Phoenix Health Fund

Don't let sickness get you down – Make sure you can rise from the ashes with Phoenix Health Fund

Looking after your health is of paramount importance for every Australian, regardless of whether you’re 25 or 55 and in order to ensure that you can get the treatment you need when you need it, private health cover is a must consideration.

There are many health funds to choose from in Australia, and Phoenix Health Fund offers a wide variety of cover options to its members. A not-for-profit, member-owned health fund, Phoenix provides basic, medium and comprehensive cover, available in either standalone or packaged forms. does not currently have access to this health insurance brand. You may wish to compare options available on the health insurance homepage.

Joining Phoenix Health Fund

Phoenix Health Fund is a member of the Members Owned Health Fund brand, which means it is run solely to benefit its members rather than to turn a profit. Since its beginnings in 1953, Phoenix Health Fund has aimed to provide affordable and top-quality health insurance to its members. It boasts a 98% member satisfaction rate and offers cover to suit singles, couples and families.

As a member of the Australian Health Service Alliance (AHSA), Phoenix can offer its members access to more contracted doctors and hospitals than any of the big health funds, as well as offer an Access Gap Scheme to reduce and even remove your out of pocket expenses.

It offers four levels of hospital cover, three levels of extras cover and three packaged policies to meet the needs of a variety of Australians and their differing needs and budgets. If Phoenix Health Fund sounds like it has the right cover for you, you can join online or apply via mail, email or fax.

Phoenix Health Fund Levels of Cover

If you’re looking for standalone hospital cover, consider the following options from Phoenix:

  • Basic Hospital $500 Excess. As the name clearly suggests, this policy provides hospital cover for a range of essential procedures and requires you to pay a $500 excess when you are admitted to hospital. No excess is payable for dependent children and you can enjoy cover for accidental injuries, appendix and tonsil removal, knee reconstruction and wisdom teeth removal in private and public hospitals around Australia.
  • Mid Hospital $500 Excess. This policy aims to provide a happy medium between a broad range of benefits and affordable cover. It covers accidental injuries, prostheses, appendicitis, joint reconstruction, colonoscopies and more, while heart-related services and cosmetic surgery covered by Medicare are also included.
  • Top Hospital $500 Excess. This comprehensive cover option covers all the same things as Mid Hospital Cover but adds extra features like pregnancy, assisted reproductive services, major eye surgery, renal dialysis and psychiatric services. This is the top level of hospital cover available from Phoenix.
  • Top Hospital. This offers the same level of cover as the above policy but does not require you to pay a $500 excess when you are admitted to hospital.

For standalone extras cover, consider the following options:

  • Basic Extras. This entry-level extras cover option includes cover for ambulance, dental, physio, chiro and physio, giving you cover for the treatments you’re likely to use and none you probably won’t need. This is a good policy option for members who are young and healthy.
  • Mid Extras. This option is the next step up and provides a moderate level of extras cover for the treatments younger people commonly require. This includes everything from optical, dental and physio to podiatry and natural therapies, but a host of more expensive treatments are excluded from cover to keep premium costs down.
  • Top Extras. Top Extras offers the highest level of general treatment cover available from Phoenix. It covers major dental, orthodontics, optical, physio, chiro, non-PBS pharmaceuticals, midwifery, home nursing, speech therapy, occupational therapy, natural therapies, remedial massage, psychology, hearing aids, dietetics and more.

If you’d like to combine hospital and extras cover, Phoenix Health Fund offers the following packaged policies:

  • YoungSavers. This basic option is designed for younger members and attracts a $500 hospital excess. It combines Phoenix’s Basic Hospital Cover with Mid Extras to offer affordable health protection.
  • Value 500. Combining Top Hospital Cover and an intermediate level of extras cover, this option also includes ambulance cover and access to a healthy lifestyle program.
  • Top Cover. Combining Top Hospital Cover and Top Extras Cover from Phoenix, this policy does not charge a hospital access and is designed to give you maximum peace of mind.

Are there any additional benefits?

  • Claim on mobile. Easy mobile claiming through the Phoenix Health Fund smartphone app.
  • Not-for-profit. Phoenix is run to offer the right products and services to its members, not to turn a profit.
  • Satisfied customers. Phoenix’s latest customer survey revealed a 98% customer satisfaction rating.
  • Speak to a real person. You can speak to a Phoenix staff member whenever you call the health fund, rather than having to speak to a machine.
  • Travel insurance discounts. Phoenix Health Fund members can enjoy discounts on a range of QBE Travel Insurance policies.
  • Optical discounts. Phoenix Health Fund offers substantial optical and eyewear discounts through a range of partner companies.

General exclusions and waiting periods

Phoenix Health will not pay your claim under a range of circumstances, such as if:

  • It is for services or treatments that you receive before you have served any relevant waiting periods
  • It is for a hospital procedure for which no Medicare benefit is payable, for example cosmetic surgery that is not medically necessary
  • Your premiums are in arrears
  • It is for services received at least two years prior to the date you lodge your claim
  • It is for services provided outside Australia
  • It is for services that can be claimed as compensation or damages from another source, for example workers’ compensation insurance
  • It is for services provided by family members of relatives.

Phoenix Health Fund members, and members of any other Australian private health fund, will also need to consider the waiting periods that apply when they sign up for cover. While you won’t have to serve a waiting period before you can receive ambulance and accident cover, a two-month waiting period applies to most hospital and extras benefits. Some treatments and procedures, for example major dental, obstetrics and hearing aids, require you to serve longer waiting periods.

Phoenix Health Fund excess

Depending on the hospital cover you choose, you may need to pay an excess when you are admitted to hospital. This is your contribution to the cost of your hospital stay and treatment, and the higher your excess is the lower your premiums will be. For example, Top Hospital Cover is available in two forms: one that requires you to pay a $500 excess when you are admitted to hospital and one that has a $0 excess attached.

It’s also important to point out that no excess is payable for any dependent children on your policy.

Making a Claim

In the majority of cases, many general treatment providers will provide on-the-spot electronic claiming when you receive your treatment. All you have to do is swipe your Phoenix Health Fund membership and any benefits you are entitled to will be automatically deducted from your bill.

Where this is not an option, you’ll be required to fill out and send in a claim form that includes your receipt, your membership number, the date the service was provided, the details of the service provided and the details of the service provider. Your claim form can then be submitted via email, post or fax, or via your smartphone using the Phoenix Health Fund Mobile Claiming app.

Get the Phoenix Health Fund Mobile Claiming app

Phoenix Health Fund


Q. Where can I download the Phoenix Health Fund Mobile Claiming app?

  • A. The app is available for download from the iTunes App Store or the Google Play store.

Q. I’m joining from another health fund - will I need to re-serve my waiting periods?

  • A. No, Phoenix Health will recognise any waiting periods you have already served with your previous health fund for an equivalent level of cover.

Q. Am I covered when I visit my GP?

  • A. No. The Australian Government does not allow health funds to cover the cost of outpatient services or visits to your GP.

Q. What about cover for my children?

  • A. As long as you ensure that your children are listed on your Phoenix Health Fund policy, they will automatically receive cover until they reach 21 years of age. If your child is a full-time student, register him or her as a student dependent and they will be covered until they turn 25 or until they finish their study.

Q. How can I transfer from another health fund to Phoenix?

  • A. This is easy to do and you don’t even need to contact your current fund; Phoenix can do that on your behalf. You’ll simply need to provide the necessary details about the other fund during the application process.

Compare policies from our panel of health insurers

If you want competitive, affordable and quality health cover, consider the policies available from Phoenix Health Fund. However, you should always weigh up all your options before you decide which fund can provide the cover you and your family need.

Claim amounts by medical procedure

Phoenix Health Fund will allocate a benefit amount proportionate to the seriousness of your condition and the treatment you claim for. For example, you will receive a larger payment if your claim is for heart surgery and a smaller one if its for tonsil removal.

This calculation process is not unique to Phoenix Health Fund, and is common practice among all Australian providers. Here you can find the dollar amounts that Phoenix will pay for 22 commonly claimed for medical services. Medicare's (MBS) benefit amounts are also included for the purpose of comparison.

Phoenix Health Fund falls under the title AHSA in this table:

Basal Cell Carcinoma or Squamous Cell Carcinoma removal from nose, eyelid, lip, ear, digit or genetalia$221.35$366.10
Breast, benign lesion surgical biopsy of excision$260.05$356.40
Carpal Tunnel Release$276.80$440.20
Cataract Surgery$760.55$1,239.70
Complicated Delivery (of baby)$1,629.35$1,855.90
Coronary Artery Bypass$2,200.00$3,783.30
Cytotoxic Chemotherapy$97.95$107.80
Femoral on Inguinal Hernia$464.50$909.70
Hip Replacement$1,317.80$2,214.50
Knee Replacement$2,047.60$2,563.40
Overnight investigation for sleep apnoea$588.00$682.20
Tonsils or Tonsils and Adenoid$295.70$513.90
Uncomplicated Delivery (of baby)$693.95$1,484.50
Vaginal Hysterectomy$674.70$1,066.20
Varicose Veins$109.80$164.80


I recognise most of these funds except for the AHSA, what is that?

The Australian Health Service Alliance is a management services organisation that represents a number of small to medium sized health insurance funds, allowing them to combine resources to deliver a higher quality of service to their members.

The funds represented by the ASHA are:

  • ACA Health Benefits Fund
  • Australian Unity Health Limited
  • CBHS Health Fund Limited
  • CUA Health Limited
  • Defence Health
  • GMF Health
  • Budget Direct Health Insurance
  • Frank Health Insurance
  • GU Health
  • HBF Health Ltd
  • Health Care Insurance Limited
  • Health Insurance Fund of Australia Limited
  • Health Partners
  • Navy Health
  • onemedifund
  • Peoplecare Health Insurance
  • Phoenix Health Fund
  • Police Health Limited
  • Queensland Country Health Fund Limited
  • Reserve Bank Health Society Ltd
  • rt health fund
  • Teachers Health Fund > UniHealth Insurance
  • Teachers Union Health
  • The Doctors' Health Fund Pty Ltd
  • Transport Health
  • Westfund
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