Phoenix Health Fund’s Top Hospital Nil Excess offers members comprehensive Hospital benefits with no excess to pay for Hospital admissions. The Basic Extras package as an add on, also gives members coverage for general dental optical, Ambulance and more.

Hospital cover inclusions

 

Treatments Covered Waiting Period
Treatment for injuries sustained in an accident Yes NIL
Prosthesis Yes 2 months
Appendicitis treatment Yes 2 months
Removal of Appendix Yes 2 months
Removal of tonsils and adenoids Yes 2 months
Joint reconstruction and investigations Yes 2 months
Surgical removal of wisdom teeth (hospital charge only) Yes 2 months
Colonoscopy/Gastroscopy Yes 2 months
Obstetrics related services (e.g Pregnancy and birth related services) Yes 12 months
Fertility treatment (e.g IVF & GIFT programs) Yes 12 month waits
Heart related services Yes 2 month waits
Major eye surgery (including cataract and eye lens services) Yes 2 month waits
Joint replacements Yes 2 month waits
Surgery on broken bones Yes 2 month waits
Renal dialysis Yes 2 month waits
Cosmetic surgery covered by Medicare Yes 2 month waits
Cosmetic surgery (not covered by Medicare) N
Psychiatric services Yes 2 month waits
Rehabilitation Yes 2 month waits
Palliative care Yes 2 month waits
Emergency Ambulance Yes (refer to Ambulance section on this product page for more information) NIL
All other in-patient services where a Medicare benefit is payable Yes 2 month waits

 

 

Extras cover Inclusions

Unless otherwise stated, benefit limits apply per person per calendar year. Initial consultation benefits are paid only once per person per calendar year.

Benefit and limit amounts are effective from 1st April 2015.

 

Treatments Covered Waiting Period
General Dental 011 – Periodic oral examination – $32.00
114 – Scale & clean – $55.20
121 – Fluoride treatment – $19.20
322- Surgical tooth extraction – $128.00
$500
Optical
(Excluded: Sunglasses, where no sight corrective are needed)
1021 – Single vision lenses & frames – $150.00
1022 – Multi-focal lenses & frames – $150.00
1010 – Contact lenses (hard) – $150.00
$150
Non PBS Pharmaceuticals (Excluded: contraceptives and items purchased over the counter) Per eligible prescription – $30.00 (Paid after General PBS copayment has been paid) $200
Chiropractic/Osteopathic Chiro/Osteo Initial visit – $32.00
Chiro/Osteo Subsequent visit – $24.00
Chiropractic X-rays – $80.00
$250
Physiotherapy Physiotherapy Initial visit – $40.00
Physiotherapy Subsequent visit – $29.60
$250
Emergency Ambulance* 100% of cost $200

 

* Emergency Ambulance service is available for members with hospital cover who live in NSW and the ACT automatically. For members living outside of NSW and the ACT, Phoenix will pay for the subscription for your local Ambulance service membership/account, or the best available coverage in your local area. Please contact the fund for more information regarding your Ambulance Cover options

Important Hospital Information

For hospital services to which Phoenix Health Fund provides coverage, Top Hospital Nil Excess provides coverage 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.
  • Public or Private Hospital bed – shared or private room (if available)
  • Same day patient fees
  • Theatre fees
  • Intensive care
  • Labour ward
  • In hospital pharmacy
  • Prosthesis (Commonwealth Government approved)

 

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.

 

Excluded services

If you are to be admitted into a public or private hospital as an in-patient for an excluded service on your policy, the fund will not pay a benefit.

Excess

If you are admitted to a hospital, you will not pay an up-front excess.

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.

 

Top Hospital Nil Excess + Basic Extras waiting periods

Hospital

  • 12 month waiting periods for pre-existing conditions and assisted reproductive services
  • 12 month waits for pregnancy and birth related services
  • 2 month waiting periods for all other hospital items

Extras

  • 2 month waits for General Dental claims
  • 12 month waits Major Dental, Endodontic and Orthodontic claims
  • 6 month waits for Optical claims
  • Nil waiting periods for Emergency Ambulance subscription.
  • 2 month waits for all other extras item claims

 

Ex-Gratia Payments

Phoenix Health Fund, at the absolute discretion of the Board, in special circumstances, may make ex-gratia payments on application.

 

Fund Rules

For the complete description of the Fund rules, relating this product, please refer to the General Information section on our website.