FAQs

FAQs

Not sure about something and need some help? Below are some of the most common questions that people ask about private health insurance. If your question is not listed below, or you would like further information, please contact us on 1300 362 144 or email us at info@lhs.com.au

Do I have a 'cooling-off' period?

Rest assured that if you change your mind for any reason whatsoever, and decide to cancel your cover within 30 days of commencing or upgrading your cover, we will provide a full refund of any premiums that you have paid, providing no claims have been made under the cover.

Can my partner manage my membership too?

On a family or couples cover, you and your partner both have equal authority to make any kind of transaction and to give Latrobe any kind of instruction including cancelling your cover. If this does not meet with your needs, please call us to make suitable arrangements.
Due to privacy laws, we must have your authority if you want another person, who is not on the membership, to have control or access to your membership (for example in the event of absence overseas, illness or incapacity, speech, hearing or language difficulties). Please tick the appropriate box on the application form and we will send a form to you. Alternatively, call us with the relevant details and we can update your membership whilst you are on the phone - no paperwork involved.

If I transfer to Latrobe from another health fund, am I covered immediately?

Waiting periods may apply depending on how long you have held cover with your previous fund.  You will receive continuity of cover for the entitlements you had with your previous fund when:
  1. You transfer within 30 days of your paid to date with your current fund.
  2. You have served the required waiting periods with the other fund. However, if you’ve served part, but not all of the waiting periods, you must serve the remaining period with Latrobe before you are eligible to claim.
  3. The cover you take with Latrobe is not an upgrade of the cover you had with the other fund.
When you transfer to Latrobe and also upgrade your cover, you are entitled to benefits equivalent to the benefits payable by your previous fund or Latrobe’s closest approximate cover, until the relevant waiting periods are completed.
 
Please note: Any excess paid for a hospital admission at the previous fund is not transferrable and you will be required to pay any excess obligation to Latrobe.

What happens if my newborn baby needs hospital treatment?

When a newborn baby is in hospital with its mother, no accommodation charges apply for the baby unless the baby becomes an admitted patient in their own right. This happens when the baby requires admission to a neo-natal intensive care unit or it is the second or later child of a multiple birth. If the child/children are admitted, co-payments and excesses may also be payable, according to your level of cover. If you hold a single membership, you must change to a family membership at least 2 months prior to the baby’s birth for the baby to be covered.

If I have children, how long can they stay on my cover?

A child can remain as a dependant on a parent’s membership until they reach the age of 18 providing they are not married or living in a defacto relationship. If your child is unmarried and not in a defacto relationship, and is attending a full-time course of study at a Latrobe recognised educational institution, they can remain on your cover until they reach the age of 25 years. For continued cover, you must complete and return the Student Dependant Registration form that is sent to you each year.
 
We will also include alternative health cover solutions in case your child is no longer a full time student and would like to take out their own cover.  From their 25th birthday, your children are required to take out their own cover even if they are still studying full time.
 
If your children are no longer full time students, Family Care is your family’s hospital health cover solution.
They may even be living away from home, or earning their own income. For just a little extra, you can maintain quality health cover for all your family on 1 membership, including your children up to their 25th birthday (providing they are not married or living in a defacto relationship).

How do changes to the Rebate affect me and what do I need to do?

Australian Government Rebate on Private Health Insurance
The Australian Government Rebate on Private Health Insurance helps reduce the cost of health insurance premiums. The level of Rebate that you are entitled to claim will depend on your income and age.
The Australian Taxation Office has specific rules regarding how to calculate your income for Australian Government Rebate purposes. Single people with a taxable income of less than $90,000 per annum and families/couples with a taxable income of less than $180,000 per annum (threshold increases $1,500 per child after the first child) will not be affected and no action is required.
The Rebate is indexed annually by the Federal Government.
 
The following table may be of assistance to you in deciding which Rebate tier you are eligible to claim.
 
 
Unchanged Tier 1 Tier 2 Tier 4
 Singles
Up to $90,000
$90,001 - $105,000
$105,001 - $140,000
$140,001 +
 Families
Up to $180,000
$180,001 - $210,000
$210,001 - $280,000
$280,001 +
 Age
Rebate
 Under 65 25.934% 17.289% 8.644% 0.00%
 65-69  30.256% 21.612%   12.966% 0.00%
 70 and over 34.579% 25.934% 17.289% 0.00%
 
What do I need to do?
If you believe you are affected by the changes to the Rebate, you can:
  1. Do nothing. Continue to claim your current level of Rebate and it will be taken into account when you lodge your tax return.
  2. Nominate your Rebate tier to avoid a tax liability when you lodge your tax return.
For more information on income thresholds, Latrobe encourages members to visit health.gov.au or consult their tax/financial advisor. Alternatively, you can calculate your income by using the calculator available at ato.gov.au.

What is the Medicare Levy Surcharge?

The Medicare Levy Surcharge is an additional tax paid by Australians who are classified as high income earners and do not have an appropriate level of hospital cover.

The Surcharge ranges between 1% and 1.5% depending on your taxable income and is in addition to the Medicare Levy of 2%, which is paid by most Australian taxpayers.

The Australian Taxation Office has specific rules regarding how to calculate your income for Medicare Levy Surcharge purposes. For more information on income thresholds, Latrobe encourages members to visit health.gov.au or consult their tax/financial advisor. Alternatively, you can calculate your income by using the calculator available at ato.gov.au.
 
The table below outlines the Income Thresholds and Surcharges that apply from 1 July 2016.
 
  Unchanged Tier 1 Tier 2 Tier 3
Singles Up to $90,000 $90,001 - $105,000 $105,001 - $140,000 $140,001 +
Families Up to $180,000 $180,001 - $210,000 $210,001 - $280,000 $280,001 +
Medicare Surcharge All ages 0.0% 1.0% 1.25% 1.5%
 
For more information on an appropriate level of hospital cover, call Latrobe on 1300 362 144.
 
“Appropriate hospital cover” refers to hospital cover with a total excess payment in any 1 year not greater than $500 (singles) or $1,000 couples/families. All of Latrobe’s hospital covers except CoverWise X4 and X5 qualify to avoid the Medicare Levy Surcharge. Extras cover without hospital does not exempt you from the Surcharge.

What is Lifetime Health Cover (LHC)?

Lifetime Health Cover is an Australian Government initiative designed to encourage people to take out private hospital cover at a younger age and maintain it throughout their lifetime.

When does the loading apply?

You have until 1 July after your 31st birthday to take out private hospital cover; otherwise you will pay a loading on top of the base cover rate if you join after this date. The loading is 2% for each year you delay joining, to a maximum of 70%. After 10 continuous years of cover, the loading is removed. The longer you wait to take out health cover, the more the loading increases!

Does the LHC loading apply to everyone?

Lifetime Health Cover does not apply to Extras cover or Ambulance memberships. If you were born before 1 July 1934, you are not affected and you do not pay a loading. Special rules apply to people who belong to one of the following groups and we recommend that you contact us for more information if you are:

  • Leaving the Australian Armed Services or the Antarctic Division 
  • An immigrant or a refugee 
  • An ex or current Norfolk Island resident 
  • An Australian citizen, but you were overseas when you turned 31 
  • No longer entitled to a Veterans' Affairs Gold Card

What happens if I can't afford to continue my cover?

To cover small gaps, you are able to be without hospital cover for periods totalling 1,094 days (ie. 3 years less 1 day) during your lifetime, without affecting your loading. If you have a gap of 1,095 days, you will pay a 2% loading. For every 365 days without cover after that, your loading will increase by 2%.
If you apply to Latrobe to suspend your cover for a short period, and we agree to this, this period of suspension does not affect your LHC loading (you are considered to be maintaining your cover).
 
For more information, visit the Australian Government’s Lifetime Health Cover website page at privatehealth.gov.au or
call Latrobe on 1300 362 144

Will I be covered straight away?

You are covered immediately for treatment required as a result of an accident that occurs after you join Latrobe. For all other treatments or services, you must serve a waiting period. This is a specified time that you must wait after joining before you can claim benefits under your hospital or extras cover. Waiting periods apply to members who have not previously held cover, members transferring from another fund to a higher level of cover, or where waiting periods have not been served, and existing Latrobe members upgrading their level of cover.
 
12 months waiting period
Applies to pre-existing conditions (excluding psychiatric, rehabilitation and palliative care), major dental and orthodontic treatment, optical, blood glucose monitors, blood pressure monitors, compressor pumps and nebulisers, hearing aids, C-PAP machines, TENS machines and non‑surgically implanted prostheses.
 
A 12 months waiting period also applies to pregnancy related conditions. The expected delivery date must be after the completion of a 12 month waiting period. Written confirmation of expected delivery date is required from the treating obstetrician.
 
3 months waiting period
Applies to general dental treatment and mouthguards.
 
2 month waiting period
Applies to all other services, including psychiatric care, rehabilitation and palliative care, where no other waiting period applies.
 
Psychiatric Benefit Limitation
A benefit limitation period of 2 years applies to all psychiatric care.

How do I know if a waiting period applies to me?

Transferring from another fund
Waiting periods may apply depending on how long you have held cover with your previous fund.  You will receive continuity of cover for the entitlements you had with your previous fund when:
  • You transfer within 30 days of your paid to date with your current fund.
  • You have served the required waiting periods with the other fund. However, if you’ve served part but not all of the waiting periods, you must serve the remaining period with Latrobe before you are eligible to claim.
  • The cover you take with Latrobe is not an upgrade of the cover you had with the other fund.
     When you transfer to Latrobe and also upgrade your cover, you are entitled to benefits equivalent to the benefits payable by your previous fund or Latrobe’s closest approximate cover, until the relevant waiting periods are completed.
 
Please note: Any excess paid for a hospital admission at the previous fund is not transferrable and you will be required to pay any excess obligation to Latrobe.
 
Upgrade of cover
This is any change in cover that entitles you to receive higher benefits. Higher benefits include a higher Rebate for a particular service, cover for services not included in your previous level of cover or changing to a hospital cover with a lower, or no, excess.

What's a pre-existing condition?

This is any ailment, illness or condition where the signs or symptoms were, in the opinion of a Latrobe appointed medical practitioner, in existence during the 6 months prior to the day you joined or upgraded your cover. Latrobe's medical practitioner takes into account information provided by your own practitioner who treated the condition, when forming an opinion as to whether or not your condition is pre-existing. No benefits are paid for the treatment of a pre-existing condition during the first 12 months of starting a new cover. 

What if I have a pre-existing condition?

If you're a new member, you'll have to wait 12 months before you can receive benefits for items or services related to a pre-existing condition. If you're changing to a higher level of cover (either within Latrobe or from another fund), you may have to wait 12 months to receive the higher benefits, including benefits for services not previously covered.

What's an out-of-pocket expense?

While private health cover gives you more options for your healthcare, it also means that there may be some extra costs that you will need to pay yourself. Your doctor may charge more than the Medicare Benefit Schedule Fee, or you may have to pay some of the costs for your hospital accommodation and theatre fees - especially if you are admitted to a hospital that is not a Latrobe participating hospital. Your hospital cover may also have an excess or co-payment. We strongly suggest that you contact us prior to any hospital admission so that we can provide you with an estimate of your out-of-pocket costs.
 
You may also experience out-of-pocket costs for extras services (dental, physio, optical etc.) when the provider charges more than the benefit payable by Latrobe.

Will I be fully covered if I am admitted to hospital?

Depending on your level of cover, you may have to pay an excess or co-payment. This can depend on a number of things, such as: 
 
  • The level of cover you have chosen,
  • The anticipated length of stay,
  • The type of treatment you are having, and
  • Whether the hospital you will use is public or private.
Restricted benefits are payable on treatment not covered by Medicare, ie. procedures that do not have a benefit payable under the Medicare Benefit Schedule.
Accommodation charges may not be fully covered if you are admitted to a non-participating private hospital.
 
To check your personal cover details, please call us on 1300 362 144 as soon as you find out you will be going into hospital. 

How will I know if my hospital is a Latrobe participating hospital?

Your Latrobe hospital cover applies in every Australian public hospital. However, if you are going to a private hospital or day surgery centre, you should ensure that it is a participating hospital. This will protect you against unexpected hospital accommodation costs. Latrobe has agreements with hundreds of participating hospitals around Australia.
 
To check, please call us on 1300 362 144 as soon as you find out you will be going into hospital.
 
If you prefer, visit our Publications & forms page to download a list of participating hospitals and day surgery centres.

 

Will I have out-of-pocket costs ("gaps") for my treatment?

Depending on your treatment, you will probably have a number of different service providers as well as your main specialist, for example an assistant surgeon, an anaesthetist and perhaps an assistant anaesthetist, pathologists and radiologists. If your medical practitioners all charge the Medicare Benefit Schedule Fee, you will not have any medical gaps. Medicare rebates 75% of the Schedule Fee, and Latrobe rebates the rest.
 
If your providers charge more than the Medicare Benefit Schedule Fee, Latrobe’s Just Ask! Scheme can reduce or even eliminate the gaps. Participating in Just Ask! is easy and could save you a great deal of money by paying additional medical gap benefits over and above the standard 25% of the Medicare Benefit Schedule Fee. 

What if I have a complaint?

Latrobe Health Services is committed to providing excellent service in every aspect of our business and in all our dealings with members, agents, health service providers and other business partners. We believe that the way in which we resolve concerns, complaints or disputes is an important contributing factor in achieving and maintaining this aim.
 
How to lodge a complaint
Contact us with details about the complaint.