Phoenix Health Fund’s Gold Top Hospital 500 offers Members all the same great comprehensive benefits as our Top Hospital cover, but with the added extra of a hospital excess of $500 to help you save money. 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
Assisted reproductive services Yes
Back neck and spine Yes
Blood Yes
Bone, joint and muscle Yes
Brain and nervous system Yes
Breast surgery (medically necessary) Yes
Cataracts Yes
Chemotherapy, radiotherapy and immunotherapy for cancer Yes
Dental surgery Yes
Diabetes management (excluding insulin pumps) Yes
Dialysis for chronic kidney failure Yes
Digestive system Yes
Ear, nose and throat Yes
Eye (not cataracts) Yes
Gastrointestinal endoscopy Yes
Gynaecology Yes
Heart and vascular system Yes
Hernia and appendix Yes
Hospital psychiatric services Yes
Implantation of hearing devices Yes
Insulin pumps Yes
Joint reconstructions Yes
Joint replacements Yes
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 Yes
Palliative care Yes
Plastic and reconstructive surgery (medically necessary) Yes
Podiatric surgery (provided by a registered podiatric surgeon – limited benefits) Yes
Pregnancy and birth Yes
Rehabilitation Yes
Skin Yes
Sleep studies Yes
Tonsils, adenoids and grommets Yes
Weight loss surgery 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 Example of Benefit Annual 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. $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 – $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
Speech, Orthoptic and Occupational Therapy Speech Therapy Initial visit – $76.50
Speech Therapy Subsequent visit – $40.50
Orthoptic Therapy Initial visit – $40.50
Orthoptic Therapy Subsequent visit – $39.60
Occupational Therapy Initial visit – $54.00
Occupational Therapy Subsequent visit – $36.00
$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 $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

Important Hospital Information

For hospital services to which Phoenix Health Fund provides coverage, Gold Top 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
  • 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.

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.

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 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.

Gold Top Hospital 500 + 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.