Peoplecare Health Fund Review

Peoplecare was founded in 1952, as the health fund for John Lysaght Australia, later expanding to BHP employees. In 2006, the fund changed its name to Peoplecare, and opened up its membership to the general public.

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by Gary Andrews

Last update 15 Apr 2021

Overview

Peoplecare is a not-for-profit mutual fund, 100% owned by more than 34,000 members.

It's part of Members Health Fund Alliance.

Peoplecare has five straightforward hospital plans, with simple tiers of Bronze, Silver, Silver Plus and Gold.

Four extras policies are also available.

Members can get discounts at a range of retailers, across dentists, optical retailers and travel insurance.

You'll also receive a gift card if you refer a friend or family member.

Key Points

Claims 96% member satisfaction in 2019*.
Offers Access Gap program to limit out-of-pocket expenses for medical care in hospital.
Pays 80% of claims within 48 hours.

Compare Peoplecare and other insurers on our panel.

Click below to get started.

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Hospital cover

Nobody chooses to go to hospital.

But when you do, hospital cover will help you get the treatment you need, where and when you want it.

It also helps to pay the bills, as fees for hospital rooms and specialists can add up.

Think about what services you're likely to need, in line with your budget.

If you earn over $90,000 individually or $180,000 as a couple, you could avoid paying the Medicare Levy Surcharge.

Peoplecare's hospital plans are as straightforward as they come, with generous inclusions across all policies.

Basic Plus

Peoplecare's budget plan for the young and healthy has a number of items included that aren't common to cheapest tier hospital plans from other insurers.

Useful for younger Australians looking to lock in their Lifetime Health Cover loading before they turn 31.

Key inclusions:

  • Avoids Medicare Levy Surcharge.
  • Dental surgery
  • Gynaecology
  • Tonsils, adenoids and grommets

Bronze

Peoplecare's plan for the young, healthy, and budget conscious.

Comes with a generous range of inclusions.

Key inclusions:

  • Diabetes management (excluding insulin pumps)
  • Bone, joint and muscle
  • Hernia and appendix
  • Chemo, radiotherapy and immunotherapy for cancer

Silver

A mid-level plan that gives young singles, couples and families, who want comprehensive cover without paying for services they don't need, like pregnancy and joint replacements.

Key inclusions:

  • Heart and vascular system
  • Podiatric surgery
  • Lung and chest
  • Plastic and reconstructive surgery (medically necessary)

Silver Plus

A higher level of cover that includes everything except obstetrics and psychiatric services in a private hospital.

Useful for older Australians who don't want to pay for pregnancy-related items in their top tier cover.

Key inclusions:

  • Joint replacements
  • Cataracts
  • Dialysis for chronic kidney failure
  • Insulin pumps

Gold

Peoplecare's top level of cover with no exclusions and no excess for kids.

Cover includes pregnancy and birth services, so this plan is suitable if you're starting or growing your family.

Key inclusions:

  • Pregnancy and birth
  • Assisted reproductive services
  • Weight loss surgery
  • Hospital psychiatric services

Ambulance Cover

Emergency ambulance cover is included on all hospital policies after a one-day waiting period.

This includes land, sea and air ambulance with no annual limits.

Extras cover

Extras insurance helps cover the bills for routine treatments with rebates of up to 100% and covers out-of-hospital treatments such as dental, optical, to chiro and more.

While we've summarised the key points of each plan below, it's always worth digging a little deeper into any gap fees, how much you can claim back, and whether your preferred healthcare provider, such as your local dentist, has an agreement with the health fund.

Take the time to work out what you need and what you're prepared to pay.

If this feels a bit overwhelming, you can speak to one of our experts who can talk you through what's included in each extras policy.

Peoplecare offers four simple extras policies to suit a range of needs.

Simple Extras

A budget plan designed for the young and healthy, with up to 50% back on general dental and several other services, with up to 100% on optical.

Some services have set benefits.

Mid Extras

Claim 60% back on a range of services including general and major dental.

Up to 100% back on optical.

Some services have set benefits.

High Extras

Comprehensive cover that gives you up to 70% back on most covered services.

Up to 100% back on optical.

Allows hearing aids every three years.

Premium Extras

Top level cover with 80% back on many services, with the highest annual limits for you and your family.

Up to 100% back on optical.

Some services have set benefits.

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Waiting periods

To stop people signing up, claiming, then cancelling their health insurance, all insurers apply waiting periods.

Generally, the more expensive the treatment, the longer you'll wait.

But keep an eye out for special deals with waiting periods reduced or waived.

Basic Plus Bronze Silver Silver Plus

  • 1 day -- ambulance
  • 2 months -- rehabilitation, psychiatric and palliative care (including where the condition is pre-existing)
  • 2 months -- all other hospital treatments
  • 12 months -- all other pre-existing conditions

Gold

  • 1 day -- ambulance
  • 2 months -- rehabilitation, psychiatric and palliative care (including where the condition is pre-existing)
  • 2 months -- all other hospital treatments
  • 12 months -- all other pre-existing conditions
  • 12 months -- pregnancy and birth

Member benefits

Members can get discounts at a range of retailers, across a large number of dentists, optical retailers.

They also offer travel insurance discounts.

Peoplecare members living in Wollongong, NSW can also get discounts at the city's Peoplecare Eyes and Teeth clinic.

How to claim

Claim on the spot through the HICAPS payment system at your provider.

You can also claim through Peoplecare's Larry app or the Online Member Services hub.

You can also email or post your claim form.

Hospital agreements

Peoplecare has agreements with most private hospitals and day clinics across Australia.

When comparing policies, it's worth checking if your local hospitals and clinics are covered.

Our specialists at Compare Club can do this for you.

Customer service

Peoplecare received 2 complaints from 1 January to 30 March 2020.

That's 0.2% of complaints vs 0.5% market share, indicating customer service is excellent.

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FAQs

Is Peoplecare a not-for-profit fund?

Yes, Peoplecare is not-for-profit and part of the Members Health Fund Alliance.

Who can apply? Are there any restrictions?

There are no restrictions to join Peoplecare.

Is it easy to switch to Peoplecare?

Yes, you can sign up right now.

We’ll take care of the paperwork.

Do I need to re-serve waiting periods?

No, providing you transfer to Peoplecare within 30 days of leaving your old fund on an equivalent or lower level of cover.

Can I change my level of cover?

Yes, you can choose a lower or higher level of cover to suit your different life stages.

If you move to a higher level of cover, you will usually need to serve waiting periods on the extra services and/or higher benefits.

Do I get the government rebate?

For every dollar of private health insurance premiums, the Australian Government provides eligible Australians with a rebate of up to 33.4% (depending on your age and income).

Do I have to pay the Lifetime Health Cover loading?

If you're 31 or over, you usually need to pay 2% loading for each year you've gone without health cover since the 1st July following your 31st birthday.

You can find out more here.

When do extras reset?

Extras reset on 1 July each year.

What age are children covered up to?

Children are allowed to stay on a Peoplecare family policy up to the age of 21.

If they’re studying full time, dependents can be covered as a student under a family policy up to the age of 25.

Children must not be married or living in a de facto relationship.

Peoplecare also offers Family Plus Cover, a product that allows non-student children to stay on their parents’ policy until the age of 25 for an extra 30% premium.

How do I contact Peoplecare?

Visit www.peoplecare.com.au or call 1800 808 704

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This guide is opinion only and should not be taken as medical or financial advice. Check with a financial professional before making any decisions.