How do I use telehealth extras benefits?
Learn about claiming telehealth benefits on your extras cover. We’re here to help with this short explainer.
Take the guesswork out of common eye surgeries
We compare laser eye surgery to cataract surgery.
Both laser eye surgery and cataract surgery treat eyes. But did you know that laser surgery is only claimable on some extras covers and that cataract surgery is only available on some hospital covers?
It sounds confusing but a little trick can help you make sense of it for this scenario:
- extras cover improves your sight (laser eye surgery, glasses & contacts)
- hospital cover removes things from your eyes (cataracts, infections, trauma to the eye)
Let’s go into it in more detail to show you which covers you need to claim these surgeries, what the benefits are and how to claim.
Waiting periods – these apply to all health funds
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.
Any waiting periods you have served when transferring from a similar level of cover within 30 days will be recognised. When upgrading your cover, waiting periods still apply if your new level of cover has higher benefits or covers more eye treatments.
Example: You have Mid Extras cover and you upgrade to High Extras, you need to wait 24 months before getting laser eye surgery to claim on your cover.
The waiting periods below are only those for eye surgeries. Our waiting periods page has our full list of waiting periods.
| Extras category | Waiting period |
|---|---|
| Laser eye surgery | 24 months |
| Hospital categories | Pre-existing conditions* | Hospital waiting period |
|---|---|---|
| Cataracts | 12 months | 2 months |
| Eye (not cataracts) | 12 months | 2 months |
* The pre-existing conditions rule only applies to hospital covers.
Laser eye surgery
What is laser eye surgery?
Lasers can do a number of things to our eyes but what we’re talking about here is the common procedure to change the shape of the cornea in each eye to improve vision for people who usually need to wear glasses or use contact lenses to see.
There are a lot of things to think about before getting laser eye surgery and a consultation with a GP, ophthalmologist or optometrist is a good place to go for help if you are considering laser eye surgery.
Is laser eye surgery claimable from Medicare?
No, unfortunately. You could claim some of the cost from us (more on that below) and pay the remainder yourself.
How much does laser eye surgery cost?
Consumer group Choice wrote in 2020 that laser eye surgery costs about $2,500–$3,000 per eye. That’s certainly not cheap as the total cost for two eyes would then be around $5,000–$6,000.
Peoplecare laser eye surgery benefits
| Peoplecare extras cover | Laser Eye Surgery | Limit per person |
|---|---|---|
| Premium Extras | 80% | $600 per eye, every 2 years |
| High Extras | 70% | $500 per eye, every 2 years |
| Mid Extras | N/A | N/A |
| Simple Extras | N/A | N/A |
| Closed Peoplecare extras covers | Laser Eye Surgery | Limit per person |
|---|---|---|
| Comprehensive Extras | 100% | $500 per eye, every 2 years |
| Value Extras | NIL | NIL |
| Standard Extras | NIL | NIL |
* These covers are closed to new members but existing members who have them can remain on them and use their benefits.
How to claim laser eye surgery
We can pay for surgery by Medicare-registered specialists, subject to your waiting periods and cover.
1. Get a receipt with the following details
- Patient name
- Specialist name and provider details
- Date and cost of the surgery
2. Submit your receipt to claim
There are a number of ways to submit your receipt. Our page on extras claiming shows you how (see ‘How to make an extras claim’ 2 to 5 here).
Cataract surgery
A cataract is a problem that clouds the normally clear lens of the eye and causes vision trouble, common as we age but also associated with risk factors like family history, UV sunlight exposure, diabetes and smoking.^
Cataract surgery removes a cataract and replaces it with a clear artificial lens.
Which Peoplecare hospital covers is cataract surgery on?
| Peoplecare hospital cover | Cataracts |
|---|---|
| Silver Plus Hospital | Included |
| Silver Plus Grow Hospital | Excluded |
| Silver Hospital | Excluded |
| Bronze Plus Hospital | Excluded |
| Basic Plus | Excluded |
| Closed Peoplecare hospital covers* | Cataracts |
|---|---|
| Gold Hospital | Included |
| Premium Hospital (Gold) | Included |
| Mid Hospital (Basic Plus) | Restricted |
| Basic Hospital (Basic Plus) | Excluded |
| Public Hospital (Basic) | Restricted |
* These covers are closed to new members but existing members who have them can remain on them and use their benefits.
What are inclusions, restrictions and exclusions?
- Inclusions are things you have cover for.
- Restrictions are services that are only paid at the standard public hospital rate, rather than a private hospital rate. This means you are only 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.
- Exclusions are things you don’t have any cover for from us.
Do I need to pay my excess when I go to hospital for cataract surgery?
Yes, if you have an excess on your hospital cover. This excess will be payable to the hospital. For more details on how the hospital will take the payment, read step 6 of our Going to Hospital Guide.
How is Peoplecare’s hospital excess calculated?
With Peoplecare hospital covers you pay:
- Half the excess for same-day admission in hospital (e.g. $375 if you have a $750 excess)
- Full excess for an overnight stay or longer (e.g. $750 if you have a $750 excess)
- No excess for kids under 21 on a family hospital cover if they go to hospital
The maximum excess per financial year no matter how many times you go to hospital:
- Single covers – the full excess amount (e.g. $750 if you have a $750 excess)
- Couple and family covers – double the excess amount (e.g. $1500 if you have a $750 excess)
How much does cataract surgery cost in out-of-pocket costs?
Before you go to hospital it’s important to give our Going to Hospital Guide a quick squiz as it could save you some big dollars and save you from needless stress.
Just as a ballpark figure from Australian statistics for all health funds:
- 53% of cataract surgeries don’t cost anything after members have paid their excess (if applicable)
- of the remaining 47% of cataract surgeries, the average gap is $400 after members have paid their excess (if applicable)
Read more about common surgery costs.
How to claim cataract surgery
There are two types of bills: medical bills and hospitals bills. We show you how to claim them in step 7 of our Going to Hospital Guide.
