BHP Health Plan

PLEASE NOTE: The BHP Health Plan has been closed, except for existing members covered by the BHP Health Plan as at 30 September 2004. Existing members of the BHP Health Plan will continue to be covered as outlined below, however no additional members can take this level of cover. Also existing members that leave this level of cover will be unable to re-commence this level of cover at a later date.

Excess - BHP Health Plan

If you are admitted to hospital you will pay 25% of hospital costs until you have reached your excess maximum of $250 for a single or $500 for a family within a financial year (1st July to 30th June).

Please note:

1. Excess waived for dependent children under the age of 21.
2. Excess applies where treatment is provided in any hospital or day surgery including:
   • As an overnight patient in a private hospital, private or shared room.
   • As a day patient in a private hospital or day surgery, or
   • In a public hospital.
3. Excess applies to hospital services only, not medical or ancillary services.

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Prices

The following premiums are applicable from 1 April 2010. The premiums displayed are after deducting the Federal Government’s 30% Rebate and assumes that you do not have a Lifetime Health Cover loading.

Please note:

• Fortnightly, Quarterly, Half-Yearly, Yearly rates are available upon request. No discounts apply for different payment freqencies.
• Payment can be made by Direct Debit or Payroll Deduction (if we have a payroll deduction arrangement established with your employer).

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BHP Health Plan Hospital Cover

The BHP Health Plan provides Hospital cover Australia wide:

Hospital Cover

• 100% cover for most private and public hospital services nationwide (after the up front excess has been paid) with access to an extensive range of quality services and approved programs in contracted private hospitals. The fund has agreements with the vast majority of private hospitals in all States and Territories of Australia. You can search our agreement hospitals schedule here.
• The services listed in the table above are applicable in all private hospitals that have entered into an agreement with Peoplecare. There are a small number of private hospitals that do not have agreements with the fund. In these cases a limited personal payment may apply.

• We do not have any treatment exclusions on services eligible for Medicare Benefits.

Access Gap Cover

• Peoplecare has “Access Gap” arrangements with over 19,000 Doctor’s Australia wide.
• These arrangements maximise the financial benefits for our member’s in-hospital medical bills. The ultimate aim is to minimise or eliminate member’s out of pocket expenses when our members’ are treated as hospital in-patients.
• We understand that being admitted to hospital can be a very stressful and uncomfortable experience and we are working very hard to minimise or eliminate the financial impact of this experience.
• What is great about these “Access Gap” arrangements is that YOU will have either no out-of-pocket expenses to pay or will know exactly how much you will have to pay before treatment begins, AND be unlikely to have to lodge a claim for benefits as your doctor can bill Peoplecare direct, making it even easier for you.
• Search here for a specialist that has a No / Known Gap arrangement with Peoplecare.
• Peoplecare is unable to provide details of all Doctor’s that we have “Access Gap” arrangements with via this search facility as some doctors have requested not to be publicly listed. If the doctor you are looking for is not listed, please give us a call on 1800 808 690 during business hours or send us an email.

Ambulance Cover

• 100% reimbursement of the cost of service , irrespective of distance travelled within the Commonwealth of Australia.
• There is no annual $ claim limit on these ambulance services and there is no waiting period.

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BHP Health Plan Ancillary Cover

The BHP Health Plan provides broad Ancillary cover:

Please note:

1. Financial Year is 1 July to 30 June and waiting periods may apply (see waiting periods explanation below).
2. No benefits are payable by the fund when:

•  A member is given treatment without charge.
•  The services received are not recognised by the fund and are not provided by providers registered with the fund.
•  The service is provided outside of the Commonwealth of Australia (excludes persons overseas for more than 12 months).
•  An entitlement exists or may exist under any compensation, third party or sports club insurance.
•  A claim for a services is submitted more than 24 months after the date of service.
•  A claim is submitted for optical appliances not requiring sight correction.
•  The claim benefit is less than $5, although this can be accumulated with other claims
•  Services are provided by family members or relatives.
•  Services are provided outside of the Commonwealth of Australia.
•  The claim is for goods and services that are deemed to be primarily for the purposes of sport, recreation or entertainment.

General Dental Cover

• Benefits are payable for Dental services and procedures such as Extractions, Oral Surgery, Restorations and Endodontic Treatment.
• Excludes High Cost Dental: Dentures, Orthodontic, Implants, Crowns and Bridgework (see High Cost Dental below).
• Fixed benefits apply per item / type of service, No annual $ benefit limit.
• 2 month waiting period applies unless these waiting periods have already been served with another health fund (see waiting periods explanation below),

but Members transferring from another fund that have lower General Dental limits than Peoplecare must wait 2 months before they can claim more than the former funds General Dental limits.

High Cost Dental Cover

• Set Benefits are payable for each category listed in the table above.
• Annual per person limit applies each financial year (1 July to 30 June) except Orthodontic Lifetime Limit (see below).
• 12 month waiting period applies unless these waiting periods have already been served with another health fund (see waiting periods explanation below), but:
  • Members transferring from another fund that have used all or part of their annual High Cost Dental limit with this other fund will only receive the

difference between Peoplecare’s limit and the amount already claimed from the other fund in the first financial year of membership, and
• Members transferring from another fund that have lower High Cost Dental limits than Peoplecare must wait 12 months before they can claim

more than the former funds High Cost Dental limits.

Orthodontic Cover

• Coverage at 80% of the cost until the Lifetime limit is reached. However the benefit is claimed progressively to coincide with the supply of treatment;
  • Up to 50% of the Lifetime limit can be claimed at the time appliances are fitted, as there is a significant portion of cost incurred at that point in time.
  • The balance of the benefit will be apportioned over the remainder of the treatment plan, based on either a regular installment (usually monthly,

  bi-monthly or quarterly) or anticipated treatment dates to completion.

• The fund does not pay a benefit in advance of members receiving the treatment, hence if you pay the full cost up front, prior to treatment or at the time

appliances are fitted, the benefit will only be paid in accordance with the policy detailed above and a treatment plan must be requested from the orthodontist and submitted to the fund with a Lysaght Peoplecare claim form, after each installment or treatment date, in order to claim a benefit. Accounts or receipts submitted must clearly indicate the period for which payment has been made or is due.

• Lifetime limit applies per person, not per membership.
• 12 month waiting period applies unless these waiting periods have already been served with another health fund (see waiting periods explanation below), but:
  • Members transferring from another fund that have used all or part of their Orthodontic lifetime limit with this other fund/s will only receive the difference

between Peoplecare’s lifetime limit and amount already claimed from the other fund, and
• Members transferring from another fund that have a lower Orthodontic lifetime limit than Peoplecare must wait 12 months before they can claim more than the former funds Orthodontic lifetime limit.

Optical Cover

• Benefits payable only on spectacles or contact lenses prescribed by a registered optometrist or ophthalmic surgeon, where sight correction is necessary.

• 6 month waiting period applies unless these waiting periods have already been served with another health fund (see waiting periods explanation below), but:
  . Members transferring from another fund that have used all or part of their annual Optical limit with this other fund will only receive the difference between

  Peoplecare's limit and the amount already claimed from the other fund in the first financial year of membership, and
. Members transferring from another fund that have a lower Optical limit than Peoplecare must wait 6 months before they can claim more than the former funds Optical limit.

Pharmaceutical Cover

• Benefits payable only on non Pharmaceutical Benefits Scheme (PBS) prescriptions. No benefits payable on PBS prescriptions, items normally available over

the counter and contraceptives.

• 2 month waiting period applies unless these waiting periods have already been served with another health fund (see waiting periods explanation below), but

Members transferring from another fund that have a lower Pharmaceutical limit than Peoplecare must wait 2 months before they can claim more than the former funds Pharmaceutical limit.

Natural Therapy Cover

• Benefits payable only on fund recognised services and where the provider is recognised by the fund.
• 2 month waiting period applies unless these waiting periods have already been served with another health fund (see waiting periods explanation below), but

Members transferring from another fund that have a lower Natural Therapy limit than Peoplecare must wait 2 months before they can claim more than the former funds Natural Therapy limit.

Surgical Equipment / Health Aids Cover

• For items such as glucometer, blood pressure monitor, nebuliser and other approved health aids.
• Please contact the fund for individual benefit item limits and rules.

Health Management Program

Benefit conditions ofr the Health Management Program:

• Benefits may be paid at 80% of eligible cost to a maximum benefit of $150 per single member and $300 per family membership each financial year (for services received in that year).  The financial year is 1 July to 30 June.
• We are not permitted under the National Health Act to pay benefits for goods or services that are deemed to be primarily for the purposes of sport, recreation or entertainment.
• We are however permitted to provide benefits for approved health management programs where members are in receipt of services that are intended to prevent or improve a specific health condition.  This may include situations such as rehabilitation following surgery for example joint replacement, cardiac procedures or illnesses such as asthma and diabetes.
• Where these circumstances apply and the specific program is endorsed by a health professional we will continue to provide benefits under the Health Management Program to assist in the recovery or health maintenance for the member.  To enable us to pay benefits in these circumstances we will have to receive a report from the relevant health professional that recommends the health management program.

What We Will Pay For:

• Approved health management programs where members are in receipt of services that are intended to prevent or improve a specific health condition.
• Health Management improvement programs such as stress management, quit smoking, weight control, first aid courses and kits.
• Health screening services such as blood pressure testing, cholesterol checks, mammograms, hearing test.

Where these circumstances apply and the specific programs are endorsed by a health professional we will provide benefits under the Health Management Program to assist in the recovery and/or health maintenance of the member. To enable us to consider paying benefits in these circumstances we will need to receive a report from the relevant health professional that specifies the health condition and recommends the health management program.

What We Will Not Pay For:

• Sports club membership such as gym, tennis, golf, swimming lessons and sporting equipment for recreational or general fitness purposes.
• Footwear, clothing or any other goods and services that are primarily for the purposes of sport, recreation or entertainment.
• Services where a Medicare benefit is payable.
• Health screening services such as medical examinations for employment, insurance, or for other similar purposes.

Please note:

• The list of benefit items may be modified from time to time, depending on community standards.
• The claim for benefits is to be submitted with a tax invoice and/or a receipt that includes the Australian Business Number (ABN) of the provider of the service.
• 6 month waiting period applies.

If you have any questions please call us on FREECALL: 1800 808 690 during business hours or send us an e-mail.

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Waiting Periods

Please note: If a person is transferring over to Peoplecare from another fund with an equivalent or higher level of cover, is financial and waiting periods from the previous fund have been served, waiting periods will be waived, but,

• Members transferring from another fund that have used all or part of their annual limits with this other fund will only receive the difference between Peoplecare’s limit and the amount already claimed from the other fund in the first financial year of membership, and
• Members transferring from another fund that have a lower limits or benefit exclusions compared to Peoplecare must serve the waiting periods listed above before they can claim more than the former fund’s limit or benefit.
• Members transferring from another fund will not be entitled to continuity for any Lifestyle benefits ie the normal 6 months waiting period must be served before any Peoplecare benefits are payable.

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Dependents

Children / dependents are covered as dependents on a family membership to age :

• 21 years, even if they are working full time or not. However they must not be married or living in a de-facto relationship,
  or
• 25 years if they are full time students and documentation is provided annually confirming this. However they must not be married or living in a de-facto relationship.
• Once dependents cease to be covered under the family membership they are then entitled and strongly encouraged to take their own membership with us and continue to enjoy the exceptional benefits, competitive rates and first class service that we offer.
  

  Beneifits of Peoplecare Membership

      More details available at our website www.peoplecare.com.au or by calling us on 1800 808 690

• Online member services at our website www.peoplecare.com.au
• Electronic "eftpos style" claiming at more than 20,000 dentists, physiotherapists, optical dispensers, chiropractors, osteopaths and podiatrists Australia wide.
• Discounted Travel Insurance
• Home Care program.

   Privacy Statement

Peoplecare respects your privacy and is committed to keeping your personal information safe through compliance with the Privacy Act and the National Privacy Principles.

Peoplecare only collects information that is necessary to assist the fund in providing its services. We do not collect personal information unless we first ask the member or individual for it.

Peoplecare exercises great care to protect the personal information that is held.

If you wish to obtain additional information regarding our Privacy Policy please contact the fund Privacy Officer on 1800 808 690 or refer to our website www.peoplecare.com.au

   Complaints

If you have a complaint about Peoplecare please contact the fund on 1800 808 690 and ask to speak to the Complaints Officer. If your complaint is not resolved you are entitled to seek the services of the Private Health Insurance Ombudsman (PHIO). PHIO provides free independent services to private health insurance fund members. PHIO (www.phio.org.au) can be contacted on 1800 640 695 and they are located at Level 7, 362 Kent Street, SYDNEY, NSW 2000.

Change Your Level of Cover

PLEASE NOTE: The BHP Health Plan has been closed, except for existing members covered by the BHP Health Plan as at 30 September 2004. Existing members of the BHP Health Plan will continue to be covered as outlined below, however no additional members can take this level of cover. Also existing members that leave this level of cover will be unable to re-commence this level of cover at a later date.

If you have any questions please call us on FREECALL: 1800 808 690 during business hours or send us an e-mail ( info@peoplecare.com.au )

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Click here to change your Level of Cover online

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If you have any questions please call us on FREECALL: 1800 808 690 during business hours or send us an e-mail (info@peoplecare.com.au)