Private Hospital Cover - $250 excess Effective 1 July 2010 You want a comprehensive private hospital cover that provides for the health needs of yourself and everyone in your family. You don t mind paying an excess if you go to hospital if it means your premiums are lower. John, our corporate relations guy, loves long rides on his old Ducati, short black coffees, snow skiing and guiding our corporate members around their health cover. To keep you and your partner, or your family covered in the chance of an emergency, Peoplecare s Private Hospital Cover gives you 100% cover for most private hospital services as well as ambulance cover Australia wide. And at Peoplecare, we make it easy! You can join online, update your membership details, make your payments and claim online. Or you might prefer to email or call us the choice is yours! Add up what you get with Peoplecare s Private Hospital Cover - $250 excess: Private Hospital Cover - $250 Excess + Ambulance Cover And at Peoplecare, you get great discounts on Travel Insurance! Lysaght Peoplecare Limited. A registered private health insurer.abn 95 087 648 753
2 Private Hospital Cover - $250 excess Private Hospital Cover gives you100% cover for most private and public hospital services Australia wide 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, and we provide coverage for dependants to 21 years, or 25 years if full time students. Excess Excess $250 Co-payments Nil Public or Private Hospital Bed shared or private room Same Day Patient Fees Theatre Fees Intensive Care In Hospital Pharmacy Medical Gap (see Access Gap) Voluntary Sterilisation Obstetrics Cardio Thoracic Surgery Assisted Reproductive Services Psychiatric Rehabilitation Eye Surgery Joint Replacement Reconstructive Services Dialysis Other Medicare Eligible Services Cosmetic Surgery Ambulance The excess is the amount you pay up front if you go to hospital. You can choose an excess on your cover to save on your premium. The higher your excess, the less you pay in premiums. No excess for kids under 21. Private hospital (visits of 1 night or more): You pay an excess of $250 per adult. Public Hospital or Day Surgery: You only pay half the excess ($125). The good news is, no matter how many times someone on your membership goes to hospital during a financial year, the most excess you ll pay is $250 for a single or $500 for a couple/family.
3 Hospital Cover... What we ll pay for Public or Private Hospital bed shared or private room (if available) Same day patient fees Theatre fees Intensive care Labour ward In hospital psychiatric treatment In hospital rehabilitation treatment In hospital pharmacy Surgical Prostheses (for more info, see page 7) Ambulance Services Australia-wide (read more on page 4) Hospital Cover... What we won t pay for Treatment within your waiting periods (see page 5) Any treatment Medicare doesn t cover (such as cosmetic surgery) Services outside Australia Treatment covered by compensation or some other insurance (like third party or sports club insurance) Claims made more than 2 years after your treatment Outpatient services (unless there s a special agreement between us and the hospital) Some high cost drugs Prostheses that aren t approved by the Commonwealth Government. (A prosthesis is an artificial substitute for a missing body part) Ambulance subscriptions or state-based ambulance levies Ambulance services paid for by the government, compensation or another type of insurance Ambulance services that aren t medically necessary Just give us a buzz on before you have your treatment, so we can tell you how much you ll get back.
4 Ambulance Cover Did you know that an ambulance ride could cost you thousands? The great news is that all of our Hospital and Extras covers already include 100% Ambulance Cover. Or you can just take ambulance cover on its own. Service Benefit Annual Limit Ambulance Australia wide 100% of cost No limit What you re not covered for Ambulance subscriptions State-based ambulance levies Ambulance Cover... What we ll pay for 100% of the cost of your ambulance treatment and transport within Australia, no matter how far you need to travel It also includes land, air and sea ambulance Unlimited cover No waiting periods Ambulance Cover... What we won t pay for Ambulance subscriptions or state-based ambulance levies Ambulance services paid for by the government, compensation or another type of insurance Ambulance services that aren t medically necessary
Love the fine print Waiting periods More Important Info 5 Nobody loves waiting. But all health funds have waiting periods to protect their whole membership from hit and run claims from new members, or people who might join a health fund to claim after the event. Sort of like trying to get car insurance after you ve already had an accident. (We know you wouldn t do that, but there are some people out there who do!) Some things you can claim straight away, and usually more expensive treatments have a longer waiting period. Just to be on the safe side for all our members. The table above lists all of the waiting periods. If you transfer to us from another fund where you had similar or higher cover and you ve finished your waiting periods, you won t have those waiting periods again. This means you can claim straight away for the things you were already covered for. On the other hand, if your old cover had lower limits or benefits than your new one, you ll have waiting periods before you can claim more than you were covered for before. Family Plus Cover We cover kids on their parents membership until they re 21 (not 18 like some other health funds). And if they re studying full-time, they can stay on your membership until they re 25 (as long as they re not married or living with their partner). If your kids reach 21 and they re not studying full-time, our Family Plus cover lets you keep them on your membership until they re 25 for an extra premium of 30%, no matter how many of your kids are in this age group. There are a few more conditions, so please contact us if you d like to know more. Exclusions We do not have any treatment exclusions on services eligible for Medicare benefits.
6 Excesses An excess is the amount you pay up front if you go to hospital. You can choose an excess on your cover to save on your premium. The higher your excess, the less you pay in premiums. Other things you need to know about your excess: There s no excess for kids under 21 If you go to a Public Hospital or Day Surgery you only pay half the excess You only pay the excess a maximum of once per person per year The good news is, no matter how many times someone on your membership goes to hospital during a financial year, the most excess you ll pay is $250 for a single membership or $500 for a couple/family. Agreement Hospitals We have agreements with most private hospitals in Australia. You can search our agreement hospitals list at. Our Private Hospital covers give you 100% cover for private and public hospital services Australia wide (after your up-front excess has been paid). There are only a few private hospitals we don t have an agreement with. In these cases we may not cover the full cost of your hospitalisation, but if you call us for a chat before you go into hospital we ll be able to tell you exactly what you re up for. Access Gap Cover (also called Gap Cover or Medical Gap Cover ) In our arrangements with doctors across the country, we try to reduce your out-of-pocket expenses as much as possible. We have Access Gap arrangements with over 21,000 doctors Australia wide. Ask your doctor if they ll participate in Access Gap before you go to hospital. If they do participate, they can bill us direct, making it easier for you. If your doctor participates in Access Gap Cover you will have either: No Gap: we will pay the full cost of your treatment OR Known Gap: you will know exactly what your out of pocket expenses will be before you have treatment. Some doctors prefer not to be publicly listed. If the doctor you re looking for isn t listed on our website, contact them to find out how they ll charge you for your treatment.
7 Prostheses A prosthesis is a surgically implanted medical device or artificial body part, like hip and knee joints and heart pacemakers. If you have a surgery that needs a prosthesis, there is always at least one that will be fully covered by your hospital cover. This is called a no gap item. But in a few situations, you and your doctor may want to use a different prosthesis, which costs more than the standard no gap prosthesis fee. If so, you ll need to pay this additional amount yourself. What should you do? Before you go to hospital, contact us to check your level of cover with the fund If your surgery includes a prosthesis, ask your surgeon which will be best for you and which no gap prostheses are available If the surgeon suggests a prosthesis for which a gap is payable, ask why this is being recommended Ask the surgeon to explain the cost of the surgery including the prosthesis. If there are any gaps for you to pay ask for a written cost estimate Contact the fund again with this info so that we can tell you what we ll cover and whether there will be any gap payments How do I make a payment? The easiest way to pay your premiums is through a regular direct debit from your account. This makes sure your membership is kept up to date and you don t have to remember to make your payments because they come out of your account automatically on the day you choose. Or, if you d prefer, you can pay by credit card over the phone or website, BPay or cheque. How do I transfer from another fund? Switching is simpler than you think! We can help you choose the right level of cover and can even help you compare with your old cover, so you know exactly what you re covered for. What have you got to lose? You won t have any waiting periods that you ve already served with your old health fund, which means that you ll only have waiting periods for things you re not covered for now. More details about waiting periods are on page 5. To switch, just join Peoplecare from the same day you stop your cover with your old health fund. We send them a request for details of your cover with them (this is called a Clearance Certificate) and then credit you with the waiting periods you ve already completed. Sometimes if you ve used all of your annual limit with your old fund, you ll have to wait for the new financial year until we can renew your limits.
How do I claim? 8 Making a Hospital claim Hospitals usually check your cover with us before you re admitted and let you know of anything you need to pay them up front. When you re discharged, just check their account to make sure it s right and then the hospital will send the claim straight to us. We take care of it all for you and let you know how much we ve paid on your behalf later. Making a Medical claim Your doctor should tell you about all of the costs of your treatment before you re admitted to hospital. They usually send the claim straight to us and we ll take care of it for you. If they don t send the claim to us, you need to claim from Medicare first. You can do this by completing two Medicare forms (their claim form and their 2-way claim form) and send it to Medicare with your accounts. Once Medicare have paid their bit, they ll electronically send the claim to us and we ll take care of our part. We know that Medicare can be confusing and difficult to navigate, so if you need help at any time, just call us on. How do I change my cover? You can change your cover any time you like. You can do it online at or if you d like to have a chat about it, ring us on. 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 page 5.
Love 24 x 7 Service Using our Online Services 9 Using our web services is an easy, convenient, cost-effective way of managing your health cover 24 hours a day, 7 days a week. You can use our secure online services to: choose the cover that s right for you join the fund claim online view or change your membership details make credit card payments view your claims history download forms and brochures order a membership card find a healthcare provider (hospital, Access Gap doctor or extras provider where you can use your magnetic swipe membership card) print your annual tax statement view our online newsletter download health information & healthy recipes arrange travel insurance
Love a bit of privacy Your Privacy 10 We all love our privacy from time to time. And it s up to you who you share your personal information with. At Peoplecare, it s our job to keep your private personal information safe and we re 100% committed to the Privacy Act and National Privacy Principles. We only collect information that we need to give you access to health services. We don t collect personal information unless we ask you first. And we protect your personal details with everything we ve got. If you d like more info about Privacy, contact us on or visit. Love cooling off If you change your mind We love helping you choose the health cover that s right for you. And we want you to be sure about your choice. So if you change your mind for any reason, we ll be happy to refund your premiums (as long as you haven t made any claims, of course!). All you need to do is let us know within 30 days of joining the fund or changing your level of cover. Love your thoughts What to do if you re not happy At Peoplecare, it s all about you. We love happy members and if you re not happy we want to hear about it, so that we can make things even better. Just call us if you want to have a chat on. Most of the time we can sort things out on the spot, but if you want to talk to a manager or our CEO at any time, all you have to do is ask. If you d rather write to us, you can email us at or write to Locked Bag 33, Wollongong NSW 2500. In the rare event that we still can t make you happy, you can contact the Private Health Insurance Ombudsman (PHIO). PHIO is free, independent and protects the rights of private health fund members. You can contact PHIO on 1800 640 695 or email info@phio.org.au and they are located at Level 22, 580 George Street, SYDNEY NSW 2000 or phio.org.au. Please retain this document for future reference.