Overview

St Lukes Health is a not-for-profit, Tasmanian-based insurer. For families, the fund provides a flexible "Mix and Match" policy structure, allowing members to combine different Hospital and Extras tiers. A key differentiator for St Lukes is the application of Individual Limits, ensuring each family member has their own benefit bank for services like dental and physio.

Hospital Cover Tiers

Hospital cover provides private patient status and helps avoid public waiting lists. It is essential to choose a hospital cover that aligns with your health needs and financial situation. Below, we delve into the various tiers of hospital cover available, outlining the benefits and limitations of each to assist you in making an informed decision.

• Gold Hospital: This is the most comprehensive level of cover, designed to provide peace of mind by covering a wide range of treatments with no exclusions. Gold Hospital cover includes major medical procedures such as pregnancy-related services, heart surgeries, and weight-loss operations. It is an excellent choice for individuals or families seeking extensive coverage for all possible health scenarios.

• Planner Silver Plus: Tailored specifically for growing families, this cover emphasizes services related to pregnancy and childbirth. It offers a balanced level of coverage that ensures new parents have access to necessary medical services without the comprehensive cost of Gold cover. This makes it a cost-effective option for families expecting additions.

• Protector Silver Plus: Ideal for established families, this cover provides high-level protection for most major surgeries. However, it is important to note that it excludes coverage for pregnancy and obstetric services. This makes it a suitable choice for families who may have already completed their family planning and are looking for comprehensive coverage for other major health events.

• Bronze Plus: This tier offers essential cover tailored to common family health needs, such as ear, nose, and throat procedures like tonsillectomies and grommet insertions. It is designed to provide coverage at a lower premium, making it an attractive option for those looking for basic protection against common medical issues without the higher costs associated with more comprehensive covers.

Extras Cover & Upgrades

Extras cover provides rebates for non-hospital services. When a member upgrades their Extras tier, the following rules apply:

• The Upgrade Rule: Members can claim at their previous (lower) benefit level immediately. New waiting periods apply only to the increased benefit amount or any brand-new services included in the higher tier.

• Common Waiting Periods: * 2 Months: General dental, physiotherapy, and chiropractic.

  • 12 Months: Major dental and orthodontics.

• Super Extras: Recommended for families with children approaching the age for braces (Orthodontics).

• Wellbeing Extras: The standard mid-tier choice for general health maintenance.

Annual Payments and Rate Locking

Members have the option to pay their premium 12 months in advance.

• Rate Protection: Paying the annual premium before April 1st allows members to "lock in" the current year’s rates, effectively delaying the impact of the annual Commonwealth-approved premium increase for 12 months.

• Discounts: Upfront annual payments typically attract a discount (refer to the current billing schedule for the exact percentage).

• Payment Methods: Payments can be processed securely over the phone via Credit Card (Visa or Mastercard).

Legislative Requirements

When a policy is reviewed or changed, the following must be provided to the member:

• Private Health Information Statement (PHIS): A summary of the new cover levels must be sent via email or post within 14 days of the change.

• Waiting Period Disclosures: Members must be verbally advised of any new waiting periods resulting from a cover upgrade.

Family Policy Definitions

• Dependents: Children are covered until age 21.

• Full-time Students: Coverage can be extended up to age 25 if the dependent is a single, full-time student.

• Newborns: To ensure continuous cover with no waiting periods, newborns should be added to the policy within 90 days of birth.