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Frequently
Asked Questions |
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Who
is eligible for Peoplecare cover? |
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From 1 December 2006, membership
of Peoplecare is available to any resident of Australia with
a Medicare card.
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How
do I make a claim on Peoplecare? |
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Complete a Peoplecare
claim form with
the supporting documentation
Send your completed claim form to Peoplecare
and attach the supporting documentation for the services you
are claiming.
You should read the section on Making
a Claim |
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Where
can I get a Peoplecare claim form? |
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A claim form can
be downloaded,
or you can contact
us and we will send you one. |
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Someone
covered by my Peoplecare membership is being admitted to hospital. What
do I need to do? |
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You should read
the section on Making
a Claim in particular the Hospital and the Medical Gap
sections. You may wish to talk to the doctor/s and or anesthetist/s
that will be treating you and ask them if they will be charging
above the Medicare schedule fee and if they are - by how much. |
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When
can I make a claim on Peoplecare? |
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You can claim
whenever you have incurred an expense which is covered by
Peoplecare. |
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Is
there a time limit to make a claim? |
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You must submit
a claim within 2 years of receiving the service. A service
provided more than 2 (two) years ago cannot be claimed. |
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Can my De facto be covered by Peoplecare? |
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De factos can
be covered as dependants in a family membership. |
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Does Peoplecare cover me if I am traveling overseas? |
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No benefits are payable
for services provided outside the Commonwealth of Australia
(excludes members overseas for more than 12 months who have
been pre-approved by the fund for overseas benefits. Please
note these benefits will only be the equivalent to an average
benefit paid for the service in Australia. In some countries,
charges from Medical providers and Hospitals are considerably
higher than they would be if provided in Australia and the
member will have a large out-of-pocket expense, unless they
have additional Travel Insurance).
Members or their families going overseas
privately are strongly advised to obtain appropriate travel
insurance, in case of inadmissible or higher hospital and
medical expenses being incurred outside Australia. Peoplecare
provides comprehensive QBE Travel Insurance policies at significantly
discounted rates.
Refer to our travel
insurance section of this website for more information
or to purchase a travel insurance policy on-line.
or
Contact
us for more information or to obtain a brochure and application
form.
Medicare benefits are
not claimable for services provided in countries other than
Australia, special reciprocal arrangements do however, apply
with some countries.
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I need a Statement for my Tax Return |
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Peoplecare is
required to send out the annual Tax statements by 15th July
each year. Please ensure your address details are correct
with the fund even if you have resigned from the fund during
the financial year. |
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What Providers are Recognised? |
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The Fund pays
benefits for Natural Therapy only where the provider
is recognised by the fund. Please contact
us for details on recognised providers. |
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How much can I claim from Peoplecare? |
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This depends on
the type of service provided. You should read the sections
on Making a
Claim. Please note: Dental services are fixed benefits
based on ADA item numbers. Accurate benefits may be
obtained by contacting
us with full item details. |
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I'm
having a baby. What do I need to know? |
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Benefits for Obstetrics
related conditions are paid from the Hospital
table (except Ante-Natal Classes). Childbirth benefits are
subject to 12 months waiting period.
Peoplecare will
pay all of the agreed Hospital costs subject to any excess
you may have. Benefits are also paid for Inpatient Medical
Services - You will be covered up to the Schedule Fee except
where the Doctor enters into an agreement with the fund. In
these cases you may still be out-of-pocket, however the amount
may be considerably less. You should approach your Doctor
regarding these arrangements.
You may contact
the fund to see if your Doctor has entered into an agreement,
however he/she may choose not to use this system for your
procedure.
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Will I have to serve waiting periods? |
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Waiting periods
can apply.
If you have transferred
across from another fund, served waiting periods with that
fund and take up an equivalent or lower level of cover with
Lysaght Peoplecare, you will not have to serve waiting periods.
If you are a new member
or transferring from another fund with a lower level of cover
than what you are applying for, you may have to serve waiting
periods.
Please see below for waiting periods that may apply:
| Months |
Claim Category |
| NIL |
• Ambulance |
| NIL |
• Accidents |
| NIL |
• Transfers from other funds or parent’s membership for equivalent level of cover and if currently financial with the other fund. |
| 2 |
• On joining the fund or upgrading tables. |
| 2 |
• Rehabilitation and Psychiatric services |
| 6 |
• Optical and Health Management Programs |
| 12 |
• For services relating to an obstetrics condition |
| 12 |
• High cost dentistry including crowns, bridgework, implants orthodontics and dentures |
| 12 |
• Pre-existing Ailments; an ailment, illness or condition, the signs or symptoms of which, in the opinion of a medical practitioner appointed by the health insurer, existed at any time during the six months prior to taking out hospital cover or upgrading to a higher level of cover Note: This waiting period applies to hospital cover, not extras cover. For more details please download our Pre-Existing Ailment information brochure (91 KB) |
| 24 |
• Laser Eye Surgery and Hearing Aids |
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Over what period do limits apply? |
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Limits apply each
financial year, 1st July through 30th June.
Some ancillary services
have different limit anniversaries. Services which this applies
to are: Orthodontics, Orthotics, Hearing Aids, Laser Eye Surgery
and Surgical Equipment. |
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Is Peoplecare the same as other Health Funds? |
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Peoplecare is
a Registered Health Fund with the Department of Health the
same as all the other Funds which operate in the community.
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