St Lukes
Pasplan Gold Status 85
St Lukes
How $612.22 is worked out
- Premium as filed - $806.80 a month (hospital share $514.45)
- Government rebate - 24.1% of the premium (never of the loading): -$194.58
- A month - $612.22
Go to insurer no commission on this policy
Hospital: what is covered
Covered (38)
- 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
Restricted (0)
None.
Not covered (0)
None.
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 - No excess.
- 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
| Service | Waiting period | Example benefits, as filed | Limits |
|---|---|---|---|
| General dental * | 2 months | Check-up (item 012): 100% back; Scale and clean (item 114): 100% back; Fluoride treatment (item 121): $36.00; Tooth extraction (item 322): $234.00 | $1,200 per person a year |
| Major dental | 12 months | Crown (item 615): $1005.00 | no yearly limit |
| Root canal | 12 months | Root canal (item 417): $215.00 | $1,000 per person a year |
| Braces | 12 months | Braces, upper and lower, with a retainer (item 881): 85% back | $1,000 per person a year, $2,800 lifetime |
| Glasses and contact lenses | 6 months | Single vision glasses: 100% back; Multifocal glasses: 100% back | $300 per person a year |
| Prescriptions not on the PBS | 2 months | Prescription: $70.00 | $600 per person a year |
| Physiotherapy | 2 months | First visit: $72.00; Follow-up visit: $56.00 | $850 per person a year (shared with other services) |
| Chiropractic | 2 months | First visit: $53.00; Follow-up visit: $41.00 | $500 per person a year (shared with other services) |
| Podiatry | 2 months | First visit: $55.00; Follow-up visit: $49.00 | $400 per person a year |
| Psychology | 2 months | First visit: $160.00; Follow-up visit: $125.00 | Benefits payable towards counselling services - Initial consultation $85/subsequent consultation $80 included in $700 Psychology Limit |
| Acupuncture | 2 months | First visit: $53.00; Follow-up visit: $47.00 | $400 per person a year |
| Remedial massage | 2 months | First visit: $53.00; Follow-up visit: $47.00 | $400 per person a year (shared with other services) |
| Hearing aids | 36 months | Hearing aid: $1250.00 | 2 appliances every 5 years |
| Blood glucose monitors | 12 months | Blood: $200.00 | Overall Limit of $1000 per person applies to Health Appliances and Aids**. $250 sub limit applies to foot orthotics. (shared with other services) |
| Audiology | 2 months | First visit: $70.00; Follow-up visit: $70.00 | 2 services every year |
| Antenatal and postnatal | 2 months | First visit: $56.00; Follow-up visit: $56.00 | $850 per person a year (shared with other services) |
| Chinese herbal medicine | 2 months | First visit: $50.00; Follow-up visit: $45.00 | $400 per person a year (shared with other services) |
| Dietitian | 2 months | First visit: $90.00; Follow-up visit: $55.00 | $500 per person a year |
| Exercise physiology | 2 months | First visit: $60.00; Follow-up visit: $46.00 | $850 per person a year (shared with other services) |
| Eye therapy (orthoptics) | 2 months | First visit: $75.00; Follow-up visit: $48.00 | $400 per person a year |
| Home nursing | 2 months | First visit: $70.00; Follow-up visit: $70.00 | $400 per person a year |
| Occupational therapy | 2 months | First visit: $85.00; Follow-up visit: $67.00 | $400 per person a year |
| Orthotics | 12 months | Benefit: $250.00 | Overall Limit of $1000 per person applies to Health Appliances and Aids**. $250 sub limit applies to foot orthotics. (shared with other services) |
| Osteopathy | 2 months | First visit: $65.00; Follow-up visit: $59.00 | $500 per person a year (shared with other services) |
| Speech therapy | 2 months | First visit: $130.00; Follow-up visit: $82.00 | $400 per person a year |
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 ACT
St Lukes has agreements with 11 private hospitals here, as filed with the Ombudsman.
The list
- ACT Endoscopy - Deakin (day hospital)
- Barton Private Hospital - Barton
- Brindabella Endoscopy Centre - Garran (day hospital)
- Calvary Bruce Private Hospital - Bruce
- Calvary John James Hospital - Deakin
- Canberra Imaging Group - Deakin (day hospital)
- Canberra Microsurgery - Phillip (day hospital)
- Canberra Surgicentre - Braddon (day hospital)
- Icon Cancer Centre Canberra - Bruce (day hospital)
- Mugga Wara Endoscopy Centre - Deakin (day hospital)
- National Capital Private Hospital - Garran
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 J4C/WDZX1Y, filed by St Lukes, issued 1 Apr 2026.
† Monthly premium: the premium the insurer filed with the Private Health Insurance Ombudsman for this state, household and excess, before the Australian Government rebate. Answer the income and age questions and every figure becomes the premium after your rebate, with any Lifetime Health Cover loading added to the hospital share (the rebate never applies to the loading) and the age-based discount taken off it where the policy offers one. Insurers may quote a different payment frequency and round each step; check the figure with the insurer before you join.
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