healthslips.com.au Policy Information

Phoenix Health Fund Limited

Silver Plus Advantage 250 & Base Extras

$628.45 / month

(Before Rebate, Discount & Loading)

Available in WA

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: Two adults & dependants, including non-student dependants (3 or more people, only 2 of whom are adults).

Children (0 - 17), non-classified* dependant (18 - 20), students (21 - 24) and non-students (21 to 24), as well as persons with a disability who qualify as a child, non-classified* dependant, student and non-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/SEBA/WDAY2Y

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
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)
Rehabilitation
Skin
Tonsils, adenoids and grommets

This policy does not include cover for

Assisted reproductive services
Pregnancy and birth
Sleep studies
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 $500 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.

Other features of this hospital cover

Phoenix Health Hospital Cover features include... *Access Gap – Where your Doctor agrees to participate in our Access Gap Program, you can eliminate or reduce your out-of-pocket costs that you may have otherwise incurred towards your hospital procedure. *Hospital Care Programs – supporting you beyond a hospitalisation, you have access to programs designed to support your health and wellbeing before and after a hospital admission. *Full Ambulance Cover – medically required emergency and non-emergency Ambulance treatment and transport is covered on all of our Hospital Covers, Australia-wide.

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
Chiropractic 2

$250 per person

combined limit for chiropractic & osteopathy

  • Initial visit: $32
  • Subsequent visit: $24
General dental 2

$500 per person

  • Fluoride treatment: $19.2
  • Scale & clean: $55.2
  • Periodic oral examination: $29.2
Non PBS pharmaceuticals 2

$200 per person

  • Per eligible prescription: $30
Optical 6

$150 per person

  • Multi-focal lenses & frames: $80
  • Single vision lenses & frames: 80% of charge
Osteopathy* 2

$250 per person

combined limit for chiropractic & osteopathy

  • Initial visit: $32
  • Subsequent visit: $24
Physiotherapy 2

$250 per person

  • Initial visit: $40
  • Subsequent visit: $29.6

Chiropractic

Waiting period:  2 months

Benefit limits per 12 months unless otherwise stated

{$250 per person}

{combined limit for chiropractic & osteopathy}

Examples of maximum benefits

{Initial visit: $32}

{Subsequent visit: $24}

General dental

Waiting period:  2 months

Benefit limits per 12 months unless otherwise stated

{$500 per person}

Examples of maximum benefits

{Fluoride treatment: $19.2}

{Scale & clean: $55.2}

{Periodic oral examination: $29.2}

Non PBS pharmaceuticals

Waiting period:  2 months

Benefit limits per 12 months unless otherwise stated

{$200 per person}

Examples of maximum benefits

{Per eligible prescription: $30}

Optical

Waiting period:  6 months

Benefit limits per 12 months unless otherwise stated

{$150 per person}

Examples of maximum benefits

{Multi-focal lenses & frames: $80}

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

Osteopathy*

Waiting period:  2 months

Benefit limits per 12 months unless otherwise stated

{$250 per person}

{combined limit for chiropractic & osteopathy}

Examples of maximum benefits

{Initial visit: $32}

{Subsequent visit: $24}

Physiotherapy

Waiting period:  2 months

Benefit limits per 12 months unless otherwise stated

{$250 per person}

Examples of maximum benefits

{Initial visit: $40}

{Subsequent visit: $29.6}

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

Acupuncture
Ante-natal/Post-natal classes
Audiology
Blood glucose monitors
Chinese medicine
Dietetics/dietary advice
Endodontic
Exercise physiology
Eye therapy (orthoptics)
Health management / Healthy lifestyle
Hearing aids
Home nursing
Major dental
Occupational therapy
Orthodontic
Orthotics (podiatric orthoses)
Podiatry
Psychology
Remedial massage
Speech therapy
Vaccinations

Ambulance cover

In WA 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

Silver Plus Advantage 250 & Base Extras

$628.45 / month

(Before Rebate, Discount & Loading)

Available in WA

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/SEBA/WDAY2Y

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