Health cover - April 2021 - Peoplecare
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health cover April 2021
Get in touch Proudly Not-for-profit
Looking for cover? Since day dot (many moons ago), we’ve been not-for-profit and
1800 808 700 member-owned. It guides how we treat you. As an owner, you’re the
boss and we’re here for you.
Already part of the family?
1800 808 690
Members Health
@ info@peoplecare.com.au Peoplecare is proud to be part of Members Health Fund Alliance, the peak
industry body for not-for-profit health funds that all share a common value of
putting our members’ health before profit.
peoplecare.com.au Members Health is group of not-for-profit and mutual health funds that share
the same approach of putting members’ needs ahead of profits.
As a not-for-profit fund, we focus on what matters most – supporting your
Larry health and wellbeing. Like all funds in the Members Health group, we can do
Download the app! this because we don’t give payouts to shareholders.
f facebook.com/Peoplecare
@Peoplecarehealthcover
PeoplecareLovePeople
#1 Health Fund
@Peoplecare Call Centre
in Australia
The info in this brochure may change. For the most up-to-date info, go to peoplecare.com.au Source: 2017 Ipsos survey
Please read this info carefully and keep as a handy reference guide.
2 3
Shopping around? Join the fam
We get it. We understand that You can use this sheet to help What’s important to me? It’s easy. Give us a buzz and Online - peoplecare.com.au Post – download an
choosing your health cover is a you compare different funds. we’ll pick up before you’ve application form from our
Peace of mind
big decision. At Peoplecare, we And we’ve done your homework made it across the kitchen to put Phone - 1800 808 700 website and send it to -
do everything we can to make for you too. Too easy! A price I can afford the kettle on! Our health cover Locked Bag 33,
your health cover as simple as
possible. So we created a handy Avoiding extra tax
experts love a chat and are only
too happy to point you in the
@ Email – download an Wollongong, NSW 2500.
application form from our
If you need help at any time,
comparison guide for you to use Growing a family right direction – whether that’s website and send it to
we love to chat. Just give us a
while you’re shopping around. with us or someone else. info@peoplecare.com.au
buzz on 1800 808 700.
We’re all about helping, and
honesty is key to that.
Option 1 Option 2 Option 3
Peoplecare Fill these in when Switching
4 Not-for-profit - We only charge what it costs us to pay
claims and run the fund
shopping around is easy
Switching is simpler than you
think! It takes around five minutes
4 Member-owned - We don’t have shareholders. In and you can switch over the
fact, we are 100% owned by our members
phone, online or by sending in
your application.
4 Give you more back - We paid 92% of our revenue
for member benefits in 2017/18 Don’t worry, if you’re transferring
from another fund we’ll make
4 Free health programs - Really useful freebie sure we recognise any waiting
programs to help you stay healthy and get out of periods you’ve already served if
hospital faster and recover at home you switch within 30 days! More
details about waiting periods are
4 Kids eat free! - No excess for kids under 21 on pages 11, 12 & 24.
To switch, just join Peoplecare
4 Family Plus cover options - Keeping the kidults from the same day you stop
covered (from 21 until they’re 25) your cover with your old health
fund (you won’t spend any time
4 Over 36,000 doctors on the books and without cover that way!). We
550 hospitals to choose from send them a request for details
of your cover with them (this is
4 Quick and easy mobile claiming - called a Transfer Certificate) and
Betcha those other funds you’re looking at don’t have then we’ll recognise the waiting
an app named Larry! periods you’ve already served.
4 Half price excess - When you have day surgery Sometimes if you’ve used all of
your annual limit with your old
fund, you’ll have to wait for the
4 Unlimited ambulance across Australia -
100% ambo cover is included in all our levels of cover
new financial year to renew your
limits.
4 Access Gap - We pay more towards your medical
services so you might not have to
4 96% members satisfied*
4 A real person answers the phone - Our
Peoplecarers love answering the phone in
person, so if you ever need us, give us a buzz
4 10% off extras when you get combo cover with us
4 *Source: Discovery Research: 2020 Member Satisfaction Survey results 5
Why we think you’ll love us You’ll also love our:
At Peoplecare, we genuinely Love our Peoplecarers Love what’s under the hood Just go to peoplecareeyes.com.au • Great benefits for dental, optical, physio, chiro and more
love people. And that means Our staff love answering in What’s the point of a slick to see how much you could • 100% Ambulance cover which is included in all Peoplecare levels of
giving you more of the things you person and giving you simple exterior if the engine doesn’t save (hint: our regular prices cover (see page 24)
love and fewer of the things you answers to your questions, so if match? We make health cover are up to 30% off retail prices,
don’t. and we often add extra offers • Hospital cover 365 days per year (see pages 11-19)
you’re not sure about anything, that purrs and lives up to what’s
just give us a buzz. on the tin. Peoplecare topped on top of that).
• Health management benefits for health programs like quit smoking
Love getting more for less the Ipsos net satisfaction of all courses, stress management & weight control courses (see pages
Not-for-profit funds like If you prefer, you can access open health funds in 2017 (and Love covering your kids for 20, 22 & 23)
Peoplecare give back more in your membership anytime you the two surveys before that mind longer
need to with our 24x7 Online you!). Need we say more? • National coverage – we have arrangements with over 36,000
benefits per dollar on average We cover kids on their doctors and 550 private hospitals around Australia
compared to for-profit funds.* Member Services. It lets you parents’ memberships until
check your coverage, change Love member perks they’re 21 (not 18 like some • Access Gap cover with participating doctors (see page 14)
your cover, make a claim and other health funds).
Love service you can call on make a payment. Can’t resist a hot deal? Being • Hospital substitution options & health programs – we’ve got some
Do you deserve the best? We a Peoplecare member gives And if they’re studying full- really useful freebies with our hospital covers (see page 16-19).
think so. Our call centre provides you fantastic deals at our online time, they can stay on your
you the best service in the optical shop, Peoplecare Eyes membership until they’re 25
country.^ What’s even better? Online and a range of other eye (as long as they’re not married
At Peoplecare, 95% of calls are care outlets around the country. or living with their partner).
picked up by a person. Sure At Peoplecare Eyes Online you If your kids reach 21 and they’re
Love being Love freebies
beats waiting. can order your prescription not studying full-time, our Family ‘appy as Larry It’s better when your kids eat
contacts, glasses and sunglasses Plus cover lets you keep them Larry, our free right? Here at Peoplecare
below retail prices. And, if you on your family membership until award-winning we offer top cover and charge
take out extras cover with us, they’re 25 for an extra premium app, helps no extra for kids to be added
you won’t even have to send in of 30%, no matter how many of save you time to any couples policy. If that’s
a claim! We’ll automatically take your kids are in this age group. and hassle with not enough, if they’re ever
care of it when your order’s sent If you’re a single parent, this your health cover. Open Larry to admitted to hospital, you won’t
to you. percentage might be a little check your benefits, limits and be charged an excess if they’re
different. There are a few more payment details, update your under 21. Bonus.
conditions, so please contact us contact details, cruise through
Plus, on any combo cover
on 1800 808 690 if you’d like to useful health info and shoot
(Hospital and Extras) we’ll take
know more. through pictures of your receipts
You guys are the best, to claim in rapid time.
10% off the price of the Extras
cover. What a deal hey?
I constantly recommend Simple. Quick. Functional.
We hope he makes you
you to family and friends as ‘appy as Larry
and you have been
a great support for me
during an otherwise rough
health patch. Keep doing
what you do, it is way
better than the best.
Alan
* Members Own Health Fund
^ Health Care and Insurance
Australia 2017, Ipsos
*Members Health Fund Alliance
6 7
^Health Care and Insurance
Australia 2017, Ipsos results
Why have private health insurance?
1. Less time waiting 2. Choosing your own doctor 6. It gets better with age 8. Your mental health is a
Like ripping off a Band-Aid, you It’s important to feel comfortable There’s one rule mightier than private issue
want your hospital stay over with your doctor, and private them all – the older and golder One thing that patients and the
with as quickly as possible. If you hospital cover lets you choose you get, the more likely you’ll government agree on is that the
rely on the public system you’ll who treats you. need the health system. Top private hospital system does a
be put onto the public hospital hospital covers tend to include great job at plugging the gaps in
In a public hospital, you’ll be
waiting list, which could mean the things you’ll increasingly psychiatric care.
treated by the doctor on duty,
waiting months (or more) for your need, such as heart, chest, lung,
unless you go in as a private The great thing about joining
procedure. Even on the day you hip and eye surgeries as well as
patient (when you can choose). any level of hospital cover is that
could be bumped if there’s an rehab, psych, palliative care
emergency. and dialysis for chronic renal after 2 months, you’ll be eligible
3. Save on tax failure. Lower hospital covers for the government’s wait-free
You could be waiting:* upgrade to psychiatric services.
High income earners could save tend to exclude or restrict these
services. Just note you only get the wait-
• 55+ days for a hysterectomy tax by taking out hospital cover.
free upgrade once in a lifetime.
• 85+ days for cataract surgery See information on the Medicare The higher levels of extras cover
Levy Surcharge on page 27 for tend to cover the big ticket items In short, getting access to crucial
• 90+ to have varicose veins more information. services that could impact
such as hearing aids, health aids,
stripped anyone of any age is a massive
orthotics and podiatry, and pay
bonus.
• 110+ days for a total hip 4. Avoid paying a loading higher benefits on physio, high-
replacement Who’s down with LHC? No, cost dental and optical.
• 97+ days to have tonsils not me! Lifetime Health Cover
removed Loading is a government 7. Give yourself a sporting
imposed charge for not taking chance
• 195+ days for a total knee out hospital cover by 1 July after
replacement Sporty types don’t like sitting idle
your 31st birthday. See page 27
for long when injury strikes. And
And 50% of people will wait even for details.
take it from those who know,
longer than that. injury has a way of striking at
5. Score a rebate random. A matter of weeks can
With private health cover, you’ll
be in hospital as soon as your The Government kicks in a very feel like a lifetime of sedentary
doctor’s ready, provided your handy rebate to help you cover living. If you do physical work
waiting periods have already the cost of your private hospital too, you’re doubly housebound.
been served. and extras cover. See page 27 Thankfully having private hospital
to see if you’re eligible. cover can shave months
*Source: Australian Institute of Health
and Welfare, Elective surgery waiting (sometimes even years) off your
times 2016-17: Australian hospital
statistics wait before surgery.
You might be surprised...
...by just how much a hospital stay can cost without hospital cover. To give you an idea,
here are just some of the hospital bills we’ve paid for our members in early 2018:
• $42,000 for a 40-year-old to treat lower back pain
• $47,000 for a 65-year-old’s wound infection
• $171,000 for a premature baby in an intensive care unit
• $23,000 for a 22-year-old who was treated for post-traumatic stress disorder
• $37,000 for a 64-year-old’s knee replacement
• $38,000 for an 80-year-old’s hip replacement
Again it’s completely up to you, but you might want to plant that money tree just in case.
8 9
4 = Included 8 = Excluded
As at 1 April 2021 R = Restricted (see more on page 13 about restrictions)
Love getting it sorted Love going private Clinical Categories^ Waits* Basic Plus Bronze Silver Silver Plus Gold
Step 1
Rehabilitation 2 months R R R 4 4
Our hospital covers Hospital psychiatric services 2 months R R R R 4
We love keeping our hospital cover Palliative care 2 months R R R
Choose your Hospital cover
4 4
simple with four types of private hospital
Brain and nervous system 2 months 8 4 4 4 4
• Gold Hospital: cover to best suit your needs.
Eye (not cataracts) 2 months
$750 excess Please keep in mind that waiting
8 4 4 4 4
periods (including those for pre-existing Ear, nose and throat 2 months 8 4 4 4 4
• Silver Plus Hospital: conditions), excesses, restrictions &
$500 excess; or exclusions might apply. Our Australia-
Tonsils, adenoids and grommets 2 months 4 4 4 4 4
$750 excess wide covers include agreements with Bone, joint and muscle 2 months 8 4 4 4 4
• Silver Hospital: around 36,000 doctors and 550 private Joint reconstructions 2 months 4 4 4 4 4
hospitals across Australia.
$500 excess; or Kidney and bladder 2 months 8 4 4 4 4
$750 excess
Male reproductive system 2 months 8 4 4 4 4
• Bronze Hospital*:
Digestive system 2 months
$500 excess; or 8 4 4 4 4
$750 excess Hernia and appendix 2 months 4 4 4 4 4
• Basic Plus Hospital*: Gastrointestinal endoscopy 2 months 8 4 4 4 4
$500 excess; or Gynaecology 2 months 4 4 4 4 4
$750 excess
Miscarriage and termination of pregnancy 2 months 4 4 4 4 4
*The age-based discount is available on this cover;
Chemotherapy, radiotherapy and immunotherapy for cancer 2 months 8 4 4 4 4
see page 14
You can take hospital cover on its own but most Pain management 2 months 8 4 4 4 4
people add extras cover to give them broader Skin 2 months 8 4 4 4 4
coverage.
You can read more about this on pages 10-19 Breast surgery (medically necessary) 2 months 8 4 4 4 4
Diabetes management (excluding insulin pumps) 2 months 8 4 4 4 4
Step 2 Heart and vascular system
Lung and chest
2 months
2 months
8
8
8
8
4
4
4
4
4
4
Choose your Extras cover Blood 2 months 8 8 4 4 4
Extras cover gives you benefits for things Back, neck and spine 2 months 8 8 4 4 4
that aren’t covered by Medicare. Like your Plastic and reconstructive surgery (medically necessary) 2 months 8 8 4 4 4
teeth, glasses, chiro, physio and more. Dental surgery 2 months 4 8 4 4 4
• Premium Extras Podiatric surgery (provided by a registered podiatric surgeon) 2 months 8 8 4 4 4
• High Extras Implantation of hearing devices 2 months 8 8 4 4 4
• Mid Extras Cataracts 2 months 8 8 8 4 4
• Simple Extras Joint replacements 2 months 8 8 8 4 4
You can take extras cover on its own but most Dialysis for chronic kidney failure 2 months 8 8 8 4 4
people add hospital cover for their hospital &
Pregnancy and birth 12 months 8 8 8 8 4
medical costs.
Assisted reproductive services 12 months 8 8 8 8 4
You can read more about this on pages 20
Weight loss surgery 2 months 8 8 8 8 4
Step 3 Insulin pumps
Pain management with device
2 months
2 months
8
8
8
8
8
8
4
4
4
4
Sleep studies 2 months 8 8 8 4 4
Take 10% off your extras Common services 2 months 4 4 4 4 4
When you combine Hospital and Extras Support services 2 months 4 4 4 4 4
covers, we take 10% off your extras
premiums. Happy days.
Ambulance 1 day 4 4 4 4 4
You can read more about this on pages 10-24
^Any restrictions or exclusions on your cover will apply here too. Please see page 13 for more information on restrictions and exclusions.
10 *Anything within the above table that is a pre-existing condition has a 12-month waiting period except for rehabilitation, hospital psychiatric services and 11
palliative care which have a 2-month waiting period and ambulance which has a 1-day waiting period.
Important information
Pre-existing condition
A pre-existing condition is any ailment, illness, or condition that
Hospital cover – what’s
covered
Hospital cover – what’s not
covered
Hospital
you had signs or symptoms of (in the opinion of a medical
(depending on your level of There are a few things that
practitioner appointed by the health insurer) that existed during
cover): aren’t covered by your hospital
the 6 months before you joined a hospital cover or upgraded to
cover. They include treatments &
a higher hospital cover. It is not necessary that you or your doctor 4 Public or private hospital bed
services that
knew what your condition was or that the condition had been – shared or private room Restrictions & exclusions
diagnosed. A condition can still be classed as pre-existing even if (if available) 8 are received within your
you hadn’t seen your doctor about it before joining the hospital waiting periods (see pages There are some restricted
4 Same-day surgery or excluded services under
cover or upgrading to a higher hospital cover. Please contact us 11-12)
before any Hospital service to confirm your cover. 4 Theatre fees our Hospital covers. All of our
8 Medicare doesn’t cover (like Hospital products exclude
Other waiting periods include: 4 Special unit accommodation cosmetic surgery) cosmetic surgery and services
8 are received outside Australia not covered by Medicare.
4 In-hospital psychiatric
Hospital services Waiting period
treatment A restricted service means you’ll
8 are covered by compensation
No waiting get a public hospital benefit (as
• Hospitalisation related to an accident 4 In-hospital rehabilitation or another type of insurance
period a private patient). If you have
treatment (like third party or sports club
insurance) restricted services on your cover
• Ambulance 1 day 4 In-hospital pharmacy and you’re admitted to a private
• Upgrading your cover 8 were received more than 2 hospital for one of these services,
4 Surgical prostheses, up to
years ago you’ll have large out-of-pocket
• Health programs (see page 16-19) the benefit listed on the
costs.
• Hospital substitution programs (see page 18) Government’s Prostheses List 8 Outpatient treatment &
(a prosthesis is an artificial services (unless there’s a An excluded service means you
• Rehabilitation, psychiatric services 2 months special agreement between
substitute for a body part) have no cover at all.
and palliative care (even for pre-existing us and the hospital)
conditions) 4 Ambulance services Australia
• All other services, except for those listed wide (read more on page 24) and: Going to public hospital as a
below private patient?
4 Emergency ambulance 8 High cost (non PBS/TGA
treatment and transport to approved) drugs. If you have Hospital cover,
• Pregnancy and birth you can choose to go into a
hospital via road, air and
• Assisted reproductive services 8 Pharmacy – most pharmacy public hospital as either a public
sea by a state ambulance
12 months items that you’re given while patient or a private patient for
• Pre-existing conditions (except for provider
you’re in hospital are covered services included in your hospital
rehabilitation, hospital psychiatric services
4 Non – emergency road and by your hospital bill. The cover.
and palliative care)
air ambulance transport hospital may charge you extra
for pharmacy items that you But, having private hospital
Waiting periods might not apply when transferring from a similar 4 Emergency ambulance cover doesn’t mean that you
take home with you and this
level of cover within 30 days, provided you join Peoplecare within treatment without transport can’t or shouldn’t ever go
isn’t covered by your hospital
30 days, we’ll recognise any waiting periods you’ve already cover. See our Extras covers publicly. You have the right to be
4 Emergency ambulance
served when upgrading your cover. When upgrading your cover, on pages 20-23 for pharmacy fully covered by Medicare as a
transport between private
waiting periods still apply. Please see page 11 for waiting benefits public patient if that’s what you
hospitals
period list, or give us a buzz on 1800 808 690. choose. Whatever you choose,
4 Hospital substitution programs 8 Prostheses that aren’t listed on the hospital and your doctor
Excess (read more on page 18) the Government’s Prostheses should tell you what your out-
List. (A prosthesis is an artificial of-pocket costs will be before
• An excess is the amount you pay up front if you go 4 Health programs (read more
substitute for a body part. you’re admitted (this is called
to hospital on page 17)
8 General patient transport, Informed Financial Consent).
• If you want to change your excess, there is a 2-month
e.g. hospital to home, nursing If you go to a public hospital,
waiting period (except for pre-existing conditions,
home, medical appointments you’ll be asked to sign a ‘patient
assisted reproductive services and pregnancy and birth,
election form’, which tells the
which is 12 months) 8 Ambulance subscriptions, hospital whether you want to be
• No excess for kids under 21 feesand state-based levies admitted as a private or public
• Day surgery: you only pay half the excess per admission 8 Ambulance services that are patient.
• Overnight hospital stay: you pay the full excess paid for by the Government, Public hospital waiting lists apply
• The good news is, no matter how many times someone on your compensation or other kinds of whether you are a public or
membership goes to hospital during a financial year, the most insurance a private patient, so check
excess you’ll pay is: 8 Any transport provided by these with your doctor and the
a non-recognised state hospital.
What’s Maximum excess for the year
ambulance provider
your excess Single Couple/Family
8 Some medical devices and
$250 $250 $500 consumables
$500 $500 $1,000 8 Experimental treatments
12 $750 $750 $1,500 8 Incidental fees such as Foxtel 13
& newspapers
The peace of mind offered by having your service and
care to call upon during these situations has been a relief.
Love looking after How does it work? don’t, you will need to complete The little things such as the packs of claim forms and tips
your hip pocket two Medicare forms (their claim
Peoplecare’s Access Gap
Access Gap scheme is where we agree
form and their Two-way claim prior to hospital stays and a letter asking if everything is
form) and send it to Medicare
to pay doctors more than the
No member wants out-of-pocket
Medicare Schedule fee for their
with your accounts. Once okay after an ambulance bill have meant a lot!
expenses. We hear you, so we Medicare have paid their bit,
services. The important thing
did something about it. we’ll take care of our part.
Out-of-pocket expenses come
is to ask your doctor if they’ll Peter
participate (as this is completely We know that Medicare can
when doctors charge more than
up to them). be confusing and difficult to
the Medicare Benefits Schedule
navigate, that’s why we have a
Fee. And by doctors, we’re
How to make team of experts to help you do
talking about everyone from
just that. So if you need help at
surgeons to anaesthetists. a hospital claim
any time, just give us a buzz on
The solution? We’ve made Hospitals usually check your 1800 808 690.
it easier for members to find cover with us before you’re
doctors who participate in admitted (hospitals can check
online 24x7, so you won’t need Love an age-based
Access Gap. Access Gap is
to wait for business hours) and let discount
an agreement with doctors to Agreement
reduce out-of-pocket expenses you know of anything you need Are you 29 years old or younger
to pay them up front. When and looking for cheaper cover? hospitals
– often resulting in little to no
out-of-pocket expenses for our you’re discharged, just check We have agreements
We offer an age-based discount
members. their account to make sure it’s with most private
on our Bronze Hospital cover
right and then the hospital will hospitals in Australia.
Note: Doctors can choose to and Basic Plus Hospital cover
send the claim straight to us. We If you’re admitted to
take part in Access Gap on a of up to 10%. You can learn all
take care of it all for you and let one of the few private
case-by-case basis. about it at peoplecare.com.au/
you know how much we’ve paid hospitals that we don’t
agediscount.
on your behalf later. have an agreement
with, we may not
Check out peoplecare.com. cover the full cost of
au/findaprovider to find doctors your hospitalisation.
who’ve taken part in Access
Gap in the past. So if you’re Medical claims You can search our
up for an operation, say with a Your doctor should tell you about agreement hospital list
Cardiothoracic Surgeon, you all of the costs of your treatment at peoplecare.com.au/
can search in advance to find before you’re admitted to findahospital, and we
a surgeon who could offer you hospital. This is called Informed recommend that you give
gap-free services. Financial Consent. us a buzz if you’re planning
a hospital admission to
Your doctor will usually send the discuss exactly what you’ll be
claim straight to us and we’ll covered for.
take care of it for you, but if they
Please make sure you read the
information about this on pages
10-14 because it’s important that
you know what you’re covered
for, what’s restricted & what’s
excluded.
14 15
Health Programs & Support
Who doesn’t love a little bonus?
And that’s what our health
programs are – a little something
extra to help you keep on top of
your health and out of hospital.
Health Programs
You could receive confidential, one-on-one support over the phone to help manage things like anxiety,
depression, diabetes, obesity, heart disease and more. These programs are designed to help you keep on
top of your health and live a healthier life.
Psst, you’ll need to be on one of our Silver, Silver Plus or Gold hospital covers, have served your 2-month
waiting period and have a referral from your treating doctor to be eligible.
and Peoplecare took care
I had to go to hospital recently
. It wa s so mu ch be tter tha n having to chase up and The Coach
of everything
ct fro m a health insurer. Peoplecare Program
run aroun d lik e you’d expe
cu stomer service. I recommend
MindStep
s ea sy with their gre at
makes thing Hear that whistle? That’s your coach calling! Feeling down or anxious? Not sure how to
love Peoplecare. We’ve got an innovative coaching program to
Peoplecare to all my friends. I
manage your worrying thoughts? If you’ve had
help with chronic conditions such as managing these feelings, you’re not alone. MindStep is
conditions like type 2 diabetes, heart disease here to help you. MindStep is a mental health
Kathie and Chronic Obstructive Pulmonary Disease program for Peoplecare members to help you
(COPD). It’s a proven health coaching program manage the symptoms of anxiety or depression.
provided over the phone and by regular written
communication.
Healthy Weight Strive for
for Life Health
Strive for Health is a chronic disease
The Healthy Weight for Life program is a program management program that looks at your
that can assist with heart disease, diabetes and individual risk factors for a disease and gives you
osteoarthritis management with strategies to the power to stay healthy. How? Loads of useful
help you maximise your overall health, strength health info, caring support and helpful advice
and quality of life. Healthy Weight for Life can to give you the reins to manage your health risk,
help you with weight loss, strength exercises and any chronic conditions and boost your health
education to help you maintain healthy habits. and wellbeing.
Ask one of our experts on our website at peoplecare.com.au/askourexperts or give us a buzz
on 1800 808 690 for more info.
16 17
service and support!
Thank you very much for your high quality
to pay the cost of private
Like many people I was initially reluctant
s with Peoplecare it has
health insurance; however in our dealing
ssful times of life a little
made some of the hardest and most stre
care!
easier. Thank you to all the staff at People
Pete
Chemo at Home
Health Online Did you know that if you are
Free health support right at your fingertips! covered on Peoplecare’s
hospital cover for
chemotherapy,
you can get your
chemo treatment at home?
My Health Health Risk That’s a nice touch for what is a
pretty disruptive treatment.
Online Assessment Our trusted providers have
a program called Chemo
Your own personal health record – store & send Find out more about your health. The Health Risk
at Home. You can get the
health info to your doctor, track your health and Assessment only takes about 10 – 20 minutes
treatment you need (if it’s
more. Think of this record as your very own health to do and you’ll end up with a health report
covered by Medicare) delivered
filing cabinet. It gives you a place for secure showing where you’re doing well and what you
in your home including chemo,
storage of important health info, medical docs might need to look out for.
targeted cancer therapies and
and handy health information.
targeted therapies for inflammatory
bowel disease.
Hospital Substitution Programs*
Get out of hospital earlier or recover where you’re most comfortable, better yet, avoid it completely with
Want to know more?
in-home hospital services.
Psst, you’ll need to be on one of our hospital covers, have served your 2-month waiting period and have
a referral from your treating doctor to be eligible. Please note, anything that is a pre-existing condition will
have a 12-month waiting period.
Ask our friendly team
of experts!
Our resident health program experts
Hospital Rehab love a chat. They know you don’t need
any extra stress and make our health
at Home at Home programs & hospital programs easy.
If you’re a member who’s keen to
We’ve got a treatment program called Rehab know more about our health programs
Going to hospital? Want to be back in your
at Home that can help get you home from or hospital programs, whether it’s
own home recovering as soon as possible?
hospital sooner – we hear the food isn’t that recovering at home post-op or helping
Say goodbye to embarrassing hospital gown
great in there anyway! Rehab at Home is a you manage a chronic disease, we’re
mishaps and hello to watching trashy TV in your
hospital substitute treatment program that here to help.
favourite PJs with our Hospital at Home program.
covers you for rehab services such as physio &
It’s a program that lets you receive short-term Ask one of our experts
occupational therapy in the comfort of your
therapy services such as IV antibiotics and on our website at
home rather than staying in hospital.
wound care at home. peoplecare.com.au/askourexperts
or give us a buzz on
*Hospital substitution programs Hospital at Home and Rehab at Home can ONLY substitute hospital treatments you are covered for. Exclusions and restrictions apply.
1800 808 690.
18 19Love the little extras How to make
Our extras covers
Choosing an extras cover is easy.
• Health management - We
pay benefits for approved
and: Registered providers
Extras providers need to be
an extras claim
1
8 Pharmaceutical Benefits
We have four options – Premium, programs to manage or treat registered with Medicare or
High, Mid & Simple – so you can
choose the best one for your
a specific health condition.
Health screening services
Scheme (PBS) prescriptions
under the standard PBS
amount, contraceptives or
recognised by Peoplecare before
benefits will be paid.
Swipe your card
needs & budget.
To get the full product info,
such as blood pressure
testing, cholesterol checks,
mammograms and hearing
over-the-counter medicine
8 Natural therapies & Western
We reserve the right to refuse
payment for services rendered by
– claim instantly!
just contact us or download tests can be claimed if herbal medicine a provider who does not satisfy EFTPOS-style claiming is easy. Swipe your
a cover description from Medicare don’t pay a benefit. the fund criteria. If you wish to membership card and claim paid! On-the-
peoplecare.com.au. 8 First-aid kits & courses ensure that the provider you are
Please give us a buzz for spot claiming, called HICAPS, is available
details. Under the Private 8 Non-prescription glasses, attending is covered by the fund
Please keep in mind that most at most health providers like dentists,
Health Insurance Act, we contacts & sunglasses you can search for registered
services have an annual limit optometrists, physios, chiros and more.
can’t pay benefits for goods providers on our website
and waiting periods might apply. 8 Ambulance subscriptions, fees You just pay the difference between their
and services that are for the peoplecare.com.au/members/
Don’t worry, if you’re transferring and state-based levies providers/other-health-providers or fee and your fund benefit – no claim form
purposes of sport, recreation
from another fund within 30 days or entertainment (like gym give us a buzz before you go. needed. Nice.
8 Ambulance services that are
2
we’ll make sure we recognise memberships). You’ll need paid for by the Government,
any waiting periods you’ve
Claim with Larry,
to send us a Declaration compensation or other kinds of
already served! of Condition Form found insurance
at peoplecare.com.au/
Extras cover - more info
• Annual limits are for a financial
Members/Forms.
Please see your cover
8 Any transport provided by
a non-recognised state
ambulance provider
our mobile app
year (1 July – 30 June) and are description for full product info.
8 Non-Government Ambulance Larry is all about making claiming
usually per person (unless it
Already a member? Give us services a breeze! Forget faffing about with scanning
says otherwise).
a buzz on 1800 808 690 before and emailing – simply take a photo of your
• Optical benefits (glasses & having any treatment so we can 8 Receipts issued by a third
receipt on your smart phone or tablet, open
contacts) are paid when tell you how much you’ll get party, like group buying
websites or group deals our app, submit your pic and hey presto –
glasses or contacts are back. your claim is on its way to us in record time.
prescribed by a registered 8 If you’re using a gift voucher,
optometrist. They have to be we can’t pay the difference Download the app by searching
What’s not covered (extras)
for sight correction and we between the cost of the ‘Peoplecare’ on the Google Play store or
don’t pay on non-prescription There are a few things that
service and the value of the App Store.
aren’t covered by your extras
3
sunglasses. voucher. For example, if you
cover. They are treatments &
• Smiles all ‘round - We’ve use a $60 voucher to pay for a
teamed up with the
smile.com.au network of
services
8 received within your waiting
$40 service, you can only claim
back the $40 as the official fee Claim online
quality dentists to help take the periods (see page 24) for that service
Claiming online is super easy! Just like with
bite out of your wallet. 8 received outside Australia 8 Benefits higher than the our app, all you need to do is upload a
You can now visit any of the amount you paid for the
8 covered by compensation photo of your receipt. Upload it on Online
friendly smile.com.au dentists service. For example, if you
or another type of insurance Member Services and you’re done.
around the country and receive treatment that’s
you’ll get at least 15% off their (like third party or sports club
discounted from $65 to $30, To register for our Online Member Services,
usual fee for all treatments – insurance)
we only pay a benefit towards just visit peoplecare.com.au. It only takes a
just for having extras cover 8 received more than 2 years the fee you paid (i.e. $30) few minutes.
with Peoplecare! This offer is ago
4
separate to your extras limits 8 Surcharges, delivery costs and
Email us
and waiting periods, so you’ll 8 received from providers that credit card processing fees
get savings all year ‘round. aren’t registered or recognised
by Peoplecare
8 received from a family Just scan your completed claim form with
member, relative, business your receipts and email us at
partner or yourself info@peoplecare.com.au
8 you weren’t charged for
8 for sport, recreation or
entertainment
20 21Our Extras Covers
Please note:
(as at 1 April 2021)
periods
Annual Limits are per person, per financial year (unless otherwise stated) Simple Extras Mid Extras High Extras Premium Extras
Service Waiting periods Benefit Annual limit Benefit Annual limit Benefit Annual limit Benefit Annual limit
Ambulance Ambulance 1 day 100% No limit 100% No limit 100% No limit 100% No limit
General dental $750 $1,000 $1,500
(preventative, x-rays, basic restorations, 2 months 50% $500 per person 60% 70% 80%
per person per person per person
basic surgery & extractions)
Major dental $500 $1,000 $1,500
Dental (periodontics, endodontics, crowns & 12 months x x 60% 70% 80%
per person per person per person
bridges, implants & dentures)
$800 per person $1,000 per person
Orthodontics 12 months x x x x 70% 80%
$2,400 lifetime limit $3,000 lifetime limit
Prescriptions $200 per person $300 per person $400 per person $500 per person
Pharmacy* (after the standard PBS amount has been 2 months 50% to $50 60% to $60 70% to $70 80% to $80
$400 per family $600 per family $800 per family $1,000 per family
deducted)
Glasses & contact lenses 6 months 100% $150 per person 100% $200 per person 100% $250 per person 100% $300 per person
Optical
$500 per eye $600 per eye
Laser eye surgery 24 months x x x x 70% 80%
every 2 years every 2 years
Physiotherapy
Initial: $35 † $300 Initial: $43 † $350 Initial: $51† $500 Initial: $59† $600
Occupational Therapy
Standard: $25 per person Standard: $33 per person Standard: $41 per person Standard: $49 per person
Physiotherapy &
Orthoptics (eye therapy) 2 months
other therapies
$600 $700 $1,000 $1,200
Exercise physiology per family per family per family per family
50% 60% 70% 80%
Hydrotherapy
Chiropractic
Chiropractic & Initial: $35 † $300 per person Initial: $40 † $350 per person Initial: $45 † $500 per person Initial: $50 † $600 per person
2 months
osteopathic Standard: $25 $600 per family Standard: $30 $700 per family Standard: $35 $1,000 per family Standard: $40 $1,200 per family
Osteopathic
Chinese herbal consults
$300 $350 $400
Remedial massage per person per person per person
Complementary Initial: $40
†
Initial: $45
†
Initial: $50
†
2 months x x
therapies Standard: $30 Standard: $35 Standard: $40
Acupuncture $600 $700 $800
per family per family per family
Dietetics
Initial: $40 † $200 per person Initial: $45 † $400 per person Initial: $50 † $500 per person
Podiatry Podiatry (chiropody) 2 months x x
Standard: $30 $400 per family Standard: $35 $800 per family Standard: $40 $1,000 per family
Initial: $90 † $400 per person Initial: $110 † $500 per person
Psychology Psych/group therapy 2 months x x x x
Standard: $70 $800 per family Standard: $90 $1,000 per family
$400 per person $500 per person
Speech Therapy Speech therapy 2 months x x x x 70% 80%
$800 per family $1,000 per family
Health $100 per person $150 per person $200 per person $250 per person
management Preventative health 6 months 50% 60% 70% 80%
$200 per family $300 per family $400 per family $500 per family
programs
Equipment (every 3 years) 2 months
70% $500 80% $700
Health aids & services per person per person
Health aids 2 months
(Such as home nursing) x x x x
& wellness
$1,000 $1,400
Orthotics (Custom made or heat 70% up to $150 per family 80% up to $200 per family
2 months
moulded) (every 2 years) per person per person
$1,000 per person $1,500 per person
Hearing aids Hearing & audiology 24 months x x x x 70% 80%
every 5 years every 5 years
*Pharmacy benefits apply after the standard PBS amount has been deducted. The PBS amount changes every year If you’re transferring from another fund, we’ll recognise any waiting periods you’ve already served if you switch to us within
on 1 January and is $41.30 as at 1 January 2021. This means that you will pay the first $41.30 yourself and then we pay a 30 days. Plus, if you’ve only served part of a waiting period, say, 2 months of a 6-month waiting period, you’ll only need to
percentage of the balance per script depending on the level of your extras cover. serve the remaining 4 months when you transfer to Peoplecare.
1 initial consult per year per service except physiotherapy which has 2 initial consults per year.
† If you’re upgrading your cover, waiting periods still apply for the services that you weren’t previously covered for.
22 23How do I…
Make a payment Find a registered
The easiest way to make your healthcare provider
payments is through a regular To find out whether your hospital,
direct debit from your bank Access Gap doctor or extras
account or credit card. This provider is recognised by
makes sure your membership is Peoplecare, go to
kept up to date and you don’t peoplecare.com.au/
have to remember to make your findaprovider email us at
payments because they happen info@peoplecare.com.au
automatically on the day you or give us a buzz on
choose. 1800 808 690.
Change my cover
You can change your cover
any time you like. You can do it
online at peoplecare.com.au
or if you’d like to have a chat
about it, give us a buzz on 1800
808 690.
If you’re upgrading your cover,
you may have waiting periods
for things you weren’t covered
for before. More details about
waiting periods are on pages 11,
12 & 24.
Love a free ride What’s not covered:
Did you know that an ambulance ride
could cost you thousands? 8 General patient transport, e.g. hospital
to home, nursing home, medical
We paid a $24,000 air ambulance fare in appointments
2018 with zero out-of-pocket expenses for
our member. 8 Ambulance subscriptions, fees and
state-based levies
Our ambulance cover is included free with
any of our Combo, Hospital or Extras covers. 8 Ambulance services that are paid for
by the Government, compensation or
other kinds of insurance
What’s covered:
8 Any transport provided by a non-
4 Emergency ambulance treatment and recognised state ambulance provider
transport to hospital via road, air and
sea by a state ambulance provider
4 Non – emergency road and air
ambulance transport by a state
ambulance provider
4 Emergency ambulance treatment
without transport
4 Emergency ambulance transport
between private hospitals
4 Unlimited nationwide
4 1 day waiting period
4 No annual limits
24 25Who pays? Government incentives
There are a few government Here’s a table to help you work out your rebate tier:
carrots and sticks that apply to
$ $ health insurance and they can
be confusing. Here’s a rundown Step 1:
Step 2:
Age & rebate amount
Medicare
Levy
for you. Income threshold
Age of the oldest person Surcharge
on your cover
(for 2020/21 (This will only apply
Carrot: Australian financial year) Under 65 - 69 70+
if you don’t
have private
Government Rebate on 65 years years years hospital cover)
Private Health Insurance Single
Basically, the government pays a Base $90,000 or less
24.608% 28.710% 32.812% 0%
percentage of your premiums for Tier Family*
$180,000 or less
you. Depending on your income
and age, it can be up to a third Single
Tier $90,001 - 105,000
of your premium. The rebate 16.405% 20.507% 24.608% 1%
1 Family*
helps with the cost of private $180,001 - 210,000
health insurance (so that more Single
people take out private cover), Tier $105,001 - 140,000
8.202% 12.303% 16.405% 1.25%
to help take the pressure off the 2 Family*
public hospital system. $210,001 - 280,000
Single
There are a few things to know Tier $140,001 or more
0% 0% 0% 1.5%
about the Government Rebate. 3 Family*
They are: $280,001 or more
• If you have a Lifetime Health *If you’re a family with children, the income threshold for each tier is increased by
Cover loading, the Rebate $1,500 for every child after your first.
isn’t applied to that portion of Family includes couples and single parent families. For the most up-to-date info,
visit peoplecare.com.au/rebate
your premium.
Peoplecare
• The Rebate you get is based
Medicare Hospital Extras You on the age of the oldest Stick: Medicare Levy have to worry about it.
Between Medicare, private person of your membership, Surcharge
Ambulance (emergency and/or If you decide to get hospital
health insurance and out- 8 4 4 8 your taxable household
non emergency) The Medicare Levy Surcharge cover later, you’ll pay 2% more
of-pocket costs, figuring out income (for Medicare Levy
is paid by high income earners for cover for every year you’re
who pays what can be tricky. Doctors fees outside hospital Surcharge purposes) and CPI
(that’s singles who earn over over 30. This is called your
Lucky for you, we’ve come (outpatient) (inflation)
4 8 8 4 $90,000 and families that earn Lifetime Health Cover loading.
up with this handy guide: Things like GP & specialist fees, over $180,000 in the 2020/21
• It’s up to you to let us know
radiology & pathology financial year) who don’t hold Other things to know about LHC:
Benefits depend on your level your Rebate Tier. But don’t
of cover and any restrictions, Doctor fees in hospital (inpatient) worry – if you don’t tell us private hospital cover for the full • The maximum LHC loading you
exclusions or waiting periods Things like specialists, radiology & (or choose the wrong one) financial year. can have is 70% at 65 years old
pathology fees, accommodation &
4 4 8 4 the ATO will work out any
you have. The surcharge is between 1% • People who were born on or
theatre fees while you’re in hospital difference when you do your
You can check what you’re and 1.5% (depending on your before 1 July 1934 are exempt
tax
covered for and your waiting Public hospital charges household income) and is paid from the loading
periods using our Online If you’re admitted as a public 4 8 8 8 • If you aren’t sure which Tier on top of the 2% Medicare Levy
paid by most Australian tax • LHC loadings stay on your
Member Services, or by giving patient to choose, head to health.
payers. cover for 10 years. Once
us a buzz on 1800 808 690. gov.au or ask your tax agent,
Public hospital charges you’ve had hospital cover for
financial advisor or the ATO
If you’re admitted as a private 4 4 8 4 10 years straight the loading
patient • You don’t have to take Stick: Lifetime Health Cover is removed (some conditions
the Rebate as a reduced (LHC) apply)
Private hospital charges
Like accommodation, theatre fees premium, you can pay the full Lifetime Health Cover is
8 4 8 4 Please visit
and prosthesis cost of your health cover and designed by the government to
peoplecare.com.au/LHC for
claim any Rebate back at tax encourage people to take out
more info about Lifetime Health
Other services time hospital cover at a young age.
8 8 4 4 Cover.
Things like dental, optical & physio If you have private hospital
cover by 1 July after your 31st
birthday and keep it, you don’t
26 27What to do Love a bit
if you’re not happy of privacy
At Peoplecare, it’s all about you. We love Your privacy
happy members, and if you’re not happy we We’re 100% committed to the Privacy
want to hear about it so we can make things Act and Australian Privacy Principles,
even better. which means we only collect the
If you have any problems with your cover, give information we need to give you access
us a buzz on 1800 808 690. Most of the time we to health services. We won’t collect any
can sort things out on the spot, but you can personal information unless we’ve asked
always ask to speak to a manager if you’d first, and we protect the information we
prefer. If you’d rather write to us, you can email do have with everything we’ve got.
info@peoplecare.com.au or write to Locked Want more info?
Bag 33, Wollongong, NSW 2500. You can read our full Privacy Policy at
If you’re still not happy after contacting us, peoplecare.com.au/privacy or give us a
you can contact the Private Health Insurance buzz on 1800 808 690.
Ombudsman (PHIO).
PHIO is free, independent and protects the Love a big tick
rights of private health fund members. The Private Health Insurance Code of
Conduct is a voluntary industry code. It
You can call PHIO on 1300 362 072,
sets standards for health funds to make
email phio.info@ombudsman.gov.au
sure they do the right thing by consumers
or send mail to:
in having great staff training, clear policy
Private Health Insurance Ombudsman documentation, watertight privacy and
Commonwealth Ombudsman easy dispute resolution.
GPO Box 442
Peoplecare is proud that we meet
Canberra, ACT 2601
100% of the standards in the Code of
For more information, visit their website Conduct. This means we can display the
ombudsman.gov.au. Code of Conduct tick on our materials
To get a copy of our full complaints policy, go to show you we’re doing the right thing.
to peoplecare.com.au or contact us and we’ll
We love giving our members:
send you a copy.
• personalised, efficient service that will
Cooling off blow them away
• easy to understand information in plain
English
If you change your mind…
• the right information over the phone in
Changed your mind about your cover? No a way that’s clear and simple
worries! Just let us know within 30 days of
joining or upgrading your cover and you’ll get • crystal clear policy documentation
a full refund of any premiums paid (as long as • highly trained, expert staff who love
you haven’t made any claims in that time, of giving you the answers you need
course).
• the opportunity to have your say –
Love when you love our work & when you
think we could do better
jargon-busting
• the promise that we protect your
private information
Making sense of health cover gibberish can be
like trying to understand Finnish (unless you’re
Finnish of course)! We tackle the common
jargon so you know what we’re on about at
peoplecare.com.au/jargonbuster
28 29Use Larry, our mobile app
What can you do with our All you need,
Give us a buzz! new app?
Because Larry understands you
want to spend as little time as
right at your fingertips:
• One click to take or add a
photo claim of your Extras
possible doing the boring stuff,
receipts
Looking for cover? he takes the most popular
1800 808 700
features from our Online Member • Track your claims
Services and bins the rest to save
• Check your benefits & limits
you time and hassle.
• See all your payment details
Already part of the family?
1800 808 690 • Update your contact info
• Provide you with some super
@
useful health info
info@peoplecare.com.au
peoplecare.com.au
Larry
Download the app!
f facebook.com/Peoplecare
@Peoplecarehealthcover
PeoplecareLovePeople
@Peoplecare
30 31Peoplecare Health Limited. A registered private health insurer. ABN 95 087 648 753.
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