Section 1: Hospital Cover Overview

Hospital Cover provides benefits to help pay towards the cost of treatment you receive whilst admitted into hospital. When you’re admitted into hospital as a private patient you’re covered for things like your medical treatment and hospital accommodation.

Hospital covers are broken into different tiers ranging from basic through to Gold, each providing cover for a different range of services. You can learn more about Phoenix Health Hospital covers in the later sections of this guide.

Everyone has their own reason to take out and maintain private health insurance, with a major one being for peace of mind.

If the unexpected happens and you need to go to hospital, you know that you have choices; the hospital, the surgeon, and probably most importantly the ability to avoid the waiting lists in the public system. Plus, by taking private hospital cover, you may also avoid penalties like the Medicare Levy Surcharge and the Lifetime Health Cover Loading.

An inclusion is a service or clinical category that’s included in your cover. If a service is included, it means you’ll be able to seek treatment for it after you’ve served the applicable waiting periods.

An exclusion is a service or clinical category that’s not included in your cover. If a service is excluded, it means you’ll have significant out-of-pocket expenses if you seek treatment in a private hospital. You can still be treated in a public hospital as a public patient, but you’ll be subject to the public hospital waiting lists.

A restriction or restricted service/clinical category means you are covered as a private patient but only in a public hospital. If you seek treatment for a restricted service in private hospital you will have significant out-of-pocket expenses.

As part of the changes the Government made in 2019-2020, health insurers are required to include the hospital tier in the name of the cover. The tiers are Basic, Bronze, Silver and Gold. To be classified as a tier the product must include all the treatments and clinical categories (See Section 1.7) that make up that tier.

You may have also noticed that you can get “plus” tiers: Bronze Plus, Silver Plus etc, this happens when all the clinical categories of one tier are included plus at least 1 clinical category from a higher tier.

Currently Phoenix Health does not offer a Gold tier product for new members, which also means we don’t offer private hospital cover to new members for the below services:

• Hospital Psychiatric Services
• Weight Loss Surgery

If you’re a new member and require private hospital cover for any of the services above, unfortunately you’ll need to look at a different health insurer for your insurance.

A Clinical Category is made up of a group of treatments covered by private hospital cover – so if a service or treatment is Medicare recognised and covered by private health insurance, then it will fit into one of the Clinical Categories as set out by the Government.

On the 1st of April 2020 the Government created hospital tiers to make understanding hospital cover easier – so all hospital insurance policies are classified as Basic, Bronze, Silver or Gold.

The clinical categories are what make up the inclusions, exclusions, and restrictions of each of the hospital tiers.

For a clinical category to be included in a hospital tier, the health insurer must include all treatments as per the Medicare Benefits Scheduled Fee (MBS) that fall under that clinical category.

Phoenix Health has six levels of Hospital Cover available for purchase:

• Basic Accident Only Hospital
• Bronze Hospital
• Bronze Plus Essentials Hospital
• Silver Plus Support Hospital
• Silver Plus Family Hospital
• Silver Plus Advantage Hospital

You can choose to take them out as stand-alone products or combine with any level of available Phoenix Health Extras cover.

For more information about Hospital Cover and the benefits available on each level of cover, see the relevant product information sheet. Please read these in conjunction with the Phoenix Health Member Guide.

The table below offers an overview of services that are included (✔), excluded (✘) and restricted (R) on all levels of Phoenix Health Hospital cover.