Healthy Lifestyle benefits come under Extras Cover and provide a benefit towards approved services and programs designed to manage a specific health condition, as recommended by a doctor or health professional.
Healthy Lifestyle benefits fall under 3 categories:
- Health Education
- Health Screenings
- Health Management
We go into more detail about those categories in the next sections of this guide.
Benefits are payable towards the following approved education courses and programs:
- Benefits available for the following Quit smoking courses
Quit Smoking
Smokenders
No benefits are payable towards laser therapy or on consumables provided as part of a program.
- Benefits available for the following Weight management programs
Weight Watchers
CSIRO (no benefits available towards the refund program)
Interval Weight Loss
Benefits are not available towards health, fitness or weight loss apps. No benefits are payable towards laser therapy for weight loss, food, supplements or consumables.
- Asthma management
Benefits are available towards programs provided by organisations associated with the Asthma Foundation or an accredited educator.
- Diabetes Education
Benefits are available towards programs provided by organisations associated with Diabetes Australia or providers registered with The Australian Diabetes Educators Association.
You can claim benefits towards diagnostic testing services where a Medicare benefit is not claimable
| Diagnostic Tests | ||
|---|---|---|
| Blood Pressure tests | Faecal Calprotectin | Pap Smear / Cervical Screen |
| Bone Density tests | Hearing tests (including Auditory Processing Disorder testing) | PET (Positron Emission Tomography) |
| Bowel Cancer test kits | Heart Calcium test | PSA (Prostate Specific Antigen) screen |
| Brain Mapping | MRI (Magnetic Resonance Imaging) | Removal of Sun Spot or Mole including Photodynamic Therapy |
| BRCA tests (Breast Cancer gene mutation testing) | Mammograms | Retinal Photography |
| Cervical Screenings | Mole Mapping / Skin Check | QuantiFERON (QFT) blood test |
| Cholesterol tests | OCT (Optical Coherence Tomography) | Ultrasound |
Are there tests or screenings I can’t claim for?
There are certain diagnostic tests that are not eligible for a benefit, they include:
- Any test or screening that attracts a Medicare benefit
- Breath testing
- Drug testing
- Medical Exams – for insurance, super, employment etc
- Preparation kits – for pre-colonoscopy, gastroscopy etc
- Vitamin K testing
- X-Rays
- Platelet Rich Plasma Treatment (PRP injection)
- Scans used for non-diagnostic purposes – for exercise guidance etc
- Any scans done by an Allied Health professional who has used a diagnostic testing device they are not accredited to use.
Benefits are payable towards approved programs that have been designed and recommended by your health care professional, to manage a chronic health condition like asthma, joint conditions or weight management.
To claim a Health Management benefit, a Healthy lifestyle Treatment Plan must be completed by your treating Health Professional, outlining the program they’ve recommended and the condition it will be treating. (Find out more about a Healthy Lifestyle Treatment Plan Section 2.4
What kind of programs are covered under Health Management benefits?
Health Management benefits are available towards:
Gym and Fitness memberships
For us to pay a benefit towards a gym and fitness memberships, the provider must:
- Have an active membership and association with AUSactive (previously known as Fitness Australia), FITREC, Physical Activity Australia (PAA) or The Health and Fitness Association of Australia (HFAA);
- Follow the National Fitness Industry Code of Practice;
- Have qualified professionals providing the services; and
- Offer membership-based services.
To find out if your gym or personal trainer is registered, click on their websites linked above, or get in touch with the Phoenix Health team for more information.
Swimming classes at an AUSTSWIM or Swim Australia swim centre
A Healthy Lifestyle Treatment Plan must be completed by your treating Health Professional (GP, physio, dietician) and submitted to Phoenix Health with your claim for benefits. This form outlines the details about the program they’ve recommended and what condition it’s been designed to treat.
Why do I need a Healthy Lifestyle Treatment Plan?
Health fund benefits are only available to treat a medical condition – they’re not available for general health and wellbeing. A Healthy Lifestyle Treatment Plan outlines why you need to undertake a Health Management Program, so we can make sure you meet the necessary requirements so we can pay a benefit.
Who can fill the Healthy Lifestyle Treatment Plan for me?
Your Treatment Plan needs to be completed by the treating health professional that has recommended your program. This can include your GP, physiotherapist or dietician.
I’ve already paid for my gym membership, but I haven’t got a Healthy Lifestyle Treatment Plan… can it be backdated so I can claim a benefit?
No, unfortunately you need to have a current Healthy Lifestyle Treatment Plan in place at the date you’ve paid for your service. We’re unable to backdate your Healthy Lifestyle Treatment Plan, so any treatments you’ve received prior to your Doctor completing your Treatment Plan will not be eligible for a benefit.
How long does my Healthy Lifestyle Treatment Plan last?
Phoenix Health require an updated Healthy Lifestyle Treatment Plan to be submitted and assessed every 12 months.
There is a 2-month waiting period before you’re able to claim Healthy Lifestyle benefits.
For more information about waiting periods, click here.
Healthy Lifestyle benefits are available on select levels of Phoenix Health Extras and vary depending on your cover. You can check your level of cover and the benefits available by logging into your Online Member Services and viewing your Product Information Sheet – if you’re not sure, get in touch with the Phoenix Health team – we’d be happy to help!
Healthy Lifestyle benefits and limits are claimable per person per calendar year.
Want to know if you can claim for a particular treatment or service? Want to check if a provider is registered for benefits with Phoenix Health? Get in touch with a member of the Phoenix Health team and we can answer any questions you have.
To claim Healthy Lifestyle benefits, you’ll need to get your treating health professional to complete a Phoenix Health Healthy Lifestyle Treatment form, which details the program they’ve recommended for you, and the condition the program is designed to treat.
You’ll need to submit your Healthy Lifestyle Treatment form with a copy of your itemised invoice for the treatment or service by the following:
- Phoenix Health App or Online Member Services
- Phoenix Health claim form, emailed to [email protected] or post to PO Box 156 Newcastle NSW 2300
As with any Extras claim, if you’re submitting your claim to us via the Phoenix Health App or Online Member Services, you’ll need to provide us with a copy of the itemised invoice for your treatment that includes the following information:
- Details of who received the treatment
- Details of the provider, including their provider number
- The date of service
- The item numbers for each service provided
- The fee for each item number charged
If you submit your claim to us manually, you’ll also need to complete a Phoenix Health Claim form to accompany your invoice.
