Going to hospital can be a stressful time, so we're here to help.
We really do care about our members and we want you to know we’ve got your back when you need us. We’ve put together a guide for your hospital stay – from what to ask your doctor to how we pay the bills so that you’re fully informed.
Download the Hospital Stays Guide
Planning your hospital stay
- Discharge Planner
A Discharge Planner manages patient transition from hospital to another health facility or home. - Physio/exercise physio
Physios & exercise physios specialise in your physical recovery from hospital and help you strengthen your muscles with targeted exercises, movements and hands-on treatment.
- Social worker
Social workers can help connect you to community services that can assist in your care when you return home.
- Nurse Unit Manager
A Nurse Unit Manager (who used to be called a Matron) is the head nurse who manages all the nurses.
Peoplecare is the not-for-profit health fund devoted to making going to hospital easy for you. The hint is in the name!
Peoplecare is the #1 health fund for*:
- Customer service
- Providing helpful advice
- Providing clear explanations of inclusions & exclusions
- Providing products to suit your needs
- Making private health insurance easy to understand
In short, we’re here for you.
* IPSOS 2021 survey results for open private health insurance funds
We like to keep things simple at Peoplecare, but there are still a few things to learn to help you understand how to use your health cover.
Accommodation
Accommodation covers a bed and meals in hospital. It also includes in-hospital services like nursing and is separate to your doctors’ bills.
Excess
An amount you agree to pay per admission when you go to hospital in exchange for a lower premium. Peoplecare lets ‘kids eat free’, meaning that you don’t have to pay an excess to go to hospital for kids under 21 who are covered by a family policy. Your excess is halved if it’s a day stay and the full excess applies for an overnight stay. You only have to pay your excess once each financial year on single cover and on couple and family covers, your excess is double. (e.g. the full excess for two parents on a family cover).
Medical expenses
Fees for medical services while you’re in hospital. Things like doctor & specialist fees, radiology, pathology and anaesthetists.
Out-of-pocket expenses
When doctors charge more than the Medicare Benefits Schedule Fee, you will pay this expense. And by doctors, we’re talking about a range of specialists from surgeons to anaesthetists. Also called out-of-pocket costs. Same thing.
Pre-existing condition
A pre-existing condition is any aliment, illness, or condition that you had signs or symptoms of (in the opinion of a medical practitioner appointed by the health insurer) that existed during the 6 months before you joined a hospital cover or upgraded to a higher hospital cover. It is not necessary that you or your doctor knew what your condition was or that the condition had been diagnosed. A condition can still be classed as pre-existing even if you hadn't seen your doctor about it before joining the hospital cover or upgrading to a higher hospital cover. This waiting period only applies to hospital cover, not extras cover.
Pre-existing condition restrictions don’t apply to the following services:
- Rehabilitation, hospital psychiatric services, palliative care have a 2-month waiting period
- Ambulance has a 1-day waiting period
Read more about pre-existing conditions.
Theatre fees
Costs for procedures performed in an operating room, including day surgery facilities.
Waiting period
How long you have to hold your cover before you can make a claim. Refer to your Cover Description or call us for more detail.
View our entire glossary here.
Between Medicare, private health insurance and out-of-pocket expenses, figuring out who pays what can be tricky. Luckily for you, we’ve come up with this helpful chart.
Benefits depend on your level of cover and any restrictions, exclusions or waiting periods you have and the 12-month wait for pre-existing conditions.
You can check what you’re covered for and your waiting periods using our Online Member Services, or by giving us a call on 1800 808 690.
View your full cover description for more detailed information.
| Medicare | Peoplecare | You | ||
|---|---|---|---|---|
| Hospital | Extras | |||
| Ambulance (state-based providers only) | No | Yes | Yes | No |
|
Outside of hospital (outpatient) Things like specialist fees, radiology and pathology. |
Yes | No | No | Yes |
| Private Hospital (inpatient)
Remember that your waiting periods need to be served before you go into hospital and we can only pay for the services you’re covered for. If you have an excess or use things that hospitals can charge you for like TV access or newspapers, those will be at your own cost. |
||||
|
Medical Things like specialist fees, radiology and pathology. |
Yes | Yes | No | Yes |
|
Hospital Things like accommodation fees, theatre fees and prostheses. |
No | Yes | No | No |
|
Public Hospital (inpatient) as a Private patient If you have an excess or use things that hospitals can charge you for like TV access or newspapers, those will be at your own cost. Your hospital might ask you to pay additional charges for your admission. |
||||
|
Medical Things like specialist fees, radiology and pathology. |
Yes |
Yes |
No |
Yes |
|
Hospital Things like accommodation fees, theatre fees and prostheses. |
Yes |
Yes |
No |
No |
|
Public Hospital (inpatient) as a Public patient You may have out of pocket costs from your doctor or specialist even if you’re a public patient in a public hospital. If you have an excess or use things that hospitals can charge you for like TV access or newspapers, those will be at your own cost. |
||||
|
Medical Things like specialist fees, radiology and pathology. |
Yes |
No |
No |
Yes |
|
Hospital Things like accommodation fees, theatre fees and prostheses. |
Yes |
No |
No |
Yes |
|
Other services Things like dental, optical & physio. (There are some interesting items on Medicare like dental for kids and some free consults for chronic conditions you could get after seeing your GP) |
Yes |
No |
Yes |
Yes |
See step 7 for how to claim your hospital stay.
