Phoenix Health Extras
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Extras, or General Treatment cover, provides benefits towards services to help cover the cost of looking after your everyday health, where there is no Medicare rebate available.
Extras cover services like dental, optical and physiotherapy – things that keep you healthy on a day to day basis.
The services that you can claim will depend on the level of Extras cover, so it is important that you choose a cover that will suit your needs.
For details specific to each level of cover, see the relevant product information sheet. Please read these in conjunction with the Phoenix Health Member Guide.
Everyday Extras 60 and Healthy Flex Extras 50 are only available for purchase when you combine them with a Phoenix Health Hospital Cover, to create your own packaged cover.
|Everyday Extras 60*||Kick Start Extras 50||Healthy Flex 50*|
|Gap Free Dental||✓||✓||✓|
|Major Dental/ Endodontics||✓||x||✓|
|Mental Health (including Psychology & Counselling)||✓||x||x|
|Aids to Recovery||✓||x||x|
Where a service is covered on the level of cover.
Where a service is excluded and not covered on the level of cover.
*Everyday Extras 60 and Healthy Flex Extras 50 are only available for purchase when combined with Phoenix Health Hospital Cover.
This is a snapshot of the services covered on each level of Extras cover, refer to the Product Information Statement and Phoenix Member Guide for specific cover and benefit information.
*100% benefits payable for comprehensive oral examination (item 011), periodic oral examination (012), oral examination – limited (item 013), removal of plaque and/or stain (item 111), removal of calculus – first appointment (item 114), removal of calculus – subsequent appointment (item 115), topical application of remineralisation and/or cariostatic agents, one treatment (item 121) and fissure and/or tooth surface sealing – per tooth (item 161).
Claimable once per appointment, up to twice per person per calendar year. Limits and exclusions apply, please refer to Cover Information sheet for specific product information and eligibility. Any additional treatments will be payable according to your level of cover.
We understand that some things in life just happen, and we want to give you assurance that you are covered when you need it. That’s why, on all our Extras, we provide cover for emergency and non-emergency Ambulance services. So, you know we’ve got you covered for all medically necessary Ambulance treatments and transports, by road, sea and air. Limits do vary depending on your level of cover, so make sure you check the individual Cover Information sheets for more details.
Where you are covered in your State by an emergency services levy, the ambulance account must be submitted for payment through this source.
Love your Provider
Do you love your current physio, dentist or health professional? At Phoenix Health we believe that the choice is yours, that is why when you take Extras cover you get the same great benefits at the provider of your choice – we don’t lock you into any preferred provider schemes.
Imagine not having to change health professionals just so you can receive a better benefit – imagine having no-gap dental* services available with your own dentist!
Is there anything I cannot claim?
There are some instances where a benefit is not payable under your General Treatment cover, these include:
- where a service attracts a Medicare benefit
- where treatment is received outside of Australia
- where a treatment is received while admitted in hospital
- towards experimental treatments or clinical trials
- where the service was provided free of charge
- where a service is provided over the phone or online
- where a treatment is provided by a family member/relative or business partner
- where a provider is not registered
- where multiple services are rendered on the same day by the same provider for the same condition (benefits will only be payable towards the first service)
Benefits are not claimable when:
- you have not served the relevant waiting period
- where you have reached your limits
- where you are not covered on your membership for a specific treatment or service
- where you have not provided supporting documentation where relevant
- your membership payments are in arrears
- where a service or treatment can be claimed through a third party
How do I claim?
At Phoenix Health, we make claiming easy!
The quickest and easiest way to claim your Extras services is to carry your Phoenix Health member card with you and swipe it at the time of your treatment. Then all you need to do is pay the difference… if there is one!
If you don’t use your member card to claim benefits on-the-spot you can submit your claim via:
- The Phoenix Health mobile claiming app – register or log in, take a photo of your invoice and submit.
- Filling in a Claim Form. Download a Claim Form our website and send the completed form with a copy of your invoice to:
Email: [email protected]
Post: PO Box 156 Newcastle NSW 2300
What do I need to provide when I claim?
When submitting a claim to us, we will need you to complete a Phoenix Health Claim Form and provide following information:
- your itemised invoice and/or receipt showing the date of service, who the service was for, the item number(s) and what service was provided,
- your Phoenix Health membership number,
- the details of the service provider and
- whether or not the account has been paid.
How do I receive my benefit?
Benefits are paid into your nominated bank account. Simply register your details online via the Online Member Services (OMS) if you haven’t already. Claims generally take 3-5 business days to be processed and credited into your bank account with confirmation of the payment.
Claims must be submitted and assessed within 2 years of the date of service. Claims older than 2 years are not payable.
When processed, benefits will apply to; and are deducted from the yearly limits of the year in which the service was received.
I've reached my limits. When can I claim again?
At Phoenix Health, Extras limits run on the calendar year, with most Extras benefits refreshing on 1 January each year.
There are some benefits like Aids to Recovery and Hearing Aids that only become available every 2 or 3 years, so make sure you refer to your Product Information Statement for more details. You can also check your personal available limits in the Phoenix Health App or by logging into your Online Member Service (OMS) Portal.
Can I visit a Provider of my choice?
At Phoenix Health, your preferred provider is ours too!
When it comes to our health, who treats us is a personal decision. So instead of locking you into a preferred provider network, you’re free to be treated by any registered provider you choose and still get the same great benefits.
If you’re unsure if your chosen provider is registered or not, get in touch and we can let you know!
Waiting Periods for Extras
What is a Waiting Period?
A waiting period is the time you’ll need to wait before you can claim a benefit on your membership, and will apply whether you’re taking out private health insurance for the first time, switching to Phoenix Health from another fund, or you’re a current Phoenix Health member changing your level of cover.
Click here for everything you need to know about Waiting Periods, including what happens if you’re new to private health insurance, transferring from another fund or you’re already a Phoenix Health member.
What are the Waiting Periods for Extras?
|Major Dental, Orthodontics, Hearing Aids and Aids to Recovery||12 months|
|All other Extras services||2 months|
For all the information you need to know about Waiting Periods, including what happens if you’re new to private health insurance, transferring from another fund or a current Phoenix Health member changing your level of cover, click here.
Looking for information about Hospital Cover? Click here.