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As at 1 April 2016

Mid Extras
Mid-level cover for a range of the most common extras services.

Mid Extras

+
Ambulance cover

1800 808 690


info@peoplecare.com.au
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
0316 v2.0

Mid Extras cover


Heres what youre covered for:
Service

Benefit

Annual limit
(financial year)

Ambulance

Ambulance

100%

No limit

Chiropractic &
osteopathic

Chiropractic
Osteopathic

initial: $40
standard: $30

$350 per person


$700 per family

Natural therapy
Remedial massage
Acupuncture
Dietetics

initial: $40
standard: $30

$300 per person


$600 per family

60%

$750 per person

60%

$500 per person

60%

$150 per person


$300 per family

Glasses & contact


lenses

100%

$200 per person

Laser eye surgery

60% up to $60

$300 per person


$600 per family

Complementary
therapies

General dental

(preventative, x-rays, basic


restorations, basic surgery &
extractions)

Dental

Major dental

(periodontics, endodontics,
crowns & bridges, implants &
dentures)

Orthodontics
Equipment

(CPAP machine, blood


pressure monitor, etc.)

Health aids &


wellness

Health services

(Allergy treatments, home


nursing, pre/post-natal
classes, etc.)

Orthotics
Preventative health
Health
management
programs

Hearing aids
Optical

(Health screenings, travel


expenses, improvement
process, etc.)

There are some rules around


what we can and cant pay
for. Please contact us for
more info.

Hearing & audiology

Pharmacy

Prescriptions (over the


PBS amount)

Physiotherapy &
other therapies

Physiotherapy
Occupational therapy
Orthoptics (eye therapy)
Exercise physiology
Hydrotherapy

Podiatry
Psychology
Speech therapy

initial: $43
standard: $33

$350 per person


$700 per family

60%
initial: $40
standard: $30

$200 per person


$400 per family

Psych/group therapy

Speech therapy

Podiatry (chiropody)

Please note:
This isnt the full list of services covered. Its always best to give us a buzz before having
any treatment to check exactly what youre covered for.
Annual limits are per person, per financial year (unless otherwise stated).
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 $38.30 as at 1 January 2016.

Whats not covered (Extras)


There are a few things that arent
covered by your extras cover. They are:
Treatment & services received within
your waiting periods (see page 3)
Treatment & services received
outside Australia
Treatment & services covered by
compensation or another type of
insurance (like third party or sports
club insurance)
Treatment & services received more
than 2 years ago
Contraceptives, over-the-counter
medications and prescriptions less
than the PBS amount
Naturopathic & herbal medicines
First aid kits & courses
Non-prescription glasses, contacts &
sunglasses
Treatment & services received from
providers that arent registered or
recognised by Peoplecare
Treatment & services received from
a family member, relative, business
partner or yourself
Treatment & services you werent
charged for
Services for sport, recreation or
entertainment
Ambulance subscriptions or statebased levies
Ambulance services paid for by
the Government, compensation or
another type of insurance
Ambulance services that arent
medically necessary
Receipts issued by a third party, like
group buying website or group deals
If youre using a gift voucher, we
cant 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 that service
Benefits higher than the amount you
paid for the service. For example,
if you receive treatment thats
discounted from $65 to $30, we only
pay a benefit towards the fee you
paid (e.g. $30)

Ambulance cover
Did you know that an ambulance ride could cost your
thousands? Weve got your back with our Australiawide, 100% ambulance cover.

Love a free ride

Whats 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

Whats not covered:


Ambulance subscriptions or state-based ambulance
levies
Ambulance services paid for by the government,
compensation or another type of insurance
Ambulance services that arent medically necessary

Your Extras cover

Waiting periods

Annual limits are based on the financial year (1


July 30 June), and are per person (unless it says
otherwise)
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 youve received can be
claimed for, please get in touch
Please keep in mind that we arent able to pay
benefits towards goods and 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 $38.30 as at 1 January 2016
Complementary therapy benefits can only be
paid for services received by providers registered
with either Medicare or the Australian Regional
Health Group (ARHG)

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:
Extras services
Ambulance
Services covered by another
fund (when transferring directly
to a similar level of cover)

Waiting period

No waiting period

Joining the fund


Upgrading your cover
General dental, pharmacy,
physio, chiro, podiatry and
natural therapies

2 months

Optical and health


management programs

6 months

High cost dentistry including


crowns, bridgework, implants,
orthodontics, endodontics,
periodontics and dentures
Pre/post-natal services (including
midwifery)

12 months

Laser eye surgery & hearing aids

24 months

Dont worry, if youre transferring from another fund well


make sure we recognise any waiting periods youve
already served!

Things to know about


Making an extras claim

If you change your mind

Claiming couldnt be easier! The choice is yours:

Changed your mind about your cover? No worries! Just


let us know within 30 days of joining or upgrading your
cover and youll get a full refund of any premiums paid
(as long as you havent made any claims in that time,
of course).

HICAPS just swipe your membership card at


participating providers and well pay your benefits
straight to the provider. Youll only have to pay the
difference between what they charge and our
benefit, and you wont have to submit a claim form
From your phone with our quick & easy Mobile
Claiming app. Download it now from peoplecare.
com.au/mobile
Online claim for the following services using our
Online Member Services at peoplecare.com.au/
oms:
Dental

Podiatry

Chiro

Optical

Osteo

Occupational therapy

Love your thoughts


At Peoplecare, its all about you. We love happy
members, and if youre not happy we want to hear
about it so we can make things even better.
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 youd prefer. If youd rather write
to us, you can email info@peoplecare.com.au or write
to Locked Bag 33, Wollongong NSW 2500.

Physio

If youre still not happy after contacting us, you can


contact the Private Health Insurance Ombudsman
(PHIO).

Email scan and email your completed claim form


and the receipts for your service to
info@peoplecare.com.au.
Post send a completed claim form and the
receipts for your service to Locked Bag 33,
Wollongong NSW 2500

PHIO is free, independent and protects the rights of


private health fund members. You can call PHIO on
1300 362 072, email phio.info@ombudsman.gov.au or
send mail to:



Online Member Services


Love having access to your membership 24/7? Then
our Online Member Services is for you.

For more information, visit their website


ombudsman.gov.au.

Here is what you can do in Online Member Services


wherever and whenever you like:

To get a copy of our full complaints policy, go to


peoplecare.com.au or contact us and well send you a
copy.

View & update your membership details


Check how much of your Extras limits youve used &
find out how much youll get back for an upcoming
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
head-start on your tax

For the most up-to-date info, visit


peoplecare.com.au
Please read this document carefully
and keep it for future reference.

And more! Registering is quick and easy, so sign up


today at peoplecare.com.au/oms.

Your Privacy
Were 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 wont collect any personal
information unless weve asked first, and we protect
the information we do have with everything weve
got.
Want more info? You can read our full Privacy Policy
at peoplecare.com.au/privacy.

Private Health Insurance Ombudsman,


Commonwealth Ombudsman,
GPO Box 442,
Canberra, ACT 2601.