What's covered?

Premium Hospital - $250 Excess

Our top level of hospital cover gives you private hospital cover for most services - perfect if you like to be ready for anything. You can choose our Premium Hospital cover with or without an excess.

Service Included?
Hospital accommodation
(in a private or public hospital bed in a shared or private room)
Same-day patient fees
Special unit accommodation
(like ICU & neonatal)^
In-hospital pharmacy
(pharmacy items you’re given while you’re admitted)
Theatre fees for services included in your cover^
Hospital substitution options^
Palliative care
Psychiatric services
Rehabilitation
Obstetrics (pregnancy-related services), including midwifery
Assisted reproductive services
(like IVF)
Eye procedures
(like cataract & lens)
Cardio-thoracic & related services
(like heart & chest)
Dialysis for chronic renal failure
Sterilisation
Plastic & reconstructive surgery
Hip & knee replacements & related services
Other joint replacements & related services
(shoulder, wrist, ankle, elbow)
Spinal procedures & related services
Gastric banding & obesity related services
Other Medicare eligible services
Cosmetic surgery
Services not covered by Medicare
What's not covered

This list looks bad, but we promise it’s fair (or decided by the Government).

  • Treatment & services you have in your waiting periods
  • Treatment & services that Medicare doesn’t cover (like cosmetic surgery)
  • Treatment & services received outside of Australia
  • Treatment & services that are covered by compensation or another type of insurance (like third party or sports insurance)
  • Outpatient treatment & 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
  • Pharmacy items that are given to you when you leave hospital

Restrictions & exclusions

As long as you don’t need cover for everything, having some restrictions or exclusions on your cover is a great way to keep the cost down. Make sure you’ve looked at any restrictions or exclusions on this product before joining, and always check with us to see if you’re covered before receiving treatment.

Restrictions

A restriction is a service that is only paid at the standard public hospital rate, rather than a private hospital rate. This means you are only fully covered for this service in a public hospital. If you're admitted to a private hospital for one of these services, you'll have large out-of-pocket costs. If you have restrictions on your hospital cover it will be marked as ‘Restricted’ in the table showing the services covered.

Exclusions

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. If you have exclusions on your hospital cover, it will be marked with an ‘x’ in the services covered table.

Waiting periods

We know waiting is the worst, but believe it or not waiting periods are there to look out for all of our members. Without them, people could join, claim and leave, which would put the cost of health cover up for everyone. These are our waits:

Service

Wait

Hospitalisation related to an accident

No waits (woohoo!)

Services covered by your old fund (if you transfer straight to a similar level of cover with us)

Health programs 2 months
Rehab, psychiatric services & palliative care
Upgrading your cover

2 months
and
12 months

Pregnancy & birth related services

12 months

Pre-existing conditions

Hospital substitution options (Hospital @ Home & Rehab @ Home)

If you’ve switched to us within 30 days of leaving another fund, we’ll recognise any waiting periods you served with them once we’ve got a Transfer Certificate (as long as you were on a similar or higher level of cover). Like a bad first date, we won’t make you go through that again!

Excess

What you’ll pay when you’re admitted to hospital so you can lower the cost of your cover. You’ll only have to pay the full excess each financial year and this is halved if it’s a day stay or you’re admitted to a public hospital.

There is no excess for kids under 21 if they go to hospital.

Cooling Off Period

You’ve got 30 days to change your mind! If you think this cover isn’t for you after all, let us know within 30 days and we’ll refund anything you’ve paid (as long as you haven’t made any claims in that time, of course).

Agreement hospital

An agreement hospital is a private hospital or day surgery that we’ve got an agreement with to provide services with low or no out-of-pocket costs. Find your closest agreement hospital by logging in to Online Member Services.

Access Gap

AKA Gap Cover or Medical Gap Cover.

Access Gap is a program that aims to reduce the difference between the Medicare fee and what doctors charge. Doctors can choose to take part in Access Gap on a case-by-case basis, and if they take part you’ll either have no gap or be told exactly what your out-of-pocket costs will be.

Prostheses

A prosthesis is a surgically implanted medical device or artificial body part, like hip and knee joints and heart pacemakers.

You may have out-of-pocket costs for your prosthesis, depending on how your doctor charges for it. We'll pay the Government's set benefits for prostheses that are listed on their Prostheses List, and if your doctor charges above that amount, you'll need to pay the difference. 

^You’re covered for this unless it’s related to a restricted or excluded service. Check your cover description for more info on what is and isn’t covered.

* We’ll pay the Government’s set benefits for prostheses that are listed on their Prostheses List, and if your hospital charges above that amount, you’ll need to pay the difference. 

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.

Premium Extras

Our very best extras cover, with top benefits and limits for a huge range of services. Here’s what you’re covered for:

Service Included? Benefit Annual limit
General dental 80% No limit
Major dental 80% $1,500 per person
Orthodontics 80% $1,000 per person $3,000 lifetime limit
Pharmacy 80% up to $80 $500 per person $1,000 per family
Glasses & contact lenses 100% $300 per person
Laser eye surgery 80% $600 per eye every 2 years
Physiotherapy Initial consult: $59 Standard consult: $49 $600 per person $1,200 per family
Occupational therapy
Orthoptics (eye therapy)
Exercise physiology 80%
Hydrotherapy
Chiro Initial consult: $50 Standard consult: $40 $600 per person $1,200 per family
Osteo
Natural therapy Initial consult: $50 Standard consult: $40 $400 per person $800 per family
Remedial massage
Acupuncture
Dietetics
Podiatry (chiropody) Initial consult: $50 Standard consult: $40 $500 per person $1,000 per family
Psych/group therapy Initial consult: $110 Standard consult: $90 $500 per person $1,000 per family
Speech therapy 80% $500 per person $1,000 per family
Health management programs 80% $250 per person $500 per family
Health aid equipment 80% $700 per person $1,400 per family
Health aids & wellness (like allergy treatments & home nursing)
Orthotics 80% up to $200 per person
Hearing aids & audiology 80% $1,500 every 5 years
Ambulance 100% No limit
What's not covered

This list looks bad, but we promise it’s fair (or decided by the Government).

  • Treatment & services you have in your waiting periods
  • Treatment & services received outside of Australia
  • Treatment & services that are covered by compensation or another type of insurance (like third party or sports insurance)
  • Treatment & services received more than 2 years ago
  • Contraceptives, over-the-counter medications and prescriptions less than the Pharmaceutical Benefits Scheme amount
  • Naturopathic & herbal medicines
  • First aid kits & courses
  • Non-prescription glasses, contacts & sunglasses
  • Treatment & services received from providers that aren’t registered or recognised by Peoplecare
  • Treatment & services received from a family member, relative, business partner or yourself
  • Treatment & services you weren’t charged for
  • Services for sport, recreation or entertainment
  • Receipts issued by a third party, like group buying websites or group deals
  • If you’re using a gift voucher, we can’t pay the difference between the cost of the service and the value of the voucher. For example, if you use a $60 voucher to pay for a $40 service, you can only claim back the $40 as the official fee for the service
  • Benefits higher than the amount you paid for the service. For example, if you receive treatment that’s discounted from $65 to $30, we only pay a benefit towards the fee you paid (e.g. $30)
  • Ambulance subscriptions and state-based levies
  • Ambulance services that are paid for by the Government, compensation or other kinds of insurance
  • Ambulance services that aren't medically necessary (like being driven home from the hospital

The nitty gritty

This isn’t the full list of services covered. It’s always best to give us a buzz before having any treatment to check exactly what you’re covered for

  • Annual limits are based on the financial year (1 July – 30 June) and are per person (unless it says otherwise)
  • Optical benefits (glasses & contacts) are paid when glasses or contacts are prescribed by a registered optometrist. They have to be for sight correction and we don’t pay on non-prescription sunglasses.
  • Health management program benefits are available for approved services that manage or treat a specific health condition. Things like blood pressure testing, cholesterol checks, mammograms and hearing tests can be claimed. To find out if a service you’ve received can be claimed for, give us a buzz
  • Please keep in mind that we aren’t able to pay benefits for goods & services that are used for sport, recreation or entertainment (like gym memberships or sports shoes)
  • Pharmacy benefits can be claimed for prescription medication that costs more than the current Pharmaceutical Benefit Scheme (PBS) amount. This amount changes on 1 January every year and is $38.80 as at 1 January 2017. This means that you will pay the first $38.80 yourself and then we pay a percentage of the balance depending on the level of your extras cover.
  • Complementary therapy benefits can only be paid for services received by providers registered with either Medicare or the Australian Regional Health Group (ARHG)
  • Ambulance rides are 100% covered with no annual limits for medically necessary ambulance treatment and transport within Australia - no matter how far you need to travel. This includes air, land and sea ambulance. See What's not covered above for more information on the types of ambulance services that are not covered (for example ambulance services that aren't medically necessary, like being driven home from hospital)

Waiting periods

We know waiting is the worst, but believe it or not waiting periods are there to look out for all of our members. Without them, people could join, claim and leave, which would put the cost of health cover up for everyone. These are our waits:

Service

Wait

Services covered by your old fund (if you transfer straight to a similar level of cover with us)

No waits (woohoo!)

Upgrading your cover

2 months

General dental, pharmacy, physio, chiro, podiatry & natural therapies

Optical & health management programs

6 months

High cost dentistry – including crowns, bridgework, implants, orthodontics, endodontics, periodontics & dentures

12 months

Pre/post-natal services (including midwifery)

Laser eye surgery & hearing aids

24 months

If you’ve switched to us within 30 days of leaving another fund, we’ll recognise any waiting periods you served with them once we’ve got a Transfer Certificate (as long as you were on a similar or higher level of cover). Like a bad first date, we won’t make you go through that again!

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.

Annual limits are for a financial year (1 July – 30 June) and are usually per person (unless it says otherwise).

Ambulance

Our 100%, Australia-wide ambulance cover is included in all levels of cover, with no waits and no limits. No matter how far you need to travel or whether it’s by air, land or sea ambulance.

What’s not covered

  • Ambulance subscriptions or state-based levies
  • Ambulance services paid for by the Government, compensation or another type of insurance
  • Ambulance services that aren’t medically necessary

FAQs

 What’s the best way to compare covers?

Review our comparison tables easily online by clicking either Singles, Couples or Families. From there you’ll get a nice visual comparison of three covers to choose from.

Confused about where to start? Give us a buzz on 1800 808 700. We know health insurance inside and out and because we love the personal touch we’re always happy to chat about your choices and help out by comparing your health cover. 

What’s the best way to find the right cover?

Finding the right health cover can be tricky. And it can be even more confusing trying to compare your cover with another policy.

We can help in a few different ways. Firstly, every health fund has a one page summary of every product in a standard format, to help you compare them side by side. You can easily get this Standard Information Statement (SIS) from the Private Health Insurance Ombudsman’s website at privatehealth.gov.au.

If you’d like some personalised help, we’re just a phone call away. Our new member experts are happy to help you choose the right level of cover for you, and can help you compare your old cover so you know exactly what you’re covered for. Just give us a call on 1800 808 700. After all, what have you got to lose?!

How do I change my cover?

You can change your cover any time you like.

You can do it online or if you need a hand finding the right cover for you, use our handy Cover Chooser.

Of course, if you'd rather have a chat about it, just 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. 

I don’t claim much, so why do I pay the same as someone who claims heaps?

Our hands are tied with this one. All health funds are covered by Government legislation that says we have to charge everyone the same amount (for the same level of cover) – regardless of their age, health status or claims history. It’s called Community Rating, and we think it’s pretty fair to keep health cover more affordable for most people.

I’ve been offered discounts from another health fund through my work, why don’t you give me a discount?

Some health funds offer corporate discounts to workplaces, but the trick is comparing products to make sure you’re actually getting a better deal. We’ve heard of corporate deals that are more expensive than Peoplecare products, even with their “discount”!

We don’t offer corporate discounts because we don’t think it’s fair to offer one group of people a better deal than another – we’d rather offer great value cover for everyone.

If you ever need a hand comparing health cover products, just give us a buzz and we’ll talk you through it.

 How can I join?

Select either Singles, Couples or Families on the floating dark purple navigation bar at the top of your screen to join.

Why not road test our amazing customer service by calling 1800 808 700

 How do I transfer from another fund?

Just give us the details when you join and we’ll take care of it all for you. Too easy!

We’ve got couples cover, so why do we pay the same as families with kids?

You’ll probably be surprised to learn that, on average, couples actually claim more than families with kids. Who knew? This is mostly because a high proportion of couples are older people whose healthcare costs are generally higher than younger people, and also because kids generally have lower healthcare costs and don’t need to claim as much.

What about a no claim bonus if I don’t make any claims?

We get this one a lot, but unfortunately Government says no. Private Health Insurance legislation says that health funds aren’t allowed to offer No Claim Bonuses.

Why can’t I claim for running shoes or other healthy stuff?

This is another thing that’s controlled by Government legislation. We’re only allowed to pay benefits for products and services that treat a specific medical condition. If you have a medical condition and there’s something you think you might be able to claim for, get in touch and we’ll see what we can do.

*Price is for family cover and includes an Australian Government Rebate of 25.415% with a 0% Lifetime Health Cover Loading. Excesses, limits, restrictions, exclusions and waiting periods (including 12 months for pre-existing conditions) might apply.

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