Private Health Information Statement - Combined policy

Silver Plus Essentials Hospital $750 & Simple Extras

Monthly Premium

$565.15 #

(before any rebate, loading or discount)

Covers two adults & dependants, including non-student dependants (3 or more people, only 2 of whom are adults)

Available in Northern Territory

# You may be entitled to an Australian Government rebate on the above premium. Your premium may also include a Lifetime Health Cover loading, an age-based discount or an insurer discount. Check with your insurer for details.

This policy covers children, students up to and including the age of 30 and non-students up to and including the age of 30, as well as persons with a disability who qualify as a child, student or non-student in these age ranges.

Hospital cover

This policy exempts you from the Medicare Levy Surcharge.

This policy does not provide accident cover or benefits for travel and accommodation (outside of hospital).

This policy includes cover for

Hospital Cover Legend
Back, neck and spineEye (not cataracts)Miscarriage and termination of pregnancy
BloodGastrointestinal endoscopyPain management
Bone, joint and muscleGynaecologyPalliative care
Brain and nervous systemHeart and vascular systemPlastic and reconstructive surgery (medically necessary)
Breast surgery (medically necessary)Hernia and appendixPodiatric surgery (provided by a registered podiatric surgeon – limited benefits)
Chemotherapy, radiotherapy and immunotherapy for cancerImplantation of hearing devicesRehabilitation
Dental surgeryJoint reconstructionsSkin
Diabetes management (excluding insulin pumps)Kidney and bladderSleep studies
Digestive systemLung and chestTonsils, adenoids and grommets
Ear, nose and throatMale reproductive systemHospital psychiatric services

This policy does not include cover for

Hospital Cover Legend
Assisted reproductive servicesInsulin pumpsPregnancy and birth
CataractsJoint replacementsWeight loss surgery
Dialysis for chronic kidney failurePain management with device

The benefits paid for hospital treatment will depend on the type of cover you purchase and whether your fund has an agreement in place with the hospital in which you are treated. See ‘Agreement Hospitals’ on privatehealth.gov.au for which hospitals have arrangements with your insurer – https://privatehealth.gov.au/dynamic/agreementhospitals.

Under this policy, you may have to pay out-of-pocket costs above what you get from Medicare or your private health insurer. Before you go to hospital, you should ask your doctors, hospital and health insurer about any out-of-pocket costs that may apply to you.

The following payments may also apply for hospital admissions

Excess: You will have to pay an excess on admission. This is limited to a maximum of $750 per person and $1500 per policy per year.

Co-payments: No co-payments

The following waiting periods for hospital admissions apply to new or upgrading members

Waiting periods:

  • 2 months for palliative care, rehabilitation and hospital psychiatric treatments, even if pre-existing
  • 12 months for other pre-existing conditions
  • 2 months for all other treatments

Gap Cover

This provider offers 'known gap' or 'no gap' cover for medical bills for this product.

The Medical Costs Finder lets you find out more about the cost of specialist medical services.

Other features of this hospital cover

No waiting period applies for hospital treatment resulting from an accident.

For further information about this policy see

https://www.peoplecare.com.au/siteassets/documents/cd/oms/silver-plus-essentials-hospital---500-750-excess-simple-extras.pdf

General Treatment Cover

By using Peoplecare's 'preferred providers' you may have lower out of pocket costs on Dental and Optical treatments and have access to more 'no gap' treatments. A list of 'preferred providers' is available from Peoplecare. See https://peoplecare.com.au/Members/Providers/Other-health-providers.

This policy includes General treatment (Extras) cover for

General treatment legend
TreatmentWaiting period (months)Benefit limits (per 12 months unless otherwise stated)Examples of maximum benefits
General dental2$500 per personPeriodic oral examination - 50% of charge
Scale & clean - 50% of charge
Fluoride treatment - 50% of charge
Surgical tooth extraction - 50% of charge
Optical6$150 per personSingle vision lenses & frames - $150.00
Multi-focal lenses & frames - $150.00
Non PBS pharmaceuticals2$200 per person up to $400 per policy
(combined limit for non pbs pharmaceuticals & vaccinations - Sub-limits apply)
Per eligible prescription - $50.00
Physiotherapy2$300 per person up to $600 per policy
(combined limit for physiotherapy, exercise physiology, eye therapy (orthoptics), occupational therapy & other services)
Initial visit - $40.00
Subsequent visit - $40.00
Chiropractic2$300 per person up to $600 per policy
(combined limit for chiropractic & osteopathy)
Initial visit - $40.00
Subsequent visit - $40.00
Exercise physiology2Combined limit - see PhysiotherapyInitial visit - 50% of charge
Subsequent visit - 50% of charge
Eye therapy (orthoptics)2Combined limit - see PhysiotherapyInitial visit - $35.00
Subsequent visit - $25.00
Health management / Healthy lifestyle6$100 per person up to $200 per policyHealth management - 50% of charge
Occupational therapy2Combined limit - see PhysiotherapyInitial visit - $35.00
Subsequent visit - $25.00
Osteopathy2Combined limit - see ChiropracticInitial visit - $40.00
Subsequent visit - $40.00
Vaccinations2Combined limit - see Non PBS pharmaceuticalsPer service - $50.00

This policy does not include General treatment (Extras) cover for

General treatment legend
AcupunctureMajor dentalRemedial massage
Blood glucose monitorsOrthodonticOther treatments - check with your insurer
EndodonticPodiatry
Hearing aidsPsychology

For further information about this policy see

https://www.peoplecare.com.au/siteassets/documents/cd/oms/silver-plus-essentials-hospital---500-750-excess-simple-extras.pdf

Ambulance cover

In Northern Territory this policy provides:

Emergency: Unlimited with a waiting period of 1 day.

Non-emergency: Unlimited transport with a waiting period of 1 day.

Call-out fees: will be paid for each attendance, including emergency treatment without transport to hospital.

Other features of this ambulance cover

Unlimited Ambulance covers you Australia wide for land, sea and air transport.

For further information about this policy see

https://www.peoplecare.com.au/health-insurance/hospital-cover/ambulance

Disclaimer

The information contained in this Private Health Information Statement was provided by the insurer and is intended as general information. It may not take into account your particular circumstances. For information please contact the insurer.

Covered

For information on what is covered under each category, see https://www.privatehealth.gov.au/categories

Restricted

Restricted categories partially cover your hospital costs as a private patient in a public hospital. You may incur significant expenses in a private room or private hospital.

Not Covered

These categories are not covered by this policy.