Making a claim

EFTPOS-style claiming is easy. Swipe your membership card and the claim is paid. On-the-spot claiming, called HICAPS, is available at most health providers like dentists, optometrists, physios, chiros and more. You just pay the difference between their fee and your fund benefit – all processed instantly. 

This is what you do if you can’t use your Peoplecare card or you forgot it.

First of all, make sure you get a receipt with the following details on it:

• Patient’s name
• Provider’s name and number
• Date of service
• Service provided
• Amount paid

Once you have the receipt with all those details, send your claim to us via the Peoplecare mobile app. Simply open the app and take a photo of your receipt, add any supporting documents if applicable (like a Declaration of Condition or an Orthodontic Treatment Plan) and hit submit.

Photo tip: Turn off the flash if using your phone to take a photo of your receipt

Download the Peoplecare mobile app for iPhone or Android.

Upload a photo of your receipt to Online Member Services and you’re done. Log in here to start claiming. 

Just scan your completed claim form with your receipts and email us at info@peoplecare.com.au.

Send your claim to us along with a claim form by post, addressed to Peoplecare, Locked Bag 33, Wollongong NSW 2500.

There are a variety of reasons:

• some providers aren’t connected to HICAPS, our swipe claiming provider
• we need to assess this claim manually
• supporting info is required (e.g. a Declaration of Condition)

Get a receipt with the following details on it:

• Patient’s name
• Provider’s name and number
• Date of service
• Service provided
• Amount paid

Important: We can’t pay your claim without the above information on it. Some providers might just give you a receipt with the price on it and their business name. If this happens to you, just ask for a full receipt with all the details we need.

All health funds have waiting periods. In short, a waiting period is how long you need to wait after taking out your cover before you can receive benefits for services or items covered. You aren’t able to claim on treatments you get receive during this waiting period. Your cover description has a full list of all the waiting periods.

Any orthodontic waiting periods you have served or partly served when transferring from another a similar level of cover with Peoplecare or another health fund within 30 days will be recognised. When upgrading your cover, the full 12-month waiting period applies.

IMPORTANT: We need this before we can pay your claim.

You can’t swipe your Peoplecare membership card to claim orthodontic benefits.

Complete an Orthodontic Treatment Plan (or perhaps your orthodontist has already given you one). This  form  needs to be completed and sent to us with your first payment – so take it with you and complete what you can yourself.

Value tip: Have Premium Extras or High Extras? Consider maximising your claimable Peoplecare benefits by asking to be billed over 3 financial years. See the last section of this page for how our Extras covers work.

Have our closed Comprehensive Extras? You only have a lifetime limit and not an annual limit, so you can pay in a lump sum.

Retain your receipt and make sure it contains all the information required in step 4.

• patient’s name
• dental item number(s)
• amount and date paid and date of service
• orthodontist’s provider details and address

Otherwise, we can’t pay you benefits.

Take a photo of your receipt & Orthodontic Treatment Plan and send them to us using our app or Online Member Services.

Alternatively, you can email or post them to us with a claim form.

If you’re ever wondering about your benefits & limits, you can check them any time with our app or Online Member Services.

Peoplecare can only pay a benefit on medicines that are:

• above the $31.60 as at 1 January 2024. PBS co-payment amount;
• approved by the Therapeutic Goods Administration;
• not excluded by the health fund (for instance, medicines for contraception are excluded);
• prescription only medicines (you can’t claim medicine you can get without a prescription); and
• was purchased less than two years ago.

The types of medications members typically claim through Peoplecare are immunisations (for instance, the shots you get before you travel) and the many drugs that have been deemed safe by the Therapeutic Goods Administration but haven’t yet made it on to the PBS.

*Peoplecare provides benefits towards pharmacy on all of its extras covers. Waiting periods apply.

An eligible pharmacy claim might look like this example for someone who hasn’t yet used any of their annual limit:

• Medicine cost = $110
• minus PBS co-payment amount before calculating benefit = $78.40

To claim for pharmacy, send your full pharmacy receipt to us via our app, by email (along with a claim form) or by post (along with a claim form) to Peoplecare, Locked Bag 33, Wollongong NSW 2500.

Taking a photo of your extras receipt and claiming through our mobile app,or Online Member Services is the best. Here are some quick tips to get it right first time:

• Be sure to take a clear photo that’s easy for us to read
• Just send us the provider receipt (jump to the top of the page to see the receipt details we need). We don’t need to see anything from HICAPS
• Check your name on the receipt matches the name on your policy

Chronic Disease Management Plans (CDMPs) are for chronic conditions that have lasted for at least six months. CDMP claiming allows you to get help from both the government and Peoplecare if you follow our steps.

How does it work?

Your GP writes the plan for services that you can claim on Medicare first. Usually Medicare provides benefits for five visits. For the sixth and subsequent visits you can then claim from your extras cover and start drawing down on your limits.

What can you claim for?

Lots of services. That’s why extras cover is so helpful. These are some of the most popular ones:

• Chiro
• Dietetics
• Exercise physiology
• Eye therapy (orthoptics)
• Occupational therapy
• Osteo
• Physio
• Podiatry
• Psychology
• Speech therapy

To get the most out of your extras cover, you need to know how to get the most out of your Health Management Benefits. To claim for the following things you need a diagnosis of a medical condition first from a medical professional (that’s our Declaration of Condition form):

• Gym equipment
• Fitness programs
• Some Health aids (contact us for more information)
• Medications usually used as contraceptives