Top Hospital Cover
Phoenix Health Fund has agreements with over 470 private hospitals throughout Australia. These agreements mean that in most cases Phoenix Health Fund will pay 100% of the medically-related costs incurred for treatment as an admitted patient in hospital. 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.
The only cost to you will be the difference, if any, between what the doctor charges and the Medicare Benefits Schedule fee; 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. Your doctor should advise you beforehand if prostheses devices are not fully covered.
Where doctors participate in the Australian Health Service Alliance Access Gap Cover Scheme, members will have no co-payment, or a known co-payment. To check whether your doctor participates in the Scheme, use our Doctor Search facility.
Benefits payable to private hospitals where Phoenix Health Fund does NOT have an agreement are in accordance with the relevant default benefits as determined by the Federal Minister for Health.
Top Hospital Cover also provides benefits to cover 100% of the prescribed daily fee for accommodation in a private room in PUBLIC hospitals.
Top Cover
Our Top Cover product combines Top Hospital Cover with Ancillary benefits, providing you with the highest level of cover available, for complete peace of mind.
Medical Gap Benefits
Benefits are payable covering the difference between the Medicare Benefits Schedule fee and the Medicare benefit for professional services for admitted patients in hospital or patients in a registered day hospital facility. Where doctors participate in the Australian Health Service Alliance Access Gap Cover Scheme, members will have no co-payment, or a known co-payment. If your doctor does not participate, refer them to our Access Gap Cover brochure.
Nursing Home Type Patients
Unless a doctor certifies otherwise, patients in hospital in excess of 35 days continuously are regarded as nursing home type patients. Nursing home type patients are required by legislation to pay part of the daily accommodation charge as approved by the Federal Minister for Health.
Same Day Patients
Benefits are payable towards the cost of same day treatment in public and private hospitals and registered free-standing day hospital facilities.
Surgically Implanted Prostheses
Benefits are payable up to the minimum benefit for prostheses that are listed on the Federal Government approved prostheses schedule only.
Ambulance (NSW and ACT only)
Free ambulance services are available for members with hospital cover who live in NSW and the ACT. Members outside NSW and the ACT should refer to the Ancillary Benefits table. (Members in NSW and ACT with ancillary but not hospital cover should check with the fund for Ambulance Cover options.)
Exclusions
- Cosmetic surgery where Medicare does not pay a benefit;
- Podiatric surgery; limited benefits for surgical podiatry in hospital for recognised surgical podiatrists only.
