Claiming Terms and Conditions
By submitting a claim to St Luke’s Medical and Hospital Benefits Association (‘St Lukes’) you agree to be legally bound by these Claiming Terms & Conditions as varied from time to time and the St Lukes Fund Rules (‘Fund Rules’). Updated versions of these Claiming Terms & Conditions will be posted to our website. A copy of the Fund Rules is available for inspection at any Customer Care Centre.
Declaration
- When submitting a claim you declare and agree that:
all information supplied in connection with the claim is true and correct; - You will inform St Lukes immediately if you become aware that any details of the claim are incorrect;
- You consent to the handling of the personal and sensitive information provided with the claim in accordance with the St Lukes Privacy Policy;
- Submission of a claim does not guarantee payment of benefit. The claim is subject to assessment by St Lukes and benefits will be paid in accordance with your level of cover, the St Lukes Fund Rules and Membership Conditions. A summary of Membership Conditions can be found here.
- You, or the person on whose behalf you are submitting this claim, have no entitlement to claim benefit for these services under Repatriation, from another private health insurer, worker’s compensation, motor vehicle accident insurance, damages action, persons liable at law, or any other source;
- The services, treatments or appliances supplied in relation to this claim were provided within Australia;
- The services, treatment or appliances supplied in relation to this claim were not provided by a dependant who is covered under your membership policy;
- St Lukes does not guarantee a response or payment of benefit within a particular period;
- You will retain all invoices and receipts related to the claim for 6 months from the date of claim;
- St Lukes may require production of relevant invoices or receipts prior to finalising the assessment of any claim and prior to the payment of any benefit in respect of that claim. If supporting documentation is requested, no benefit will be paid until the requested documentation is produced and assessed by St Lukes;
- You authorise St Lukes to contact the provider to clarify or verify any details of the attached claim;
- If you are lodging the claim for another person covered by your policy including any Dependant, you declare that you have their consent to lodge the claim and to make the above declarations and acknowledgements on their behalf;
- From time to time St Lukes may undertake audits of providers or members in respect of claims paid in the previous two years and may request additional information in respect of those claims. This may include, but is not limited to, requesting additional supporting documentation or a Statutory Declaration in relation to those claims;
- St Lukes reserves the right to terminate a policy where a policy holder has acted improperly and will give notice in writing including a reason for the termination. A policy holder has the right to request reinstatement which will be considered at the Fund’s discretion.
General
By submitting a claim, you are declaring you have authorisation to submit the claim on behalf of both the person and membership for which you are lodging the claim on behalf of.
A list of the accepted claiming options is available on our How to Claim webpage.
Mobile Claims
When submitting a claim using the St Lukes mobile claiming app (‘the app’), you are agreeing to the Terms and Conditions of the app and consent to providing St Lukes with a valid email address, which St Lukes may use at its discretion to contact you regarding the claim submitted. If you would like to update
your contact details for your membership, please contact our Customer Care Consultants on 1300 651 988, email general@stlukes.com.au or visit one of our Customer Care Centres.
Payments
Your benefit (if one is payable to you) will be paid into the nominated bank account. If you have not nominated a bank account, we will pay the benefit by cheque. If you wish to update your bank account details, please contact our Customer Care Consultants on 1300 651 988.
If you have any questions relating to a claim submitted please contact our Customer Care Consultants on 1300 651 988, email general@stlukes.com.au or visit one of our Customer Care Centres.
Version Control
These Terms & Conditions were updated on 19 March 2024.