St.LukesHealth has introduced a new Dependant Extension option, on selected hospital and package products for parents with children turning 23, who are no longer students. This allows non-student child dependants to remain on their parent’s policy until their 25th birthday for an additional premium - so long as they are not married or living in a de-facto relationship.
We have recognised a need of parents who want to protect their children that are not completing full time study. It is important for young adults to stay covered, so they can continue to have immediate access to private hospital treatment and not have to re-serve waiting periods, allowing them to be protected longer.
If you do not extend cover for your non-student child dependants they may not be able to immediately access private hospital treatment, with a doctor of their choice. Where extras cover lapses, your non-student child dependant may also have to serve a 12-month waiting period for claims like major dental, or a six-month waiting period before claiming for glasses or contact lenses.
So how can you make sure your family member stays covered and avoids waiting periods? You have 30 days from your non-student child dependant’s 23rd birthday to extend your cover to a Dependant Extension option. During this period, they will not be penalised with waiting periods.
To qualify for the Dependant Extension, you must hold one of the following levels of cover:
Don’t forget, single full time student dependants can remain covered until their 25th birthday, providing they are studying full-time, not married or living in a de-facto relationship.
It is also important to note that if your child is moving interstate for work or study, we have them covered with contracted hospitals Australia-wide. We look forward to continuing to serve you and your family.
St.LukesHealth has taken home the prestigious 2016 Roy Morgan Customer Satisfaction award for Private Health Insurance.
The award was announced at a packed Melbourne venue last week and caps off a stellar 2016 for the expanding Tasmania company which also won eight of the 12 monthly customer satisfaction awards for the private health insurance industry.
The Launceston based company’s opposition included the nation’s largest health insurers such as Bupa, Medibank, nib and ahm.
St.LukesHealth CEO Chris Williams said the not-for-profit organisation had come a long way since it was established in Launceston, 65 years ago.
“Winning this award is a great honour for all St.LukesHealth staff, our executive team and board members,” said Mr Williams.
“We understand that consumer preferences are always changing and therefore in order to best service the needs of our members, we as a business need to change too.
“The fact we are a smaller, locally managed and not-for-profit private health insurance company means we are nimble enough to quickly make changes to the organisation and all profits are directed back in the business.
“Our goal is to deliver high quality private health insurance to all Australians, with the highest degree of customer satisfaction possible.
“St.LukesHealth has made many innovative changes to the way were deliver private health insurance over the past few years.
“This award proves these changes have been well received by our customers and have made their private health insurance experience better.
“We have invested resources into the development of a Mobile Claiming Application. This mobile technology provides an easy and useful mobile experience for all members. The app is cutting edge amongst the Hospital and Medical Benefits System (HAMBS) fund community, with St.LukesHealth being one of the first health insurance funds in Australia to provide such a service.
“Across Tasmania, we have also redefined the face-to-face customer experience, moving away from a bank teller style set up and turning our Customer Care Centres into spaces where St.LukesHealth staff can truly engage with the customer to find them the best outcome.
“St.LukesHealth is moving away from the old indemnity model for health insurance, to be an innovative organisation empowering its members.”
A guide to private health insurance cover when you’re having a baby.
Planning to start a family?
It is important to make sure you know what to expect from your private health insurance when you’re planning to start a family. This information guide will help to answer the common questions that you may have.
Should I go public or private?
Health care costs can vary depending on whether you choose to be a public patient in a public hospital or a private patient in either a public or private hospital. This decision can only be made by you in consultation with your practitioner. Your choice will depend on what options are available to you and whether or not you wish to have a private Obstetrician.
For example, in some locations you may not have a choice between a public or private hospital, as there may only be one local hospital in your area. However, you may wish to elect to be treated as a private patient in a public hospital so that you can choose which Obstetrician treats you and so you can have access to a private room if one is available.
Or your choice may be guided by which hospital your private Obstetrician can treat you in, or by the services offered by your local private hospital. So it’s worth understanding what you will be covered for and what, if any, out of pocket costs you may have.
Am I eligible for cover and will my baby be covered?
Pregnancy and birth related services are covered in both a public and private hospital on most St.LukesHealth private hospital products, after a 12 month waiting period has been served. IVF and assisted reproductive services also have a 24 month benefit limitation period (contact the health fund for more information on IVF services).
If you have been covered by a family hospital policy for more than 12 months, then you and your baby will be covered, providing your baby is added onto to your policy within 2 months.
If you have been covered by a single hospital policy for more than 12 months, then you will be covered but your baby will not. To cover your baby from birth, you should upgrade your cover to a family policy from the baby’s date of birth. This should be done within 2 months of your baby’s birth date. St.LukesHealth does not apply waiting periods to new born babies if added within this 2 month period.
If you are not currently insured and are already pregnant, unfortunately you will not be covered for any treatment related to your pregnancy. You should take out an appropriate Private Hospital product at least 3 months before you are pregnant so that you have served the 12 month waiting period prior to being admitted for the delivery.
If you are covered on Budget 500 Level 2 or Package Budget 500 Level 2 you only have limited cover and you should contact St.LukesHealth to discuss your entitlements.
What is covered prior to my hospital admission?
Most medical expenses that arise prior to your hospital admission are claimable through Medicare rather than your Private Health Insurance. Medicare will reimburse 100% of the Medicare Benefits Schedule (MBS) fee for GP services and 85% of the MBS fee for specialist services and all other medical treatments such as ultrasounds and blood tests. If your doctor direct bills (bulk bills) Medicare, you will have nothing to pay. The Medicare Safety Net may also help to minimise any out-of-pocket expenses you may have for medical services provided prior to your delivery. You should contact Medicare for more information on the Medicare Safety Net.
What is covered once I am admitted to hospital?
Once you are admitted to hospital, St.LukesHealth will cover the cost of your admission in a Public or Private Hospital, less any excess that applies to your policy, providing you have served your 12 month waiting period.
Between St.LukesHealth and Medicare you will be covered up to the MBS Fee for any medical services related to your hospitalisation, such as your obstetrician, anaesthetist, or assisting mid wives etc. If any of the medical charges are higher than the MBS Fee, then you may have an out-of-pocket cost for these services. However, if your doctor charges you under the St.Lukes Gap Cover Scheme, your out-of-pocket costs will be reduced or eliminated.
You should discuss with your specialists if they will be charging you under the St.Lukes Gap Cover Scheme.
What charges will apply to my baby?
If your baby is healthy, he or she won’t need to be formally admitted to hospital, meaning there will be no fees raised for the baby’s stay in hospital.
However, if your baby does need special treatment they will most likely be admitted in their own right. This means fees will also be raised for your baby. If you have taken the required steps to cover your baby under your policy, St.LukesHealth will cover the costs of your baby’s hospital admission (less any excess that may apply to child dependants on your policy). On most products however, the excess doesn’t apply to child dependants. (please contact St.LukesHealth to check the level of cover on your product)
If you are expecting twins (or any multiple births) at least one baby will be formally admitted to the hospital, even if they are both healthy. If your policy has no excess on child dependants, then you will not be charged an excess for the baby's admission, however fees will be raised for their time in hospital.
What will I have to pay for?
Medical services that occur outside of hospital including specialist consultations and obstetrician’s check-ups. These costs, like your visits to your GP, can only be claimed through Medicare.
The ‘Gap’ on Medical services incurred while admitted to hospital. You are covered up to the MBS Fee for these medical services however you may have to pay any charges above the MBS fee if your doctor does not participate in the St.Lukes Gap Cover Scheme. You should discuss any out-of-pocket costs that might occur with your doctors, and ask them if they have a ’no gap’ or ’known gap’ arrangement with St.LukesHealth. This may significantly reduce your out-of-pocket costs.
Your baby’s pre-release check-up. Before you and your baby can go home, in some cases a paediatrician will check on his or her progress. Unless your baby has been formally admitted to hospital in their own right, the fee for the paediatrician’s visit cannot be claimed on your private health insurance policy. This cost can only be claimed through Medicare and usually a gap is payable, depending on how much the paediatrician charges above the MBS Fee.
Any excess that applies to your policy. Before being admitted to hospital you should contact St.LukesHealth to discuss your level of excess and how it applies.
Tips to help you avoid out-of-pocket costs
Ask your specialist if they have a ‘no gap’ or ‘known gap’ arrangement with St.LukesHealth and if they can provide you with a written quote outlining any expected out-of-pocket costs.
Confirm with St.LukesHealth that the private hospital you have chosen is contracted with the fund.
Contact Medicare to discuss the Medicare Safety Net and how it may assist you with any out-of-pocket costs you may have on services provided out of hospital.
What if I am trying IVF or other assisted reproductive services?
I’ve held hospital cover with St.LukesHealth since before 1st April 2010 or I joined St.LukesHealth after 1st April 2010 and transferred from another fund which covered the above services:
The in-hospital costs associated with IVF and other assisted reproductive services will be covered by St.LukesHealth less any excess that applies to your policy, providing you have served the 12 month pre-existing waiting period. You should check with your doctor and IVF Clinic for a written quote for any costs that will not be part of your hospital admission. Services that aren’t part of your hospital admission, including consultations and tests, may be claimable through Medicare.
I joined St.LukesHealth after 1st April 2010 and did not transfer from another fund or I transferred from a fund that excluded the above services:
Effective from 1st April 2010, a 24 month benefit limitation period applies to the above services inclusive of the 12 month pre-existing waiting period. This means you will not be covered for the first 12 months and will only receive minimum benefits for this treatment during your second year of membership. You will therefore have large out-of-pocket costs if you receive IVF or similar treatment in your first two years of membership.
Premature Births and Complications
Premature births or complications arising from a pregnancy where a medical practitioner confirms your baby’s expected date of birth is after the 12 month waiting period will be covered, subject to any excess that applies to your policy.
Pre-natal classes and post-natal services
If you hold extras cover with St.LukesHealth you may be able to claim a benefit for pre-natal classes. The classes must be provided by a physiotherapist in private practice who is registered with this fund. To find out if you are eligible for these benefits contact St.LukesHealth on 1300 651 988.
Post natal services such as home nursing consultations and lactation support visits may also be claimable if you hold extras cover with St.LukesHealth. The provider must be a registered nurse in private practice and registered with this fund. To find out if you are eligible for these benefits contact St.LukesHealth.
What you need to know about out-of-pocket costs associated with private hospital admissions.
Finding out you need to be admitted to hospital can be a daunting experience, especially when you are uncertain about the expenses you may have to pay. As a member of St.LukesHealth, we want to make this sometimes difficult situation as easy as possible, and this information sheet will explain how.
What to do before you are admitted: Before you receive treatment in hospital you should first speak to your treating doctor and to us, your health fund. Doing this before your admission will ensure you know what to expect from your hospital stay and can save you from experiencing the shock of out-of-pocket costs.
What you should ask your doctor:
Your specialist and any other medical professionals assisting with your treatment should provide you with written confirmation of what your expected charges will be. This information will enable St.LukesHealth to more accurately inform you what your out-of-pocket costs will be. Any quote must include MBS item numbers. If these numbers are not supplied on the quote, we will be unable to confirm if you have any out-of-pockets costs. Some procedures (like cosmetic surgery) cannot be billed with MBS item numbers as they are not covered by Medicare, which means these services cannot be claimed through either Medicare or St.LukesHealth.
Who pays your hospital and medical charges?
If you hold private hospital cover, your private health insurance provides cover towards the cost of the hospital portion of your admission. This includes theatre fees and accommodation fees for treatment received in all contracted hospitals within Australia, any fees associated with intensive or coronary care and the cost of approved surgically implanted prostheses involved in your treatment, subject to your level of cover and any waiting periods that may apply.
When you receive a medical service in hospital, Medicare will pay a benefit of 75% of the Medicare Benefits Schedule (MBS) fee and your private hospital cover will pay the remaining 25% of the MBS fee. This means you are fully covered up to the MBS fee. However, doctors can charge above the schedule fee and when they do, the difference between the MBS fee and your doctor's charge is called the 'gap.' If the doctor has charged you more than the scheduled fee, you are responsible for paying the difference unless they charge you under the St.Luke’s Gap Cover scheme (see the section titled “What is St.Luke’s Gap Cover”).
If you have already contacted the fund before your admission you will be well prepared for any expected out-of-pocket costs. Make sure you contact us before any hospital admission to avoid any unexpected surprises!
How the costs are paid:
Any excess that applies to your hospitalisation is normally payable upon admission. In some circumstances you will be sent an account directly from the hospital after you are discharged, if your admission was unplanned. The hospital account for your theatre and accommodation fees etc, is sent directly to St.LukesHealth for payment, you will not receive a bill directly from the hospital. We will send you a benefit statement advising you what St.LukesHealth has paid.
There are two ways the Medical expenses can be claimed:
1. If your medical providers are participating in St.Luke’s Gap Cover, they can forward all accounts directly to us for payment. (for more information see the section titled "What is Gap Cover?".)
2. If your specialist and other assisting medical providers are not participating in St.Luke’s Gap Cover, they will bill you directly for their services once you have been discharged. In this instance you have two claiming options:
a) Pay the accounts and claim them yourself
Once you have paid the accounts, take the original accounts and receipts to Medicare who will process the claim and pay you your Medicare entitlement. Medicare will provide you with a Statement of Benefit, which you will need to forward to us. We can then process the claim for the remaining fund benefit and pay the money directly to you. Some specialists may offer a discount for payments made upfront or by a certain date - make sure you read the fine print of any account you receive, as this can be a great way to save money.
b) Forward the unpaid accounts to Medicare and then to St.LukesHealth
If you choose not to pay your account first you should send it to Medicare and they will process the claim making the benefit refund payable to the provider. Medicare will send you a Statement of Benefit with the benefit cheque. When you receive this benefit statement you need to forward it to St.LukesHealth and we will process our portion of the claim, drawing another cheque in favour of the provider. You will need to forward both cheques to the provider for payment of the accounts, as well as any out of pocket costs that may apply. For some hospital admissions you will receive several accounts from different medical providers associated with your treatment. For each account you will need to follow the same procedure.
What is St.Luke’s Gap Cover?
St.Luke’s Gap Cover is designed to reduce or eliminate the 'gap' between the Medicare Benefits Schedule (MBS) fee and the doctor's charge for your inpatient medical services.
Your surgeon, anaesthetist and other medical professionals involved in your admission, have the option to decide whether they will charge you through the St.Luke’s Gap Cover scheme. If your doctor agrees to participate in St.Luke’s Gap Cover you will either be fully covered for your in-hospital medical services or your 'gap' will be significantly reduced.
We encourage you to check with your doctors to see if they participate in the St.Luke’s Gap Cover arrangement before you commence your hospital treatment.
What out of pocket costs may I have?
The following is a summary of possible out of pocket costs:
At St.LukesHealth we are constantly looking at improving the ways in which we service our members. In order to keep in touch with the changing needs of our members, we have developed a mobile application which allows members to easily perform a variety of tasks including:
- Submit claims
- Securely access their information
- Review their cover options
- Search for contracted hospitals, medical specialists, optometrists, registered alternative therapists and pharmacies
- Contact us or locate your nearest St.LukesHealth office.
To access these services, download our free app from either the iTunes App store for iPhone or Google Play for Android phones. You can find our app by searching for St.LukesHealth.
At St.LukesHealth we value the relationship we have with our members and that’s why we have 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 the dental benefits and annual dental limits.
Member rewards applies to the following products, Packaged Platinum Plus, Packaged Platinum, Packaged Gold, Packaged Silver and Super Extras.
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 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 rewards is for your length of membership with St.LukesHealth
This is another great reason to maintain your top extras cover with St.LukesHealth.