Upgrading Extras Cover

Upgrading Extras Cover

When you upgrade your Extras cover with Saint Luke's Health, the primary legislative implication is around waiting periods.

• New Waiting Periods for Higher Benefits: If you upgrade to a higher level of Extras cover (e.g., from Starter Extras to Super Extras), you will likely have to serve new waiting periods for the increased benefits or for new services that were not included in your previous, lower-level Extras policy.

  • Example: If your old policy didn't cover orthodontics, and your new upgraded policy does, you would need to serve the 12-month waiting period for orthodontics. If your old policy covered general dental at a lower annual limit, and your new policy offers a higher limit, you would need to serve a new waiting period to access the increased benefit.

• Continuity of Cover: For services you were already covered for at the same or a lower benefit level on your previous Extras policy, you generally won't have to re-serve waiting periods. This is often the case when transferring from another fund too, provided you switch within a certain timeframe.

• Pre-existing Conditions: While generally more relevant to Hospital cover, some Extras services (like clinical psychology, major dental, or health appliances) may have longer waiting periods (e.g., 12 months) that apply even on an upgrade if the condition is deemed pre-existing.

• Review Your Needs: Saint Luke's encourages members to review their cover regularly to ensure it meets their lifestyle needs. They offer a personalised cover review service

"No Charge to Hospital Cover" When Upgrading Extras

The phrase "no charge to hospital cover" when upgrading Extras cover generally refers to the fact that upgrading your Extras policy does not automatically affect your Hospital cover or incur additional charges on your Hospital cover component, unless you are choosing to combine or change your Hospital cover simultaneously.

• Separate Products: Hospital cover and Extras cover are distinct products, even when packaged together. You can upgrade one without necessarily changing the other.

• Premium Adjustment: If you upgrade your Extras cover, your overall premium will increase to reflect the higher level of benefits you are now receiving on your Extras policy. This isn't a "charge to" your Hospital cover, but rather an increase to your total premium.

• Combination Policies: Saint Luke's offers combined Hospital and Extras policies. If you were on a Hospital-only policy and decide to add Extras, or if you had a basic combined policy and upgrade both, then your premium will obviously change. However, upgrading only the Extras portion of a combined policy means only the Extras component's premium will adjust upwards.

Relevant Legislative Framework (Australian Context)

Private health insurance in Australia, including Saint Luke's Health in Tasmania, is governed by a comprehensive legislative framework, primarily the Private Health Insurance Act 2007 (Cth) and its associated regulations. Key aspects relevant to upgrades include:

• Community Rating: This principle means that health funds cannot refuse to insure someone or vary premiums based on a person's health status, claims history, or age (once over 31 and subject to LHC). This ensures that upgrading is generally permissible.

• Waiting Periods: The Act sets out the maximum standard waiting periods that health insurers can apply for various services, including for pre-existing conditions and upgrades. Funds like Saint Luke's must adhere to these.

• Private Health Information Statements (PHIS): Health funds are legally required to provide a PHIS for every product. This statement clearly outlines inclusions, exclusions, restrictions, excesses, and all applicable waiting periods for a specific policy. When considering an upgrade, reviewing the PHIS for the new Extras policy is crucial for understanding all legislative details.

• Lifetime Health Cover (LHC): While primarily impacting Hospital cover, LHC loading can be removed after 10 continuous years of holding Hospital cover. Upgrading Extras cover won't typically affect an existing LHC status unless you also make changes to your Hospital cover that impact its "appropriate" status for MLS/LHC purposes.

• Medicare Levy Surcharge (MLS): This is a tax surcharge for higher-income earners who do not hold an "appropriate level" of private Hospital cover. Upgrading Extras cover has no direct impact on MLS unless you are also changing your Hospital cover in a way that makes it "inappropriate" (e.g., opting for an excess higher than the government-specified threshold for MLS exemption).