We know that everyone wants the best cover they can afford, but if you’re young and healthy, comprehensive hospital cover may not meet your needs or your budget. That’s why we have Packaged Simplicity Starter Bronze Plus 500. This cover is combined with Extras Protect so members enjoy the highest level of extras benefit.

The clinical category of hospital psychiatric services is a restricted service meaning the benefit is limited, once the excess is deducted, to the public hospital shared ward room rate if you elect to be treated as a private patient in a public hospital.  There is very limited cover for a restricted service in a private hospital. If you do elect to be treated in a private hospital for the restricted services significant out-of-pocket costs will apply.  Some clinical categories are excluded from cover and therefore no benefit is payable.

The excess for adults will apply to both overnight and same-day hospitalisations. The same-day excess will be half the chosen excess up to the maximum product excess. The excess does not apply to children covered by the policy.

Includes full cover for the following clinical category services:

  • Rehabilitation
  • Palliative care
  • Ear, nose & throat
  • Tonsils, adenoids & grommets
  • Bone, joint & muscle
  • Joint reconstructions
  • Hernia & appendix
  • Gynaecology
  • Brain & nervous system
  • Digestive system
  • Gastrointestinal & endoscopy
  • Chemotherapy, radiotherapy and immunotherapy for cancer
  • Pain management
  • Breast surgery (medically necessary)
  • Eye (not cataracts)
  • Kidney and bladder
  • Male reproductive system
  • Miscarriage and termination of pregnancy
  • Skin
  • Diabetes
  • Dental Surgery
  • Lung and chest
  • Blood
  • Plastic & reconstructive surgery (medically necessary)
  • Implantation of hearing devices
  • Insulin pumps
  • Pain management with device
  • Sleep studies

Restrictions:

  • Hospital psychiatric services

Exclusions:

  • Back, neck & spine (including fusion)
  • Heart & vascular system
  • Podiatric surgery (provided by an accredited podiatric surgeon)
  • Pregnancy and birth
  • Assisted reproductive services
  • Cataracts
  • Joint replacements
  • Dialysis for chronic kidney disease
  • Weight loss surgery
  • Cosmetic surgery and other surgical procedures not covered by Medicare. (Refer to Membership Conditions 6 & 8)

For information on waiting periods, including pre-existing conditions click here.

For information on exclusions, restrictions and/or excesses refer to our membership conditions.

A full list of the private hospitals and day hospital facilities that are contracted with the underwriter St.LukesHealth is available here.

To find out more about pricing, please click here.

Packaged Simplicity Starter Bronze Plus 500

Combined Plan Single Excess Couples & Family Excess Extras Cover
Per calendar year Per person, per calendar year Maximum per policy, per calendar year
Packaged Simplicity Starter Bronze Plus 500 $500 $500 $1000 comprehensive

The excess for adults will apply to both overnight and same-day hospitalisations. The same-day excess will be half the chosen excess up to the maximum product excess. The excess does not apply to children covered by the policy.

Dependant extension option available on this product:
Our dependent extension option means that your non-student child dependant can remain on their parent’s policy for an additional premium, provided they are aged between 23 and 25, not studying full-time and are not married or living in a defacto relationship.

For more information on Dependant Extension, contact Astute Simplicity Health on 1300 090 960.

Hospital Benefits

Full cover for hospital accommodation and theatre fees in all contracted private hospitals and day hospital facilities within Australia (Medical certification is required after 35 continuous days in hospital).

Full cover for intensive and coronary care in all contracted private hospitals subject to clinical category (Medical certification is required).

Benefits will be paid at no less than the minimum benefit when you elect to be treated as a private patient in all public hospital within Australia.

Benefits towards approved surgically implanted prostheses.

The gap between the Medicare benefit and the Medicare Benefit Schedule (MBS) fee for medical services performed while you are an inpatient in hospital.

Additional gap cover benefit for medical services provided by practitioners participating in St.LukesHealth Medical Gap Cover.

Benefits towards uncontracted private hospitals (Patient gaps may apply, you should check with the underwriter St.LukesHealth before being admitted to an uncontracted hospital).

Restricted and excluded services apply to this product (Refer to membership conditions 4 and 5).

Not covered: cosmetic surgery and other surgical procedures not covered by Medicare (Refer to membership conditions 6 and 8).

Excess applies to adults on overnight hospitalisations.

The excess for adults on same-day hospitalisations will be half the chosen excess up to the maximum product excess.

No excess on child dependants.

Waiting periods apply (Refer to membership condition 1).

Exempts high-income earners from having to pay the additional Medicare Levy Surcharge.

Ambulance subscriptions are claimable up to an annual premium, where there is no state-based Ambulance scheme or levy.

Extras benefits included in Packaged Simplicity Starter Bronze Plus 500

Examples of benefits are included in the table below and where applicable annual limits are per person covered per calendar year unless otherwise specified. A calendar year runs from January to December. Benefits are only payable when rendered by a practitioner in private practice who is registered by the underwriter St.LukesHealth. You should contact the fund to ensure your provider is registered before undergoing treatment.

Gap Free Preventative Dental

The highly-regarded Gap Free Preventative Dental feature is available on Extra Protect. Under Gap Free Preventative Dental, we pay 100 per cent of your dentist’s regular fee* up to a maximum benefit for each eligible service. This means that for most dentists you will have no gap or out-of-pocket to pay for an examination, x-ray, scale and clean and fissure sealing. If your dentist charges above the maximum benefit a gap or out-of-pocket may apply.

The stand out feature of Gap Free Preventative Dental for Astute Simplicity Health members is that it applies to both adults and children at your choice of dentist.

We don’t tell you which dentist you need to go to in order to receive the higher benefit for preventative dental as it applies to all dentists^. A great way to help you keep your teeth and gums healthy.

An extra feature for children is gap free cover^ for fissure sealing. Placement of sealants in children assessed as having a high risk of tooth decay, is a safe and effective way in preventing dental decay in permanent teeth.

^ Includes examination, x-rays, scale and clean and fissure sealing. Benefits of 100 per cent of the dentist’s regular fee* apply up to a maximum benefit per service on Extras Protect. If your dentist charges above the maximum benefit, or in excess of the regular fee* he or she charges all patients, a gap or out of pocket may apply. Benefit applies to both adults and children who have served their two month waiting period. Other preventative services such as topical fluoride application and provision of mouth guard are not included. Annual limits apply.

* Regular fee refers to the average fee your dentist charges to all patients.

Benefits as of April 1, 2020.

Service Category Benefits Annual Limit
Per person, per calendar year
General Dental – 2 month waiting period
Annual Limit – $1000
preventative dental (examinations, x-rays and scale and clean) *Regular fee refers to the average fee your dentist charges to all patients of his or her practice for each eligible service. 100% of dentist’s regular fee up to maximum benefit per service* limit of two general dental consultations per person, per calendar year
comprehensive oral examination see above limit of two general dental consultationsper person, per calendar year
scaling and clean see above
simple extraction $101
mouthguard $96 limit of one per person, per calendar year
posterior tooth filling – 1 surface $91
Major Dental – 12 month waiting period
Annual Limit – $1500
Periodontics Set benefits apply Sub-limit – $1000
Endodontics Set benefits apply Sub-limit – $1000
Crowns & Bridges Set benefits apply Sub-limit – $1000
Procedures for Dental Implants Set benefits apply Sub-limit – $1000
Dentures Set benefits apply Sub-limit – $800
Orthodontics Set benefits apply Sub-limit $1000

 

Lifetime limit of $2800

Pharmacy – 2 month waiting period
Annual Limit – $600
per non PBS prescription $70
for prescriptions not covered by the PBS, excluding contraceptives, anabolic steroids, items normally available without prescription and drugs not approved for sale in Australia. A co-payment applies to each prescription item equal to the current non-concessional PBS co-payment amount.
Optical – 6 month waiting period
Annual Limit – $300
frames 100% of fee up to annual limit
single vision lenses* 100% of fee up to annual limit
bi-focal lenses* 100% of fee up to annual limit
multi-focal lenses* 100% of fee up to annual limit
soft contacts $300
hard contacts $300
disposable contacts (12 months supply) $300
repair to frames $25
*includes benefit towards hardening of lenses
Physiotherapy – 2 month waiting period
Annual Limit – $850
physiotherapy – initial (including telehealth services) $55
physiotherapy – subsequent (including telehealth services) $42
exercise physiology Sub-limit – $200
– initial (including telehealth services) $45
– subsequent (including telehealth services) $35
other approved group session (including hydrotherapy) $15 Sub-limit -$300
ante natal/post natal $25 Sub-limit -$400
lymphedema $40 included in physiotherapy limit
Other Therapies – 2 month waiting period
Annual Limit – $1000
Podiatry Sub-limit -$400
– initial $40
– subsequent $32
Occupational Therapy Sub-limit -$400
– initial (including telehealth services) $70
– subsequent (including telehealth services) $49
Eye Therapy Sub-limit -$400
– initial (including telehealth services) $65
– subsequent (including telehealth services) $38
Speech Therapy Sub-limit -$400
– initial (including telehealth services) $80
– subsequent (including telehealth services) $52
Dietetics Sub-limit -$200
– initial (including telehealth services) $75
– subsequent (including telehealth services) $45
Alternative Therapies – 2 month waiting period
Annual Limit – $500
Chiropractic Sub-limit -$400
– initial $40
– subsequent $28
Chiropractic X-rays $60 included in chiropractic limit
Osteopathic included in chiropractic limit
– initial (including telehealth services) $50
– subsequent (including telehealth services) $40
Acupuncture Sub-limit -$400
– initial $35
– subsequent $30
Natural Therapies Sub-limit -$400
– initial $32
– subsequent $28
includes Chinese & Myotherapy
Remedial Massage included in natural therapies limit
– initial $35
– subsequent $30
Mental Wellness – 12 month waiting period
Annual Limit – $400
Clinical Psychology – Initial consultation (including telehealth services) $85
Clinical Psychology – Subsequent consultation (including telehealth services) $80
Counselling – Initial consultation (including telehealth services) $35
Counselling – Subsequent consultation (including telehealth services) $30
Home Nursing – 2 month waiting period
Annual Limit – $500
per service $50
for services rendered by a registered nurse in private practice
Health Appliances and Aids – 12 month waiting period
Annual Limit – $1000
foot orthotics (custom-made) 85% Sub-limit -$200
repair to custom made foot orthotics $30 limit of one repair per person, per calendar year
other specified orthotics*
eg. custom made spinal & knee braces
90% limits apply to individual items
specified prosthetic appliances*
eg. breast prosthesis after mastectomy
90% limits apply to individual items
other specified health aids*
eg. blood glucose monitor, nebuliser
90% limits apply to individual items
*a full list is available by contacting the Astute Simplicity Health Team.
Audiology – 2 month waiting period
2 per year
per consultation $40
only payable when service rendered by an Audiologist in private practice and approved by this fund. Benefit will not be payable if the service is claimable from any other source.
Diabetes Education – 2 month waiting period
– initial (including telehealth services) $55 included in dietetics limit
– subsequent (including telehealth services) $45 included in dietetics limit
Health Management Programs – 3 month waiting period
singles policy 70% $150
family/couples policy 70% $300
Benefits are payable for approved health management programs. Limits apply to the policy, not to each person covered by the policy. Contact the Astute Simplicity Health Team for more information on health management programs.
Member Rewards – 5 year qualifying period
5% increase in dental benefits (excluding preventative services paid under Gap Free Preventative Dental)
5% increase in annual dental limits
Member reward benefits are payable after 5 years continuous membership on an eligible Astute Simplicity Health product. Qualifying conditions apply.

The overall limit for each service category is highlighted. Some categories have sub-limits which are included within the overall limit for that service category.

Want to find out more?

Call today on 1300 090 960