Phoenix health fund review

Phoenix Health Fund is a not-for-profit health insurer, originally established in 1953 exclusively for Stewarts and Lloyds steel industry employees. Today, Phoenix Health offers health insurance to anyone who wishes to join.

Phoenix Health states their aim is to provide simple and easy-to-understand information to all members, working within the principles of respect, responsiveness and integrity. 

As a not-for-profit fund, Phoenix Health invests profits back into the fund to offer higher benefits for members.

Hospital cover

Nobody chooses to go to hospital. But when you do, appropriate hospital cover will help you get the treatment you need, where and when you want it.

It also helps to pay the bills, as fees for hospital rooms and specialists can add up.

Think about what services you’re likely to need, in line with your budget. If you earn over $90,000 individually or $180,000 as a couple, taking out appropriate hospital cover may help you avoid paying the Medicare Levy Surcharge (MLS).

Phoenix Health offers six types of hospital cover, ranging from Bronze Hospital for no-frills budget cover and Silver Plus Content Hospital for comprehensive cover. 

You can lower premiums by choosing between $700, $500 or $250 excess. None of their policies cover weight-loss surgery or sleep studies.

Bronze Hospital

Phoenix Health’s entry-level hospital policy helps you avoid the Medicare Levy Surcharge on a budget price. It also comes with a large number of inclusions for a Bronze level policy.

Key inclusions:

• Chemotherapy, radiotherapy and immunotherapy for cancer

• Gastrointestinal endoscopy

• Joint reconstructions

Bronze Plus Essentials Hospital

Phoenix Health’s second lowest tier of hospital cover includes the wide range of common procedures in the Bronze policy, plus some key inclusions for other procedures, including wisdom teeth removal in hospital.

Key inclusions:

• Lung and chest

• Blood

• Dental surgery

Bronze Plus Care Hospital

This mid-range cover is close to a Silver level policy and offers a couple of additional items from the Bronze Essentials package, but doesn’t include items commonly found in higher tiers, such as pregnancy and cataracts.

Key inclusions:

• Heart and vascular system

• Plastic and reconstructive surgery (medically necessary)

Silver Everyday Hospital

Phoenix Health’s Silver Plus policy is aimed at older Australians and covers a number of common procedures for the over 50s, while excluding pregnancy and family planning items.

Key inclusions:

• Back, neck and spine

• Podiatric surgery

• Implantation of hearing devices

Silver Plus Content Hospital

This version of Phoenix Health’s Silver Plus policy is designed with would-be parents in mind, as it covers pregnancy and reproductive items, but doesn’t include common procedures for older Australians, such as dialysis and kidney pumps.

Key inclusions:

• Joint replacement

• Pregnancy and birth

• Assisted reproductive services

Silver Plus Advantage Hospital

Silver Plus Advantage Hospital excludes family planning options, but is the only policy that covers a number of major procedures that are common for older Australians.

Key inclusions:

• Dialysis for chronic kidney failure

• Insulin pumps

• Cataracts

Ambulance cover 

All Hospital policies include unlimited emergency and non-emergency ambulance cover Australia-wide for all medically necessary transport by air, land and sea.

Some extras covers have limited benefits for ambulance services.

Extras cover

Extra Reset on 1st of January

From dental, to optical, to chiro and more, extras insurance helps cover the bills for routine treatments with rebates of up to 100%.

While we’ve summarised the key points of each plan below, it’s always worth digging a little deeper into how much you can claim back, and whether your preferred healthcare provider, such as your local dentist, is recognised by the health fund.

Take the time to work out what you need and what you’re prepared to pay. If this feels a bit overwhelming, you can speak to one of our experts.

Phoenix Health offers three extras policies, which can be purchased either separately or with hospital cover. All extras policies include 100% back on two preventative check-ups a year.

Kick Start Extras 50

Phoenix Health’s low cost entry-level package gives you at least 50% back on some basic services (up to annual limits). It doesn’t include major dental treatment or services such as podiatry or mental health treatment.

Key inclusions:

• $500 annual limits per person on general dental

• $200 annual limits on per person physio

• $200 combined annual limits per person on chiro, osteo, remedial massage and acupuncture

Everyday Extras 60

Phoenix Health’s mid-tier package offers 60% back (up to annual limits) on most commonly claimed-for items like glasses and orthodontics, making it a cost-effective option for Australians of all ages.

Key inclusions:

• No annual limit on General Dental

• $800 annual limits on both Major Dental and Endodontic

• $800 annual limits (and $2100 lifetime) on Orthodontic

Complete Extras 70

The most comprehensive extras cover, Complete Extras are ideal for people looking for higher limits and benefits on a wider range of services.

Key inclusions:

• $1000 overall limit on Physio, Chiro and Osteo

• $400 annual limits on Orthotics

• $400 limit per therapy on Psychology, Speech, Eye and Occupational Therapies

• $200 limits on Hearing Aids available once every 3 years

Waiting periods

Waiting periods are there to stop people from signing up, claiming and then cancelling their cover. It means once you take out a new plan, you may have to wait a certain amount of time before receiving your benefit.

When you switch to Phoenix Health from another provider, you won’t have to re-serve new waiting periods, unless your new policy pays higher benefits or covers something you didn’t have before.

Hospital Waiting Periods

• 12 months for pre-existing conditions

• 12 months for Obstetrics

• 2 months for Psychiatric care, Rehabilitation or Palliative care (whether or not these are pre-existing conditions)

• 2 months in all other circumstances

Extras Waiting Periods

• 36 months for Hearing Aids

• 12 months for Major Dental

• 12 months for Orthodontics

• 12 months for Hearing Aids

• 6 months for Optical

• 12 months for Non-surgically implanted Prosthesis or Devices

• 2 months for all other services, including General Dental, Physio and Chiro

Member benefits

All Phoenix Health members can be treated by their preferred provider of choice, rather than being locked into a health fund network. 

Members can also register for the fund’s Shop.Save.Support program, which allows members to save up to 7% when they purchase e-Gift cards from some of Australia’s biggest brands. 

On average, 2% of all purchases made through the online stores will be donated back to a charity nominated by the member.

How to claim

Hospital

Simply tell the hospital you are a member of a Phoenix Health policy. Your hospital account will be sent directly to Phoenix Health for them to assess on your behalf. If you’re billed directly via your provider, you can also claim via your MyGov account or by going into a Medicare office.

It is recommended you call your fund before your admission date to check what benefits you are entitled to and if any out-of-pocket expenses or excess will be payable on the day,

Extras

You can swipe your membership card to claim directly on the spot with your provider’s HICAPS or iSOFT terminal.

Members can also claim after the treatment via Phoenix Health mobile claiming app or through email, fax or mail.

Hospital agreements

Phoenix Health has agreements with a large number of hospital and day surgery providers across Australia.

When comparing policies, it’s worth checking if your preferred local hospitals and clinics are covered. Our specialists at Health Insurance Comparison can do this for you.

Customer service

Phoenix Health received six private health insurance complaints in 2020. This is under their market share of 0.1%, which suggests their customer service is good.

FAQ

1. Is Phoenix Health Fund a not-for-profit fund?

Yes. As a not-for-profit fund, Phoenix Health is part of the Members’ Health Alliance.

2. Who can apply? Are there restrictions? 

No. Phoenix Health started out as a restricted fund for Stewarts and Lloyds employees, but is now open for all to join.

3. Is it easy to switch to Phoenix Health Fund?

Phoenix Health isn’t on our panel so you’ll need to contact them directly to switch. We’re confident the Compare Club team can find you a great deal from the insurers on our panel.

4. Do I need to re-serve waiting periods?

You can switch to an equivalent or lower level of cover without re-serving new waiting periods. You’ll need to serve new waiting periods if you have upgraded to a higher level of cover.

5. Can I change my level of cover?

Yes, but you’ll need to modify your cover with Phoenix Health directly. 

6. Do I get the government rebate?

For every dollar of private health insurance premiums, the Australian Government provides eligible Australians with a rebate of up to 33.4% (depending on your age and income). To learn what you’re entitled to, read our rebate guide.

7. Do I have to pay the Lifetime Health Cover loading?

If you’re 31 or over, you usually need to pay 2% loading for each year you’ve gone without hospital cover since the 1st July following your 31st birthday. You can find out more here.

8. What age are children covered up to?

Children are automatically covered under family cover until the day before they turn 21. 

Full-time students can be registered as Student Dependents, and they’ll be covered for no extra cost until the day before they turn 25 or whenever they finish full time study (whichever comes first).

This guide is opinion only and should not be taken as medical or financial advice. Check with a financial professional before making any decisions.