Make Your Claim

Following are the easy steps you need to complete to make a claim:

	Click here to download the claim form
	Print the claim form
	Fill in the claim form completely, including signing and dating the form at the bottom
	- If mailing:    Attach your health care provider receipts and accounts to the claim form.
	- If faxing:     Scan all forms and receipts through seperately so there is one receipt or account to a page.
	- If emailing:  Scan all forms and receipts and attach to the one email.
	Send, fax or email your claim form, receipts and accounts to Peoplecare.

Please note:

Claims will only be paid for services performed less than 2 years prior to the date of submission to Peoplecare.

If you have paid the account in full you must send health care provider receipts with the claim form.

If you have not paid the account in full you must send the health care provider accounts with the claim form.

One of our key areas of focus is the speed of payment of your claims. Under normal circumstances we aim to have all claims processed within 2 business days and regularly meet this target.

Peoplecare also routinely audits members’ claims to ensure that our members’ are only paying for “legitimate” health services provided to their fellow members.

We will no longer accept Transition Benefit Fund (TBF) claims and TBF Membership Cards or Blue Lysaght Peoplecare Membership Cards are no longer valid and cannot be used.

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)

There are three different types of claims that can be made on your Peoplecare Health Insurance, depending on your level of cover. These are:

1. Hospital Claims
2. Medical Gap Claims
3. Ancillary Claims

Hospital Claims

Definition: Services provided as a private patient in a private or public hospital approved by the Department of Health. These services are covered under Peoplecare Hospital cover.

• Peoplecare has agreements with the vast majority of private hospitals in all States and Territories of Australia. Our hospital agreements total more than 500 Australia wide and you can search our agreement hospitals schedule here .
• The Hospital you are being admitted to should contact us to confirm the benefits you are entitled to and how much of your excess has to be paid for this Financial Year.
• The hospital may require you to pay your excess (if any) either on admission or discharge.
• The hospital will bill us on your behalf and we will settle your bill directly with the hospital.
• Whilst we have agreemnents with more than 500 hospitals, there may in some instances, still be some minor expenses you may have to pay.
• Agreements are not required for public hospitals as their charging and services are defined by government legislation.
• We retain all documents related to your hospital treatment.
• Click here to search for a contracted hospital.

Related Information: Health Cover Options or Cover Selector

Return to Top

Medical Gap Claims

Definition: The Federal Government sets a schedule fee for each medical service that is included in the national Medicare program. A Medical Gap may occur where the cost of the medical service for an inpatient hospital service exceeds the Government Medicare Benefit Schedule Fee (MBS). These services are covered under Peoplecare Hospital cover.

• If you have been treated by a doctor that has an Access Gap agreement with Peoplecare, you may not receive their bill. It will normally be sent directly to the fund for processing. If you are treated by a doctor that does not have an agreement with Peoplecare you must do the following to make your claim.
• When you get a bill from your doctor, radiologist or pathologist for services provided whilst you were an ‘inpatient’ in hospital, you must submit it to Medicare first by filling in a Medicare Claim Form and a Medicare Two Way Claim Form. These forms are available by clicking here.
• Medicare will process your claim send you a Medicare refund and send your claim it on directly to us for processing. We will process your Medical Gap claim after we have received confirmation from the hospital that you were an inpatient. .
• If you have paid the doctor for the Medical services you are claiming, then LPC will either draw a cheque in your favour or deposit your benefits into a Bank, Building Society or Credit Union account using our Easy Claim system. Click here to obtain an Easy Claim Registration form if you have not signed up for this service.
• If you have not paid for the services before claiming, then we will draw a cheque in favour of the doctor, radiologist or pathologist.
• All cheques are sent to you. If cheques are in favour of the provider, you will have to send them on to the doctor, radiologist or pathologist etc.
• We will retain your claim form but will return all other documents to you.

Related Information: Health Cover Options or Cover Selector

Return to Top

Ancillary Claims

Definition: Services that are not classed as Medical or Hospital. E.g.Dental, Optical, Physiotherapy, Pharmaceutical, etc.

• Many claims for ancillary services can be made using the electronic swipe card claiming system called HICAPS (Health Insurance Claiming and Payments System).
• HICAPS is available from participating Dentists, Physiotherapists, Optical Dispensers, Chiropractors and Podiatrists. Click here to search for a HICAPS provider.
• When you receive an Ancillary service, ask the provider if they have HICAPS. If so, they will swipe your membership card through their HICAPS machine and Peoplecare processes all the details of your service on the spot within seconds.
• There are no PIN numbers to remember but you must sign for the services you receive and keep the receipt for auditing purposes. ( Please be aware of what services you are signing for.) The only amount you will have to pay is the difference between the providers fee, and the LPC benefit.
• DO NOT leave your membership card with a provider under any circumstances.
• Blue Lysaght Peoplecare Membership Cards or Transition Benefit Fund (TBF) Membership Cards or are no longer valid and cannot be used.
• For a HICAPS claim, you don't need to fill in a separate claim form and send it into Peoplecare. The Peoplecare benefit you would normally receive, will be automatically paid to the provider of the service.

If you receive an ancillary service from a provider that does not have HICAPS claiming facilities you need to do the following to claim a benefit.

• Complete a Peoplecare claim form with the details from the itemised account given to you by the Ancillary service provider.
• Send your completed claim form to Peoplecare and and attach all the accounts and receipts for the services you are claiming. Claim forms can be either mailed or faxed to us. Click here to view our mail and fax details.
• Peoplecare will generally assess your claim within 2 business days from the day of receiving your claim.
• If the claim is eligible for your level of cover and financial year limits and you have paid for the services you are claiming, then Peoplecare will either draw a cheque in your favour or deposit your benefits into a Bank, Building Society or Credit Union account using Easy Claim system. Click here to obtain an Easy Claim Registration form if you have not signed up for this service.
• Peoplecare will retain your claim form but will return all other documents to you.

Related Information: Health Cover Options or Cover Selector

Return to Top

Need to Check Your Current Level of Cover?

To check your current level of cover you can either:

• Log in to on-line member services, or

• View our Health Cover Options, or

• Call us on FREECALL: 1800 808 690 during business hours, or

• Email us at info@peoplecare.com.au

Return to Top