Mid Hospital ($500 excess)
Great value hospital cover for people who want private hospital cover for most
services, but are happy to have some restricted services to help keep the cost
down. Perfect if you’re young, healthy and not planning a family.
Mid Hospital
($500 excess)
+
Ambulance cover
1800 808 690
[email protected]
peoplecare.com.au
Please read this document carefully and keep
it for future reference. For the most up-to-date
info, visit peoplecare.com.au.
Peoplecare Health Limited. A registered
private health insurer. ABN 95 087 648 753
0117 v2.1
As at 1 January 2017
Exclusions
Mid Hospital cover
($500 excess)
If you need treatment for any procedure listed as an
exclusion, you won’t receive any benefits from us and
you may have significant out-of-pocket expenses. Make
sure you’ve looked at the exclusions on this product,
and always check with us to see if you’re covered
before receiving treatment.
Here’s what you’re covered for:
Hospital service
Covered
Excess
Ambulance (see page 4)
4
Hospital accommodation (a private or public
hospital bed in a shared or private room)
4
Same-day patient fees
4
Special unit accommodation
4
In-hospital pharmacy (pharmacy items that you
4
The excess is payable per adult per financial year. Once
paid, you won’t have to pay an excess for any other
hospital admissions in that financial year (yay!).
Theatre fees for services included in your
cover^
4
What’s not covered (Hospital)
(like ICU & neonatal)
are given while you’re admitted to hospital)
Palliative care
Restricted
Psychiatric services
Restricted
Rehabilitation
Restricted
Obstetrics (pregnancy-related services),
including midwifery
Restricted
Assisted reproductive services (like IVF)
Restricted
Eye procedures (like cataracts & lens)
Restricted
Cardio-thoracic & related services
(like heart & chest)
Restricted
Dialysis for chronic renal failure
Restricted
Sterilisation
4
Plastic & reconstructive surgery
4
Hip & knee replacements & related
services
Restricted
Other joint replacements & related
services (shoulder, wrist, ankle, elbow)
4
Spinal procedures & related services
4
Gastric banding & obesity related services
4
Other Medicare eligible services
4
Cosmetic surgery
6
Services not covered by Medicare
6
^
This is the amount you’ve chosen to pay up-front if
you’re admitted to hospital. The good news is it’s halved
if you’re admitted to a public hospital or day surgery.
Even better, there’s no excess for dependants under 21.
There are a few things that aren’t covered by your
hospital cover. They are:
••Treatment & services received within your waiting
periods (see page 4)
••Treatments & services that Medicare doesn’t pay a
benefit for (like cosmetic surgery)
••Treatment & services received outside Australia
••Treatment & services covered by compensation or
another type of insurance (like third party or sports
club insurance)
••Treatment & services not included or restricted on this
level of cover which may be needed unexpectedly
while under anaesthetic. (Out of pocket costs may
result)
••Treatment & services received more than 2 years ago
••Outpatient treatment & services (unless there’s a
special agreement between us and the hospital)
••Some high cost drugs
••Prostheses that aren’t listed on the Government’s
Prostheses List (a prosthesis is an artificial substitute for
a 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
••Pharmacy - most pharmacy items that you’re given
while you’re in hospital are covered by your hospital
bill. The hospital may charge you extra for pharmacy
items that you take home with you and this isn’t
covered by your hospital cover.
You are not covered for theatre fees on excluded or restricted services.
Please keep in mind that this isn’t the full list of services covered. If you’re
planning a trip to hospital, it’s always a good idea to call us and check what
you’re covered for before being admitted.
Please get in touch with us if you’re planning a hospital
admission so we can talk you through your cover and
any out-of-pocket costs you might have.
What’s a restricted service?
These are services that are fully covered in a public
hospital only. There are 11 types of restricted services
on our Mid Hospital Cover (shown above), and if you’re
admitted to a private hospital for any of these services
you’ll have large out-of-pocket costs.
Hospital
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Hospital
Ambulance cover
Did you know that an ambulance ride could cost your thousands? We’ve got you back with our Australia-wide, 100%
ambulance cover.
What’s covered:
What’s not covered:
••100% of the cost of medically necessary ambulance
treatment and transport within Australia – no matter
how far you need to travel
••Air, land and sea ambulance
••No annual limits
••No waiting periods
••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
Waiting periods
Hospital substitution
options
Nobody likes waiting, but all health funds have waiting
periods on some services to keep things fair for all
members. The following waiting periods apply before
these services are covered on your membership:
Hospital services
••Ambulance
Love a
free ride
Waiting period
We give you the option of having care at home for things
that you’d normally be stuck in hospital for – all you need
is a referral from your treating doctor.
No waiting
period
Hospital @ Home gets you out of the hospital bed and into
your own. We’ll cover you to have the services you’d be
getting in hospital (things like wound care or IV antibiotics)
at home.
••Hospitalisation related to an
accident
••Services covered by another fund
(when transferring directly to a similar
level of cover)
Rehab @ Home helps you recover in the comfort of your
own home with short term therapy for joint replacements,
fractures, spinal conditions, stroke, respiratory conditions,
cardiac conditions and mobility problems. We offer
physio, occupational therapy and more.
••Joining the fund
••Upgrading your cover
••Health programs (see same page)
••Rehabilitation, psychiatric services
and palliative care
Health programs
2 months
••Reducing your excess (except for
pre-existing conditions and obstetrics
admissions) (see page 4 for more info)
Like finding $5 on the street, 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.
My Health Online is your own personal health record. Store
& send health info to your doctor, read through the health
library, track your health and more. To get started, register
for our Online Member Services at peoplecare.com.au/
oms and head to ‘My Health Online’ in the left-hand
menu.
••Obstetrics (pregnancy-related
services), including midwifery
••Pre-existing conditions (see below)
••Reducing your excess –
pre-existing conditions and obstetrics
admissions (see page 4 for more info)
12 months
Health Risk Assessment helps you find out more about
your health. The online questionnaire gives you a health
report showing where you’re doing well and what you
might need to look out for. To take the assessment,
register for our Online Member Services at peoplecare.
com.au/oms and head to ‘My Health Online’ in the lefthand menu.
Don’t worry, if you’re transferring from another fund we’ll make
sure we recognise any waiting periods you’ve already served!
What’s a pre-existing condition?
Pre-existing conditions have a special, governmentregulated waiting period of 12 months. They only
apply to hospital cover. A pre-existing condition is
any ailment, 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 or upgraded hospital
cover. It’s not actually 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 or upgrading hospital
cover.
Health Support Programs are designed to help you
manage your health at home with expert phone and
face-to-face support programs.
Strive for Health
A 24x7 health coach at
your fingertips to help
with chronic conditions.
The COACH Program
Your own personal
health coach to help
you with all things heart
disease.
MindStep
Confidential, one-on-one support over the phone to
help manage anxiety and depression.
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Things to know about
Access Gap
Waiting periods for reducing your excess
To try and reduce your out-of-pocket costs as much
as possible, we have Access Gap arrangements with
over 30,000 doctors across Australia. This means you will
have either no gap (where we pay the full cost of your
treatment) or a known gap (where you’ll know your out-ofpocket costs before you have treatment).
If you reduce the excess on your cover from $500 to $250,
there’s a 2 month waiting period before the $250 excess
is applied. The exception to this is obstetrics admissions,
which have a 12 month waiting period. If you’re admitted
to hospital within these waiting periods, you’ll still need to
pay a $500 excess.
Before you go to hospital, ask your doctor if they’ll take
part in Access Gap - if they do they’ll even send their bills
straight to us, making life easier for you.
If you reduce the excess on your cover to $0, there’s a 2
month waiting period before the $0 excess is applied, as
long as the condition is not considered pre-existing. A 12
month waiting period applies for pre-existing conditions. If
you’re admitted to hospital within this waiting period, your
old excess (either $250 or $500) will apply.
Hospital agreements
We have agreements with most private hospitals in
Australia. If you’re admitted to one of the few private
hospitals that we don’t have an agreement with, we may
not cover the full cost of your hospitalisation.
Your Privacy
We’re 100% committed to the Privacy Act and Australian
Privacy Principles, which means we only collect the
information we need to give you access to health services.
We won’t collect any personal information unless we’ve
asked first, and we protect the information we do have
with everything we’ve got.
You can search our agreement hospital list at peoplecare.
com.au, and we recommend that you give us a buzz if
you’re planning a hospital admission to discuss exactly
what you’ll be covered for.
Making a hospital or medical claim
Want more info? You can read our full Privacy Policy at
peoplecare.com.au/privacy.
Hospitals will send your claim straight to us and we’ll let you
know what we’ve paid once it’s all sorted. You don’t have
to do anything - too easy!
Love your thoughts
At Peoplecare, it’s all about you. We love happy members,
and if you’re not happy we want to hear about it so we
can make things even better.
Doctors will usually send their medical claims straight to us
as well, but sometimes they don’t. If they don’t, you’ll need
to submit a claim to Medicare first (using a Medicare claim
form and Medicare 2-Way claim form), and they’ll send
your claim to us once they’ve done their bit. Again, we’ll
let you know what we’ve paid once it’s all sorted.
If you have any problems with your cover, give us a buzz
on 1800 808 690. Most of the time we can sort things out on
the spot, but you can always ask to speak to a manager or
our CEO if you’d prefer. If you’d rather write to us, you can
email [email protected] or write to Locked Bag 33,
Wollongong NSW 2500.
Online Member Services
Love having access to your membership 24/7? Then our
Online Member Services is for you.
If you’re still not happy after contacting us, you can
contact the Private Health Insurance Ombudsman (PHIO).
Here is what you can do in Online Member Services
wherever and whenever you like:
PHIO is free, independent and protects the rights of private
health fund members. You can call PHIO on 1300 362 072,
email [email protected] or send mail to:
••View & update your membership details
••Check how much of your Extras limits you’ve used & get
a quote for a future service
••View your claims history
••Make a membership payment by credit card
••Find a registered healthcare provider
••View & print your annual Tax Statement to get a headstart on your tax
Private Health Insurance Ombudsman,
Commonwealth Ombudsman,
GPO Box 442,
Canberra, ACT 2601.
For more information, visit their website
ombudsman.gov.au. To get a copy of our full complaints
policy, go to peoplecare.com.au or contact us and we’ll
send you a copy.
And more! Registering is quick and easy, so sign up today
at peoplecare.com.au/oms.
For the most up-to-date info, visit
peoplecare.com.au
If you change your mind
Changed your mind about your cover? No worries! Just let
us know within 30 days of joining or upgrading your cover
and you’ll get a full refund of any premiums paid (as long
as you haven’t made any claims in that time, of course).
Please read this document carefully and
keep it for future reference.
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