General FAQ
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
Please refer to the government website www.privatehealth.gov.au for more information.
- 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.
- 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.
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.
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
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).
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.
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:
- Will you participate in the Access Gap Cover scheme?
- Will I have any out-of-pocket expenses, and if so, can you provide a written estimate of how much?
- Will any assisting doctors also use Access Gap Cover and if so, how can I obtain a quote for their services?
- Are you prepared to send the bill to Phoenix Health Fund directly?
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
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.
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% |
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.
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.
If you would prefer choosing a tier, please inform Phoenix Health Fund, who will apply your tier of choice to your membership.
| 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% | |