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Following are the easy
steps you need to complete to make a claim:
| Mailing Address: |
Peoplecare
Locked Bag 33
WOLLONGONG NSW
2500 |
| Fax Number: |
02 4224 4300
Please note:
The claim form and health care provider receipts or accounts
must be faxed on separate pages. If the receipts
or accounts appear to be amended or illegible then the
claim will not be processed until the original documents
are mailed to Peoplecare and verified.
|
| Email |
info@peoplecare.com.au
Please
note:
The claim form
and health care provider receipts or accounts must be
scanned and attached to the one email. If the receipts or accounts
appear to be amended or illegible then the claim will not
be processed until the original documents are mailed to
Peoplecare and verified. Please ensure that the email size
is under 10mb. |
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Blue Lysaght Peoplecare Membership Cards are no longer valid and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:
- Hospital Claims
- Medical Gap Claims
- 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
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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
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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
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Need to Check
Your Current Level of Cover?
To check your current
level of cover you can either:
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