Pasplan Gold Status 85 with excess

Hospital: what is covered

Restricted means partially covered for hospital costs as a private patient in a public hospital; in a private room or private hospital you may face significant expenses.

Excess, waiting periods and hospital

• Tier - Gold
• Hospital - Private or public hospital
• Excess - Capped per person and per policy per year. $150 per person a year. $300 per policy a year. No excess for day surgery.
• Co-payments - None.
• Known gap - Yes, with the fund's doctors
• Age-based discount - Not offered
• Accident cover - No
• Travel and accommodation benefits - Yes

Waiting periods

• Most treatments - 2 months
• Existing conditions - 12 months
• Pregnancy and birth - 12 months
• Rehabilitation, psychiatric and palliative care - 2 months

As filed by the insurer: 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: what you get back

Not covered: Health management programs, Vaccinations.

* Under Preventative Dental, we pay up to 100% of the average fee charged Australia wide up to the maximum benefit for each eligible service. This applies to examinations, x-rays, scale and clean and fissure sealing. If your dentist charges above the maximum benefit, or in excess of the average fee, a gap or out of pocket may apply. Annual limits, fund rules and waiting periods apply. A 2-month waiting period applies to Psychology with the exception of functional assessment for the purpose of diagnosing ADHS and/or autism spectrum disorders diagnosis which has a 12-month waiting period.

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

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

No ambulance cover.

Agreement hospitals in Queensland

St Lukes has agreements with 84 private hospitals here, as filed with the Ombudsman.

This policy's other options

Every state, household and excess the insurer filed for this policy, with the premium before the rebate.

Member retention (hospital cover)

87.9% is the Commonwealth Ombudsman's figure for St Lukes in its State of the Health Funds Report 2024-25 (Table 1, page 15; data at 30 June 2025).

The Ombudsman describes it as one measure of the comparative effectiveness of insurers and of their level of member satisfaction: the percentage of members, hospital memberships only, who have remained with the insurer for 2 years or more (page 12). It is published for the insurer, not for this policy, and is not adjusted for policies that lapse when a member dies. The Ombudsman cautions that no single indicator shows an insurer's overall performance (page 27).

It is shown as published. The list is not sorted, filtered or ranked by it.

Member retention is the Commonwealth Ombudsman's figure, from its State of the Health Funds Report 2024-25. Source: Licensed from the Commonwealth Ombudsman under a Creative Commons 4.0 licence. This report is available from the Commonwealth Ombudsman website at www.ombudsman.gov.au.

Where this comes from

Policy details come from the PrivateHealth.gov.au dataset published by the Private Health Insurance Ombudsman on data.gov.au (release of 1 Oct 2026), licensed under Creative Commons Attribution 3.0 Australia. Statement J4D/WEBK20, filed by St Lukes, issued 1 Apr 2026.