Surgically Implanted Prostheses

A surgically implanted prosthesis provided as part of an episode of hospital treatment or hospital substitute treatment, is covered on all Astute Simplicity Health hospital products, providing the service attracts a Medicare benefit and the prosthesis has been approved for the payment of private health fund benefits by the Department of Health.

What is a surgically implanted prosthesis?

A surgically implanted prosthesis is a piece of equipment that is surgically implanted into the body during a hospital procedure, to replace or assist a bodily function. For example, an artificial hip, a pacemaker, a cardiac stent, intraocular lenses, screws and plates.

Will I be fully covered for a prosthesis?

The Department of Health produces a list of approved prostheses showing what benefit health funds should pay for each prostheses. Most Government approved surgically implanted prostheses are fully covered by your hospital cover. However some will require a patient contribution (gap) to be paid if the supplier charges above the listed benefit.

What should I do if I require surgery that may involve a prosthesis?

If you require surgery that involves a surgically implanted prosthesis, you should check with your surgeon to see if a patient gap applies to the prosthesis being used.

If the prosthesis is not fully covered, ask your surgeon if there is an appropriate no gap option.

If a prosthesis that has a patient gap is to be used, your surgeon should obtain your informed financial consent and advise you prior to surgery of the amount of gap you will be required to pay.

You should also contact Astute Simplicity Health prior to surgery to confirm your benefit entitlements.

Want to find out more?

Call today on 1300 090 960

Underwritten by St.LukesHealth


These products are underwritten by St Luke's Medical and Hospital Benefits Association ACN 009 479 618 (St.LukesHealth), a registered private health insurer, [trading as Astute Simplicity Health] and members are introduced by Astute Financial Management Pty Ltd or related entities (collectively known as Astute) for which Astute receives a commission.

* The discount cannot be combined with other discounts available under other arrangements between St.LukesHealth and other alliance partners. The discount quoted is off the gross St.LukesHealth premiums. Direct debit is the only payment method available to Astute Simplicity Health members.

^ For some preventative dental items on selected products. Annual limits, fund rules and waiting periods apply. Under Gap Free Preventative Dental we pay 100% of your dentists regular fee up to a maximum benefit for each service.

#Selected products are Packaged Astute Gold 250, Packaged Astute Gold 500, Astute Top Hospital Gold 250, Astute Top Hospital Gold 500