General Information
This is the “fine print” page with necessary legal information. If any point is unclear, please call us for a human explanation.
1. Eligibility
Membership is open to all current and former employees, spouses and children of our associated steel industry companies. Immediate family members of current and former employees are also eligible to join.
2. Waiting Periods
| Months | Claim Category |
| NIL | Ambulance subscriptions for states other than NSW/ACT |
| NIL | Accidents |
| NIL |
Transfers from another fund or Phoenix Health Fund membership where all of the following occurs:
|
| 2 | On joining the fund or upgrading level of cover |
| 6 | Dental |
| 12 |
Pre-Existing Conditions: In respect of an ailment, condition or illness the signs or symptoms of which existed at any time during the six months preceding the day of joining or upgrading tables. For more details see general information on our website or contact our office. |
| 9 | Obstetrics (restricted services for YoungSavers) |
| 2 | Psychiatric, Rehabilitation and Palliative Care (restricted services for YoungSavers) |
In the first calendar year of membership, transferring members who have used all or part of their annual limits under their previous cover will only receive the difference between the Phoenix Health Fund limit for their level of cover and the amount already claimed. Members transferring from another cover that has benefit exclusions or lower limits compared to the chosen Phoenix Health Fund cover must serve the waiting periods listed above before they can claim more than the previous cover’s benefits or limits.
3. Continuation of Membership
Members leaving the employ of the company are encouraged to retain their membership. Refer to Payment of Contributions for alternative payment options.
4. Dependants
Dependants may remain in the fund in their own right after reaching the age of twenty-one (21) years. Members who have children who wish to join the fund should contact our office for further information.
Sons and daughters will still be covered as student dependants under their parents’ membership provided the following conditions are met:
- Unmarried
- A full time student at a school, college or university which is recognised for income tax purposes
- Is under the age of 25 years
- Is in receipt of an annual income not in excess of that which is recognised as the maximum annual income a person may derive before taxation becomes payable, and
- A Student Declaration form is submitted.
5. International Travel & Purchases
The Fund does not pay benefits for services provided outside the Commonwealth of Australia. Members should consider Travel Insurance for the period of overseas travel.
The Fund does not pay a benefit for any items purchased outside of the Commonwealth of Australia.
6. Exclusion Rules
- A contributor who is in arrears for a period of up to two months and pays all such arrears before the end of that period is entitled to benefits for services during that period.
- Fund benefits are not payable where a contributor or dependant has received or established a right to receive a payment by way of compensation or damages (including a payment in settlement of a claim for compensation or damages) under the law that is or was in force in a State or Internal Territory, which, in the opinion of the organisation, includes an amount for expenses equivalent to the fund benefit that would otherwise be payable.
- Cosmetic surgery where Medicare does not pay a benefit.
- The fund will pay limited benefits for surgical podiatry in hospital for recognised podiatric surgeons only.
7. Payment of Contributions
- Payroll deductions: This is only available to employees of eligible companies. Check with your payperson who will arrange for regular payroll deduction.
- By monthly direct debit to your bank, building society or credit union debit account.
- By quarterly payments in advance. We forward accounts to your postal address detailing contributions owing to the end of the next applicable quarterly period (i.e. periods ending 31 March, 30 June, 30 September and 31 December). Several payment options are available, including our Online Payment Facility.
8. Payment of Benefits
The maximum payment from each table will be as stated or the amount of the account, whichever is the lesser. Initial consultation benefits are paid only once per person per calendar year.
9. Limitation of Benefits
All limits are per person. In all cases where benefit payments are limited to a calendar year the period will be from 1st January to 31st December.
10. Submission of Claims
Members must ensure that all claims are submitted for processing within two (2) years from the date of service.
11. Alternative Therapies
Payment of benefits is limited to Approved Therapies and Accredited Associations. The respective lists are available here, or by contacting the office of the Fund.
12. Lifetime Health Cover
People over the age of 30 who have not had continuous private patient hospital cover since 1st July 2000 may be subject to Lifetime Health Cover loadings. Contribution rates included with this brochure may be adjusted in accordance with Lifetime Health Cover Legislation. Contact our office for further information, or visit the Federal Government’s information site.
13. Medicare Levy Surcharge
Individuals and families on incomes above the Medicare Levy Surcharge thresholds, who do not have private patient hospital cover, may have to pay the Medicare Levy Surcharge. Income thresholds for the Medicare Levy Surcharge can be obtained from the Australian Taxation Office.
All Phoenix Health Fund products that include hospital cover exempt members from the Medicare Levy Surcharge.
14. Privacy Policy Statement
Members are encouraged to peruse the Privacy Policy Statement of the fund.
15. ‘Cooling Off’ Period
We will allow any member who has not yet made a claim to cancel their policy and receive a full refund of any premiums paid within a period of 30 days from the commencement date of their policy.
16. Additional Information
Employees wishing to join the fund or current members who require any additional information should contact our office. This web site provides a summary of available benefits and should be read in conjunction with the registered rules.
