Phoenix Health Fund Review
Overview
Phoenix Health is a not-for-profit, mutual health fund that was established over 65 years ago as an exclusive fund for Stewarts and Lloyds employees. They no operate as an open health fund and offer membership to all Australian citizens and permanent residents while still maintaining their strong ties to Stewarts and Lloyds and their affiliated companies.
Phoenix health is part of Members Own, a group of 19 like-minded, mutual health funds that invest their dividends back into their members through higher benefits and paid claims.
Phoenix Health Fund Key Facts
Founded: 1953
For-Profit or Not-For-Profit?: Mutual, Not-For-Profit
Private Hospital Agreements Nationwide: 283
Day Hospital Agreements Nationwide: 259
Health Deal Represented? No
Headquarters: Newcastle, NSW
Phoenix Health Hospital Cover
Phoenix Health has a range of covers to suit all ages and needs. These range from Bronze Plus Starter Hospital all the way up to Gold Top Hospital. Here is a list of the current hospital policies currently available:
- Bronze Plus Starter Hospital
- Bronze Plus Mid Hospital
- Silver Plus Essentials Hospital
- Gold Top Hospital
Phoenix Health Extras Cover
Extras Cover takes care of the everyday healthcare service expenses that are not generally covered under Medicare such as dental services, prescription glasses, and physiotherapy. Here is a list of the current extras covers available:
- First Start Extras
And 3 extras policies that are available for purchase together with a hospital cover:
- Base Extras
- Mid Extras
- Top Extras
Phoenix Health Combined Cover
The following Combined covers are currently available with Phoenix Health:
- Bronze Plus YoungSavers Cover
- Gold Value Cover
Phoenix Health Waiting Periods
Phoenix Health recognises the waiting periods you have already served with a previous health fund if you switch, this is called “portability”. For first-timers taking out a hospital cover, members who may have lapsed in hospital coverage and those upgrading their level of cover, the waiting periods below will have to be served before members can claim on services:
Phoenix Health Hospital Waiting Periods
- Ambulance services: 1 day
- Accidental Injury: None
- New Conditions: 2 Months
- Pregnancy and birth-related services: 12 months
- Pre-existing conditions: 12 months
- Rehabilitation & Palliative care: 2 months
- Weight Loss Surgery: 12 months
How Do You Claim Extras with Phoenix Health?
Phoenix Health offers several quick and effortless ways to claim on your extras. This can be done in the following ways:
On the spot: Swipe your membership card at a health provider that uses the HICAPS system to have your claim processed immediately.
Via a mobile app: You can lodge a claim using the by submitting a photo of your receipt to the Phoenix Health App.
Online: You can log into their website and lodge your claim by providing the details on your receipt.
By Mail: You can lodge your claim by posting a completed claims form along with your relevant accounts and receipts to:
Phoenix Health Fund,
PO Box156
Newcastle NSW 2300
Phoenix Health Gap Cover
Phoenix Health’s gap cover is called the Access Gap Cover. If your doctor charges you more than the standard MBS fee, this is known as the ‘gap’ and can leave you with an out-of-pocket expense. Access Gap can help to minimise or eliminate personal expense but it is the choice of the physician to participate in any given gap scheme.
Gap Cover Ratings By State
To determine how beneficial a gap scheme will be, we suggest comparing health funds in the same state or territory to show which of the funds offer a greater proportion of medical services covered with no gap. While it is more likely that a medical service covered under your health fund can be utilized at no personal cost to you, it is entirely the choice of the physician whether or not to participate in the gap cover scheme.
Medical Services with No Gaps — The percentage of claims that were fully refunded.
Medical Services with No or Known Gaps — The percentage of claims that were fully refunded, or where the policy holder knew the cost before the surgery was performed.
The information below outlines the percentages of services covered under no-gap and known-gap.
Phoenix Health medical services with No Gap: 81.3%
Industry Average: 79.1%
Phoenix Health medical Services with No or Known Gap: 95.4%
Industry Average: 90.5%
Phoenix Health medical services with No Gap: 92.3%
Industry Average: 89.5%
Phoenix Health medical Services with No or Known Gap: 98.8%
Industry Average: 95.7%
Phoenix Health medical services with No Gap: 90.4%
Industry Average: 86.7%
Phoenix Health medical Services with No or Known Gap: 98.9%
Industry Average: 95.1%
Phoenix Health medical services with No Gap: 90.8%
Industry Average: 89.2%
Phoenix Health medical Services with No or Known Gap: 97.8%
Industry Average: 94.5%
Phoenix Health medical services with No Gap: 93.7%
Industry Average: 89.5%
Phoenix Health medical Services with No or Known Gap: 99.7%
Industry Average: 96.6%
Phoenix Health medical services with No Gap: 86.7%
Industry Average: 84.4%
Phoenix Health medical Services with No or Known Gap: 97.2%
Industry Average: 96.2%
Phoenix Health medical services with No Gap: 92.6%
Industry Average: 90.2%
Phoenix Health medical Services with No or Known Gap: 100%
Industry Average: 96.7%
Phoenix Health medical services with No Gap: 83.9%
Industry Average: 84.2%
Phoenix Health medical Services with No or Known Gap: 94.6%
Industry Average: 93.8%
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