contracted private hospitals (medical certification is required). Benefits will be paid at no less than the minimum benefit when you elect to be treated as a private patient in all public hospitals within Australia. Benefits towards approved surgically implanted prostheses (see page 34 for more detail). The gap between the Medicare benefit and the Medicare Benefit Schedule (MBS) fee for medical services performed while you are an inpatient in hospital. Additional gap cover benefit for medical services provided by practitioners participating in St.Lukes Gap Cover (see page 34 for more detail). Benefits towards uncontracted private hospitals (patient gaps may apply, you should check with St.LukesHealth before being admitted to an uncontracted hospital). Restricted services (refer page 11 and to membership condition 5 on page 39). no no yes no Cosmetic surgery and other surgical procedures not covered by Medicare (refer to membership conditions 6, 8 and 9 on pages 39 and 40). not covered not covered not covered not covered Excess on overnight hospitalisation (see page 33 for more details). Excess on same day hospitalisation (see page 33 for more details). Excess on child dependants (see page 33 for more details). Waiting periods and benefit limitation periods apply (refer to page 30 and membership conditions 1, 2 and 3 on page 39 for more details). Exempts high income earners from having to pay the additional Medicare Levy Surcharge (refer to page 5 for more details). no yes yes yes no no yes yes no no no yes yes yes yes yes yes yes yes no A full list of the private hospitals and day hospital facilities contracted with St.LukesHealth is available on request or by visiting our website at 22 St.LukesHealth singles, couples and families

25 St.LukesHealth singles, couples and families 23

26 Extras cover Stand alone extras products St.LukesHealth offers benefits towards the cost of an extensive range of other health care services not covered by our hospital cover or by Medicare. Examples of benefits are included in this extras benefit comparison and where applicable annual limits are per person covered per calendar year unless otherwise specified. A calendar year runs from January to December. Benefits are only payable when rendered by a practitioner in private practice who is recognised by this Fund. Contact the Fund on to check whether your practitioner is registered. Super Extras and Budget Extras can be taken on their own if you only need extras cover, or you can tailor your own hospital and extras package by combining an extras option with a hospital cover from our stand alone hospital range. Comprehensive option (if you want the best) Extras Plan Super Extras Level of Extras cover comprehensive Super Extras is our top stand alone extras cover and offers benefits towards an extensive range of extra health care services. If you prefer a full range of benefits then Super Extras is your best choice. For details on the extras benefits covered on Super Extras, refer to the extras benefit comparison on pages 26 to 29. Gap Free Preventative Dental A popular feature on Super Extras is Gap Free Preventative Dental. Under gap free preventative dental we pay 100% of your dentist s regular fee* up to a maximum benefit for each eligible service. This means that for most dentists you will have no gap or out of pocket to pay for an examination, x-ray, scale and clean or fissure sealing. If your dentist charges above the maximum benefit a gap or out of pocket may apply. The stand out features of Gap Free Preventative Dental for St.LukesHealth members is that it applies to both adults and children and at your choice of dentist. We don t tell you which dentist you need to go to in order to receive the higher benefit for preventative dental as it applies to all dentists^. A great way to help you keep your teeth and gums healthy. An extra feature for children is gap free cover^ for fissure sealing. Placement of sealants in children assessed as having a high risk of tooth decay, is a safe and effective way in preventing dental decay in permanent teeth. * Regular fee refers to the average fee your dentist charges to all patients of his or her practice for each eligible service. ^ Includes examination, x-rays, scale and clean and fissure sealing. Benefits of 100% of the dentist s regular fee* apply on selected products up to a maximum benefit per service. If your dentist charges above the maximum benefit, or in excess of the regular fee* he or she charges all patients, a gap or out of pocket may apply. Benefit applies to both adults and children who have served their two month waiting period. Other preventative services such as topical fluoride application and provision of mouthguard not included. 24 St.LukesHealth singles, couples and families

27 Member Rewards At St.LukesHealth we value the relationship we have with our members and that s why we have introduced Member Rewards on Super Extras. Member Rewards will reward each person who has held Super Extras cover with St.LukesHealth for five years or more with a 5% increase in their dental benefits and annual dental limits. To qualify for member rewards each individual person covered by Super Extras must meet the following conditions: You must have held membership of Super Extras with St.LukesHealth for at least five continuous years; Qualification is based on the length of membership of the individual covered; The additional 5% increase in dental benefit applies to all dental services excluding preventative services paid under gap free preventative dental; and Previous membership of another health fund does not count towards the five years continuous membership as the reward is for your length of membership with St.LukesHealth. This is another great reason to take out top extras cover with St.LukesHealth. Budget option (if you only want basic extras) Extras Plan Budget Extras Level of Extras cover basic If a limited range of extras benefits would best suit your needs, then Budget Extras is designed to provide you with cover for the more common extra health care costs, including general dental, physiotherapy and optical. For details on the extras benefits covered on Budget Extras, refer to the extras benefit comparison on pages 26 to 29. St.LukesHealth singles, couples and families 25

28 Stand alone extras benefit comparison Service Category Super Extras Benefits Budget Extras General Dental 2 month waiting period Annual Limit per person per calendar year $1,000 $500 preventative dental (examination, x-ray, scale and clean and fissure sealing) * Regular fee refers to the average fee your dentist charges to all patients of his or her practice for each eligible service. See page 24 for details on gap free preventative dental limit of two general dental consultations per person per calendar year 100% of dentist s regular fee up to maximum benefit per service* comprehensive oral examination see above $33 limit of two general dental consultations per person per calendar year scaling and cleaning see above $54 simple extraction $97 $77 mouthguard $90 $65 limit of one per person per calendar year 1 surface filling - posterior tooth $91 $71 Major Dental 12 month waiting period Annual Limit per person per calendar year $1,500 nil Periodontics course of non-surgical treatment 70% nil fixed rebates apply to some periodontic services. sublimit per person per calendar year $1,000 nil Endodontics preparation of root canal 1 canal $160 nil root canal obturation 1 canal $170 nil sublimit per person per calendar year $1,000 nil Crowns & Bridges full crown veneered indirect $805 nil sublimit per person per calendar year $1,000 nil Procedures for Dental Implants full crown attached to implant veneered indirect $630 nil sublimit per person per calendar year $1,000 nil Dentures complete upper denture $480 nil complete upper & lower denture $800 nil limit of one upper and one lower denture per person payable every 2 calendar years sublimit per person per calendar year $800 nil Orthodontics course of treatment 100% nil fixed rebates apply to some orthodontic services. sublimit per person per calendar year $1,000 nil lifetime limit $2,800 nil The overall limit for each service category is highlighted. Some categories have sub limits which are included within the overall limit for that service category. n/a 26 St.LukesHealth singles, couples and families

29 Service Category Benefits Super Extras Budget Extras Optical 6 month waiting period Annual Limit per person per calendar year $300 $200 frames 100% of fee up to $95 annual limit single vision lenses 100% of fee up to $105 annual limit bi-focal lenses 100% of fee up to $105 annual limit multi-focal lenses 100% of fee up to $105 annual limit soft contacts $300 $200 hard contacts $300 $200 disposable contacts (12 months supply) $300 $200 repair to frames $25 $20 * includes benefit towards hardening of lenses. Physiotherapy 2 month waiting period Annual Limit per person per calendar year $850 $500 physiotherapy initial $50 $40 subsequent $40 $32 exercise physiology initial $40 nil subsequent $32 nil sublimit per person per calendar year $200 nil approved group sessions (including hydrotherapy) $15 $15 sublimit per person per calendar year $300 $150 ante natal/post natal $25 $20 sublimit per person per calendar year $400 included in physiotherapy limit lymphedema $40 $32 sublimit per person per calendar year included in physiotherapy limit Pharmacy 2 month waiting period Annual Limit per person per calendar year $600 nil per non PBS prescription $70 nil for prescriptions not covered by the PBS, excluding contraceptives, anabolic steroids, items normally available without prescription and drugs not approved for sale in Australia. A co-payment applies to each prescription item equal to the current non-concessional PBS co-payment amount. Diabetes Education 2 month waiting period initial consultation $55 nil subsequent consultation $45 nil sublimit per person per calendar year included in Dietetics limit Home Nursing 2 month waiting period Annual Limit per person per calendar year $500 nil per service $50 nil for services provided by a registered nurse in private practice. The overall limit for each service category is highlighted. Some categories have sub limits which are included within the overall limit for that service category. St.LukesHealth singles, couples and families 27

30 Service Category Super Extras Benefits Budget Extras Other Therapies 2 month waiting period Annual Limit per person per calendar year $1,000 nil Podiatry - initial $40 nil - subsequent $32 nil sublimit per person per calendar year $400 Occupational Therapy - initial $68 nil - subsequent $47 nil sublimit per person per calendar year $400 Eye Therapy - initial $45 $25 - subsequent $33 $25 sublimit per person per calendar year $400 included in physiotherapy limit Speech Therapy - initial $75 $30 - subsequent $47 $24 sublimit per person per calendar year $400 included in physiotherapy limit Dietetics - initial $75 nil - subsequent $45 nil sublimit per person per calendar year $200 Alternative Therapies 2 month waiting period Annual Limit per person per calendar year $500 included in physiotherapy limit Chiropractic - initial $40 nil - subsequent $28 nil sublimit per person per calendar year $400 Chiropractic X-rays $60 nil sublimit per person per calendar year included in chiropractic limit Osteopathic - initial $45 nil - subsequent $35 nil sublimit per person per calendar year included in chiropractic limit Acupuncture - initial $35 $25 - subsequent $30 $25 sublimit per person per calendar year $400 $200 Natural Therapies - initial $32 $29 - subsequent $28 $25 includes chinese & western herbal consultations, homeopathy, naturopathy, myotherapy and remedial massage therapy. sublimit per person per calendar year $400 $200 Clinical Psychology 12 month waiting period Annual Limit per person per calendar year $400 nil initial consultation $85 nil subsequent consultation $80 nil The overall limit for each service category is highlighted. Some categories have sub limits which are included within the overall limit for that service category. 28 St.LukesHealth singles, couples and families

31 Service Category Super Extras Benefits Budget Extras Health Appliances and Aids 12 month waiting period Annual Limit per person per calendar year $1,000 nil foot orthotics (custom made) 85% nil sublimit per person per calendar year $200 nil repair to custom made foot orthotics $30 nil sublimit per person per calendar year other specified orthotics* eg. custom fitted spinal & knee braces. limit of one repair per person per calendar year 90% nil sublimit per person per calendar year specified prosthetic appliances* eg. breast prosthesis after mastectomy. limits apply to individual items 90% nil sublimit per person per calendar year other specified health aids* eg. blood glucose monitor, nebuliser. limits apply to individual items 90% nil sublimit per person per calendar year * a full list is available at any of our offices. limits apply to individual items Audiology 2 month waiting period Annual Limit per person per calendar year 2 per year nil per consultation $40 nil Only payable when service rendered by an Audiologist in private practice and approved by this Fund. Benefit will not be payable if the service is claimable from any other source. Member Rewards 5 year qualifying period 5% increase in dental benefits Yes No (excluding preventative services paid under gap free preventative dental). 5% increase in annual dental limits Yes No Member reward benefits are payable after 5 years continuous membership on an eligible St.LukesHealth product. See page 25 for qualifying conditions. Combine Super Extras with a Hospital Cover and receive additional benefits If you combine Super Extras with a stand alone hospital cover, you will be eligible for the following benefits towards Health Management Programs. These benefits do not apply when Super Extras is taken without hospital cover. Health Management Programs 3 month waiting period single policy per year 70% nil annual limit per policy per calendar year $100 nil couples & families policy per year 70% nil annual per policy per calendar year $200 nil Benefits are payable for approved health management programs. Limits apply to the policy, not to each person covered by the policy. Contact St.LukesHealth for more information on approved health management programs. The overall limit for each service category is highlighted. Some categories have sub limits which are included within the overall limit for that service category. St.LukesHealth singles, couples and families 29

32 Information about private health cover Waiting Periods A waiting period is the length of time you have to wait before you become eligible for benefits. A two month waiting period applies to all benefits with the following exceptions: Pre-existing conditions* (other than psychiatric, rehabilitation & palliative care) Obstetric related conditions (including Private Postnatal Care Services) Health management programs Optical Major Dental (including Periodontics, Endodontics, Crowns & Bridges, Dental Implants, Dentures & Orthodontics) Health appliances and aids Orthotic appliances Clinical Psychology Hearing aids 30 St.LukesHealth singles, couples and families 12 months 12 months 3 months 6 months 12 months 12 months 12 months 12 months 36 months Waiting periods apply to new members and to members rejoining after a lapse in cover. Waiting periods may also apply to additional benefits when you change your level of cover. Benefit Limitation Periods A benefit limitation period is an initial period of time during which only a minimum benefit is paid for some types of hospital treatment. Benefit limitation periods apply to new members to private health insurance and to members rejoining after a lapse in cover. They do not apply to existing members changing their hospital cover or to new members transferring from another private health insurer providing their previous cover did not exclude the following services and they are transferring within 2 months of ceasing their previous cover. A benefit limitation period of two years applies from the date of joining on the following services: Joint replacements (excluding joint replacement that results from an accident) Bariatric procedures (weight loss surgery, including repair, replacement, removal and adjustment) Spinal surgery (excluding spinal surgery that results from an accident) Psychiatric Service (including drug and alcohol rehabilitation) Dialysis for chronic renal failure Assisted reproductive services including IVF and GIFT. The hospital benefits payable on all hospital covers during a designated benefit limitation period will be the minimum benefit as declared by the Minister for Health, except when a waiting period is also being served, in which case no benefit applies.

33 Transferring from another fund without loss of benefits? If you have served all your waiting periods with another fund, you can transfer to equivalent or lower cover with St.LukesHealth without having to re-serve waiting periods on benefits common to both funds, providing you transfer within 2 months of ceasing to be covered by your previous fund. If you transfer to a higher level of cover, some waiting periods may apply for the higher benefits. For more information on waiting periods and pre-existing conditions, refer to page 30 and membership conditions 1 and 3 on page 39. St.LukesHealth singles, couples and families 31

34 Lifetime Health Cover Lifetime Health Cover is a Australian Government initiative. Under Lifetime Health Cover, people who join a hospital cover earlier in life and maintain their hospital cover, will pay lower premiums throughout their life compared to someone who joins later in life. Lifetime Health Cover is a financial loading that may be payable on the full base rate premium for hospital cover. The contribution rates included in this brochure show the base rate premiums that apply to all St.LukesHealth products, with the exception of half yearly premiums which incorporate a 3.85% discount on the base rate premium. To qualify for the base rate premium, a person must take out hospital cover before 1 July immediately following their 31st birthday. People who join after this date will pay an additional premium loading of 2% (in addition to the base rate premium) for each year they are over the age of 30, up to a maximum loading of 70%. On 1 July 2013, the Australian Government introduced a change to remove the rebate from any Lifetime Health Cover loading that may apply to a policy, meaning that as from 1 July 2013, the rebate only applies to the base rate premium of a private health insurance product. If a Lifetime Health Cover loading has been applied to your premium, it can be removed after you have held hospital cover for a continuous period of 10 years. Special provisions apply to people who were overseas when they turned 31, migrants, people covered by a Department of Veterans Affairs Gold Card and members of the Australian Defence Force. Lifetime Health Cover only applies to hospital cover. It does not apply to extras (ancillary) cover. For further information on Lifetime Health Cover, please contact St.LukesHealth on or visit our website at The Australian Government Rebate The Australian Government provides a rebate on premiums paid for private health cover. On 1 July 2012 the rebate became subject to income testing, meaning the level of rebate you may be eligible for is based on your level of income. You must also be eligible for Medicare to be entitled to the rebate. The amount of rebate you are entitled to is based on which income tier you fall in to. Most Australians will be eligible for the full rebate, however the rebate is reduced for higher income earners. In addition to the income test, the level of rebate you may be entitled to also depends on the age of the oldest person covered by your policy as the rebate increases when you turn 65 and again when you turn 70. People earning above the highest income tier may not be eligible for any rebate from the Government. 32 St.LukesHealth singles, couples and families

35 On 1 July 2013, the Australian Government introduced a further change to remove the rebate from any Lifetime Health Cover loading that may apply to a policy, meaning that as from 1 July 2013, the rebate only applies to the base rate premium of a private health insurance product. If you are eligible for a Government rebate and wish to claim the rebate as a premium reduction, you will need to nominate a rebate tier so that we know how much rebate you wish to claim. To register for a premium reduction all you need to do is complete the Australian Government Rebate application form. Alternatively, you can claim the rebate in your annual tax return. To view the current thresholds go to our premiums on pages 46 to 50 or visit our website at For more information refer to our separate brochure entitled The Australian Government Rebate on Private Health Insurance. We recommend you read this separate brochure or visit our website to see the level of rebate you may be entitled to under the income test. More information is also available on the Australian Taxation Office (ATO) website at or you can call the ATO on We also recommend you consult your tax advisor to see how the rebate income test affects your individual circumstances. An excess You can lower your premium by choosing an excess on your hospital cover. An excess is the amount you agree to pay in each calendar year towards your hospital treatment. A calendar year runs from January to December. Once you have paid your excess for hospital treatment you will not have to pay another excess for the rest of that calendar year, no matter how many times you are admitted to hospital for treatment. For families there is a safety net. The excess on a family policy applies to the first two persons on the policy admitted to hospital in the same calendar year. This means, no more than two people on a family policy will be required to pay an excess in the same calendar year. The excess does not apply to children covered on the policy with the exception of Hospital 1000 where the excess applies to both adults and children. For a single parent policy the excess only applies to the adult. It does not apply to the children covered on the policy. Furthermore, on Hospital 300, Hospital 500, Packaged Gold, Packaged Silver and Packaged Bronze Plus, the excess does not apply to children covered by the policy or to same day hospital treatment. On Packaged Budget 500 Level 1 and Level 2 and Budget 500 Level 1 and Level 2 the excess applies to both overnight and same day hospital treatment for adults, however the excess does not apply to children covered on the policy. St.LukesHealth singles, couples and families 33

36 On Hospital 1000 an excess of $200 per admission applies to same day hospital treatment, up to the maximum excess of $1000 per person. The full excess of $1000 per person applies to overnight hospital treatment (less any excess that has already been applied to same day hospital treatment for that person in the same calendar year). The excess applies to both adults and children on Hospital The excess does not apply to inpatient medical services or extras benefits. On products where the excess does not apply to children, if no adult is covered by the policy, the excess will apply to whichever child is nominated as the policy holder. St.Lukes Gap Cover St.Lukes Gap Cover is designed to eliminate or reduce the gap between the Medicare Benefits Schedule (MBS) fee and the doctor s charge for medical services provided in hospital by a participating doctor. St.Lukes Gap Cover provides a schedule of fees that participating doctors use when treating eligible St.LukesHealth members. A doctor who participates in St.Lukes Gap Cover can either agree to charge no more than the St.Lukes Gap Cover schedule fee, in which case there will be no gap or out-of-pocket expense for the patient. Alternatively, a doctor may charge a specified known gap in which case the patient will be advised by the doctor of what their out-of-pocket expense will be. Prior to going to hospital, you should ask your doctor if he or she and other doctors involved in your hospital treatment are participating in St.Lukes Gap Cover. If your doctor is not aware of the arrangement, please ask your doctor to contact St.LukesHealth for details. For further information on St.Lukes Gap Cover, please refer to our separate brochure or contact St.LukesHealth on or visit our website at Surgically implanted prostheses A surgically implanted prostheses provided as part of an episode of hospital treatment, where the service attracts Medicare benefit, is covered on all hospital products, providing the prostheses has been approved for the payment of private health fund benefits by the Department of Health and Ageing. A limited number may require a patient contribution ( gap ) to be paid. If you require surgery that involves a surgically implanted prostheses, you should check with your surgeon if the prostheses attracts a patient gap. If the prostheses does attract a patient gap, discuss with your surgeon the option of using a no gap listed prostheses. 34 St.LukesHealth singles, couples and families

37 Payment options St.LukesHealth offers a variety of easy payment options. Automated payment options Direct Debit You can have your premium automatically debited from your bank, building society, credit union or credit card account. Simply complete the relevant section on the membership application form (Refer to membership condition 15 on pages 41 to 43 for our direct debit service agreement). Payroll Deduction Where your employer offers a payroll deduction facility, you may also be able to pay by salary deduction. Check with your pay office or contact St.LukesHealth for more information. An authority to deduct from salary form is included in the membership application form. Other payment options Customer Care Centres and Agents You can pay direct over the counter at any St.LukesHealth customer care centre or agent. A list of customer care centres is shown on the back cover of this brochure or visit our website for a list of agents. Telephone You can pay over the phone by credit card by calling during normal business hours. Online If you register for online member services you can pay by credit card through our website at See page 37 for more details on online member services. BPAY and Postbillpay You can pay by BPAY by using your financial institution s telephone or internet banking or by Postbillpay through Australia Post. Renewal notices sent to St.LukesHealth members paying quarterly, half yearly or yearly will display a BPAY Biller Code and reference number and a Postbillpay barcode, reference number and Billpay code. This information will be required when paying your renewal through BPAY or Postbillpay. For more information on BPAY contact your bank, building society or credit union or visit For more information on Postbillpay visit St.LukesHealth singles, couples and families 35

38 Claiming options Hospital claims and most inpatient medical claims will be sent direct to St.LukesHealth by the provider. Claims for extras benefits can be made by one of the following methods. Point of service (HICAPS) St.LukesHealth is a participant in the Health Industry Claims and Payments Service (HICAPS). HICAPS is an electronic claiming process which offers members the convenience of automatic claims processing, on the spot at the point of service. HICAPS is currently available at participating dentists, optometrists, physiotherapists, podiatrists, chiropractors, clinical psychologists, occupational therapists, acupuncturists, remedial masseurs, dieticians and speech therapists. Mobile Claims ios/android Claims can be submitted using your iphone or Android phone through the St.LukesHealth app. See page 37 for details. Customer Care Centres and Agents Claims can be paid at any St.LukesHealth customer care centre or agent. A list of customer care centres is shown on the back cover of this brochure. You can visit our website for a list of agents or you can contact us on You will need your St.LukesHealth card in order to claim at an agency. Agents are restricted from paying benefit on some services. Receive your benefit refund by direct credit If you have already paid your provider for services being claimed, your benefit refund can be deposited directly into your nominated bank, building society or credit union account. To choose this method of benefit payment, complete the relevant section on the back of the membership application form or contact St.LukesHealth for a Benefit Deposit Request Form. 36 St.LukesHealth singles, couples and families

39 Online member services As a member of St.LukesHealth you can log in to a secure members only section of our website. Online Member Services provides you with online access to: View details of your membership View your claims history Change your contact or cover details Change your Direct Debit contribution details Make credit card payments and more. To access online member services you must first register to obtain a password. For more information visit our website at St.LukesHealth on your phone At St.LukesHealth we are constantly looking at improving the ways in which we service our members. In order to keep in touch with the changing needs of our members, we have developed a mobile application which allows members to easily perform a variety of tasks including: Submit claims Securely access their information Review their cover options Search for contracted hospitals, medical specialists, optometrists, registered alternative therapists and pharmacies Contact us or locate your nearest St.LukesHealth customer care centre. To access these services, download our free app from either the itunes App Store for iphones or Google Play for Android phones. You can find our app by searching for St.LukesHealth. When installing the app for the first time you will need to provide the following details: member number, address, mobile number, all dependant names and the member s date of birth. To submit a claim, all that is required is to simply take a clear photo of the account and press the confirm button, select who the claim was for and send. It s that easy. St.LukesHealth singles, couples and families 37

40 Complaints, compliments and suggestions St.LukesHealth management and staff are committed to providing the highest quality customer service. As part of our continual aim to maintain the highest quality service, we welcome your feedback. We endeavour to ensure that all complaints are resolved satisfactorily and in a timely manner with professionalism, fairness and equity. We will respect your privacy and keep your information confidential at all times. For more information on our complaints resolution policy or on providing us with your feedback please ask for our separate brochure entitled Complaints, Compliments and Suggestions, or visit our website at 38 St.LukesHealth singles, couples and families

41 Important information you need to know Membership conditions (summary only) 1. Waiting Periods A waiting period is the length of time you have to wait before you become eligible for benefits. For more information on waiting periods refer to page Benefit Limitation Period A benefit limitation period is an initial period of time during which only a minimum benefit is paid for some types of hospital treatment. For more information on benefit limitation periods refer to page Pre-existing condition A pre-existing condition is an ailment, illness or condition the signs or symptoms of which, in the opinion of a medical practitioner appointed by St.LukesHealth, existed at any time in the period of 6 months ending on the day on which the person became insured under the policy. A 12 month waiting period applies to all pre-existing conditions. 4. Accidents Hospital treatment that results from an accident which occurred after joining, is covered immediately on hospital cover, providing there is no right to claim compensation and damages from another source. An accident is an event or occurrence which is unforeseen and unintended, which results in physical hurt or damage to the body and requires immediate treatment. An accident does not include an obstetric related condition, or an unforeseen ailment, illness or condition brought on by medical causes. 5. Restricted service Benefits for a restricted service are limited to a shared room benefit in a public hospital should you elect to be treated as a private patient. There is very limited cover in a private hospital meaning you will have significant out of pocket costs if you use a private hospital for a restricted service. These costs include accommodation fees and theatre fees charged by the private hospital. You are entitled to Medicare Benefit Schedule rates for any medical services and therefore you may also have out of pocket cost from your doctors. Your prosthesis costs will be in accordance with normal fund rules. 6. Cosmetic Surgery and surgical procedures not covered by Medicare No benefit is payable on any hospital cover for treatment relating to cosmetic surgery or other surgical treatment that does not meet the eligibility criteria for the payment of Medicare benefits, or is not listed in the Medicare Benefits Schedule (with the exceptions of membership conditions 8 and 9). St.LukesHealth singles, couples and families 39

42 7. Obstetric Related Services A 12 month waiting period applies to obstetric related conditions. After the 12 month waiting period has been served, the mother s hospitalisation will be covered on a single policy and both the mother and baby will be covered on a family policy. However, the baby will not be covered on a single policy if it requires hospitalisation in its own right after birth. To ensure coverage of a new born child, a single policy must be upgraded to a family cover from the child s date of birth, providing the change occurs within 30 days of the child s birth. A newborn child should also be added to a family cover within 30 days of the child s birth to ensure that no waiting periods apply to the child. Premature births or complications arising from a pregnancy where a medical practitioner confirms the baby s expected date of birth is after the 12 month waiting period, will be covered. St.LukesHealth offers private postnatal services to Northern Tasmanian members on selected products. A 12 month waiting period applies to new members and members transferring from another fund 8. Sterilisation/Vasectomy or reversal of Sterilisation, vasectomies and reversals of, are only covered on our hospital covers when they attract a Medicare benefit. Benefit is not payable for procedures not covered by Medicare. Where Medicare benefit is payable, a 12 month waiting period will apply under the pre-existing rule. 9. Podiatric Surgery Surgical procedures performed by a Podiatric Surgeon do not attract Medicare benefit and therefore would normally be excluded from fund benefit. However, St.LukesHealth will pay the Minimum benefit as declared by the Minister for Health on all hospital covers for hospital accommodation relating to surgery performed by a Podiatric Surgeon, providing all waiting periods have been served. Fees raised by the Podiatric Surgeon are not covered. 10. Overseas Treatment No benefit is payable for services, treatment or appliances rendered or purchased outside of Australia. 11. Who is covered? A single membership covers the individual only. A couple membership covers the member and their partner/spouse. A family membership covers the member, partner/ spouse and dependants. A dependant extension membership covers the member, partner/spouse and dependants including non-student child dependants. On a family membership, dependants include children under 23 years of age and single full time students under 25 years of age who are not married or living in a defacto relationship and if totally dependent on their parents. On a Dependant Extension membership, dependants include non-student child dependants under 25 years of age who are not married or living in a defacto relationship. Dependants will receive immediate cover for equivalent benefits providing they join their own membership within 2 months of ceasing to qualify as a dependant or non-student child dependant and providing all waiting periods have been served under their parent s policy. 40 St.LukesHealth singles, couples and families

43 12. Transferring to higher cover When changing to higher levels of cover, waiting periods and the pre-existing condition rule will apply for the additional benefit payable on the higher cover. In the interim, your previous level of cover applies provided you have served the waiting periods on your previous level of cover. 13. Transferring from other funds Members who transfer from another registered health fund within 2 months of ceasing financial membership of the previous fund, may do so without waiting periods providing the benefits are common to both funds, the transfer is to equivalent or lower levels of cover and all waiting periods have been served with the previous fund. If a break in hospital cover does occur on transfer, the days without hospital cover will be counted as a period of absence for the purpose of Lifetime Health Cover. Should the transfer be to a higher level of cover or a higher benefit than the previous fund then all waiting periods, including the pre-existing condition waiting period will apply for the additional benefit. When transferring from another fund, your original age at joining hospital cover with your previous fund will be taken into consideration for the calculation of any premium loading payable under Lifetime Health Cover. 14. Payment of contributions Contributions are payable in advance. A discount is allowed to persons who pay half yearly or yearly in advance. 15. Direct Debit Request Service Agreement Debiting your account By signing a Direct Debit Request or by providing St.LukesHealth with a valid instruction, you have authorised St.LukesHealth to arrange for funds to be debited from your account. We will only arrange for funds to be debited from your account as authorised in the Direct Debit Request. If the debit day falls on a weekend or public holiday, we may direct your financial institution to debit your account on the following banking day. Monthly, quarterly, half yearly and yearly direct debit payments are deducted on the 25th of the month, or within 2 business days after the 25th. Premiums will be deducted for the following calendar month, quarter, half year or year. Weekly and fortnightly direct debit payments are deducted in advance on the Friday of each week or fortnight, or within 2 business days after. An adjustment may be taken with your first direct debit payment to bring your payments in line with your chosen direct debit cycle. Amendments by us St.LukesHealth may vary any details of this Agreement or a Direct Debit Request at any time by giving you at least 14 days written notice. Amendments by you You may change or defer a debit payment, or terminate this Agreement by providing us with at least 7 days notification in writing. St.LukesHealth singles, couples and families 41

44 Your obligations It is your responsibility to ensure that there are sufficient clear funds available in your account to allow a debit payment to be made in accordance with the Direct Debit Request. If there are insufficient clear funds in your account to meet a debit payment you may be charged a fee and/or interest by your financial institution or you may also incur fees or charges imposed or incurred by us and you must arrange for the debit payment to be made by another method or arrange for sufficient clear funds to be in your account by an agreed time so that we can process the debit payment. You should check your account statement to verify that the amounts debited from your account are correct. Dispute If you believe that there has been an error in debiting your account, you should notify St.LukesHealth and confirm that notice in writing with us as soon as possible so that we can resolve your query more quickly. Alternatively you can take it up with your financial institution direct. If St.LukesHealth concludes as a result of our investigations that your account has been incorrectly debited we will respond to your query by arranging for your financial institution to adjust your account (including interest and charges) accordingly. We will also notify you in writing of the amount by which your account has been adjusted. If St.LukesHealth concludes as a result of our investigations that your account has not been incorrectly debited we will respond to your query by providing you with reasons and any evidence for this finding in writing. Accounts You should check with your financial institution whether direct debiting is available from your account as direct debiting is not available on all accounts offered by financial institutions. You should also check that your account details which you have provided to us are correct by checking them against a recent account statement and you should check with your financial institution before completing the Direct Debit Request if you have any queries about how to complete the Direct Debit Request. Confidentiality St.LukesHealth will keep information (including your account details) in your Direct Debit Request confidential. We will make reasonable efforts to keep any such information that we have about you secure and to ensure that any of our employees or agents who have access to information about you do not make any unauthorised use, modification, reproduction or disclosure of that information. St.LukesHealth will only disclose information that we have about you to the extent specifically required by law, or for the purposes of this Agreement (including disclosing information in connection with any query or claim). 42 St.LukesHealth singles, couples and families

45 Notice If you wish to notify us in writing about anything relating to this Agreement, you should write to us at the Head Office or address on the back page of this brochure. St.LukesHealth will notify you by sending a notice in the ordinary post to the address you have given us in the Direct Debit Request. Any notice will be deemed to have been received on the third banking day (other than a Saturday, Sunday or public holiday listed throughout Australia) after posting. 16. Overdue payments If contributions are in arrears, payments will not automatically be accepted. It may be necessary to re-serve waiting periods from the date of payment of the arrears and entitlement to benefit for services rendered while in an unfinancial period may be lost. If premiums fall more than two months in arrears, the policy will be subject to cancellation and all waiting periods may have to be re-served. 17. Claims lodgement Benefits are not payable for services which took place two years or more prior to the date of lodgement of the claim. 18. Compensation from other sources Benefits are not payable for any condition for which members or dependants have the right to recover costs from any other source, including third party, workers compensation or persons liable at law. 19. Approved providers Benefits are only payable when rendered by a practitioner in private practice who has been approved and registered with this Fund. The approval and registration by St.LukesHealth of a Provider, Medical Practitioner, Hospital or Day Hospital Facility (as defined in the Rules and By-Laws of St.LukesHealth) for the payment of benefits does not constitute a representation or recommendation by St.LukesHealth or any of its agents that any particular Provider, Medical Practitioner, Hospital or Day Hospital Facility or any service, product or treatment recommended or provided by that Provider, Medical Practitioner, Hospital or Day Hospital Facility, will or may be of benefit to St.LukesHealth members. St.LukesHealth thus accepts no responsibility for the outcome of any advice, service, product or treatment given to members by a Provider, Medical Practitioner, Hospital or Day Hospital Facility registered with this Fund. St.LukesHealth singles, couples and families 43

46 20. Hospital claims Benefits are payable at the insured rate for 365 days for all persons covered in any one year (subject to conditions 1, 2, 3, 6, 8, 9, 16 and 21). For hospitalisation that extends beyond 35 continuous days, benefits will be reduced unless a medical certificate for ongoing Acute Care is provided by the patient s doctor and approved by the Fund. 21. Benefit limited to fee charged Benefits shall be limited to the fee charged or the insured amount whichever is the lesser. 22. Medicare Benefits Schedule fee The Medicare Benefit Schedule fee is set for the purpose of paying Medicare Benefits. It does not necessarily indicate the amount that the doctor will charge but forms the basis from which the Medicare and medical gap benefit is determined. 23. Periods of absence from hospital cover Under Lifetime Health Cover, if you cease your hospital membership for 3 years or more over your lifetime, an additional premium loading may apply when you rejoin. Refer to our website at or contact St.LukesHealth on for more information. 24. Policy suspension Members may suspend their policy in certain circumstances on application to St.LukesHealth. The fund will consider suspension for periods of extended overseas travel, for periods of unemployment and in special cases of financial hardship. A suspension application will need to be completed. An additional Medicare Levy Surcharge may apply to high income earners during any period of policy suspension. See page 5 for further details on the Medicare Levy Surcharge. 25. Privacy policy St.LukesHealth is committed to respecting your right to privacy and protecting your personal information. We are bound by the Australian Privacy Principles in the Privacy Act 1988 (Commonwealth), as amended, which regulates how we collect and manage your personal information. Our staff are trained to respect your privacy in accordance with our standards, policies and procedures. Our Privacy Policy outlines how we manage your personal information. It also describes in general terms the type of personal information held, for what purposes, and how that information is collected, stored, used and disclosed. Our Privacy Policy applies to all your dealings with us whether at one of our customer care centres, via our website or with one of our customer care or business development consultants. To view our privacy statement, visit a St.LukesHealth customer care centre or our website. 44 St.LukesHealth singles, couples and families

47 26. Private Health Insurance Code of Conduct St.LukesHealth supports the Private Health Insurance Code of Conduct. The PHI Code of Conduct is an Industry self regulatory code which aims to promote informed relationships between private health insurers, consumers, agents and brokers. To view a copy of the code visit a St.LukesHealth customer care centre or click the link on our website. 27. Private Health Insurance Ombudsman If you are unable to resolve a complaint with us to your satisfaction, you have the right to address your complaint to the Private Health Insurance Ombudsman (PHIO). These services are free to members. The Private Health Insurance Ombudsman also provides an annual State of the Health Funds Report to assist consumers in assessing the relative performance and service delivery of each registered health fund. A copy of the report is available from the office of the ombudsman or from the PHIO website at The contact details for the Private Health Insurance Ombudsman are: Private Health Insurance Ombudsman GPO Box 442 Canberra ACT 2601 Phone: select option 4 for Private Health Insurance Fax: (02) phio.info@ombudsman.gov.au Website: Online complaints: Notation The above is a summary of St.LukesHealth Rules. The complete Rules and By-Laws are available to all members for examination on request at any St.LukesHealth customer care centre. The information contained in this brochure cancels and supersedes all previously published material. The Rules may be amended from time to time. If they are, then by signing the declaration in this brochure you agree to be bound by any amendments which are made. St.LukesHealth singles, couples and families 45

48 Australian Government Rebate Income Tiers Table Single Income $0 - $90,000 Couples/Families Income $0 - $180, St.LukesHealth singles, couples and families Base Tier Tier 1 Tier 2 Tier 3 $90,001 - $105,000 $180,001 - $210,000 $105,001 - $140,000 $210,001 - $280,000 $140,001 + $280,001+ Packaged Premiums effective 1 April 2017 Singles base rate Base Tier Rebate (Full Rebate) Excess Weekly Monthly Quarterly Half Yearly % Packaged Platinum Plus nil $62.40 $ $ $ Packaged Platinum nil $50.85 $ $ $ Packaged Gold $300 $46.45 $ $ $ Packaged Silver $500 $44.20 $ $ $ Packaged Bronze Plus $500 $37.85 $ $ $ Packaged Budget 500 Level 1 $500 $34.75 $ $ $ Packaged Budget 500 Level 2 $500 $27.45 $ $ $ Tier 1 Rebate % Excess Weekly Monthly Quarterly Half Yearly Packaged Platinum Plus nil $69.65 $ $ $ Packaged Platinum nil $56.75 $ $ $ Packaged Gold $300 $51.90 $ $ $ Packaged Silver $500 $49.35 $ $ $ Packaged Bronze Plus $500 $42.25 $ $ $ Packaged Budget 500 Level 1 $500 $38.80 $ $ $ Packaged Budget 500 Level 2 $500 $30.65 $ $ $ Tier 2 Rebate 8.644% Excess Weekly Monthly Quarterly Half Yearly Packaged Platinum Plus nil $76.95 $ $ $ Packaged Platinum nil $62.70 $ $ $ Packaged Gold $300 $57.30 $ $ $ Packaged Silver $500 $54.50 $ $ $ Packaged Bronze Plus $500 $46.65 $ $ $ Packaged Budget 500 Level 1 $500 $42.90 $ $ $ Packaged Budget 500 Level 2 $500 $33.85 $ $ $ Tier 3 Rebate (No Rebate) Excess Weekly Monthly Quarterly Half Yearly Packaged Platinum Plus nil $84.25 $ $ $ Packaged Platinum nil $68.65 $ $ $ Packaged Gold $300 $62.75 $ $ $ Packaged Silver $500 $59.70 $ $ $ Packaged Bronze Plus $500 $51.10 $ $ $ Packaged Budget 500 Level 1 $500 $46.95 $ $ $ Packaged Budget 500 Level 2 $500 $37.05 $ $ $ Rebate percentages shown apply to eligible people less than 65 years of age. For rebate percentages and premiums for people 65 years and over refer to St.LukesHealth. A 3.85% discount applies to the base rate premium if you pay half yearly or yearly in advance. This discount does not apply to any Lifetime Health Cover loading.

49 Packaged Premiums Couples & Families base rate Base Tier Rebate (Full Rebate) Excess Weekly Monthly Quarterly Half Yearly % Packaged Platinum Plus Nil $ $ $ $ Packaged Platinum Nil $ $ $ $ Packaged Gold $600 $92.95 $ $ $ Packaged Silver $1000 $88.40 $ $ $ Packaged Bronze Plus $1000 $75.70 $ $ $ Packaged Budget 500 Level 1 $1000 $69.55 $ $ $ Packaged Budget 500 Level 2 $1000 $54.85 $ $ $ Tier 1 Rebate % Excess Weekly Monthly Quarterly Half Yearly Packaged Platinum Plus Nil $ $ $ $ Packaged Platinum Nil $ $ $ $ Packaged Gold $600 $ $ $ $ Packaged Silver $1000 $98.75 $ $ $ Packaged Bronze Plus $1000 $84.50 $ $ $ Packaged Budget 500 Level 1 $1000 $77.65 $ $ $ Packaged Budget 500 Level 2 $1000 $61.30 $ $ $ Tier 2 Rebate 8.644% Excess Weekly Monthly Quarterly Half Yearly Packaged Platinum Plus Nil $ $ $ $ Packaged Platinum Nil $ $ $ $ Packaged Gold $600 $ $ $ $ Packaged Silver $1000 $ $ $ $ Packaged Bronze Plus $1000 $93.35 $ $ $ Packaged Budget 500 Level 1 $1000 $85.75 $ $ $ Packaged Budget 500 Level 2 $1000 $67.70 $ $ $ Tier 3 Rebate (No Rebate) Excess Weekly Monthly Quarterly Half Yearly Packaged Platinum Plus Nil $ $ $ $ Packaged Platinum Nil $ $ $ $ Packaged Gold $600 $ $ $ $ Packaged Silver $1000 $ $ $ $ Packaged Bronze Plus $1000 $ $ $ $ Packaged Budget 500 Level 1 $1000 $93.90 $ $ $ Packaged Budget 500 Level 2 $1000 $74.10 $ $ $ Rebate percentages shown apply to eligible people less than 65 years of age. For rebate percentages and premiums for people 65 years and over refer to St.LukesHealth. A 3.85% discount applies to the base rate premium if you pay half yearly or yearly in advance. This discount does not apply to any Lifetime Health Cover loading. St.LukesHealth singles, couples and families 47

50 Packaged Premiums Families Dependant Extension base rate Base Tier Rebate (Full Rebate) Excess Weekly Monthly Quarterly Half Yearly % Packaged Platinum Plus Extended nil $ $ $ $ Packaged Platinum Extended nil $ $ $ $ Packaged Gold Extended $600 $ $ $ $ Packaged Silver Extended $1000 $ $ $ $ Tier 1 Rebate % Excess Weekly Monthly Quarterly Half Yearly Packaged Platinum Plus nil $ $ $ $ Packaged Platinum nil $ $ $ $ Packaged Gold $600 $ $ $ $ Packaged Silver $1000 $ $ $ $ Tier 2 Rebate 8.644% Excess Weekly Monthly Quarterly Half Yearly Packaged Platinum Plus nil $ $ $ $ Packaged Platinum nil $ $ $ $ Packaged Gold $600 $ $ $ $ Packaged Silver $1000 $ $ $ $ Tier 3 Rebate (No Rebate) Excess Weekly Monthly Quarterly Half Yearly Packaged Platinum Plus nil $ $ $ $ Packaged Platinum nil $ $ $ $ Packaged Gold $600 $ $ $ $ Packaged Silver $1000 $ $ $ $ Rebate percentages shown apply to eligible people less than 65 years of age. For rebate percentages and premiums for people 65 years and over refer to St.LukesHealth. A 3.85% discount applies to the base rate premium if you pay half yearly or yearly in advance. This discount does not apply to any Lifetime Health Cover loading. 48 St.LukesHealth singles, couples and families

51 St.LukesHealth singles, couples and families 49

52 Australian Government Rebate Income Tiers Table Single Income $0 - $90,000 Couples/Families Income $0 - $180,000 Base Tier Tier 1 Tier 2 Tier 3 $90,001 - $105,000 $180,001 - $210,000 $105,001 - $140,000 $210,001 - $280,000 $140,001 + $280,001+ Hospital Premiums effective 1 April 2017 Singles base rate Base Tier Rebate (Full Rebate) Excess Weekly Monthly Quarterly Half Yearly % Hospital Platinum nil $39.35 $ $ $ Hospital 300 $300 $35.00 $ $ $ Hospital 500 $500 $32.70 $ $ $ Hospital 1000 $1000 $27.65 $ $ $ Budget 500 Level 1 $500 $29.65 $ $ $ Budget 500 Level 2 $500 $22.30 $96.65 $ $ Tier 1 Rebate % Excess Weekly Monthly Quarterly Half Yearly Hospital Platinum nil $43.95 $ $ $ Hospital 300 $300 $39.05 $ $ $ Hospital 500 $500 $36.55 $ $ $ Hospital 1000 $1000 $30.85 $ $ $ Budget 500 Level 1 $500 $33.10 $ $ $ Budget 500 Level 2 $500 $24.90 $ $ $ Tier 2 Rebate 8.644% Excess Weekly Monthly Quarterly Half Yearly Hospital Platinum nil $48.55 $ $ $ Hospital 300 $300 $43.15 $ $ $ Hospital 500 $500 $40.35 $ $ $ Hospital 1000 $1000 $34.10 $ $ $ Budget 500 Level 1 $500 $36.55 $ $ $ Budget 500 Level 2 $500 $27.50 $ $ $ Tier 3 Rebate (No Rebate) Excess Weekly Monthly Quarterly Half Yearly Hospital Platinum nil $53.15 $ $ $ Hospital 300 $300 $47.25 $ $ $ Hospital 500 $500 $44.20 $ $ $ Hospital 1000 $1000 $37.35 $ $ $ Budget 500 Level 1 $500 $40.05 $ $ $ Budget 500 Level 2 $500 $30.15 $ $ $ Rebate percentages shown apply to eligible people less than 65 years of age. For rebate percentages and premiums for people 65 years and over refer to St.LukesHealth. A 3.85% discount applies to the base rate premium if you pay half yearly or yearly in advance. This discount does not apply to any Lifetime Health Cover loading. 50 St.LukesHealth singles, couples and families

53 Hospital Premiums Couples & Families base rate Base Tier Rebate (Full Rebate) Excess Weekly Monthly Quarterly Half Yearly % Hospital Platinum nil $78.70 $ $ $ Hospital 300 $600 $69.95 $ $ $ Hospital 500 $1000 $65.45 $ $ $ Hospital 1000 $2000 $55.30 $ $ $ Budget 500 Level 1 $1000 $59.30 $ $ $ Budget 500 Level 2 $1000 $44.65 $ $ $ Tier 1 Rebate % Excess Weekly Monthly Quarterly Half Yearly Hospital Platinum nil $87.90 $ $ $ Hospital 300 $600 $78.15 $ $ $ Hospital 500 $1000 $73.10 $ $ $ Hospital 1000 $2000 $61.75 $ $ $ Budget 500 Level 1 $1000 $66.25 $ $ $ Budget 500 Level 2 $1000 $49.85 $ $ $ Tier 2 Rebate 8.644% Excess Weekly Monthly Quarterly Half Yearly Hospital Platinum nil $97.10 $ $ $ Hospital 300 $600 $86.30 $ $ $ Hospital 500 $1000 $80.75 $ $ $ Hospital 1000 $2000 $68.20 $ $ $ Budget 500 Level 1 $1000 $73.15 $ $ $ Budget 500 Level 2 $1000 $55.05 $ $ $ Tier 3 Rebate (No Rebate) Excess Weekly Monthly Quarterly Half Yearly Hospital Platinum nil $ $ $ $ Hospital 300 $600 $94.50 $ $ $ Hospital 500 $1000 $88.40 $ $ $ Hospital 1000 $2000 $74.70 $ $ $ Budget 500 Level 1 $1000 $80.10 $ $ $ Budget 500 Level 2 $1000 $60.30 $ $ $ Rebate percentages shown apply to eligible people less than 65 years of age. For rebate percentages and premiums for people 65 years and over refer to St.LukesHealth. A 3.85% discount applies to the base rate premium if you pay half yearly or yearly in advance. This discount does not apply to any Lifetime Health Cover loading. St.LukesHealth singles, couples and families 51

54 Hospital Premiums Families Dependant Extension base rate Base Tier Rebate (Full Rebate) Excess Weekly Monthly Quarterly Half Yearly % Hospital Platinum Extended nil $98.35 $ $ $ Hospital 300 Extended $600 $87.50 $ $ $ Hospital 500 Extended $1000 $81.85 $ $ $ Tier 1 Rebate % Excess Weekly Monthly Quarterly Half Yearly Hospital Platinum Extended nil $ $ $ $ Hospital 300 Extended $600 $97.70 $ $ $ Hospital 500 Extended $1000 $91.40 $ $ $ Tier 2 Rebate 8.644% Excess Weekly Monthly Quarterly Half Yearly Hospital Platinum Extended nil $ $ $ $ Hospital 300 Extended $600 $ $ $ $ Hospital 500 Extended $1000 $ $ $ $ Tier 3 Rebate (No Rebate) Excess Weekly Monthly Quarterly Half Yearly Hospital Platinum Extended nil $ $ $ $ Hospital 300 Extended $600 $ $ $ $ Hospital 500 Extended $1000 $ $ $ $ Rebate percentages shown apply to eligible people less than 65 years of age. For rebate percentages and premiums for people 65 years and over refer to St.LukesHealth. A 3.85% discount applies to the base rate premium if you pay half yearly or yearly in advance. This discount does not apply to any Lifetime Health Cover loading. 52 St.LukesHealth singles, couples and families

55 St.LukesHealth singles, couples and families 53