Frequently Asked Questions

Everyone has their own reason to take out and maintain private health insurance, with a major one being for peace of mind. If the unexpected happens you can feel confident in knowing that you have choices – you have the choice and flexibility in choosing who treats you, where you’re treated and often where you’ll be treated.

By taking out Private Hospital Cover, as well as getting a choice in your treatment, you may be able to reduce the length of time you might have to wait to be treated in the public system. You’ll also avoid possible Government penalties like the Medicare Levy Surcharge or Lifetime Health Cover Loading.

Phoenix Health Extras Cover helps to cover the cost of services you receive outside of a hospital admission, that aren’t claimable through Medicare. Benefits are available for services like dental, optical, physiotherapy and more – things that keep you healthy on a day to day basis.

No. The Australian Government doesn’t allow private health insurers to pay benefits for services received as an outpatient, like GP and specialist visits.

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.

After they turn 21, if they are studying full time you can register them with Phoenix Health as a Student Dependant and they’ll continue to be covered on your membership for no extra cost until their 25th birthday, or until they are no longer studying full time – whichever comes first.

If your dependant is over 21 and not studying full time, they can remain covered under your Phoenix Health membership, by upgrading to Extended Dependant cover, for an additional cost. Extended Dependant cover is available on most levels of cover (except Extras only policies) – get in touch with the Phoenix Health team for a quote and to find out if your cover is eligible.

Yes. On all of our Hospital covers we provide unlimited cover for all medically necessary emergency and non-emergency ambulance treatment and transport – Australia-wide, by road, sea and air. Some Extras only covers have limited ambulance services, so make sure you refer to the product information sheet for your specific level of cover for the limits available.

For more information about Ambulance benefits and claiming, please click here.

Yes we are and proud of it too!
Members Health Fund Alliance is the peak industry body, and Australia’s largest voice for not-for-profit, member-owned, regional and community-based health insurers. Phoenix Health are one of the 27 Members Health Funds, who represent over 3 million Australians, and stand for the same objective – to put the health of their members before profits.

Check out more about MHFA here.

At Phoenix Health Fund, we provide you with several easy options for making a claim including:

• At your treatment using your member card – simply swipe your Phoenix Health card through the provider’s HICAPS or CSC HealthPoint terminal at the time of your visit;
• Mobile Claiming app – forgot to take your Phoenix Health card with you to your appointment or couldn’t claim on the spot? The Phoenix Health app makes claim easy! All you need to do is download the app, take a photo of your receipts and submit along with any supporting documents (if required) for assessment;
• Email – print a claim form, complete, then scan and email with your receipts and any supporting documents to [email protected];
• Post – you can send us your completed claim form, invoice and supporting document to Phoenix Health Fund, PO Box 156 Newcastle NSW 2300.

Learn more about how to claim here.

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 are paid in advance and must be kept up to date. If contributions are overdue and no prior arrangement is made with us, your membership will fall into arrears and may lapse. If this occurs, we want to help you – please call us on 1800 028 817 to discuss your options. Please note that benefits are not payable while your contributions are in arrears and where your membership is cancelled due to arrears, waiting periods may need to be re-served.

As a new member to private health insurance, there are some waiting periods you need to serve before you are eligible to claim benefits. These range from 2 months up to 12 months, depending on the service.

New members switching to Phoenix Health and current Phoenix Health members who upgrade their cover will not have to re-serve the waiting periods they have already served. Waiting periods however will apply where they haven’t already been fully served, and to any upgrade in services, benefits and excess/co-payments applicable.

Learn more about the waiting periods that may apply when joining Phoenix Health or upgrading your cover, by visiting our General Information page or get in touch with us for more information.

Let us do the hard work! We can contact your previous fund and arrange the transfer on your behalf, so you don’t need to. If you apply online, the application process will ask for the details of your previous fund and membership – just make sure you tick the box giving us the authority to transfer your policy for you.

Your previous fund will need to complete your transfer within 14 days of our request, and will cancel your membership, give you a refund of any contributions paid past your cancellation date, and provide us with a copy of your Transfer Certificate – which is what we need to be able to confirm your previous cover, waiting periods and any Government surcharges.

Happy members make us happy, and as such we are focused on providing you with the best, most personal health insurance possible. If you would ever like to provide feedback, or if you would like to make a complaint about your membership, please reach out to us so that we can address your concerns and come to a resolution for you as quickly as possible.

Step One: Contact Us
We appreciate and take your feedback seriously and any complaints will be dealt with in accordance with our Dispute Resolution Policy.

Call us: 1800 028 817
Email us: [email protected]
Write to us: PO Box 156 Newcastle NSW 2300

Step Two: Escalation
Once you have contacted us as above, if you are not happy with the outcome the matter can be escalated internally to the Member Service Manager, and if required the Chief Executive Officer and/or Board of Directors.

Step Three: External Review
If, after our best efforts, you are still not satisfied with our review and result of your concern, you can escalate your issue to the Commonwealth Ombudsman for Private Health Insurance.

Online: ombudsman.gov.au
Phone: 1300 362 072

To view the Phoenix Health Dispute Resolution Policy, click here.

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).

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.

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?

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.

The Australian Government Rebate on Private Health Insurance is a Government incentive that applies towards the cost of Private Health Insurance cover as a reduction of premiums and is based on your age and income.

You can learn more about the Rebate, including a table of the current Rebates available on our Understanding Private Health Insurance page.

The Medicare Levy Surcharge (MLS) is an additional levy paid by Australian tax payers who earn in excess of the prescribed income thresholds and do not hold private hospital cover.

Click here to learn more about the Medicare Levy Surcharge and how you can avoid paying it.

Lifetime Health Cover is a Government initiative designed to encourage people to take out Private Hospital cover earlier in life and maintain it. If you take out private hospital cover after your 31st birthday, you’ll pay an extra 2% for your premiums for each year over 31 you are at the time of taking out hospital cover. For example, if you’re 34 when you take out hospital cover, you’ll pay 8% more for your hospital premiums than someone who took out cover before 31.

To learn more about Lifetime Health Cover, click here.

The Age-Based Discount was introduced by the Government in 2019 as an incentive to encourage younger members into Private Hospital Cover. If you are aged between 18-29 you may be eligible for a discount of up to 10% on your hospital cover.

For more information about the Age-Based Discount, click here or get in touch with the Phoenix Health team.