Phoenix Health Fund’s Top Hospital Nil Excess offers members comprehensive Hospital benefits with no excess to pay for Hospital admissions. The Basic Extras package as an add on, also gives members coverage for general dental optical, Ambulance and more.
Hospital cover inclusions
|Treatment for injuries sustained in an accident||Yes||NIL|
|Appendicitis treatment||Yes||2 months|
|Removal of Appendix||Yes||2 months|
|Removal of tonsils and adenoids||Yes||2 months|
|Joint reconstruction and investigations||Yes||2 months|
|Surgical removal of wisdom teeth (hospital charge only)||Yes||2 months|
|Obstetrics related services (e.g Pregnancy and birth related services)||Yes||12 months|
|Fertility treatment (e.g IVF & GIFT programs)||Yes||12 month waits|
|Heart related services||Yes||2 month waits|
|Major eye surgery (including cataract and eye lens services)||Yes||2 month waits|
|Joint replacements||Yes||2 month waits|
|Surgery on broken bones||Yes||2 month waits|
|Renal dialysis||Yes||2 month waits|
|Cosmetic surgery covered by Medicare||Yes||2 month waits|
|Cosmetic surgery (not covered by Medicare)||N||–|
|Psychiatric services||Yes||2 month waits|
|Rehabilitation||Yes||2 month waits|
|Palliative care||Yes||2 month waits|
|Emergency Ambulance||Yes (refer to Ambulance section on this product page for more information)||NIL|
|All other in-patient services where a Medicare benefit is payable||Yes||2 month waits|
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 2015.
|General Dental||011 – Periodic oral examination – $32.00
114 – Scale & clean – $55.20
121 – Fluoride treatment – $19.20
322- Surgical tooth extraction – $128.00
(Excluded: Sunglasses, where no sight corrective are needed)
|1021 – Single vision lenses & frames – $150.00
1022 – Multi-focal lenses & frames – $150.00
1010 – Contact lenses (hard) – $150.00
|Non PBS Pharmaceuticals (Excluded: contraceptives and items purchased over the counter)||Per eligible prescription – $30.00 (Paid after General PBS copayment has been paid)||$200|
|Chiropractic/Osteopathic||Chiro/Osteo Initial visit – $32.00
Chiro/Osteo Subsequent visit – $24.00
Chiropractic X-rays – $80.00
|Physiotherapy||Physiotherapy Initial visit – $40.00
Physiotherapy Subsequent visit – $29.60
|Emergency Ambulance*||100% of cost||$200|
* Emergency Ambulance service is available for members with hospital cover who live in NSW and the ACT automatically. For members living outside of NSW and the ACT, Phoenix will pay for the subscription for your local Ambulance service membership/account, or the best available coverage in your local area. Please contact the fund for more information regarding your Ambulance Cover options
Important Hospital Information
For hospital services to which Phoenix Health Fund provides coverage, Top Hospital Nil Excess 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)
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.
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.
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 + Basic Extras waiting periods
- 12 month waiting periods for pre-existing conditions and assisted reproductive services
- 12 month waits for pregnancy and birth related services
- 2 month waiting periods for all other hospital items
- 2 month waits for General Dental claims
- 12 month waits Major Dental, Endodontic 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
Phoenix Health Fund, at the absolute discretion of the Board, in special circumstances, may make ex-gratia payments on application.
For the complete description of the Fund rules, relating this product, please refer to the General Information section on our website.