singles, couples and families · 2017-05-22 · 6 St.LukesHealth singles, couples and families...

Effective 1 April 2016 I Tasmania singles, couples

and families

It’s Easy.

ii St.LukesHealth singles, couples and families

1St.LukesHealth singles, couples and familiesIt’s Easy.

Welcome to St.LukesHealthIf 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 1300 651 988

Visit www.stlukes.com.au

Email [email protected] 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.

2 St.LukesHealth singles, couples and families


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

10

Hospital cover Standalone hospital products

20

Extras cover Standalone extras products

24

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 51


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 32.


Avoid the Medicare Levy SurchargeThe 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 will be exempt from paying the MLS from the date the policy is effective on all hospital covers, except for our high excess product – Hospital 1000.

For further information go to our website at www.stlukes.com.au 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 www.ato.gov.au or you can call the ATO on 132861.

Medicare Levy Surcharge Income Tiers

IncomeBase 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%

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 choiceEstablished in Tasmania, St.LukesHealth has been providing private health cover to Australians since 1952. 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.


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.

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.

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 tooYou 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 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 guaranteeWe’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.


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.


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 www.stlukes.com.au.

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.


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 PlanHospital Excess Level of

Extras coverSingle policy Couple & Family policies

Per calendar year

Per person per calendar year

Maximum per policy per calendar year

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 PlanHospital Excess Level of Extras

coverSingle policy Couple & Family policies

Per calendar year


(excluding children)


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 50.

Packaged cover Packaged hospital & extras products


Budget options (if you only need a basic cover)

Combined Plan

RestrictedServices

Hospital Excess Level of Extras coverSingle policy Couple & Family policies

Per calendar year




Packaged Budget 500 Level 1

5 restricted services

(see list below)$500 $500 $1,000 basic



(see list below)$500 $500 $1,000 basic

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)







• 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.


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).

no yes yes

Excess on same day hospitalisation (see page 33 for more details).

no no yes

Excess on child dependants (see page 33 for more details).

no no no

Waiting periods and benefit limitation periods apply (refer to page 30 and membership conditions 1, 2 and 3 on page 39 for more details).

yes yes yes

Exempts high income earners from having to pay the additional Medicare Levy Surcharge (refer to page 5 for more details).

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 www.stlukes.com.au


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 1300 651 988 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.


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.


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.


Service Category Benefits

Platinum Plus

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*

n/a

limit of two general dental consultations per person per calendar year

comprehensive oral examination see above $33limit of two general dental consultations per person per calendar year

scaling and cleaning see above $54

simple extraction $110 $95 $75

mouthguard $105 $90 $65limit of one per person per calendar year

1 surface filling - posterior tooth $104 $89 $69

Major Dental – 12 month waiting period

Annual Limit per person per calendar year $2,000 $1,500 nil

Periodontics course of non-surgical treatmentfixed rebates apply to some periodontic services

80% 70% nil

sublimit per person per calendar year $1,500 $1,000 nil

Endodontics

preparation of root canal – 1 canal $180 $155 nil

root canal obturation – 1 canal $195 $165 nil


Crowns & Bridges

full crown veneered – indirect $1010 $780 nil


Procedures for Dental Implants

full crown attached to implant – veneered – indirect $845 $620 nil


Dentures

complete upper denture $600 $450 nil

complete upper & lower denture $1,000 $775 nillimit 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% nilfixed rebates apply to some orthodontic services


lifetime limit $3,000 $2,800 nil

Packaged cover – Extras benefit comparison

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.



Platinum Plus



Optical – 6 month waiting period

Annual Limit per person per calendar year $350 $300 $200

frames $175 $150 $95

single vision lenses* $175 $150 $105

bi-focal lenses* $175 $150 $105

multi-focal lenses* $175 $150 $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 $50 $45 $35

– subsequent $43 $38 $30

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 $400included 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 $85 $65 nilfor 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.




Platinum Plus



Other Therapies – 2 month waiting period


Podiatry – initial $40 $35 nil



Occupational Therapy – initial $70 $65 nil



Eye Therapy – initial $50 $45 $25



physiotherapy limit

Speech Therapy – initial $80 $75 $25



physiotherapy limit

Dietetics – initial $80 $75 nil



Alternative Therapies – 2 month waiting period

Annual Limit per person per calendar year $1,000 $500included in

physiotherapy limit

Chiropractic – initial $45 $40 nil



Chiropractic X-rays $60 $60 nil

sublimit per person per calendar yearincluded in

chiropractic limitnil

Osteopathic – initial $47 $42 nil


sublimit per person per calendar yearincluded in

chiropractic limitnil

Acupuncture – initial $40 $35 $25



Natural Therapies – initial $37 $32 $29

– subsequent $33 $28 $25Includes chinese & western herbal consultations, homeopathy, naturopathy, myotherapy and remedial massage therapy.


Clinical Psychology – 12 month waiting period




Platinum Plus




initial consultation $95 $85 nil

subsequent consultation $87 $77 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


per servicefor services provided by a registered nurse in private practice.

$55 $50 nil

Health Appliances and Aids – 12 month waiting period


foot orthotics (custom made) 90% 85% nil


repair to custom made foot orthotics $35 $30 nil

sublimit per person per calendar yearlimit of one repair per

person per calendar yearnil

other specified orthotics*eg. custom fitted spinal & knee braces.

90% 90% nil

sublimit per person per calendar yearlimits apply to

individual itemsnil

specified prosthetic appliances*eg. breast prosthesis after mastectomy.

90% 90% nil


individual itemsnil

other specified health aids*eg. blood glucose monitor, nebuliser.

90% 90% nil


individual itemsnil

* 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 nilOnly 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




Platinum Plus



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.



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 PlanHospital Excess

Single policy Couple & Family policies

Per calendar yearPer person 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 PlanHospital Excess





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 1000 - *High excess hospital coverNote: 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 50.

Hospital cover Stand alone hospital products


Budget options (if you only need a basic cover)

Combined PlanRestrictedServices

Hospital Excess





Budget 500 Level 1


(see list below)$500 $500 $1,000

Budget 500 Level 2


(see list below)$500 $500 $1,000













• 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.


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).

no yes yes yes

Excess on same day hospitalisation (see page 33 for more details).

no no yes yes

Excess on child dependants (see page 33 for more details).

no no no yes

Waiting periods and benefit limitation periods apply (refer to page 30 and membership conditions 1, 2 and 3 on page 39 for more details).

yes yes yes yes

Exempts high income earners from having to pay the additional Medicare Levy Surcharge (refer to page 5 for more details).

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 www.stlukes.com.au



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 1300 651 988 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 PlanLevel of

Extras cover

Super Extras 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.


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.

Extras cover Stand alone extras products


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 PlanLevel of

Extras cover

Budget Extras 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.


Stand alone extras – benefit comparison


Super Extras 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

100% of dentist’s regular fee up to maximum benefit

per service*

n/a

limit of two general dental consultations per person per calendar year

comprehensive oral examination see above $33limit of two general dental consultations per person per calendar year

scaling and cleaning see above $54

simple extraction $95 $75

mouthguard $90 $65limit of one per person per calendar year

1 surface filling - posterior tooth $89 $69

Major Dental – 12 month waiting period

Annual Limit per person per calendar year $1,500 nil

Periodontics

course of non-surgical treatmentfixed rebates apply to some periodontic services.

70% nil

sublimit per person per calendar year $1,000 nil

Endodontics

preparation of root canal – 1 canal $155 nil

root canal obturation – 1 canal $165 nil


Crowns & Bridges

full crown veneered – indirect $780 nil


Procedures for Dental Implants

full crown attached to implant – veneered – indirect

$620 nil


Dentures

complete upper denture $450 nil

complete upper & lower denture $775 nillimit 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% nilfixed rebates apply to some orthodontic services.


lifetime limit $2,800 nil






Optical – 6 month waiting period

Annual Limit per person per calendar year $300 $200

frames $150 $95

single vision lenses* $150 $105

bi-focal lenses* $150 $105

multi-focal lenses* $150 $105

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 $45 $35

– subsequent $38 $30

exercise physiology – initial $40 nil

– subsequent $32 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 $400included 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 $65 nilfor 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

Home Nursing – 2 month waiting period


per service $50 nilfor services provided by a registered nurse in private practice.

included in Dietetics limit




Other Therapies – 2 month waiting period


Podiatry - initial $35 nil - subsequent $30 nil

sublimit per person per calendar year $400

Occupational Therapy - initial $65 nil - subsequent $42 nil


Eye Therapy - initial $45 $25 - subsequent $30 $22


physiotherapy limit

Speech Therapy - initial $70 $25 - subsequent $45 $22


physiotherapy limit

Dietetics - initial $75 nil - subsequent $45 nil


Alternative Therapies – 2 month waiting period

Annual Limit per person per calendar year $500included in

physiotherapy limit

Chiropractic - initial $40 nil - subsequent $28 nil


Chiropractic X-rays $60 nil


Osteopathic - initial $42 nil - subsequent $32 nil


Acupuncture - initial $35 $25 - subsequent $30 $25


Natural Therapies - initial $32 $29 - subsequent $28 $25includes chinese & western herbal consultations, homeopathy, naturopathy, myotherapy and remedial massage therapy.


Clinical Psychology – 12 month waiting period


initial consultation $85 nil

subsequent consultation $77 nil

included in chiropractic limit

included in chiropractic limit





Health Appliances and Aids – 12 month waiting period


foot orthotics (custom made) 85% nil


repair to custom made foot orthotics $30 nil


other specified orthotics*eg. custom fitted spinal & knee braces.

90% nil


specified prosthetic appliances*eg. breast prosthesis after mastectomy.

90% nil


other specified health aids*eg. blood glucose monitor, nebuliser.

90% 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 nil

per consultation $40 nilOnly 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.

limit of one repair per person per calendar year

limits apply to individual items





Information about private health coverWaiting 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)

12 months

Obstetrics related conditions 12 months

Health management programs 3 months

Optical 6 months

Major Dental (including Periodontics, Endodontics, Crowns & Bridges, Dental Implants, Dentures & Orthodontics)

12 months

Health appliances and aids 12 months

Orthotic appliances 12 months

Clinical Psychology 12 months

Hearing aids 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.


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.


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.

The lowest hospital premium you can pay is called the base rate premium. The contribution rates included in this brochure show the base rate premiums that apply to all St.LukesHealth hospital products. 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 1300 651 988 or visit our website at www.stlukes.com.au

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.

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 www.stlukes.com.au. 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 www.ato.gov.au or you can call the ATO on 13 28 61. 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 and single parents there is a safety net. The excess on a family or single parent policy only applies to the first two persons on the policy who are admitted to hospital in the same calendar year. This means, no more than two people on any one policy will be required to pay an excess in the same calendar year.

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.

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 1000.

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 1300 651 988 or visit our website at www.stlukes.com.au

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.


Payment optionsSt.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 and 42 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 1300 651 988 during normal business hours.

Online

If you register for online member services you can pay by credit card through our website at www.stlukes.com.au. 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 www.bpay.com.au. For more information on Postbillpay visit www.postbillpay.com.au.


Claiming optionsHospital 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 1300 651 988.

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”.


Online member servicesAs 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 www.stlukes.com.au

St.LukesHealth on your phoneAt 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, email 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.


Complaints, compliments and suggestionsSt.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 www.stlukes.com.au


Important information you need to knowMembership 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 30.

2. 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 30.

3. 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 pockets if you use a private hospital for a restricted service.

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).


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.

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 couples membership covers the member and their partner/spouse. A family membership covers the member, partner/spouse, and dependants. Dependants include children under 23 years of age who are not married or living in a defacto relationship and single full time students under 25 years of age if totally dependent on their parents. Dependants will receive immediate cover for equivalent benefits providing they join their own membership within 2 months of ceasing to qualify as a dependant and providing all waiting periods have been served under their parent’s policy.

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.

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).

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 email 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.

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 www.stlukes.com.au or contact St.LukesHealth on 1300 651 988 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.

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 www.ombudsman.gov.au

The contact details for the Private Health Insurance Ombudsman are:

Private Health Insurance Ombudsman Office of the Commonwealth Ombudsman GPO Box 442 Canberra ACT 2601

Phone: 1300 362 072 - select option 4 for Private Health Insurance Fax: (02) 6276 0123 E-mail: [email protected] Website: www.ombudsman.gov.au

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.


Australian Government Rebate Income Tiers Table

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+

Packaged Premiums – effective 1 April 2016

Singles base rateBase Tier Rebate (Full Rebate) – 26.791%

Excess Weekly Monthly Quarterly Half Yearly

Packaged Platinum Plus nil $58.75 $254.55 $763.60 $1468.50

Packaged Platinum nil $48.60 $210.60 $631.85 $1215.10

Packaged Gold $300 $43.70 $189.35 $568.15 $1092.65

Packaged Silver $500 $41.00 $177.80 $533.45 $1025.90

Packaged Bronze Plus $500 $35.15 $152.20 $456.60 $878.10

Packaged Budget 500 Level 1 $500 $31.05 $134.30 $403.00 $775.00


Tier 1 Rebate – 17.861% Excess Weekly Monthly Quarterly Half Yearly



Packaged Gold $300 $49.00 $212.45 $637.45 $1225.90

Packaged Silver $500 $46.00 $199.50 $598.55 $1151.05







Packaged Gold $300 $54.35 $235.60 $706.75 $1359.20

Packaged Silver $500 $51.00 $221.20 $663.60 $1276.20




Tier 3 Rebate (No Rebate) Excess Weekly Monthly Quarterly Half Yearly



Packaged Gold $300 $59.70 $258.70 $776.10 $1492.50

Packaged Silver $500 $56.05 $242.90 $728.70 $1401.35




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


Packaged Premiums

Couples & Families base rateBase Tier Rebate (Full Rebate) – 26.791%


Packaged Platinum Plus Nil $117.50 $509.10 $1527.25 $2937.00

Packaged Platinum Nil $97.20 $421.20 $1263.70 $2430.25

Packaged Gold $600 $87.40 $378.75 $1136.35 $2185.25

Packaged Silver $1000 $82.05 $355.65 $1066.95 $2051.80







Packaged Gold $600 $98.05 $424.95 $1274.95 $2451.85

Packaged Silver $1000 $92.05 $399.00 $1197.05 $2302.10







Packaged Gold $600 $108.70 $471.20 $1413.55 $2718.40

Packaged Silver $1000 $102.05 $442.40 $1327.25 $2552.40







Packaged Gold $600 $119.40 $517.40 $1552.20 $2985.00

Packaged Silver $1000 $112.10 $485.80 $1457.40 $2802.70








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+

Hospital Premiums – effective 1 April 2016



Hospital Platinum nil $37.85 $163.95 $491.95 $946.05

Hospital 300 $300 $32.90 $142.75 $428.25 $823.60

Hospital 500 $500 $30.25 $131.15 $393.55 $756.85

Hospital 1000 $1000 $25.30 $109.65 $329.00 $632.65

Budget 500 Level 1 $500 $26.15 $113.30 $339.95 $653.75

Budget 500 Level 2 $500 $21.60 $93.70 $281.10 $540.60



Hospital 300 $300 $36.95 $160.15 $480.50 $924.05

Hospital 500 $500 $33.95 $147.15 $441.55 $849.20

Hospital 1000 $1000 $28.40 $123.00 $369.10 $709.85

Budget 500 Level 1 $500 $29.35 $127.15 $381.45 $733.50

Budget 500 Level 2 $500 $24.25 $105.10 $315.40 $606.55



Hospital 300 $300 $40.95 $177.55 $532.75 $1024.50

Hospital 500 $500 $37.65 $163.20 $489.55 $941.50

Hospital 1000 $1000 $31.50 $136.40 $409.25 $787.00

Budget 500 Level 1 $500 $32.55 $140.95 $422.90 $813.30

Budget 500 Level 2 $500 $26.90 $116.55 $349.70 $672.50



Hospital 300 $300 $45.00 $195.00 $585.00 $1125.00

Hospital 500 $500 $41.35 $179.20 $537.60 $1033.85

Hospital 1000 $1000 $34.60 $149.80 $449.40 $864.20

Budget 500 Level 1 $500 $35.75 $154.80 $464.40 $893.05

Budget 500 Level 2 $500 $29.55 $128.00 $384.00 $738.45



Hospital Premiums




Hospital 300 $600 $65.85 $285.50 $856.55 $1647.20

Hospital 500 $1000 $60.50 $262.35 $787.10 $1513.70

Hospital 1000 $2000 $50.65 $219.30 $658.00 $1265.30

Budget 500 Level 1 $1000 $52.30 $226.65 $679.95 $1307.55

Budget 500 Level 2 $1000 $43.25 $187.40 $562.25 $1081.20



Hospital 300 $600 $73.90 $320.30 $961.00 $1848.10

Hospital 500 $1000 $67.90 $294.35 $883.15 $1698.35

Hospital 1000 $2000 $56.80 $246.05 $738.25 $1419.65

Budget 500 Level 1 $1000 $58.70 $254.30 $762.90 $1467.05

Budget 500 Level 2 $1000 $48.55 $210.25 $630.80 $1213.10



Hospital 300 $600 $81.95 $355.15 $1065.50 $2049.05

Hospital 500 $1000 $75.30 $326.35 $979.15 $1883.05

Hospital 1000 $2000 $63.00 $272.85 $818.50 $1574.05

Budget 500 Level 1 $1000 $65.10 $281.95 $845.85 $1626.60

Budget 500 Level 2 $1000 $53.80 $233.10 $699.40 $1345.00



Hospital 300 $600 $90.00 $390.00 $1170.00 $2250.00

Hospital 500 $1000 $82.70 $358.40 $1075.20 $2067.70

Hospital 1000 $2000 $69.20 $299.60 $898.80 $1728.40

Budget 500 Level 1 $1000 $71.50 $309.60 $928.80 $1786.10

Budget 500 Level 2 $1000 $59.10 $256.00 $768.00 $1476.90





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+

Extras Premiums – effective 1 April 2016



Super Extras $10.75 $46.60 $139.90 $269.05

Budget Extras $4.85 $21.00 $63.00 $121.20


Super Extras $12.05 $52.30 $156.95 $301.85

Budget Extras $5.45 $23.55 $70.70 $136.00


Super Extras $13.35 $58.00 $174.00 $334.65

Budget Extras $6.05 $26.10 $78.40 $150.80


Super Extras $14.70 $63.70 $191.10 $367.50

Budget Extras $6.65 $28.70 $86.10 $165.60

Extras Premiums



Super Extras $21.50 $93.25 $279.80 $538.05

Budget Extras $9.70 $42.00 $126.05 $242.45


Super Extras $24.15 $104.65 $313.90 $603.70

Budget Extras $10.90 $47.15 $141.40 $272.05


Super Extras $26.75 $116.00 $348.05 $669.35

Budget Extras $12.10 $52.25 $156.80 $301.60


Super Extras $29.40 $127.40 $382.20 $735.00

Budget Extras $13.30 $57.40 $172.20 $331.20


Membership Application

Membership no. Prospective Membership no.

Your details

Title Surname

Given names

Home address

Suburb State Postcode

Postal address

Suburb State Postcode

Sex Birthdate / / Home telephone ( ) Work telephone ( )

Mobile Email

I hereby give consent for St.LukesHealth to communicate with me via email or SMS.

Your Medicare card number

Valid to /

Medicare ref no.

Your partner’s details (if applicable)

Title Surname Given names

Relationship Birthdate / / Sex

Mobile Email

I hereby give consent for St.LukesHealth to contact me via email or SMS

Partner’s Medicare card number

Valid to /

Medicare ref no.

Does your partner have a different address? Yes No (If yes, please provide detail below)

Do you authorise your partner, as named above, to also operate this membership? Yes No

Indicate which Medicare card number relates to your dependants Member Partner

Your dependant’s details (if applicable) – refer to membership condition 11 on page 40 for eligibility details

Surname Given names Relationship Birthdate Medicare ref no. Sex

/ /

/ /

/ /

/ /

/ /

/ /

If you need to add more than 6 dependants please attach a separate page with their details. Student dependants, who are 23 years of age or over, must be registered with the fund each year until they turn 25.

Is everyone covered by this policy an Australian resident? Yes No

Transfer details

Are you transferring from another St.LukesHealth policy? Yes No If yes, please provide your previous membership number below.

Membership no.

Are you or anyone else on this policy transferring from another private health insurer? Yes No

Fund Member no. Plan code Joined Ceased

Have you held private health cover with St.LukesHealth or any other private health insurer at any time since the year 2000? Yes No

Fund Member no. Plan code Joined Ceased

If you have held previous cover with another private health insurer, please complete a ‘Clearance certificate request’ over the page. This will help us to determine if any Lifetime Health Cover loading or waiting periods will apply to your policy with St.LukesHealth.

Your cover requirement

New

Change Date cover/change to commence / /

Packaged cover Hospital cover Extras cover Cover type

Packaged Platinum Plus

Packaged Platinum

Packaged Gold

Packaged Silver

Packaged Bronze Plus Hospital Platinum

Hospital 300

Hospital 500

Super Extras

Budget Extras

Single

Couples & Families Packaged Budget 500 Level 1


I acknowledge that I have been advised and am aware that in joining Packaged Budget 500 Level 1 or Level 2 I will have limited cover for the restricted services as listed in this brochure.

Please initial

Budget 500 Level 1

Budget 500 Level 2

I acknowledge that I have been advised and am aware that in joining Budget 500 Level 1 or Level 2 I will have limited cover for the restricted services as listed in this brochure.

Please initial

Hospital 1000I am aware that in joining Hospital 1000 I will not be exempt from the Medicare Levy surcharge.

Please initial

I have read and understood the information regarding the benefit limitation periods. Please initial Please turn over

Membership Application continuedPre-existing condition

A 12 month waiting period applies to pre-existing conditions. A pre-existing condition is an ailment, illness or condition the signs of symptoms of which existed at any time in the period of 6 months ending on the day on which the person became insured under the policy. Other waiting periods may apply. For more information on waiting periods refer to page 30.

If you are transferring your cover some waiting periods may not apply. Refer to membership conditions 12 and 13 on pages 40 and 41.

I have read and understood the information regarding the pre-existing condition waiting period. Please initial

Australian Government Rebate

Do you wish to receive the rebate as a reduced premium? Yes (If yes, please complete the remainder of this section)

No (If no, no further information required in this section)

What rebate tier do you wish to nominate? No Tier Tier 1 Tier 2 Tier 3

Are you covered by this membership? Yes No

If no, please provide your name, address, phone number and relationship to the policy holder in the space below.

Surname Given names Address Phone no. Relationship

Are all people on this policy listed on a Medicare card or entitled to a Medicare card? Yes No (If no, you cannot apply for the rebate until you obtain a card from Medicare)

I acknowledge that the Australian Government Rebate is income tested and eligibility for the rebate is determined by the taxable income of a single or a family. I further acknowledge that if my taxable income, or my family’s taxable income, falls into a different rebate tier to the tier I have nominated, an adjustment in the amount of rebate I have claimed will be made in my and/or my partner’s annual tax return. Please initial

If at any stage you wish to stop receiving the Australian Government Rebate as a reduced premium, you must notify St.LukesHealth in writing as soon as possible.

Some of the information provided on this form will be used for the purpose of registering you for the Australian Government Rebate on private health insurance. Its collection is authorised by law, and information collected will be disclosed to the Department of Health, Medicare Australia and Australian Tax Office.

Payment method

Weekly Fortnightly Monthly Quarterly Half Yearly Yearly

How do you wish to pay?

Payroll deduction Name of employer

(Please complete attached “Authority to deduct from salary” form)

Periodic direct debit from my bank account

(Please complete attached “Direct debit request” form) Credit card payment on this occasion only

(Please complete attached “Authority for credit card payments” form)

Periodic direct debit from my credit card

(Please complete attached “Authority for credit card payments” form) Other (cash, cheque, BPAY or Postbillpay)

Benefit deposit request

I would like St.LukesHealth to direct credit benefits into my bank, building society or credit union account as detailed below.

Tick this box if you would like benefits on paid accounts (ie Refunds on doctors bills etc) credited directly into your bank, building society or credit union account. Please note that direct credit is not available on credit card accounts.

Name of financial institution

Name of account holder/s

BSB

-

Account number

Declaration

I hereby declare the statements on this form to be true and complete and agree to be bound by the full Rules, By-Laws and related guidelines of St.LukesHealth as amended from time to time. I acknowledge that this application form and brochure does not contain all the Rules, By-Laws and related guidelines of St.LukesHealth. I also acknowledge my membership is subject to the pre-existing condition rule, waiting periods and benefit limitation periods as explained in this brochure. A summary of membership conditions are shown in this brochure. If the information supplied on this application is inaccurate or fraudulent, I acknowledge that St.LukesHealth may refuse to pay a claim, cancel the policy or require payment of any additional premium loading payable in accordance with the Lifetime Health Cover legislation.

I acknowledge St.LukesHealth has a Privacy Policy which I may view upon request, and I will inform any dependants referred to on this application of the existence of the St.LukesHealth Privacy Policy. I consent to the collection, use and disclosure of my personal and sensitive information in the provision by St.LukesHealth of a health insurance service or for a purpose identified in the St.LukesHealth Privacy Policy, and I have authority to provide and consent to the release of personal and sensitive information on behalf of the dependants referred to in this application. I acknowledge that I may withdraw my consent to the collection, use and disclosure of my personal and sensitive information and the personal and sensitive information of any dependant aged below 16 years (and any dependant aged 16 years and over may withdraw his or her consent), except where excluded by law. I authorise the release of personal and sensitive information from my previous health fund, and from any hospital, medical practitioner, or other health service provider that St.LukesHealth deems necessary to administer my policy.

Signature

Date / /

Just before you send

Check that you have completed all the sections and signed all the signature boxes relevant to your application, including the declaration above.

Office use only

Policy excess Old plan code New plan code LHC loading

PHI rebate Source code Alliance partner

Driver 1 Driver 2

Is this policy linked to another for payment purposes? If yes, membership number

Comments regarding waiting periods on promotions

General comments

151133

Clearance certificate requestAll Australian registered private health insurers are required to issue you with a clearance certificate when you cancel your health cover with them. Complete this form to authorise St.LukesHealth to cancel your existing membership and receive the clearance request on your behalf.

Details on your previous health fund

Name of previous fund Previous fund membership no.

Name of previous fund Previous fund membership no.

Details of individuals covered by previous health fund. If you need to add more than 9 people, please attach a separate page with their details.

Full name of policy holder Birthdate / /

Dependants name Birthdate / /








Please turn over

Clearance certificate request continued

Authority to cancel

I hereby authorise St.LukesHealth to cancel my/our membership from

/ / and obtain all relevant information about my/our

membership.

I also request a refund for any premiums paid in advance of my cancellation date. If my premiums are paid by direct debit please cease my deductions from the above date.

Please note if your premiums to your previous fund are made by wage/payroll deductions or by Direct Debit you should advise your paymaster or financial institution to cease deductions accordingly.

Please do not contact me in the future

Signature

Date / /

Signature

Date / /

Office use only St.LukesHealth membership no.

Please return completed form to: St.LukesHealth PO Box 915 Launceston Tas 7250 Ph: 1300 651 988 Fax: (03) 6331 9095

Authority to deduct from salary

Employee’s details

Title Surname

Given names

Home address

Suburb Postcode

Membership number/s Payroll number

I authorise the pay officer for:

Company name

To deduct from my salary $

Every Week

Fortnight Month

Commencing pay period ending

/ /

First authority

Change to existing authority

Old deduction $

New deduction $

Please turn over

Direct Debit Request

Request and authority to debit the account named below to pay St.LukesHealth

Surname or Company name Membership number

Given names (‘you’) or ACN/ABN

Request and authorise St. Luke’s Medical and Hospital Benefits Association (13665) to arrange for any amount St. Luke’s Medical and Hospital Benefits Association may debit through the Bulk Electronic Clearing System from an account held at the financial institution identified below subject to the terms and conditions of the Direct Debit Request Service Agreement.

Name of financial institution

Name of account holder/s

BSB

-

Account number

Payment frequency

Weekly

Fortnightly Commencing on Friday

/ /

Monthly

Quarterly Half yearly

Yearly Commencing on

25 / / 25

Account holder(s) signature(s). Note – if joint account, all signatures required.

Date / /

Authority to deduct from salary continuedI authorise the pay officer to cancel my existing health insurance deductions from:

Fund name

From pay period detailed on side one.

Should the amount of contribution payable by me be altered by reason of an alteration in the rate of contribution for the product under which I am covered, then this authority and request shall extend to and covers the altered contribution payable by me. I authorise you to accept from time to time notification from the fund that my contribution to the product under which I am covered has been varied to an amount specified and request that this should be acted upon. This authority is to continue until such time as it is withdrawn by me in writing.

Signature

Date / /

Office use only Group number Section number

Authority for credit card payments

Credit card payments

Member’s name Membership no.

Please charge my credit card (tick preferred option)

On this occasion only

Visa

Mastercard Diners

American Express Note: Automatic payments are not available through diners or American Express.

Credit card number

Expiry date

/

As per my direct debit request

Visa

Mastercard

Credit card number

Expiry date

/

Cardholder’s name

Signature

Date / /

15001

9

151133

1300 651 988 [email protected] www.stlukes.com.au

ABN 81 009 479 618

Head Office 17 The Quadrant Mall Launceston 7250Hobart 50a Murray Street Hobart 7000Devonport 26 Rooke Street Devonport 7310Burnie 27 Cattley Street Burnie 7320Smithton 24 Smith Street Smithton 7330Queenstown 14-16 Orr Street Queenstown 7467Deloraine 64 Emu Bay Road Deloraine 7304

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singles, couples and families · 2017-05-22 · 6 St.LukesHealth singles, couples and families...

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