healthslips.com.au Policy Information

Phoenix Health Fund Limited

Gold Complete Hospital 500 & Top Extras

$414.76 / month

(Before Rebate, Discount & Loading)

Available in NSW & ACT

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: Only one person.

Policy ID: PWA/GTTA/NBMY10

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
Assisted reproductive services
Back, neck and spine
Blood
Bone, joint and muscle
Brain and nervous system
Breast surgery (medically necessary)
Cataracts
Chemotherapy, radiotherapy and immunotherapy for cancer
Dental surgery
Diabetes management (excluding insulin pumps)
Dialysis for chronic kidney failure
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
Insulin pumps
Joint reconstructions
Joint replacements
Kidney and bladder
Lung and chest
Male reproductive system
Miscarriage and termination of pregnancy
Pain management
Pain management with device
Palliative care
Plastic and reconstructive surgery (medically necessary)
Podiatric surgery (provided by a registered podiatric surgeon)
Pregnancy and birth
Rehabilitation
Skin
Sleep studies
Tonsils, adenoids and grommets
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 $500 per admission. This is limited to a maximum of $500 per person and $500 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
  • 12 months for pregnancy and birth (obstetrics)
  • 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

$450 per policy

combined limit for acupuncture, chiropractic, osteopathy & other services

  • Initial visit: $25
  • Subsequent visit: $25
Blood glucose monitors 2

$900 per policy

  • Per monitor: 80% of charge
Chiropractic 2

$450 per policy

combined limit for acupuncture, chiropractic, osteopathy & other services

  • Initial visit: $40
  • Subsequent visit: $30
Dietetics/dietary advice 2

$300 per policy

  • Initial visit: $60
  • Subsequent visit: $40
Endodontic 2

$800 per policy

  • Filling of one root canal: $170
Exercise physiology 2

$800 per policy

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

sub-limits apply

  • Initial visit: $40
  • Subsequent visit: $30
Eye therapy (orthoptics) 2

$500 per policy

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

sub-limits apply

  • Initial visit: $45
  • Subsequent visit: $44
General dental* 2

No annual limit

  • Fluoride treatment: $24
  • Scale & clean: $69
  • Periodic oral examination: $36.5
Health management / Healthy lifestyle 2

$150 per policy

  • Health management: 80% of charge
Hearing aids 12

$1,700 per policy

sub-limits apply

  • Hearing aid: $900
Home nursing 2

$500 per policy

sub-limits apply

  • Initial visit: $15
  • Subsequent visit: $15
Major dental 12

$2,000 per policy

sub-limits apply

  • Surgical tooth extraction: $160
  • Full crown veneered: $875
Non PBS pharmaceuticals 2

$500 per policy

combined limit for non pbs pharmaceuticals & vaccinations

  • Per eligible prescription: $70
Occupational therapy 2

$500 per policy

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

sub-limits apply

  • Initial visit: $60
  • Subsequent visit: $40
Optical 6

$310 per policy

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

$1,200 per policy

$2,400 lifetime limit

sub-limits apply

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

$400 per policy

combined limit for orthotics (podiatric orthoses) & podiatry

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

$450 per policy

combined limit for acupuncture, chiropractic, osteopathy & other services

  • Initial visit: $40
  • Subsequent visit: $30
Physiotherapy 2

$800 per policy

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

  • Initial visit: $50
  • Subsequent visit: $37
Podiatry 2

$400 per policy

combined limit for orthotics (podiatric orthoses) & podiatry

  • Initial visit: $44
  • Subsequent visit: $34
Psychology 2

$500 per policy

  • Initial visit: $75
  • Subsequent visit: $75
Remedial massage 2

$800 per policy

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

sub-limits apply

  • Initial visit: $32
  • Subsequent visit: $25
Speech therapy 2

$500 per policy

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

sub-limits apply

  • Initial visit: $85
  • Subsequent visit: $45
Vaccinations 2

$500 per policy

combined limit for non pbs pharmaceuticals & vaccinations

sub-limits apply

  • Per service: $70

Acupuncture

Waiting period:  2 months

Benefit limits per 12 months unless otherwise stated

{$450 per policy}

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

Examples of maximum benefits

{Initial visit: $25}

{Subsequent visit: $25}

Blood glucose monitors

Waiting period:  2 months

Benefit limits per 12 months unless otherwise stated

{$900 per policy}

Examples of maximum benefits

{Per monitor: 80% of charge}

Chiropractic

Waiting period:  2 months

Benefit limits per 12 months unless otherwise stated

{$450 per policy}

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

Examples of maximum benefits

{Initial visit: $40}

{Subsequent visit: $30}

Dietetics/dietary advice

Waiting period:  2 months

Benefit limits per 12 months unless otherwise stated

{$300 per policy}

Examples of maximum benefits

{Initial visit: $60}

{Subsequent visit: $40}

Endodontic

Waiting period:  2 months

Benefit limits per 12 months unless otherwise stated

{$800 per policy}

Examples of maximum benefits

{Filling of one root canal: $170}

Exercise physiology

Waiting period:  2 months

Benefit limits per 12 months unless otherwise stated

{$800 per policy}

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

{sub-limits apply}

Examples of maximum benefits

{Initial visit: $40}

{Subsequent visit: $30}

Eye therapy (orthoptics)

Waiting period:  2 months

Benefit limits per 12 months unless otherwise stated

{$500 per policy}

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

{sub-limits apply}

Examples of maximum benefits

{Initial visit: $45}

{Subsequent visit: $44}

General dental*

Waiting period:  2 months

Benefit limits per 12 months unless otherwise stated

{No annual limit}

Examples of maximum benefits

{Fluoride treatment: $24}

{Scale & clean: $69}

{Periodic oral examination: $36.5}

Health management / Healthy lifestyle

Waiting period:  2 months

Benefit limits per 12 months unless otherwise stated

{$150 per policy}

Examples of maximum benefits

{Health management: 80% of charge}

Hearing aids

Waiting period:  12 months

Benefit limits per 12 months unless otherwise stated

{$1,700 per policy}

{sub-limits apply}

Examples of maximum benefits

{Hearing aid: $900}

Home nursing

Waiting period:  2 months

Benefit limits per 12 months unless otherwise stated

{$500 per policy}

{sub-limits apply}

Examples of maximum benefits

{Initial visit: $15}

{Subsequent visit: $15}

Major dental

Waiting period:  12 months

Benefit limits per 12 months unless otherwise stated

{$2,000 per policy}

{sub-limits apply}

Examples of maximum benefits

{Surgical tooth extraction: $160}

{Full crown veneered: $875}

Non PBS pharmaceuticals

Waiting period:  2 months

Benefit limits per 12 months unless otherwise stated

{$500 per policy}

{combined limit for non pbs pharmaceuticals & vaccinations}

Examples of maximum benefits

{Per eligible prescription: $70}

Occupational therapy

Waiting period:  2 months

Benefit limits per 12 months unless otherwise stated

{$500 per policy}

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

{sub-limits apply}

Examples of maximum benefits

{Initial visit: $60}

{Subsequent visit: $40}

Optical

Waiting period:  6 months

Benefit limits per 12 months unless otherwise stated

{$310 per policy}

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

{$1,200 per policy}

{$2,400 lifetime limit}

{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

{$400 per policy}

{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

{$450 per policy}

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

Examples of maximum benefits

{Initial visit: $40}

{Subsequent visit: $30}

Physiotherapy

Waiting period:  2 months

Benefit limits per 12 months unless otherwise stated

{$800 per policy}

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

Examples of maximum benefits

{Initial visit: $50}

{Subsequent visit: $37}

Podiatry

Waiting period:  2 months

Benefit limits per 12 months unless otherwise stated

{$400 per policy}

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

Examples of maximum benefits

{Initial visit: $44}

{Subsequent visit: $34}

Psychology

Waiting period:  2 months

Benefit limits per 12 months unless otherwise stated

{$500 per policy}

Examples of maximum benefits

{Initial visit: $75}

{Subsequent visit: $75}

Remedial massage

Waiting period:  2 months

Benefit limits per 12 months unless otherwise stated

{$800 per policy}

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

{sub-limits apply}

Examples of maximum benefits

{Initial visit: $32}

{Subsequent visit: $25}

Speech therapy

Waiting period:  2 months

Benefit limits per 12 months unless otherwise stated

{$500 per policy}

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

{sub-limits apply}

Examples of maximum benefits

{Initial visit: $85}

{Subsequent visit: $45}

Vaccinations

Waiting period:  2 months

Benefit limits per 12 months unless otherwise stated

{$500 per policy}

{combined limit for non pbs pharmaceuticals & vaccinations}

{sub-limits apply}

Examples of maximum benefits

{Per service: $70}

**Overall Major Dental limit $2000, with Sub Limits of $1000 for Inlays, Onlays & Veneers; $1000 for Crowns & Bridges; $1000 for Implants and $1000 for Dentures. Orthodontics limit of $1200 per person per year, up to Lifetime Limit of $2400.

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

Ante-natal/Post-natal classes
Audiology
Chinese medicine

Ambulance cover

In NSW & ACT 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

Gold Complete Hospital 500 & Top Extras

$414.76 / month

(Before Rebate, Discount & Loading)

Available in NSW & ACT

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/GTTA/NBMY10

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