Phoenix Health Fund’s Top Hospital Nil Excess offers Members comprehensive Hospital benefits with no excess to pay for Hospital admissions. Additionally with this combination you get a great Mid Extras package for services such as dental, optical and physiotherapy and much more.

 

What’s Included in Hospital Cover

 

Treatments Covered
Treatment for injuries sustained in an accident Yes
Prosthesis Yes
Appendicitis treatment Yes
Removal of Appendix Yes
Obesity Surgery Yes
Removal of tonsils and adenoids Yes
Joint reconstruction and investigations Yes
Surgical removal of wisdom teeth
(hospital charge only)
Yes
Colonoscopy/Gastroscopy Yes
Obstetrics related services Pregnancy and birth related services Yes
Fertility treatment
(e.g IVF & GIFT programs)
Yes
Heart related services Yes
Major eye surgery
(including cataract and eye lens services)
Yes
Joint replacements Yes
Surgery on broken bones Yes
Renal dialysis Yes
Cosmetic surgery covered by Medicare Yes
Cosmetic surgery
(not covered by Medicare)
Excluded
Psychiatric services Yes
Rehabilitation Yes
Palliative care Yes
All other in-patient services where a Medicare benefit is payable Yes

 

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 Benefit (for commonly claimed items) Annual Limit
General Dental 011 – Periodic oral examination – $32.85
114 – Scale & clean – $62.10
121 – Fluoride treatment – $21.60
$1,500
Sublimits include:Inlays, onlays & Veneers- $1,000 Crowns/bridgework $1,000 Implants – $1,000 Dentures – $1,000 Orthodontia (lifetime limit) – $1,000
Major Dental and Endodontic 615 – Full crown veneered – $615.00
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.
Single vision lenses & frames – $198.00
Multi-focal lenses & frames – $200.00
Frame – $90.00
Single Vision Lenses – $108.00
Multifocal Lenses – $189.00
$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
Orthoptic Therapy
Speech Therapy
Occupational Therapy
Physiotherapy Initial visit – $45.00
Physiotherapy Subsequent visit – $33.30
Orthoptic Therapy Initial visit – $40.50
Orthoptic Therapy Subsequent visit – $39.60
Speech Therapy Initial visit – $76.50
Speech Therapy Subsequent visit – $40.50
Occupational Therapy Initial visit – $54.00
Occupational Therapy Subsequent visit – $36.00
$400
Natural Therapies* Including Myotherapy, Homeopathy, Naturopathy and Chinese Herbal Medicine (consultation only)

Remedial Massage

* Benefits paid for approved associations only.  Click here for approved alternative therapy services.

Natural Therapies visits – $22.50

Remedial Massage visits – $22.50

$200
Healthy Lifestyle Program
* Approved Health Education, Health Screening, Health Management programs and Exercise Physiology 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
Exercise Physiology  visits – $27.00
All other services – 80% of charge
$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
(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, Top Hospital 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)
  • 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.

 

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 + Mid Extras waiting periods

Hospital

  • 12 month waiting periods for pre-existing conditions
  • 12 month waiting periods for assisted reproductive services
  • 12 month waiting periods 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 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.