Private Hospital
and Gold Extras Cover

Private Hospital and Gold Extras Cover
Private Hospital and Gold Extras health cover package combines:

• Private Hospital with a range of Excess options - our comprehensive Private Hospital cover with 4 different levels of excess to choose from, and
• Gold Extras - our highest level of Extras cover.

Excess Options - Private Hospital Cover

You have 3 Private Hospital excess options to choose from:
1. No Excess, or
2. $250 - $250 per single or per person and $500 per family, or
3. $500 - $500 per single or per person and $1,000 per family.

If you take an excess option you will pay an up front excess as specified below, if you are admitted to either a) a Day Surgery, b) a Public Hospital or c) a Private Hospital (for an over night stay), until you have reached your excess maximum, as specified below, within a financial year (1st July to 30th June). Excess maximums for each level of excess are:

Excess Bonus:

1. Excess waived for dependant Children under the age of 21.
2. Per person excess maximums also apply to Family cover. Excess example:A person belonging to the family with the Excess $500, who goes into a private hospital for an overnight stay, will pay a maximum excess of $500 in a financial year. If another member of the family is also admitted to a private hospital for an overnight stay they will pay a separate excess to a maximum of $500. Other members of the family admitted to hospital in the same year will pay no excess. The financial year excess limit for the membership is a maximum of $1,000.
3. Excess applies to hospital services only, not medical or extras cover..

Return to Top

Prices

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

Please note:

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

Return to Top

Private Hospital Cover

Private Hospital Cover provides comprehensive 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. Our hospital agreements total more than 450 Australia wide and 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

What We Will 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.

What We Will Not Pay For:

• Ambulance subscription or state based ambulance levies.
• Ambulance costs that are covered under government legislation or other compensable sources.
  

Return to Top

Gold Extras Cover

Gold Extras provides comprehensive extras cover:

Please note:

1. Financial Year is 1 July to 30 June and waiting periods may apply.
2. Loyalty Bonus applies after 5 years continuous membership that includes the Gold Extras cover component with Peoplecare.
3. No benefits are payable by the fund when:

• A member is given treatment without charge.
• The services received are not recognised by the fund or where service providers are not recognised and registered with the fund.
• The services are provided outside the Commonwealth of Australia.
• An entitlement exists or may exist under any compensation, third party or sports club insurance.
• A claim for a service is submitted more than 24 months after the date of service.
• A claim is submitted for optical appliances not required for sight correction..
• The claim benefit is less than $5, although this can be accumulated with other claims.
• Services are provided by family members, relatives or ones self.
• 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), 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), 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

• Where you pay for the cost of the orthodontic treatment in full at the treatment commencement, we will pay 80% of the cost to a maximum of your lifetime limit.

• Where you elect to pay the cost of the orthodontic treatment in instalments, we will pay 80% of the cost of each account/ receipt until the maximum lifetime limit has been claimed.

• Please check with the fund prior to committing to the cost of the orthodontic treatment for information about your lifetime limit and other requirements.

• You will need to submit some documentation to make a claim for orthodontic treatment. The fund requires an account/ receipt from the orthodontist, confirmation in writing that the orthodontic appliance has been fitted, a treatment plan from the orthodontist and a signed Peoplecare claim form.

• 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), 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. Prescriptions must be lodged with all claims for spectacles.
• 6 month waiting period applies unless these waiting periods have already been served with another health fund (see waiting periods explanation), 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.
  • Members transferring from another fund that have a lower Optical limit than Peoplecare must wait 6months 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), 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.

Ambulance Cover

What We Will 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.

What We Will Not Pay for:

• Ambulance subscription or state based ambulance levies.
• Ambulance costs that are covered under government legislation or other compensable sources.

Complementary Therapies Cover

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

Travel Expenses

• Benefits payable only on travel greater than 400 kms (round trip) and for a hospital admission.
• 2 month waiting period applies unless these waiting periods have already been served with another health fund (see waiting periods explanation),

Health Management Program

Benefit conditions of 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.

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.

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 year of membership, and
• Members transferring from another fund that have lower limits than Peoplecare must serve the waiting periods listed above before they can claim more than the former fund’s limit.
• Members transferring from another fund will not be entitled to continuity for any Health Management benefits ie the normal 6 months waiting period must be served before any Peoplecare benefits are payable.

Return to Top

Dependants

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

• 21 years, whether or not they are working full time. However they must not be married or living in a de-facto relationship,
  or
• 25 years if they are full time students and documentation confirming this is provided to Peoplecare annually. However they must not be married or living in a de-facto relationship.
• Once dependants 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.
  

    Benefits of membership with Peoplecare

        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.

     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

     Cooling off Period

We are committed to ensuring that you choose the health cover that is right for you. If for any reason you decide that your choice was not suitable then we will provide a refund of your premiums (provided no claims have been made). You will need to contact us within the first 30 days of joining the fund or changing your level of cover for this 'cooling off period' to be available.

     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.

  To Join

Click here to download an application form ,
or
Click here to join Peoplecare

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 )

Return to Top