Phoenix’s Top Extras provides Members with our most comprehensive extras package available. This policy provides added peace of mind, providing health benefits outside of hospital that you will most likely to need on a regular basis.
Top Extras provides benefits for a wide range of health care services (not covered by Medicare), such as dental, optical, physiotherapy, chiropractic, ambulance, pharmacy natural therapies, and more.
To get the most of out of your Health Insurance, this policy can also be purchased together with an hospital policy (covering medical expenses in hospital) to give you a diverse range of coverage in hospital and at your health service provider.
Extras cover Inclusions
Unless otherwise stated, benefit limits apply per person per calendar year. Initial consultation benefits are paid only once per person per calendar year.
Benefit and limit amounts are effective from 1st April 2017.
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 contact the fund before your treatment to check exactly what you are covered for.
|Treatment||Benefit (for commonly claimed items)||Annual Limit|
|General Dental||011 – Periodic oral examination – $36.50
114 – Scale & clean – $69.00
121 – Fluoride treatment – $24.00
|No annual limit|
|Major Dental||615 – Full crown veneered – $875.00||$2,000
Sublimits include:Inlays, onlays & Veneers- $1,000 Crowns/bridgework $1,000
Implants – $1,000
Dentures – $1,000
|Endodontic||417 – Filling of one root canal – $170.00||No annual limit|
|Orthodontic||Braces for upper/lower teeth – 80% of charge
Removal/ fitting of retainer – 80% of charge
|$1,200 per year
$2,400 life limit
* Benefit not payable for sunglasses, where no sight correction is needed.
|Single vision lenses & frames – $220.00
Multi-focal lenses & frames – $310.00
Frame – $100.00
Single Vision Lenses – $120.00
Multifocal Lenses – $210.00
|Optical repairs||100% of charge||$60|
|Artificial eyes||70% of charge||$500|
|Non PBS Pharmaceuticals
* No benefit paid for contraceptives and items purchased over the counter.
|Per eligible prescription – $70.00
(Paid after General PBS copayment has been paid)
* Benefits paid for approved acupuncture associations only.
|Chiro/Osteo Initial visit – $40.00
Chiro/Osteo Subsequent visit – $30.00
Chiropractic X-rays – $100.00
Acupuncture visits- $25.00
* Benefit not payable if medical practitioner is required to intervene and take over the delivery.
|Ante-natal visits – $30.00
Post-natal visits – $50.00
Confinement delivery – $600.00
|10 visits per confinement|
|Home nursing||Per visit – $15.00
Per day (over 6 hours) – $50.00
Ante- natal classes (not related to Ante- natal visits)
|Physiotherapy Initial visit – $50.00
Physiotherapy Subsequent visit – $37.00
Orthoptic Therapy Initial visit – $45.00
Orthoptic Therapy Subsequent visit – $44.00
Speech Therapy Initial visit – $85.00
Speech Therapy Subsequent visit – $45.00
Occupational Therapy Initial visit – $60.00
Occupational Therapy Subsequent visit – $40.00
Ante-natal classes – $40.00
(Ante-natal classes limited to 10 classes per confinement)
Including Myotherapy, Homeopathy, Naturopathy and Chinese Herbal Medicine (consultation only)
* Benefits paid for approved associations only.
Click here for approved alternative therapy services.
|Natural Therapies visits – $25.00
Remedial Massage visits – $25.00
|Podiatry||Initial visit – $44.00
Subsequent visit – $34.00
Podiatric devices – 80% of cost
* Benefits paid for registered clinical psychologists only.
* benefits paid for registered clinical hypnotherapists only.
|Psychology visits – $75.00
Hypnotherapy visit – $50.00
* Benefits paid for registered DAA Dieticians only
|Initial visit – $60.00
Subsequent visit – $40.00
|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 – $30
All other services – 80% of charge
|Hearing Aids||First appliance – $900.00
Second appliance – $800.00
|Limited to 2 appliances every 5 years|
|Aids and Appliances
(contact the fund for items payable in this category)
|80% of charge
(after $20 copayment is made)
|Travel and Accommodation
* Benefits payable where return distance is at least 200 kilometres.
* Benefit is equivalent of economy rail fare for distance travelled or 10c per kilometre. Combined benefit patient and attendant.
Overnight accommodation – per night, patient and attendant – $65
|Travel limit – $120
Accommodation limit – $260
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.
Extras waiting periods
- 2 month waits for General Dental claims
- 12 month waits Major Dental and Orthodontic claims
- 12 month waits for Hearing Aids
- 6 month waits for Optical claims
- Nil waiting periods for Ambulance coverage.
- 2 month waits for all other extras item claims
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.