healthslips.com.au Policy Information

Phoenix Health Fund Limited

Bronze Plus Mid 250 & Mid Extras

$440.76 / month

(Before Rebate, Discount & Loading)

Available in SA

You may be entitled to an Australian Government Rebate on the above premium. Your premium may also include a Lifetime Health Cover Loading or an insurer discount. Check with your insurer for details.

This policy covers: One adult & dependants (2 or more people, only one of whom is an adult).

Children (0 - 17), non-classified* dependant (18 - 20) and students (21 - 24), as well as persons with a disability who qualify as a child, non-classified* dependant and student in these age ranges. *Non-classified dependant: Dependants can stay on your family policy at no extra cost until their 21st birthday.

Policy ID: PWA/BMMA/SDOY1D

Source: Private Health Information Statement (PHIS)

Hospital Cover

  • This policy exempts you from the Medicare Levy Surcharge.
  • This policy provides accident cover - check with insurer for details.
  • This policy provides benefits for travel or accommodation outside of hospital - check with insurer for details.
Covered
Restricted Cover
Not Covered
This policy includes cover for
Blood
Bone, joint and muscle
Brain and nervous system
Breast surgery (medically necessary)
Chemotherapy, radiotherapy and immunotherapy for cancer
Dental surgery
Diabetes management (excluding insulin pumps)
Digestive system
Ear, nose and throat
Eye (not cataracts)
Gastrointestinal endoscopy
Gynaecology
Heart and vascular system
Hernia and appendix
Hospital psychiatric services
Implantation of hearing devices
Joint reconstructions
Kidney and bladder
Lung and chest
Male reproductive system
Miscarriage and termination of pregnancy
Pain management
Palliative care
Plastic and reconstructive surgery (medically necessary)
Podiatric surgery (provided by a registered podiatric surgeon)
Rehabilitation
Skin
Sleep studies
Tonsils, adenoids and grommets

This policy does not include cover for

Assisted reproductive services
Back, neck and spine
Cataracts
Dialysis for chronic kidney failure
Insulin pumps
Joint replacements
Pain management with device
Pregnancy and birth
Weight loss surgery

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 of $250 per admission. This is limited to a maximum of $250 per person and $250 per policy per year.

Excess payments do not apply to hospital admissions for dependants.

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 (https://www.health.gov.au/resources/apps-and-tools/medical-costs-finder) lets you find out more about the cost of specialist medical services.

Extras Cover

This health insurer does not operate a preferred provider scheme.

This policy includes General treatment (Extras) cover for

Treatment & waiting period (months)
Benefit limits per 12 months unless otherwise stated
Examples of maximum benefits
Acupuncture 2

$400 per person

combined limit for acupuncture, chiropractic, osteopathy & other services

  • Initial visit: $22.5
  • Subsequent visit: $22.5
Blood glucose monitors 2

$150 per person

  • Per monitor: 80% of charge
Chiropractic 2

$400 per person

combined limit for acupuncture, chiropractic, osteopathy & other services

  • Initial visit: $36
  • Subsequent visit: $27
Endodontic* 2

$1,500 per person

combined limit for endodontic, general dental, major dental & orthodontic

sub-limits apply

  • Filling of one root canal: $153
Exercise physiology 2

$400 per person

combined limit for exercise physiology, physiotherapy, remedial massage & other services

sub-limits apply

  • Initial visit: $35
  • Subsequent visit: $27
Eye therapy (orthoptics) 2

$300 per person

combined limit for eye therapy (orthoptics), occupational therapy & speech therapy

sub-limits apply

  • Initial visit: $40.5
  • Subsequent visit: $39.6
General dental* 2

$1,500 per person

combined limit for endodontic, general dental, major dental & orthodontic

sub-limits apply

  • Fluoride treatment: $21.6
  • Scale & clean: $62.1
  • Periodic oral examination: $32.85
Health management / Healthy lifestyle 2

$100 per person

  • Health management: 80% of charge
Major dental* 12

$1,500 per person

combined limit for endodontic, general dental, major dental & orthodontic

sub-limits apply

  • Surgical tooth extraction: $144
  • Full crown veneered: $787
Non PBS pharmaceuticals* 2

$250 per person

combined limit for non pbs pharmaceuticals & vaccinations

  • Per eligible prescription: $45
Occupational therapy 2

$300 per person

combined limit for eye therapy (orthoptics), occupational therapy & speech therapy

sub-limits apply

  • Initial visit: $54
  • Subsequent visit: $36
Optical 6

$200 per person

  • Multi-focal lenses & frames: 80% of charge
  • Single vision lenses & frames: 80% of charge
Orthodontic* 12

$1,500 per person

combined limit for endodontic, general dental, major dental & orthodontic

sub-limits apply

  • Braces for upper & lower teeth, including removal plus fitting of retainer: 80% of charge
Orthotics (podiatric orthoses) 2

$200 per person

combined limit for orthotics (podiatric orthoses) & podiatry

  • Orthotics supply & fit: 80% of charge
Osteopathy 2

$400 per person

combined limit for acupuncture, chiropractic, osteopathy & other services

  • Initial visit: $36
  • Subsequent visit: $27
Physiotherapy 2

$400 per person

combined limit for exercise physiology, physiotherapy, remedial massage & other services

  • Initial visit: $45
  • Subsequent visit: $33.3
Podiatry 2

$200 per person

combined limit for orthotics (podiatric orthoses) & podiatry

  • Initial visit: $39.6
  • Subsequent visit: $30.6
Remedial massage 2

$400 per person

combined limit for exercise physiology, physiotherapy, remedial massage & other services

sub-limits apply

  • Initial visit: $25
  • Subsequent visit: $22.5
Speech therapy 2

$300 per person

combined limit for eye therapy (orthoptics), occupational therapy & speech therapy

sub-limits apply

  • Initial visit: $76.5
  • Subsequent visit: $40.5
Vaccinations 2

$250 per person

combined limit for non pbs pharmaceuticals & vaccinations

  • Per service: $45

Acupuncture

Waiting period:  2 months

Benefit limits per 12 months unless otherwise stated

{$400 per person}

{combined limit for acupuncture, chiropractic, osteopathy & other services}

Examples of maximum benefits

{Initial visit: $22.5}

{Subsequent visit: $22.5}

Blood glucose monitors

Waiting period:  2 months

Benefit limits per 12 months unless otherwise stated

{$150 per person}

Examples of maximum benefits

{Per monitor: 80% of charge}

Chiropractic

Waiting period:  2 months

Benefit limits per 12 months unless otherwise stated

{$400 per person}

{combined limit for acupuncture, chiropractic, osteopathy & other services}

Examples of maximum benefits

{Initial visit: $36}

{Subsequent visit: $27}

Endodontic*

Waiting period:  2 months

Benefit limits per 12 months unless otherwise stated

{$1,500 per person}

{combined limit for endodontic, general dental, major dental & orthodontic}

{sub-limits apply}

Examples of maximum benefits

{Filling of one root canal: $153}

Exercise physiology

Waiting period:  2 months

Benefit limits per 12 months unless otherwise stated

{$400 per person}

{combined limit for exercise physiology, physiotherapy, remedial massage & other services}

{sub-limits apply}

Examples of maximum benefits

{Initial visit: $35}

{Subsequent visit: $27}

Eye therapy (orthoptics)

Waiting period:  2 months

Benefit limits per 12 months unless otherwise stated

{$300 per person}

{combined limit for eye therapy (orthoptics), occupational therapy & speech therapy}

{sub-limits apply}

Examples of maximum benefits

{Initial visit: $40.5}

{Subsequent visit: $39.6}

General dental*

Waiting period:  2 months

Benefit limits per 12 months unless otherwise stated

{$1,500 per person}

{combined limit for endodontic, general dental, major dental & orthodontic}

{sub-limits apply}

Examples of maximum benefits

{Fluoride treatment: $21.6}

{Scale & clean: $62.1}

{Periodic oral examination: $32.85}

Health management / Healthy lifestyle

Waiting period:  2 months

Benefit limits per 12 months unless otherwise stated

{$100 per person}

Examples of maximum benefits

{Health management: 80% of charge}

Major dental*

Waiting period:  12 months

Benefit limits per 12 months unless otherwise stated

{$1,500 per person}

{combined limit for endodontic, general dental, major dental & orthodontic}

{sub-limits apply}

Examples of maximum benefits

{Surgical tooth extraction: $144}

{Full crown veneered: $787}

Non PBS pharmaceuticals*

Waiting period:  2 months

Benefit limits per 12 months unless otherwise stated

{$250 per person}

{combined limit for non pbs pharmaceuticals & vaccinations}

Examples of maximum benefits

{Per eligible prescription: $45}

Occupational therapy

Waiting period:  2 months

Benefit limits per 12 months unless otherwise stated

{$300 per person}

{combined limit for eye therapy (orthoptics), occupational therapy & speech therapy}

{sub-limits apply}

Examples of maximum benefits

{Initial visit: $54}

{Subsequent visit: $36}

Optical

Waiting period:  6 months

Benefit limits per 12 months unless otherwise stated

{$200 per person}

Examples of maximum benefits

{Multi-focal lenses & frames: 80% of charge}

{Single vision lenses & frames: 80% of charge}

Orthodontic*

Waiting period:  12 months

Benefit limits per 12 months unless otherwise stated

{$1,500 per person}

{combined limit for endodontic, general dental, major dental & orthodontic}

{sub-limits apply}

Examples of maximum benefits

{Braces for upper & lower teeth, including removal plus fitting of retainer: 80% of charge}

Orthotics (podiatric orthoses)

Waiting period:  2 months

Benefit limits per 12 months unless otherwise stated

{$200 per person}

{combined limit for orthotics (podiatric orthoses) & podiatry}

Examples of maximum benefits

{Orthotics supply & fit: 80% of charge}

Osteopathy

Waiting period:  2 months

Benefit limits per 12 months unless otherwise stated

{$400 per person}

{combined limit for acupuncture, chiropractic, osteopathy & other services}

Examples of maximum benefits

{Initial visit: $36}

{Subsequent visit: $27}

Physiotherapy

Waiting period:  2 months

Benefit limits per 12 months unless otherwise stated

{$400 per person}

{combined limit for exercise physiology, physiotherapy, remedial massage & other services}

Examples of maximum benefits

{Initial visit: $45}

{Subsequent visit: $33.3}

Podiatry

Waiting period:  2 months

Benefit limits per 12 months unless otherwise stated

{$200 per person}

{combined limit for orthotics (podiatric orthoses) & podiatry}

Examples of maximum benefits

{Initial visit: $39.6}

{Subsequent visit: $30.6}

Remedial massage

Waiting period:  2 months

Benefit limits per 12 months unless otherwise stated

{$400 per person}

{combined limit for exercise physiology, physiotherapy, remedial massage & other services}

{sub-limits apply}

Examples of maximum benefits

{Initial visit: $25}

{Subsequent visit: $22.5}

Speech therapy

Waiting period:  2 months

Benefit limits per 12 months unless otherwise stated

{$300 per person}

{combined limit for eye therapy (orthoptics), occupational therapy & speech therapy}

{sub-limits apply}

Examples of maximum benefits

{Initial visit: $76.5}

{Subsequent visit: $40.5}

Vaccinations

Waiting period:  2 months

Benefit limits per 12 months unless otherwise stated

{$250 per person}

{combined limit for non pbs pharmaceuticals & vaccinations}

Examples of maximum benefits

{Per service: $45}

**Overall Dental limit $1500 with Sub Limits of $1000 each on: Crowns & Bridges; Implants; Inlays, Onlays & Veneers. Lifetime Limit of $1000 on Orthodontics

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

Ante-natal/Post-natal classes
Audiology
Chinese medicine
Dietetics/dietary advice
Hearing aids
Home nursing
Psychology

Ambulance cover

In SA this policy provides:

Emergency: Unlimited with a waiting period of 1 day.

Non-emergency: Unlimited transport with a waiting period of 1 day, or 1 day for pre-existing conditions.

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

For further information about this policy see: https://phoenixhealthfund.com.au/covers-by-life-stage/

Insurer Details

Phoenix Health Fund Limited

Bronze Plus Mid 250 & Mid Extras

$440.76 / month

(Before Rebate, Discount & Loading)

Available in SA

Disclaimer: This document is not a Private Health Information Statement (PHIS), and it is not intended to replace that document. The details contained in the healthslips.com.au Policy Information was provided by the insurer to the Australian Government. It is intended as general information. It may not take into account your circumstances. For further information contact the insurer. Information used is Licensed from the Commonwealth of Australia under a Creative Commons 3.0 licence.Private Health Information Statement is available from the Private Health Insurance Ombudsman website at https://privatehealth.gov.au/dynamic/Premium/PHIS/PWA/BMMA/SDOY1D

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