Phoenix Health Fund’s Bronze Plus Starter Hospital 500 offers Private Hospital coverage for those looking for an introductory level of Private Hospital Cover. Basic Hospital provides a combination of private and public hospital and medical cover to cover the basic needs of younger individuals and families.

This combination also comes with a great Mid Extras cover.

What’s Included in Hospital Cover

Treatments Covered
Assisted reproductive services No
Back neck and spine No
Blood Yes
Bone, joint and muscle Yes
Brain and nervous system Yes
Breast surgery (medically necessary) Yes
Cataracts No
Chemotherapy, radiotherapy and immunotherapy for cancer Yes
Dental surgery Yes
Diabetes management (excluding insulin pumps) Yes
Dialysis for chronic kidney failure No
Digestive system Yes
Ear, nose and throat Yes
Eye (not cataracts) Yes
Gastrointestinal endoscopy Yes
Gynaecology Yes
Heart and vascular system No
Hernia and appendix Yes
Hospital psychiatric services Restricted
Implantation of hearing devices Yes
Insulin pumps No
Joint reconstructions Yes
Joint replacements No
Kidney and bladder Yes
Lung and chest Yes
Male reproductive system Yes
Miscarriage and termination of pregnancy Yes
Pain management Yes
Pain management with device No
Palliative care Restricted
Plastic and reconstructive surgery (medically necessary) Yes
Podiatric surgery (provided by a registered podiatric surgeon – limited benefits) Yes
Pregnancy and birth No
Rehabilitation Restricted
Skin Yes
Sleep studies Yes
Tonsils, adenoids and grommets Yes
Weight loss surgery No

What’s Included in Extras Cover

Unless otherwise stated, benefit limits apply per person per calendar year.

Please also note that this page does not include the full detail of all services covered, and that sublimits apply for some services.  It is recommended that you either check your Online Member Services or contact us before your treatment to check exactly what you are covered for.

Treatments Example of Benefit Overall Limit
General Dental Gap Free Dental: Receive 100% benefit on 011- Periodic Oral Examination, 111- Removal of Plaque and 114- Scale & Clean. Available once per appointment, up to twice per person per calendar year.
121- Fluoride Treatment – $24.00
022- Bitewing X-ray – $25.65
$1,500
Sublimits include:Inlays, onlays & Veneers- $1,000 Crowns/bridgework $1,000 Implants – $1,000 Dentures – $1,000 Orthodontia (lifetime limit) $1,000.00
Major Dental and Endodontic 615 – Full crown veneered – $787.00
417 – Filling of one root canal – $153.00
Orthodontic Braces for upper/lower teeth – 80% of charge
Removal/ fitting of retainer  – 80% of charge
Optical
* No benefit paid for sunglasses, where no sight correction is needed.
80% of charge $200
Non PBS Pharmaceuticals
* No benefit paid for contraceptives and items purchased over the counter.
Per eligible prescription – $45.00
(Paid after General PBS copayment has been paid)
$250
Chiropractic/Osteopathic

Acupuncture
* Benefits paid for approved acupuncture associations only.

Chiro/Osteo Initial visit – $36.00
Chiro/Osteo Subsequent visit – $27.00
Chiropractic X-rays – $90Acupuncture visits- $22.50
$400
Physiotherapy
Exercise Physiology
Remedial Massage
Physiotherapy / Myotherapy Initial visit – $45.00
Physiotherapy / Myotherapy Subsequent visit – $33.30
Exercise Physiology Initial visit – $35.00
Exercise Physiology Subsequent visit – $27.00
Remedial Massage Initial visit – $25.00
Remedial Massage Subsequent visit – $22.50
$200 sublimit applies for Exercise Physiology and Remedial Massage
Overall Therapy Limit of $400 per person
Orthoptic, Occupational and Speech Therapy Orthoptic Therapy Initial visit – $40.50
Orthoptic Therapy Subsequent visit – $39.60
Occupational Therapy Initial visit – $54.00
Occupational Therapy Subsequent visit – $36.00
Speech Therapy Initial visit – $76.50
Speech Therapy Subsequent visit – $40.50
$200 sublimit applies for Speech, Orthoptic and Occupational Therapies
Overall Therapy Limit of $300 per person
Healthy Lifestyle Program*
Approved Health Education, Health Screening, Health Management programs only. Please contact the fund before you make a claim to check that the service provided is an approved program. Click here for more information.
80% of charge covered $100
Podiatry Initial visit – $39.60
Subsequent visit – $30.60
Podiatric devices – 80% of cost
$200
Aids and Appliances
* Contact the fund for items payable in this category.
80% of charge covered
(after $20 copayment is made)
$150

Ambulance Coverage

Phoenix Health Fund covers all medically necessary transport from a State Emergency Ambulance service. This also includes when an Ambulance is called to attend to you, but you do not subsequently need to be taken to hospital. Coverage is not offered when it is not medically necessary for you to be transported by an Ambulance.

Important Hospital Information

For hospital services to which Phoenix Health Fund provides coverage, Bronze Plus Starter Hospital 500 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
  • In hospital pharmacy
  • Prosthesis (Commonwealth Government approved)
  • All other in-patient services where a Medicare benefit is payable (not listed as an exclusion in the hospital table above)

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.

Restricted Services

If you are to be admitted into a public or private hospital as an in-patient for a restricted service, you will need to be aware of how your fund will pay your benefits.
Be aware that if you are admitted with a restricted service, significant out of pocket expenses can apply.

Service Category Benefit Rules
Psychiatric, Rehabilitation, Palliative care
  • If you are admitted in a public hospital, full cover for accommodation is offered in a shared ward only as a private patient
  • If you are admitted in a private hospital, 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.
  • If you are admitted in a private hospital,No benefit for private hospital theatre fees, facility fees or labour ward apply.
  • If you are admitted into hospital, only Commonwealth Government approved prostheses will be covered.

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:

  • An excess of $500 per adult applies to day or overnight admissions in a private or public hospital
  • The maximum excess per family membership is $1000
  • The excess is waived for all dependant children/adult on family/sole parent policies

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.

Bronze Plus Starter Hospital 500 + Mid Extras waiting periods

Hospital

  • 12 month waiting periods for pre-existing conditions
  • 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

Fund Rules

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

Please ensure you have read and retained the information relating to your policy of choice before applying for membership.