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@[Link]
[Link]
Please read this document carefully and keep it for future reference. For the most up-to-date info, visit [Link].
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.
[Link]/mobile
Online claim for the following services using our
Online Member Services at [Link]/
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@[Link] 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@[Link].
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 [Link]@[Link] 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
[Link].
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
[Link] 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
[Link]
Please read this document carefully
and keep it for future reference.
And more! Registering is quick and easy, so sign up
today at [Link]/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 [Link]/privacy.
Private Health Insurance Ombudsman,
Commonwealth Ombudsman,
GPO Box 442,
Canberra, ACT 2601.