healthslips.com.au Policy Information

Phoenix Health Fund Limited

Silver Plus Advantage 250 & Everyday Extras 60

$534.72 / 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: 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/SEE6/WIYI1D

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 $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.

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
Acupuncture 2

$800 per person

combined limit for acupuncture, chiropractic, exercise physiology, osteopathy, physiotherapy & remedial massage

  • Initial visit: 60% of charge
  • Subsequent visit: 60% of charge
Blood glucose monitors 12

$600 per person

sub-limits apply

  • Per monitor: 60% of charge
Chiropractic 2

$800 per person

combined limit for acupuncture, chiropractic, exercise physiology, osteopathy, physiotherapy & remedial massage

sub-limits apply

  • Initial visit: 60% of charge
  • Subsequent visit: 60% of charge
Dietetics/dietary advice 2

$200 per person

combined limit for dietetics/dietary advice, health management / healthy lifestyle & other services

  • Initial visit: 60% of charge
  • Subsequent visit: 60% of charge
Endodontic 12

$800 per person

combined limit for endodontic & major dental

  • Filling of one root canal: 60% of charge
Exercise physiology 2

$800 per person

combined limit for acupuncture, chiropractic, exercise physiology, osteopathy, physiotherapy & remedial massage

sub-limits apply

  • Initial visit: 60% of charge
  • Subsequent visit: 60% of charge
Eye therapy (orthoptics) 2

$600 per person

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

sub-limits apply

  • Initial visit: 60% of charge
  • Subsequent visit: 60% of charge
General dental* 2

No annual limit

  • Fluoride treatment: 100% of charge
  • Scale & clean: 100% of charge
  • Periodic oral examination: 100% of charge
Health management / Healthy lifestyle 2

$200 per person

combined limit for dietetics/dietary advice, health management / healthy lifestyle & other services

  • Health management: 60% of charge
Major dental 12

$800 per person

combined limit for endodontic & major dental

  • Surgical tooth extraction: 60% of charge
  • Full crown veneered: 60% of charge
Non PBS pharmaceuticals 2

$250 per person

combined limit for non pbs pharmaceuticals & vaccinations

  • Per eligible prescription: 60% of charge
Occupational therapy 2

$600 per person

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

sub-limits apply

  • Initial visit: 60% of charge
  • Subsequent visit: 60% of charge
Optical 6

$260 per person

  • Multi-focal lenses & frames: 60% of charge
  • Single vision lenses & frames: 60% of charge
Orthodontic 12

$800 per person

$2,100 lifetime limit

  • Braces for upper & lower teeth, including removal plus fitting of retainer: 60% of charge
Orthotics (podiatric orthoses) 2

$300 per person

  • Orthotics supply & fit: 60% of charge
Osteopathy 2

$800 per person

combined limit for acupuncture, chiropractic, exercise physiology, osteopathy, physiotherapy & remedial massage

sub-limits apply

  • Initial visit: 60% of charge
  • Subsequent visit: 60% of charge
Physiotherapy 2

$800 per person

combined limit for acupuncture, chiropractic, exercise physiology, osteopathy, physiotherapy & remedial massage

sub-limits apply

  • Initial visit: 60% of charge
  • Subsequent visit: 60% of charge
Podiatry 2

$300 per person

  • Initial visit: 60% of charge
  • Subsequent visit: 60% of charge
Psychology 2

$600 per person

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

sub-limits apply

  • Initial visit: 60% of charge
  • Subsequent visit: 60% of charge
Remedial massage 2

$800 per person

combined limit for acupuncture, chiropractic, exercise physiology, osteopathy, physiotherapy & remedial massage

sub-limits apply

  • Initial visit: 60% of charge
  • Subsequent visit: 60% of charge
Speech therapy 2

$600 per person

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

sub-limits apply

  • Initial visit: 60% of charge
  • Subsequent visit: 60% of charge
Vaccinations 2

$250 per person

combined limit for non pbs pharmaceuticals & vaccinations

  • Per service: 60% of charge

Acupuncture

Waiting period:  2 months

Benefit limits per 12 months unless otherwise stated

{$800 per person}

{combined limit for acupuncture, chiropractic, exercise physiology, osteopathy, physiotherapy & remedial massage}

Examples of maximum benefits

{Initial visit: 60% of charge}

{Subsequent visit: 60% of charge}

Blood glucose monitors

Waiting period:  12 months

Benefit limits per 12 months unless otherwise stated

{$600 per person}

{sub-limits apply}

Examples of maximum benefits

{Per monitor: 60% of charge}

Chiropractic

Waiting period:  2 months

Benefit limits per 12 months unless otherwise stated

{$800 per person}

{combined limit for acupuncture, chiropractic, exercise physiology, osteopathy, physiotherapy & remedial massage}

{sub-limits apply}

Examples of maximum benefits

{Initial visit: 60% of charge}

{Subsequent visit: 60% of charge}

Dietetics/dietary advice

Waiting period:  2 months

Benefit limits per 12 months unless otherwise stated

{$200 per person}

{combined limit for dietetics/dietary advice, health management / healthy lifestyle & other services}

Examples of maximum benefits

{Initial visit: 60% of charge}

{Subsequent visit: 60% of charge}

Endodontic

Waiting period:  12 months

Benefit limits per 12 months unless otherwise stated

{$800 per person}

{combined limit for endodontic & major dental}

Examples of maximum benefits

{Filling of one root canal: 60% of charge}

Exercise physiology

Waiting period:  2 months

Benefit limits per 12 months unless otherwise stated

{$800 per person}

{combined limit for acupuncture, chiropractic, exercise physiology, osteopathy, physiotherapy & remedial massage}

{sub-limits apply}

Examples of maximum benefits

{Initial visit: 60% of charge}

{Subsequent visit: 60% of charge}

Eye therapy (orthoptics)

Waiting period:  2 months

Benefit limits per 12 months unless otherwise stated

{$600 per person}

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

{sub-limits apply}

Examples of maximum benefits

{Initial visit: 60% of charge}

{Subsequent visit: 60% of charge}

General dental*

Waiting period:  2 months

Benefit limits per 12 months unless otherwise stated

{No annual limit}

Examples of maximum benefits

{Fluoride treatment: 100% of charge}

{Scale & clean: 100% of charge}

{Periodic oral examination: 100% of charge}

Health management / Healthy lifestyle

Waiting period:  2 months

Benefit limits per 12 months unless otherwise stated

{$200 per person}

{combined limit for dietetics/dietary advice, health management / healthy lifestyle & other services}

Examples of maximum benefits

{Health management: 60% of charge}

Major dental

Waiting period:  12 months

Benefit limits per 12 months unless otherwise stated

{$800 per person}

{combined limit for endodontic & major dental}

Examples of maximum benefits

{Surgical tooth extraction: 60% of charge}

{Full crown veneered: 60% of charge}

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: 60% of charge}

Occupational therapy

Waiting period:  2 months

Benefit limits per 12 months unless otherwise stated

{$600 per person}

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

{sub-limits apply}

Examples of maximum benefits

{Initial visit: 60% of charge}

{Subsequent visit: 60% of charge}

Optical

Waiting period:  6 months

Benefit limits per 12 months unless otherwise stated

{$260 per person}

Examples of maximum benefits

{Multi-focal lenses & frames: 60% of charge}

{Single vision lenses & frames: 60% of charge}

Orthodontic

Waiting period:  12 months

Benefit limits per 12 months unless otherwise stated

{$800 per person}

{$2,100 lifetime limit}

Examples of maximum benefits

{Braces for upper & lower teeth, including removal plus fitting of retainer: 60% of charge}

Orthotics (podiatric orthoses)

Waiting period:  2 months

Benefit limits per 12 months unless otherwise stated

{$300 per person}

Examples of maximum benefits

{Orthotics supply & fit: 60% of charge}

Osteopathy

Waiting period:  2 months

Benefit limits per 12 months unless otherwise stated

{$800 per person}

{combined limit for acupuncture, chiropractic, exercise physiology, osteopathy, physiotherapy & remedial massage}

{sub-limits apply}

Examples of maximum benefits

{Initial visit: 60% of charge}

{Subsequent visit: 60% of charge}

Physiotherapy

Waiting period:  2 months

Benefit limits per 12 months unless otherwise stated

{$800 per person}

{combined limit for acupuncture, chiropractic, exercise physiology, osteopathy, physiotherapy & remedial massage}

{sub-limits apply}

Examples of maximum benefits

{Initial visit: 60% of charge}

{Subsequent visit: 60% of charge}

Podiatry

Waiting period:  2 months

Benefit limits per 12 months unless otherwise stated

{$300 per person}

Examples of maximum benefits

{Initial visit: 60% of charge}

{Subsequent visit: 60% of charge}

Psychology

Waiting period:  2 months

Benefit limits per 12 months unless otherwise stated

{$600 per person}

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

{sub-limits apply}

Examples of maximum benefits

{Initial visit: 60% of charge}

{Subsequent visit: 60% of charge}

Remedial massage

Waiting period:  2 months

Benefit limits per 12 months unless otherwise stated

{$800 per person}

{combined limit for acupuncture, chiropractic, exercise physiology, osteopathy, physiotherapy & remedial massage}

{sub-limits apply}

Examples of maximum benefits

{Initial visit: 60% of charge}

{Subsequent visit: 60% of charge}

Speech therapy

Waiting period:  2 months

Benefit limits per 12 months unless otherwise stated

{$600 per person}

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

{sub-limits apply}

Examples of maximum benefits

{Initial visit: 60% of charge}

{Subsequent visit: 60% of charge}

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: 60% of charge}

*$400 sublimit for Physiotherapy/ Myotherapy & Exercise Physiology; $400 sublimit for Chiropractic, Osteopathy, Remedial Massage & Acupuncture; up to overall combined limit of $800. *$200 sublimit per modality for Mental Health (including Psychology & Counselling), Speech Therapy, Eye Therapy, Occupational Therapy; up to overall combined limit of $600. *Aids to Recovery (including Blood Glucose monitors) have a sublimit of $200 per item, up to overall limit of $600 every 2 years. *Non PBS Pharmacy benefit applies after PBS co-payment applied.

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

Ante-natal/Post-natal classes
Audiology
Chinese medicine
Hearing aids
Home nursing

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 & Everyday Extras 60

$534.72 / 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/SEE6/WIYI1D

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