YoungSavers for Singles and Families

Phoenix YoungSavers offers affordable, great value private health insurance cover to meet the needs of singles and families who do not need full cover.

YoungSavers provides a combination of private and public hospital and medical cover, as well as a wide range of ancillary benefits covering the majority of services required by younger people.

YoungSavers offers restricted cover for obstetrics and assisted reproductive services, so if you are planning to have children you should consider Phoenix Top Cover.

It is important to note that YoungSavers cover also restricts benefits for a number of hospital, medical and general treatment (ancillary) services not usually required by younger people, eg heart surgery, joint replacements, cataract and major eye surgery, and other services. Please carefully read the Restricted Services section below as it contains important information about what these restrictions are.

Minimal private hospital cover is provided for restricted services. If you are admitted to a private hospital requiring treatment for any of these restricted services you will have large out-of-pocket expenses.

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Hospital Cover

Non-Restricted Services

For hospital services other than Restricted Services (which are listed in the next section), Phoenix YoungSavers provides:

• 100% cover for private and public hospital services nationwide (after the up-front excess has been paid) with access to an extensive range of quality services and approved programs in private hospitals which have an agreement with Phoenix Health Fund.
• Phoenix Health Fund has agreements with the vast majority of private hospitals in all states and territories of Australia. To check whether your hospital you are planning on attending has an agreement with us, use our Hospital Search facility or refer to our 100% Hospital List.
• Additional costs you may incur are:
  • the amount the doctor charges above the Medicare schedule fee or “Access Gap” cover amount
  • some drugs, pharmacy items and non-PBS drugs for personal use or on discharge; and possibly
  • a co-payment for prostheses devices above the minimum benefit.
• There are a small number of public hospitals that do not have agreements with us. In these cases a personal payment may apply.
• Apart from the Restricted Services below, there are no treatment exclusions on services eligible for Medicare benefits.

Restricted Services

Service Category

Benefit Rules

Psychiatric Rehabilitation Cardiac, Cardio-Thoracic and Vascular surgery Major eye surgery, cataract/IOL surgery Joint replacements Obstetrics Assisted reproductive services e.g. IVF/GIFT etc. Dialysis Palliative care Limited hospital benefits for Podiatric surgeons Palliative care

In public hospitals, full cover for accommodation only in a shared ward as a private patient In private hospitals, accommodation benefits payable are in accordance with the relevant default benefits as determined by the Commonwealth Government, resulting in the member having a large out-of-pocket expense. No benefit for private hospital theatre fees, facility fees or labour ward Only Commonwealth Government approved prostheses are covered

Service & Hospital Comparison

	Non-Restricted Services		Restricted Services
Service Type	Private Hospital	Public Hospital	Private Hospital	Public Hospital
Hospital Bed - shared or private room (if available)			Minimum Benefits	(shared)
Same Day Patient			Minimum Benefits
Intensive Care			Minimum Benefits
Labour Ward
Theatre Fees
Access Gap Cover
Surgical Prostheses	Commonwealth Government approved prostheses only		Commonwealth Government approved prostheses only
Australia-Wide Coverage			Minimum Benefits
Overnight Excess	$500		$500
Day Surgery Excess	$250 per admission		$250 per admission
Annual Excess Maximum	$500 per person $1000 per family membership		$500 per person $1000 per family membership
Co-Payments	No		No

Excess

If you are admitted to a hospital you will pay an up-front excess of hospital costs until you have reached your excess maximum of $500 per person within a calendar year (1st January through to 31st December).

The excess is applied as follows:

• The full $500 excess is payable on the first overnight admission (private or public hospital), and
• A $250 up-front excess is payable on any day surgery admissions (private or public hospital).
• Maximum excess per family membership is $1000.

Medical Gap Cover

Phoenix Health Fund, as a member of the Australian Health Service Alliance, has “Access Gap” arrangements with more than 15,000 doctors Australia-wide. These arrangements minimise or eliminate members’ out-of-pocket expenses when our members are treated as admitted hospital patients.

If your doctor participates in the “Access Gap” scheme, you will either have no out-of-pocket expenses to pay or will know exactly how much you will have to pay before treatment begins. Your doctor can bill Phoenix Health Fund direct, so in most cases you will not be required to lodge a claim with us, making it easier for you.

To check whether your doctor participates in “Access Gap”, use our Doctor Search facility, or ask your doctor. If your doctor does not participate, refer them to our Access Gap Cover brochure.

General Treatment (Ancillary) Cover

Benefit and limit amounts are effective from 1^st April 2010. Limits are per person.

Dental	Benefit	Annual Limit	Exclusions
Cover for all dental items	Set benefits per service. Obtain ADA item numbers from your dentist and contact our office for more details.	$800	Singles: Orthodontia treatment excluded
Optical	Benefit	Annual Limit	Exclusions
Contact Lenses    Hard    Soft	$230 $230	$230	Sunglasses, where no sight correction is necessary
Frames Lenses    Stock supply, single-sighted    Specially ground, single-sighted    Bi-focal    Multi-focal    Repair	$95 $95 $105 $125 $175 $60
Artificial Eyes	$500	$500
Your optometrist’s prescription must be submitted with your claim.
	Benefit	Annual Limit	Exclusions
Pharmacy (Prescriptions Only)	Maximum benefit after deducting PBS co-payment $70	$250	Items normally available over the counter Contraceptives
Chiropractic/Osteopathic Initial consultation Subsequent consultations Acupuncture	$33 $25 $25	$225
	Benefit	Annual Limit	Exclusions
Physiotherapy Initial consultation Subsequent consultations	$45 $34	$400
Orthoptic Therapy Initial consultation Subsequent consultations	$45 $44
Speech Therapy Initial consultation Subsequent consultations	$85 $45
Occupational Therapy Initial consultation Subsequent consultations	$60 $40
	Benefit	Annual Limit	Exclusions
Natural Therapy Remedial Massage Specific therapies and associations recognised	$20	$100	Services by providers who are not registered with the fund Medications supplied by provider
Podiatry Initial consultation Subsequent consultations Podiatric devices	$44 $34 80% cost	$200	Limited hospital benefits for podiatric surgeons
Aids & Appliances	You pay the first $20 and we pay a benefit of 80% of the remaining balance	$200
Psychology	$75	$250
Hypnotherapy	$50
Ambulance NSW & ACT residents are covered automatically. In other states the cost of joining your state’s Ambulance scheme is fully covered.		Single subscription	Cost of ambulance transport

Limits are per person and apply for a calendar year, which is 1st January to 31st December. Waiting periods may apply.

No benefits are payable by the fund when:

• A member is given treatment without charge.
• The services received are not recognised by the fund and are not provided by providers registered with the fund.
• The services are provided outside the Commonwealth of Australia.
• An entitlement exists or may exist under any compensation, third party or sports club insurance.
• A claim for a service is submitted more than 24 months after the date of service.
• A claim is submitted for optical appliances not requiring sight correction.
• Services are provided by family members or relatives.
• The claim is for goods and services that are deemed to be primarily for the purposes of sport, recreation or entertainment.
• The claim is for cosmetic surgery where Medicare does not pay a benefit.

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Fine print – general information