(before any rebate, loading or discount)
Covers 2 adults (and no-one else)
Available in Western Australia
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, an age-based discount or an insurer discount. Check with your insurer for details.
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.
| Blood | Eye (not cataracts) | Miscarriage and termination of pregnancy |
| Bone, joint and muscle | Gastrointestinal endoscopy | Pain management |
| Brain and nervous system | Gynaecology | Plastic and reconstructive surgery (medically necessary) |
| Breast surgery (medically necessary) | Heart and vascular system | Skin |
| Chemotherapy, radiotherapy and immunotherapy for cancer | Hernia and appendix | Tonsils, adenoids and grommets |
| Dental surgery | Joint reconstructions | Hospital psychiatric services |
| Diabetes management (excluding insulin pumps) | Kidney and bladder | Palliative care |
| Digestive system | Lung and chest | Rehabilitation |
| Ear, nose and throat | Male reproductive system |
| Assisted reproductive services | Implantation of hearing devices | Podiatric surgery (provided by a registered podiatric surgeon – limited benefits) |
| Back, neck and spine | Insulin pumps | Pregnancy and birth |
| Cataracts | Joint replacements | Sleep studies |
| Dialysis for chronic kidney failure | Pain management with device | 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.
Excess: You will have to pay an excess of $750 per admission. This is limited to a maximum of $750 per person and $1500 per policy per year.
Co-payments: No co-payments
Waiting periods:
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.
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.
This health insurer does not operate a preferred provider scheme.
| 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 up to General Dental limits. | |||
|---|---|---|---|
| Treatment | Waiting period (months) | Benefit limits (per 12 months unless otherwise stated) | Examples of maximum benefits |
| General dental* | 2 | $700 per person | Periodic oral examination - 100% of charge Scale & clean - 100% of charge Fluoride treatment - 100% of charge |
| Major dental | 12 | $700 per person (combined limit for major dental, endodontic, optical, physiotherapy, chiropractic, podiatry & remedial massage - Sub-limits apply) | Surgical tooth extraction - 50% of charge Full crown veneered - 50% of charge |
| Endodontic | 12 | Filling of one root canal - 50% of charge | |
| Optical | 6 | Single vision lenses & frames - 50% of charge Multi-focal lenses & frames - 50% of charge | |
| Physiotherapy | 2 | Initial visit - 50% of charge Subsequent visit - 50% of charge | |
| Chiropractic | 2 | Initial visit - 50% of charge Subsequent visit - 50% of charge | |
| Podiatry | 2 | Initial visit - 50% of charge Subsequent visit - 50% of charge | |
| Remedial massage | 2 | Initial visit - 50% of charge Subsequent visit - 50% of charge | |
| $700 General Dental limit. $700 Flex Limit combined for Major Dental, Endodontics, Optical ($200 sublimit), Physiotherapy, Chiropractic, Podiatry, Remedial Massage ($200 sublimit). | |||
| Acupuncture | Non PBS pharmaceuticals | Other treatments - check with your insurer |
| Blood glucose monitors | Orthodontic | |
| Hearing aids | Psychology |
In Western Australia 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.
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.
For information on what is covered under each category, see https://www.privatehealth.gov.au/categories
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.
These categories are not covered by this policy.