General FAQ

Why do I need health insurance?
Health Insurance is purchased by more than half the Australian population and there are many reasons behind this.

Key benefits of private health insurance include:

  • Peace of mind and the security of being financially protected should your need treatment
  • Choice of surgeon/doctor
  • Choice of hospital
  • Shorter waiting periods for hospitalisation
  • Ambulance coverage
  • Extras cover for some of your everyday health expenses, including benefits for dentists, physiotherapists, chiropractors, natural therapists and much more.
  • Avoiding government Penalties including the Medicare Levy Surcharge and Lifetime Health Cover Loadings
Am I covered for doctor visits or outpatient services?
No. The Australian Government doesn’t allow private health insurers to pay benefits for doctor visits or outpatient services.
Does my health insurance cover my children?
As long as they are listed on your policy, your children are automatically covered under your family cover until the day before they turn 21. If they are full-time students, simply register them as Student Dependants, and they’ll be covered for no extra cost until the day before they turn 25 or cease full time study (whichever comes first).
Am I covered for Ambulance transport?
Yes. Phoenix Health Fund covers the cost of all medically necessary Ambulance transport across Australia for all members of the fund.  This includes medically necessary emergency and non-emergency transport.  For more informaiton on Ambulance Coverage, please click here.
Is Phoenix Health Fund a Members Owned Health Fund?
Yes we are and proud of it too!  Being a part of the Members Owned group of Health Funds is a clear sign that Phoenix Health Fund is a company that presents true value for its members.
What is Members Owned Health Funds?
Member Owned Health Funds is a group of individual, not-for-profit and mutual Australian owned health funds with a collective objective to show Australians exactly what they are missing out on when they purchase Health Insurance from for-profit and overseas owned Health Funds.
How is Members Owned Health Fund’s different from other funds?
Phoenix Health Fund and MOHF is different from most funds in that:

  • Phoenix Health Fund’s members are people, not numbers or profit centres.
  • Phoenix Health Fund operates primarily to benefit members, not shareholders or overseas owners.
  • Phoenix Health Fund is focused on giving more back and doing more for their members.
  • Phoenix Health Fund  delivers better service, have higher member satisfaction and loyalty, and receive fewer complaints than major for-profit or overseas owned Private Health Insurance companies.
How do I claim and receive payment of benefits?
At Phoenix Health Fund, we provide you with several easy options for making a claim including:

  • At the provider’s office using your member card – Claim your benefit by swiping your Phoenix Health Fund member card through the provider’s HICAPS or CSC HealthPoint terminal, and simply pay the difference or gap, if any”
  • Mobile Claiming app – Claim your receipts by downloading the Phoenix Health Fund mobile claiming app, taking a photo of your receipts and submit the claim through the app. Download the app here;
  • Email Scanning – print the claim form, complete, then scan and email with receipts to claims@phoenixhealthfund.com.au;
  • Fax – send your claim form and receipts to us via fax on 02 4968 2229;
  • Mail – post your claim form to Phoenix Health Fund, PO Box 156 Newcastle NSW 2300.

For each method of claiming (other than HICAPS, CSC HealthPoint and the Mobile Claiming app), you will be required to fill out and send in a Claim Form. You will need the following information to complete your claim:

  • your receipt or account
  • your membership number
  • the date the service was provided the details of the service provider
  • the name and type of service provided
  • whether the account has been paid or not

Optometrical claims must include optical prescriptions and pharmaceutical claims must include official pharmacy receipt.

Phoenix Health Fund can make benefit payments straight into your nominated bank account. Supply the bank account details on the Claim Form. You can also specify to be paid by cheque. Once we receive and process your claim, your cheque benefit will be sent via mail.

How do I pay my contributions?
Paying your contributions is nice and easy with Phoenix Health Fund.

1. Choose your payment method:

  • Pay by Direct Debit.  This can be paid through either a bank account or Credit card (Visa and MasterCard)
  • Pay by Quarterly Statement – For quarterly statements, the fund will forward statements to the postal address detailing contributions owing to the end of the next applicable quarterly period.  Payments options can then be found on the statement, including Bpay or over the phone payment options.
  • Pay through Online Member Services – Members have the option to log in to their Online member services to make payment.  To visit Online Member Services, click here

2. Choose your payment frequency :

  • Member can choose to pay Weekly, Fortnightly, Monthly or Quarterly through Direct Debit.

To ensure you maintain continuous cover and access to benefits, contribution payments must be up to date. If contributions are overdue and no prior arrangement is made with us, your membership may lapse. If this occurs, please call us on 1800 028 817 to discuss your options. Please note that benefits will not be payable and waiting periods may need to be re-served if your membership lapses.

Do I have to serve waiting periods if I am a new member of Health Insurance?
Waiting periods do apply for some types of claims. Consult the General Information page on this website or contact the fund for more information.
How do I transfer to Phoenix Health Fund?
Phoenix can arrange the transfer on your behalf, you do not need to contact your other fund directly. If you apply online, the application process will ask you about your other fund. If you prefer to print and mail your application forms, make sure you complete the “Transfer from another Fund” form. Your other fund will send a clearance certificate to Phoenix showing your type of cover and the length of time you’ve been a member.
I am transferring from another fund. Will I have to wait before I can make a claim?
You can claim immediately (once contributions have commenced) if you are taking out a similar type of cover, and have served the relevant Phoenix waiting periods with your previous fund. If taking a higher level of cover with Phoenix, applicable waiting periods must be served for the higher cover only.  Consult the General Information page on this website or contact the fund for more information.
Will the fund consider any ex-gratia requests from members?
Phoenix Health Fund, at the absolute discretion of the Board, in special circumstances, may make ex-gratia payments on application.
What should I do if I have a complaint?
If you have a complaint concerning your membership, contact the Fund in the first instance so that it can be resolved as quickly as possible. Your complaint will be dealt with in accordance with our Complaints Policy.  Call our office to discuss your matter on 1800 028 817.

If you are unable to resolve your complaint with the Fund, the independent Private Health Insurance Ombudsman has been established to assist with inquiries and complaints about any aspect of private health insurance. Complaints can be lodged with the Ombudsman online or by telephone on 1800 640 695.

Hospital FAQ

What should I know before going into hospital?
To get the most from your cover, Phoenix Health Fund advises that all members get in touch with the fund before being admitted into hospital.

In catching up with us, we can inform you of the following:

  • Whether you are covered for a particular treatment in hospital
  • Whether you have any waiting periods, exclusions or restricted benefits that you need to know about
  • Whether you need to pay an excess
  • Which hospitals in your area are under our contracted list of hospital
  • What your out of pocket expenses may be (if there are any).
Is there a gap scheme that Phoenix uses that will reduce or remove out of pocket expenses?
Yes, there is.

Phoenix Health Fund’s Access Gap Cover Scheme allows Phoenix Health Fund members with private hospital cover to eliminate or reduce out-of-pocket expenses for medical gap payments for in-patient hospital treatments. Phoenix Health Fund does not pay an amount charged by your doctor above the Medicare Benefits Schedule Fee unless your doctor agrees to participate in the Access Gap Cover Scheme. If a doctor does not use the Access Gap Cover Scheme, you will be responsible for any additional charges.

Should I speak with the specialist before my procedure?
Yes

Because doctors can choose whether to participate in our Access Gap Cover on a patient-by-patient basis, it’s important that you ask your doctor whether they will participate in Access Gap Cover for you. Ask these four questions:

  1. Will you participate in the Access Gap Cover scheme?
  2. Will I have any out-of-pocket expenses, and if so, can you provide a written estimate of how much?
  3. Will any assisting doctors also use Access Gap Cover and if so, how can I obtain a quote for their services?
  4. Are you prepared to send the bill to Phoenix Health Fund directly?
Which hospital should I use?
Phoenix Health Fund has agreements with most private hospitals in Australia (over 520) that are likely to be accessed by members. These agreements ensure that an agreed schedule of fees (including in-patient accommodation, theatre and special unit accommodation fees as appropriate) is charged by the hospital and paid by Phoenix Health Fund on the member’s behalf.

Members who choose a non-agreement hospital may incur out-of-pocket expenses for hospital related services irrespective of their level of cover.

Legislation FAQ

What is the government rebate on Health Insurance and how does it affect me?
The Australian Government Rebate on Private Health Insurance offers policy holders a reduced policy price. The rebate amount you get is based on the age of the oldest person covered by the policy and by annual earnings.

You can claim the Australian Government Rebate as a reduction on your premium paid to Phoenix or as a return from your annual tax return.

Who is eligible for the Australian Government Rebate?
The rebate is available to any Australian resident who is entitled to Medicare benefits and holds private health insurance. From 1 July 2012, the rebate is income/means tested so your income and age will determine what level of the Australian Government Rebate you’ll be entitled to receive.

The tables below show the Australian Government Rebate on private health insurance.

Income
Tier 0 Tier 1 Tier 2 Tier 3
Singles < $90,000 $90,001 – $105,000 $105,001 – $140,000 > $140,001
Families < $180,000 $180,001 – $210,000 $210,001 – $280,000 > $280,001
Rebate Amount
Under 65 25.415% 16.943% 8.471% 0%
65 – 69 years 29.651% 21.180% 12.707% 0%
70 and over 33.887% 25.415% 16.943% 0%
How much of a rebate am I entitled to?
The Australian Government Rebate on Private Health Insurance was introduced as a financial incentive to help Australians afford private health cover. The rebate depends on your age, is income-tested and applies to all Phoenix Health Fund products. The rebate isn’t available for the Lifetime Health Cover loadings portion of membership payments.

Your Rebate amount is based on your age and assessable income*. Below are the thresholds set by the Australian Government for the 2018/2019 financial year.

Income
Tier 0 Tier 1 Tier 2 Tier 3
Singles < $90,000 $90,001 – $105,000 $105,001 – $140,000 > $140,001
Families < $180,000 $180,001 – $210,000 $210,001 – $280,000 > $280,001
Rebate Amount
Under 65 25.415% 16.943% 8.471% 0%
65 – 69 years 29.651% 21.180% 12.707% 0%
70 and over 33.887% 25.415% 16.943% 0%

From the 1st April 2015, the rebate is indexed by the lesser of CPI (Consumer Price Index) or the percentage change in your premium each year, using a Government calculated formula, called WAR (Weighted Average Ratio).

* For the calculation of assessable income which is known as income for Medicare Levy Surcharge purposes, please seek the advice of your tax agent, financial advisor or contact the Australian Tax office Help Line on 132 862 or use their calculator.

Who will be income tested?
Each adult on the policy will be income tested for their share of premiums paid and rebate received while covered by the policy. Dependent children on any policy will not be income tested.
Which portion of my income will determine my rebate entitlement?
Your income level will be determined by your income for Medicare Levy Surcharge purposes. This includes your taxable income, fringe benefits, super contributions minus any net investment losses. If you have a spouse, your combined income will be used to calculate your rebate entitlement.

To calculate your correct income for rebate entitlement, please visit the ATO website.

If you have chosen the wrong rebate level at the end of the financial year (due to both foreseeable and unforeseeable circumstances), you will not be penalised. The Australian tax office will determine the rebate you’re entitled to when you lodge your tax return at the end of the year. If you claimed:

  • too high a rebate; you will have a tax liability in your tax return; or
  • too low a rebate; you will be entitled to a tax refund in your tax return.
What if I don’t nominate a rebate tier?
If you choose not to nominate a tier, or you nominate an incorrect tier, the ATO will correct any over or under payment of your rebate entitlement in your annual tax return in the form of a tax refund or liability.

If you would prefer choosing a tier, please inform Phoenix Health Fund, who will apply your tier of choice to your membership.

What is the Medicare Levy Surcharge?
The Medicare Levy Surcharge (MLS) is an additional tax on top of the Medicare Levy for Australian taxpayers who do not have an appropriate level of private hospital cover and earn above an income threshold. Please visit the ATO website for the latest income thresholds relating to your income. The thresholds are effective 1 July each year and are indexed annually.

Income
Tier 0 Tier 1 Tier 2 Tier 3
Singles < $90,000 $90,001 – $105,000 $105,001 – $140,000 > $140,001
Families < $180,000 $180,001 – $210,000 $210,001 – $280,000 > $280,001
Rebate Amount
Under 65 25.415% 16.943% 8.471% 0%
65 – 69 years 29.651% 21.180% 12.707% 0%
70 and over 33.887% 25.415% 16.943% 0%
Medicare Levy Surcharge
0% 1.0% 1.25% 1.5%
What happens if I decide to drop my hospital insurance for any period during a financial year?
If you earn more than the income tiers specified in the rebate table above in a year, you may have to pay the Medicare Levy Surcharge for the period you dropped your hospital cover, based on your income for the financial year. Lifetime Health Cover Loadings, which inflates the cost of your health insurance, may also affect your Health insurance quote once you decide to purchase Health Insurance again.
What is Lifetime Health Cover, and how can I avoid the loading?
According to the Lifetime Health Cover initiative those who take out Hospital cover before the age of 31 and keep it can maintain lower premiums. From 1 July following your 31st birthday, you will pay 2% more for each year you don’t have hospital cover. If you’re already over 31, take out hospital cover as early as possible to avoid paying any extra. Contact our office for details.
How long do Lifetime Health Cover loadings last for?
Any loading that applies to your premium will be removed after you’ve held hospital cover continuously for 10 years. However, the loading may be reapplied if you then cease to hold a hospital cover and subsequently take it up again.