Private Health Information Statement - Combined policy

Bronze Plus Mid 250 & Mid Extras

Monthly Premium

$532.38 #

(before any rebate, loading or discount)

Covers one adult & dependants, including non-student dependants (2 or more people, only one of whom is an adult)

Available in NSW & ACT

Closed to new members

# 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 children, students up to and including the age of 24 and non-students up to and including the age of 24, 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 provides accident cover and benefits for travel or accommodation (outside of hospital) - check with your insurer for details.

This policy includes cover for

Hospital Cover Legend
BloodGastrointestinal endoscopyPain management
Bone, joint and muscleGynaecologyPlastic and reconstructive surgery (medically necessary)
Brain and nervous systemHeart and vascular systemPodiatric surgery (provided by a registered podiatric surgeon – limited benefits)
Breast surgery (medically necessary)Hernia and appendixSkin
Chemotherapy, radiotherapy and immunotherapy for cancerImplantation of hearing devicesSleep studies
Dental surgeryJoint reconstructionsTonsils, adenoids and grommets
Diabetes management (excluding insulin pumps)Kidney and bladderHospital psychiatric services
Digestive systemLung and chestPalliative care
Ear, nose and throatMale reproductive systemRehabilitation
Eye (not cataracts)Miscarriage and termination of pregnancy

This policy does not include cover for

Hospital Cover Legend
Assisted reproductive servicesDialysis for chronic kidney failurePain management with device
Back, neck and spineInsulin pumpsPregnancy and birth
CataractsJoint replacementsWeight 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 lets you find out more about the cost of specialist medical services.

General Treatment Cover

This health insurer does not operate a preferred provider scheme.

This policy includes General treatment (Extras) cover for

General treatment legend
Note, for items marked with an asterisk *: *100% benefit available on preventative dental services- includes items 012, 013, 111, 114, 115, 121, 161. Claimable once per appointment, up to twice per person per calendar year.
TreatmentWaiting period (months)Benefit limits (per 12 months unless otherwise stated)Examples of maximum benefits
General dental*2$1,500 per person
(combined limit for general dental, major dental, endodontic & orthodontic - Sub-limits apply)
Periodic oral examination - $32.85
Scale & clean - $62.10
Fluoride treatment - $21.60
Major dental*12Surgical tooth extraction - $144.00
Full crown veneered - $787.00
Endodontic*2Filling of one root canal - $153.00
Orthodontic*12Braces for upper & lower teeth, including removal plus fitting of retainer - 80% of charge
Optical6$200 per person
(combined limit for optical & other services)
Single vision lenses & frames - 80% of charge
Multi-focal lenses & frames - 80% of charge
Non PBS pharmaceuticals*2$250 per person
(combined limit for non pbs pharmaceuticals & vaccinations)
Per eligible prescription - $45.00
Physiotherapy2$400 per person
(combined limit for physiotherapy, remedial massage, exercise physiology & other services - Sub-limits apply)
Initial visit - $45.00
Subsequent visit - $33.30
Chiropractic2$400 per person
(combined limit for chiropractic, acupuncture, osteopathy & other services)
Initial visit - $36.00
Subsequent visit - $27.00
Podiatry2$200 per person
(combined limit for podiatry & orthotics (podiatric orthoses))
Initial visit - $39.60
Subsequent visit - $30.60
Acupuncture2Combined limit - see ChiropracticInitial visit - $22.50
Subsequent visit - $22.50
Remedial massage2Combined limit - see PhysiotherapyInitial visit - $25.00
Subsequent visit - $22.50
Blood glucose monitors2$150 per person
(combined limit for blood glucose monitors & other services)
Per monitor - 80% of charge
Exercise physiology2Combined limit - see PhysiotherapyInitial visit - $35.00
Subsequent visit - $27.00
Eye therapy (orthoptics)2$300 per person
(combined limit for eye therapy (orthoptics), occupational therapy & speech therapy - Sub-limits apply)
Initial visit - $40.50
Subsequent visit - $39.60
Health management / Healthy lifestyle2$100 per person
(combined limit for health management / healthy lifestyle & other services)
Health management - 80% of charge
Occupational therapy2Combined limit - see Eye therapy (orthoptics)Initial visit - $54.00
Subsequent visit - $36.00
Orthotics (podiatric orthoses)2Combined limit - see PodiatryOrthotics supply & fit - 80% of charge
Osteopathy2Combined limit - see ChiropracticInitial visit - $36.00
Subsequent visit - $27.00
Speech therapy2Combined limit - see Eye therapy (orthoptics)Initial visit - $76.50
Subsequent visit - $40.50
Vaccinations2Combined limit - see Non PBS pharmaceuticalsPer service - $45.00
**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

General treatment legend
Hearing aidsPsychologyOther treatments - check with your insurer

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/

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.