Doctors Health Fund Review
Doctors’ Health Fund is a private health fund that was established 42 years ago for medical professionals. The fund is open to Australian registered medical practitioners, medical students, overseas qualified doctors, and employees of the Australian Medical Services, employees associated with any medical practitioner and employees of Avant Insurance Limited and Avant Law and their families.
Health Fund Key Facts
For-Profit or Not-For-Profit?: Mutual Organisation
Private Hospital Agreements Nationwide: 285
Day Hospital Agreements Nationwide: 274
Head Office: Sydney, NSW
Health Deal Represented?: No
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Doctors Health Fund Hospital Cover
Doctors Health Fund offers 3 hospital policies suitable for all needs and ages, ranging from Smart Starter Bronze Plus to Top Cover Gold. All of these policies provide coverage for your stay as a private patient and as a minimum benefit include restrictive cover for rehabilitation, psychiatric, and palliative services. Here is a list of some of the current hospital covers available:
- Smart Starter Bronze Plus
- Prime Choice Gold
- Top Cover Gold
Doctors Health Fund Extras Cover
Extras Cover takes care of the everyday healthcare service expenses that are generally not covered under Medicare such as dental services, prescription glasses, and physiotherapy. Here is a list of some of the current extras covers available:
- Starter Extras
- Essential Extras
- Total Extras
Doctors Health Fund Wait Periods
Doctors Health Fund 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:
The standard hospital wait periods are:
- 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 Doctors Health Fund?
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 mobile app by submitting a photo of your receipt.
Online: You can log into your online account and lodge your claim by providing the details on your receipt.
Fax: You can download a claim form and fax with receipts to 02 9260 9985
Post: You can lodge your claim by posting a completed form with receipts to: PO Box Q1749, Queen Victoria Building, Sydney NSW.
Doctors Health Fund Gap Cover
Doctors Health Fund’s gap cover is called 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
You can gauge how efficient a gap scheme is by comparing health funds in the same state or territory and determining which of the fund offers a greater proportion of medical services covered at no gap. While it is more likely that a medical service covered under your fund can be utilised at no personal cost to the customer, it is entirely the choice of the physician whether or not to participate in the gap 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.
Doctors Health Medical Services with No Gap: 87.2%
Industry Average 79.1%
Doctors Health Medical Services with No or Known Gap: 97.4%
Industry Average: 90.5%
Doctors Health Medical Services with No Gap: 92.4%
Industry Average: 89.5%
Doctors Health Medical Services with No or Known Gaps: 98.2%
Industry Average: 95.7%
Doctors Health medical services with No Gap: 93.4%
Industry Average: 86.7%
Doctors Health medical services with No or Known Gap: 99.1%
Industry Average: 95.1%
Doctors Health medical services with No Gap: 94.1%
Industry Average: 89.2%
Doctors Health medical services with No or No or Known Gap: 98.7%
Industry Average: 94.5%
Doctors Health medical services with No Gap: 91.0%
Industry Average: 89.5%
Doctors Health medical services with No or Known Gap: 98.8%
Industry Average: 96.6%
Doctors Health medical services with No Gap: 90.8%
Industry Average: 84.4%
Doctors Health medical services with No or Known Gap: 97.7%
Industry Average: 96.2%
Doctors Health Medical Services with No Gap: 88.5%
Industry Average: 90.2%
Doctors Health Medical services with No or Known Gap: 97.9%
Industry Average: 96.7%
Doctors Health Medical Services with No Gap: 76.9%
Industry Average: 84.2%
Doctors Health Medical Services with No or Known gap: 97.5%
Industry Average: 93.8%
What Is Doctors Health Fund Ambulance Cover?
Doctors Health Fund provides ambulance coverage on all its hospital policies as a standard benefit.
Do you need ambulance cover?