Private
Hospital Cover
effective
as at 1 April 2008 |
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| Please Note: This
document should be read carefully and retained for future
reference. |
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Private
Hospital Cover
Private Hospital is our comprehensive Private Hospital
cover with 4 different levels of excess to choose from.
Excess Options
- Private Hospital Cover
You have 4 Private Hospital excess options to choose
from:
1. No Excess, or
2. $150 - $150 per single or per person and $300 per
family, or
3. $250 - $250 per single or per person and $500 per
family, or
4. $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
Option |
Day
Surgery or Public Hospital Admission |
Overnight
Admission in a Private Hospital |
Excess
Maximums
|
| |
Per
Person |
Per
Family |
No Excess |
Nil |
Nil |
$0
|
$0 |
| $150 |
$75 |
$150 |
$150 |
$300 |
| $250 |
$125 |
$250 |
$250 |
$500 |
| $500 |
$250 |
$500 |
$500 |
$1,000 |
Excess
Bonus:
- 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.
- Excess applies to hospital services only, not medical or extras cover..
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Prices
The following premiums are applicable from 1 April 2008. The
premiums displayed are after deducting the Federal
Government’s 30% Rebate and assumes that you do
not have a Lifetime
Health Cover loading.
| Pay
Frequency |
Single
|
| |
No
Excess |
$150/$300
Excess |
$250/$500
Excess |
$500/$1,000
Excess |
| Weekly |
$21.25 |
$19.45 |
$18.40 |
$15.40 |
| Monthly |
$92.18 |
$84.32 |
$79.77 |
$66.73 |
| Pay
Frequency |
Single
Parent Family |
| |
No
Excess |
$150/$300
Excess |
$250/$500
Excess |
$500/$1,000
Excess |
| Weekly |
$31.90 |
$29.15 |
$27.60 |
$23.10 |
| Monthly |
$138.30 |
$126.45 |
$119.65 |
$100.10 |
| Pay
Frequency |
Couple
/ Family
|
| |
No
Excess |
$150/$300
Excess |
$250/$500
Excess |
$500/$1,000
Excess |
| Weekly |
$42.55 |
$38.90 |
$36.80 |
$30.80 |
| Monthly |
$184.41 |
$168.63 |
$159.53 |
$133.47 |
Please note:
- Fortnightly, Quarterly, Half-Yearly and Yearly rates
are available upon request. 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).
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Private
Hospital Cover
Private Hospital Cover provides comprehensive Hospital cover, Australia wide:
| Private
Hospital Cover |
| Service
|
Coverage
|
| Public
Hospital Bed - Shared or Private Room (if available) |
Yes
|
| Private
Hospital Bed - Shared or Private Room (if available) |
Yes
|
| Same
Day Patient |
Yes
|
| Hospital
Excess Options |
Yes
|
| Individual
and Family Excess Maximums |
Yes
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| Co-Payments
|
No
|
| Theatre
Fees |
Yes
|
| Labour
Ward |
Yes
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| Intensive
Care |
Yes
|
| Surgical
Prosthesis |
Yes
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| Are Certain Treatments Excluded |
No
|
| Treatments that have Restricted Benefits |
Services
Not Covered by Medicare |
| In-hospital
psychiatric treatment |
Yes
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| In-hospital
rehabilitation treatment |
Yes
|
| Cardio-thoracic
surgery (Heart surgery) |
Yes
|
| Major
Eye Surgery |
Yes
|
| Hip
and knee joint replacement |
Yes
|
| Obstetrics
Related Services |
Yes
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| Assisted
reproductive services |
Yes
|
| Plastic
and reconstructive surgery (excludes cosmetic) |
Yes
|
| Access
Gap Cover
|
Yes
|
| Australia
Wide Coverage |
Yes
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| Dependents
covered to 21 years (or 25 years if full time student)
|
Yes
|
| Ambulance
|
Yes |
| Waiting
Periods |
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Standard Waiting Periods
|
Yes
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Instant Coverage if Transferring from another
fund with identical cover
(see explanation below) |
Yes
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Exemption from 1% Medicare Levy Surcharge
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Yes
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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.
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Waiting Periods
| Months |
Claim
Category
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NIL |
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NIL |
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NIL |
- Transfers from other funds or parent’s membership
for equivalent level of cover and if currently financial
with the other fund.
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| 2 |
- On joining the fund or upgrading tables.
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| 2 |
- Rehabilitation and Psychiatric services
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| 2 |
- For services relating to an obstetrics condition
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| 12 |
- In respect of an ailment , condition or illness,
the signs or symptoms of which, existed at anytime
during the six months preceding the day of joining
or upgrading tables. For more details please download
our Pre-Existing
Ailment information brochure (91 KB)
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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.
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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 Change
your level of Cover
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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