Peoplecare Health Insurance Review
Overview
Peoplecare Health Insurance began as an industry-based health fund in 1952 as the health fund for John Lysaght Australia Ltd.
In the late 70s, it expanded its reach to employees of BlueScope Steel, One Steel, and BHP Billiton, in addition to more than 40 affiliated companies.
The fund has now opened its membership base to all Australian citizens and permanent residents and caters to over 70,000 members, while still retaining their strong ties with the steel industry.
Peoplecare is part of Members Own, a group of 19 like-minded, mutual health funds that invest their dividends back into their members through higher benefits and paid claims.
Peoplecare Health Insurance Key Facts
Founded: 1952
For-Profit or Not-For-Profit?: Not-For-Profit
Private Hospital Agreements Nationwide: 285
Day Hospital Agreements Nationwide: 274
Health Deal Represented? No
Headquarters: Wollongong, NSW
Peoplecare Health Insurance Hospital Cover
Peoplecare have a wide range of hospital covers to suit all ages and medical needs. These range from Bronze Hospital all the way up to Gold Hospital. The following are the hospital covers currently available with Peoplecare Health:
- Bronze Hospital
- Silver Hospital
- Silver Plus Hospital
- Gold Hospital
Peoplecare Health Insurance Extras Cover
Extras Cover takes care of the everyday healthcare service expenses that are not generally covered under Medicare such as dental services, prescription glasses, and physiotherapy. Here is a list of the current extras covers available:
- Simple Extras
- Mid Extras
- OSHC Extras
- High Extras
- Premium Extras
Peoplecare Health Insurance Waiting Periods
Peoplecare recognises the waiting periods you have already served with a previous health fund if you switch, this is called “portability”. For first-timers taking out a hospital cover, members who may have lapsed in hospital coverage and those upgrading their level of cover, the waiting periods below will have to be served before members can claim on services:
Hospital Waiting Periods
- Ambulance services: 1 day
- Accidental Injury:
- New Conditions: 2 Months
- Pregnancy and birth-related services: 12 months
- Pre-existing conditions: 12 months
- Rehabilitation & Palliative care: 2 months
- Weight Loss Surgery: 12 months
How Do You Claim Extras with Peoplecare Health Insurance?
Peoplecare Health offers 4 quick and easy ways to claim on your extras. This can be done in the following ways:
On the spot: Swipe your membership card at a health provider that uses the HICAPS system to have your claim processed immediately.
Via a mobile app: You can lodge a claim using the Peoplecare Health app by submitting a photo of your receipt.
Online: You can log into their website and lodge your claim by providing the details on your receipt.
By Mail: You can lodge your claim by posting a completed claim form along with your relevant accounts and receipts to:
Peoplecare,
Locked bag 33,
Wollongong NSW 2500
Peoplecare Health Insurance Gap Cover
Peoplecare Health’s gap cover is called the Access Gap Cover. If your doctor charges you more than the standard MBS fee, this is known as the ‘gap’ and can leave you with an out-of-pocket expense. Access Gap can help to minimise or eliminate personal expense but it is the choice of the physician to participate in any given gap scheme.
Gap Cover Ratings by State
To determine how beneficial a gap scheme will be, we suggest comparing health funds in the same state or territory to show which of the funds offer a greater proportion of medical services covered with no gap. While it is more likely that a medical service covered under your health fund can be utilized at no personal cost to you, it is entirely the choice of the physician whether or not to participate in the gap cover scheme.
Medical Services with No Gaps — The percentage of claims that were fully refunded.
Medical Services with No or Known Gaps — The percentage of claims that were fully refunded, or where the policy holder knew the cost before the surgery was performed.
The information below outlines the percentages of services covered under no-gap and known-gap.
Peoplecare medical services with No Gap: 78.6%
Industry Average: 79.1%
Peoplecare medical Services with No or Known Gap: 92.7%
Industry Average: 90.5%
Peoplecare medical services with No Gap: 92.5%
Industry Average: 89.5%
Peoplecare medical Services with No or Known Gap: 97.8%
Industry Average: 95.7%
Peoplecare medical services with No Gap: 90.8%
Industry Average: 86.7%
Peoplecare medical Services with No or Known Gap: 98.6%
Industry Average: 95.1%
Peoplecare medical services with No Gap: 91.5%
Industry Average: 89.2%
Peoplecare medical Services with No or Known Gap: 97.5%
Industry Average: 94.5%
Peoplecare medical services with No Gap: 90.7%
Industry Average: 89.5%
Peoplecare medical Services with No or Known Gap: 99.1%
Industry Average: 96.6%
Peoplecare medical services with No Gap: 87.4%
Industry Average: 84.4%
Peoplecare medical Services with No or Known Gap: 96.6%
Industry Average: 96.2%
Peoplecare medical services with No Gap: 93.6%
Industry Average: 90.2%
Peoplecare medical Services with No or Known Gap: 99.3%
Industry Average: 96.7%
Peoplecare medical services with No Gap: 85.1%
Industry Average: 84.2%
Peoplecare medical Services with No or Known Gap: 96.8%
Industry Average: 93.8%
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