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St Lukes

Pasplan Gold with excess

Corporate Policy

$320.80 / month

(Before Rebate, Discount & Loading)

Available in NSW & ACT

You may be entitled to an Australian Government Rebate on the above premium. Your premium may also include a Lifetime Health Cover Loading or an insurer discount. Check with your insurer for details.

This policy covers: Only one person.

Corporate policy: Employees of Minerals and Metals Group, Oz Minerals, Nyrstar and Perilya Ltd

Policy ID: SLM/J4B/NDWU10

Source: Private Health Information Statement (PHIS)

Hospital Cover

  • This policy exempts you from the Medicare Levy Surcharge.
  • This policy does not provide accident cover.
  • This policy provides benefits for travel or accommodation outside of hospital - check with insurer for details.
Covered
Restricted Cover
Not Covered
This policy includes cover for
Assisted reproductive services
Back, neck and spine
Blood
Bone, joint and muscle
Brain and nervous system
Breast surgery (medically necessary)
Cataracts
Chemotherapy, radiotherapy and immunotherapy for cancer
Dental surgery
Diabetes management (excluding insulin pumps)
Dialysis for chronic kidney failure
Digestive system
Ear, nose and throat
Eye (not cataracts)
Gastrointestinal endoscopy
Gynaecology
Heart and vascular system
Hernia and appendix
Hospital psychiatric services
Implantation of hearing devices
Insulin pumps
Joint reconstructions
Joint replacements
Kidney and bladder
Lung and chest
Male reproductive system
Miscarriage and termination of pregnancy
Pain management
Pain management with device
Palliative care
Plastic and reconstructive surgery (medically necessary)
Podiatric surgery (provided by a registered podiatric surgeon)
Pregnancy and birth
Rehabilitation
Skin
Sleep studies
Tonsils, adenoids and grommets
Weight loss surgery

The benefits paid for hospital treatment will depend on the type of cover you purchase and whether your fund has an agreement in place with the hospital in which you are treated. See ‘Agreement Hospitals’ on privatehealth.gov.au for which hospitals have arrangements with your insurer – https://privatehealth.gov.au/dynamic/agreementhospitals.

Under this policy, you may have to pay out-of-pocket costs above what you get from Medicare or your private health insurer. Before you go to hospital, you should ask your doctors, hospital and health insurer about any out-of-pocket costs that may apply to you.

The following payments may also apply for hospital admissions

Excess: You will have to pay an excess on admission. This is limited to a maximum of $150 per person and $150 per policy per year.

Excess payments do not apply to hospital admissions for day surgery.

Co-payments: No co-payments

The following waiting periods for hospital admissions apply to new or upgrading members Waiting periods:
  • 2 months for palliative care, rehabilitation and hospital psychiatric treatments, even if pre-existing
  • 12 months for other pre-existing conditions
  • 12 months for pregnancy and birth (obstetrics)
  • 2 months for all other treatments
Gap Cover

This provider offers 'known gap' or 'no gap' cover for medical bills for this product. The Medical Costs Finder (https://www.health.gov.au/resources/apps-and-tools/medical-costs-finder) lets you find out more about the cost of specialist medical services.

Other features of this hospital cover

Ambulance Levy included for NSW/ACT residents. Ambulance is provided free to Tas residents. Unmarried dependants covered until they turn 23 and single F/T students covered until they turn 25.

Extras Cover

This health insurer does not operate a preferred provider scheme.

This policy includes General treatment (Extras) cover for

Treatment & waiting period (months)
Benefit limits per 12 months unless otherwise stated
Examples of maximum benefits
Acupuncture 2

$400 per policy

  • Initial visit: $53
  • Subsequent visit: $47
Ante-natal/Post-natal classes 2

$850 per policy

combined limit for ante-natal/post-natal classes, exercise physiology & physiotherapy

  • Initial visit: $56
  • Subsequent visit: $56
Audiology 2
  • Initial visit: $70
  • Subsequent visit: $70
Blood glucose monitors 12

Overall Limit of $1000 per person applies to Health Appliances and Aids**. $250 sub limit applies to foot orthotics.

combined limit for blood glucose monitors & orthotics (podiatric orthoses)

  • Per monitor: $200
Chinese medicine 2

$400 per policy

combined limit for chinese medicine & remedial massage

  • Initial visit: $50
  • Subsequent visit: $45
Chiropractic 2

$500 per policy

combined limit for chiropractic, osteopathy & other services

sub-limits apply

  • Initial visit: $53
  • Subsequent visit: $41
Dietetics/dietary advice 2

$500 per policy

  • Initial visit: $90
  • Subsequent visit: $55
Endodontic 12

$1,000 per policy

  • Filling of one root canal: $215
Exercise physiology 2

$850 per policy

combined limit for ante-natal/post-natal classes, exercise physiology & physiotherapy

  • Initial visit: $60
  • Subsequent visit: $46
Eye therapy (orthoptics) 2

$400 per policy

  • Initial visit: $75
  • Subsequent visit: $48
General dental* 2

$1,200 per policy

  • Fluoride treatment: $36
  • Scale & clean: 100% of charge
  • Surgical tooth extraction: $234
  • Periodic oral examination: 100% of charge
Hearing aids 36
  • Hearing aid: $1250
Home nursing 2

$400 per policy

  • Initial visit: $70
  • Subsequent visit: $70
Major dental 12

No annual limit

sub-limits apply

  • Full crown veneered: $1005
Non PBS pharmaceuticals 2

$600 per policy

  • Per eligible prescription: $70
Occupational therapy 2

$400 per policy

  • Initial visit: $85
  • Subsequent visit: $67
Optical 6

$300 per policy

  • Multi-focal lenses & frames: 100% of charge
  • Single vision lenses & frames: 100% of charge
Orthodontic 12

$1,000 per policy

$2,800 lifetime limit

  • Braces for upper & lower teeth, including removal plus fitting of retainer: 85% of charge
Orthotics (podiatric orthoses) 12

Overall Limit of $1000 per person applies to Health Appliances and Aids**. $250 sub limit applies to foot orthotics.

combined limit for blood glucose monitors & orthotics (podiatric orthoses)

  • Orthotics supply & fit: $250
Osteopathy 2

$500 per policy

combined limit for chiropractic, osteopathy & other services

  • Initial visit: $65
  • Subsequent visit: $59
Physiotherapy 2

$850 per policy

combined limit for ante-natal/post-natal classes, exercise physiology & physiotherapy

sub-limits apply

  • Initial visit: $72
  • Subsequent visit: $56
Podiatry 2

$400 per policy

  • Initial visit: $55
  • Subsequent visit: $49
Psychology 2

Benefits payable towards counselling services - Initial consultation $85/subsequent consultation $80 included in $700 Psychology Limit

  • Initial visit: $160
  • Subsequent visit: $125
Remedial massage 2

$400 per policy

combined limit for chinese medicine & remedial massage

sub-limits apply

  • Initial visit: $53
  • Subsequent visit: $47
Speech therapy 2

$400 per policy

  • Initial visit: $130
  • Subsequent visit: $82
Acupuncture

Waiting period:  2 months

Benefit limits per 12 months unless otherwise stated

{$400 per policy}

Examples of maximum benefits

{Initial visit: $53}

{Subsequent visit: $47}

Ante-natal/Post-natal classes

Waiting period:  2 months

Benefit limits per 12 months unless otherwise stated

{$850 per policy}

{combined limit for ante-natal/post-natal classes, exercise physiology & physiotherapy}

Examples of maximum benefits

{Initial visit: $56}

{Subsequent visit: $56}

Audiology

Waiting period:  2 months

Benefit limits per 12 months unless otherwise stated
Examples of maximum benefits

{Initial visit: $70}

{Subsequent visit: $70}

Blood glucose monitors

Waiting period:  12 months

Benefit limits per 12 months unless otherwise stated

{Overall Limit of $1000 per person applies to Health Appliances and Aids**. $250 sub limit applies to foot orthotics.}

{combined limit for blood glucose monitors & orthotics (podiatric orthoses)}

Examples of maximum benefits

{Per monitor: $200}

Chinese medicine

Waiting period:  2 months

Benefit limits per 12 months unless otherwise stated

{$400 per policy}

{combined limit for chinese medicine & remedial massage}

Examples of maximum benefits

{Initial visit: $50}

{Subsequent visit: $45}

Chiropractic

Waiting period:  2 months

Benefit limits per 12 months unless otherwise stated

{$500 per policy}

{combined limit for chiropractic, osteopathy & other services}

{sub-limits apply}

Examples of maximum benefits

{Initial visit: $53}

{Subsequent visit: $41}

Dietetics/dietary advice

Waiting period:  2 months

Benefit limits per 12 months unless otherwise stated

{$500 per policy}

Examples of maximum benefits

{Initial visit: $90}

{Subsequent visit: $55}

Endodontic

Waiting period:  12 months

Benefit limits per 12 months unless otherwise stated

{$1,000 per policy}

Examples of maximum benefits

{Filling of one root canal: $215}

Exercise physiology

Waiting period:  2 months

Benefit limits per 12 months unless otherwise stated

{$850 per policy}

{combined limit for ante-natal/post-natal classes, exercise physiology & physiotherapy}

Examples of maximum benefits

{Initial visit: $60}

{Subsequent visit: $46}

Eye therapy (orthoptics)

Waiting period:  2 months

Benefit limits per 12 months unless otherwise stated

{$400 per policy}

Examples of maximum benefits

{Initial visit: $75}

{Subsequent visit: $48}

General dental*

Waiting period:  2 months

Benefit limits per 12 months unless otherwise stated

{$1,200 per policy}

Examples of maximum benefits

{Fluoride treatment: $36}

{Scale & clean: 100% of charge}

{Surgical tooth extraction: $234}

{Periodic oral examination: 100% of charge}

Hearing aids

Waiting period:  36 months

Benefit limits per 12 months unless otherwise stated
Examples of maximum benefits

{Hearing aid: $1250}

Home nursing

Waiting period:  2 months

Benefit limits per 12 months unless otherwise stated

{$400 per policy}

Examples of maximum benefits

{Initial visit: $70}

{Subsequent visit: $70}

Major dental

Waiting period:  12 months

Benefit limits per 12 months unless otherwise stated

{No annual limit}

{sub-limits apply}

Examples of maximum benefits

{Full crown veneered: $1005}

Non PBS pharmaceuticals

Waiting period:  2 months

Benefit limits per 12 months unless otherwise stated

{$600 per policy}

Examples of maximum benefits

{Per eligible prescription: $70}

Occupational therapy

Waiting period:  2 months

Benefit limits per 12 months unless otherwise stated

{$400 per policy}

Examples of maximum benefits

{Initial visit: $85}

{Subsequent visit: $67}

Optical

Waiting period:  6 months

Benefit limits per 12 months unless otherwise stated

{$300 per policy}

Examples of maximum benefits

{Multi-focal lenses & frames: 100% of charge}

{Single vision lenses & frames: 100% of charge}

Orthodontic

Waiting period:  12 months

Benefit limits per 12 months unless otherwise stated

{$1,000 per policy}

{$2,800 lifetime limit}

Examples of maximum benefits

{Braces for upper & lower teeth, including removal plus fitting of retainer: 85% of charge}

Orthotics (podiatric orthoses)

Waiting period:  12 months

Benefit limits per 12 months unless otherwise stated

{Overall Limit of $1000 per person applies to Health Appliances and Aids**. $250 sub limit applies to foot orthotics.}

{combined limit for blood glucose monitors & orthotics (podiatric orthoses)}

Examples of maximum benefits

{Orthotics supply & fit: $250}

Osteopathy

Waiting period:  2 months

Benefit limits per 12 months unless otherwise stated

{$500 per policy}

{combined limit for chiropractic, osteopathy & other services}

Examples of maximum benefits

{Initial visit: $65}

{Subsequent visit: $59}

Physiotherapy

Waiting period:  2 months

Benefit limits per 12 months unless otherwise stated

{$850 per policy}

{combined limit for ante-natal/post-natal classes, exercise physiology & physiotherapy}

{sub-limits apply}

Examples of maximum benefits

{Initial visit: $72}

{Subsequent visit: $56}

Podiatry

Waiting period:  2 months

Benefit limits per 12 months unless otherwise stated

{$400 per policy}

Examples of maximum benefits

{Initial visit: $55}

{Subsequent visit: $49}

Psychology

Waiting period:  2 months

Benefit limits per 12 months unless otherwise stated

{Benefits payable towards counselling services - Initial consultation $85/subsequent consultation $80 included in $700 Psychology Limit}

Examples of maximum benefits

{Initial visit: $160}

{Subsequent visit: $125}

Remedial massage

Waiting period:  2 months

Benefit limits per 12 months unless otherwise stated

{$400 per policy}

{combined limit for chinese medicine & remedial massage}

{sub-limits apply}

Examples of maximum benefits

{Initial visit: $53}

{Subsequent visit: $47}

Speech therapy

Waiting period:  2 months

Benefit limits per 12 months unless otherwise stated

{$400 per policy}

Examples of maximum benefits

{Initial visit: $130}

{Subsequent visit: $82}

Acupuncture, Remedial massage, Western herbal medicine, Alexander Technique, Myotherapy, Naturopathy and Shiatsu are included in the Alternative Therapies annual limit.

This policy does not include General treatment (Extras) cover for
Health management / Healthy lifestyle
Vaccinations

Other features of this general treatment cover: Generally the benefit is 85% of fee charged up to the listed maximum benefit. Diabetes Education & Nutrition benefits included in Dietetics sub-limit. Other services covered include osteopathy, occ therapy, eye/speech therapy, dietetics, audiology, approved appliances/aids and approved health management programs. Member rewards apply after 5 years continuous membership.

Ambulance cover

Health Care Concession Card, Pensioner Concession Card, and Commonwealth Seniors Health Card holders are entitled to free ambulance transport services. If you are not eligible for a concession and want to be covered, you can purchase insurance from a private health fund.

For further information about this policy see: https://www.stlukes.com.au/forms-brochures?tag=Information+sheet

Insurer Details

St Lukes

Pasplan Gold with excess

Corporate Policy

$320.80 / month

(Before Rebate, Discount & Loading)

Available in NSW & ACT

Disclaimer: This document is not a Private Health Information Statement (PHIS), and it is not intended to replace that document. The details contained in the healthslips.com.au Policy Information was provided by the insurer to the Australian Government. It is intended as general information. It may not take into account your circumstances. For further information contact the insurer. Information used is Licensed from the Commonwealth of Australia under a Creative Commons 3.0 licence.Private Health Information Statement is available from the Private Health Insurance Ombudsman website at https://privatehealth.gov.au/dynamic/Premium/PHIS/SLM/J4B/NDWU10

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