Defence Health Review
Overview
Defence Health is a restricted, non-profit health fund that was formed to provide quality and affordable private health care to current and former members of the Australian Defence Force and their immediate families.
Established over 65 years ago, they have since grown larger, and now provide health coverage for employees of the Defence Department and other defence associated departments and their immediate and extended families.
With over 260,000 members, Defence Health remains family orientated and maintains its core purpose, which is to aid ADF members to manage their personal and family health care.
Defence Health Key Facts
Founded: 1953
For-Profit or Not-For-Profit?: Not-For-Profit
Private Hospital Agreements Nationwide: 285
Day Hospital Agreements Nationwide: 274
Headquarters: Melbourne, VIC
Health Deal Represented?: No
Defence Health Hospital Cover
Defence Health has a range of covers to suit all individuals and families, these range from Essentials Hospital Basic Plus to Ultimate Hospital 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:
Defence Health Hospital Cover Options:
- Essentials Hospital Basic Plus
- Everyday Hospital Bronze Plus
- Core Hospital Silver
- Ultimate Hospital Gold
Defence Health 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 the current extras covers available:
- Essentials Extras
- Premier Extras
- Value Extras
Defence Health Insurance Waiting Periods
Defence 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:
Defence Health Wait Periods
- 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 Defence Health?
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 Defence Health mobile app by submitting a photo of your receipt.
Online: You can log into your online account through defencehealth.com.au and lodge your claim by providing the details on your receipt.
Fax: Sending a completed claim form and your accounts/receipts to 1800 241 581
Australian Military Bank Branch: Submit your claim by taking your original account, completed claim forms and receipt and they will fax your claim for you
Mail: Post a completed form along with your receipt to: Defence Health, P O Box 7518, Melbourne, VIC 3004
Defence Health Fund Gap Cover
Defence 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.
Defence Health Insurance: 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.
he information below outlines the percentages of services covered under no-gap and known-gap.
Defence Health Medical Services with No Gap: 79.5%
Industry Average 79.1%
Defence Health Medical Services with No or Known Gap: 93.6%
Industry Average: 90.5%
Defence Health Medical Services with No Gap: 89.3%
Industry Average: 89.5%
Defence Health Medical Services with No or Known Gaps: 96.6%
Industry Average: 95.7%
Defence Health medical services with No Gap: 91.1%
Industry Average: 86.7%
Defence Health medical services with No or Known Gap: 98.8%
Industry Average: 95.1%
Defence Health medical services with No Gap: 92.4%
Industry Average: 89.2%
Defence Health medical services with No or No or Known Gap: 97.7%
Industry Average: 94.5%
Defence Health medical services with No Gap: 90.3%
Industry Average: 89.5%
Defence Health medical services with No or Known Gap: 99.4%
Industry Average: 96.6%
Defence Health medical services with No Gap: 88.0%
Industry Average: 84.4%
Defence Health medical services with No or Known Gap: 96.3%
Industry Average: 96.2%
Defence Health Medical Services with No Gap: 91.4%
Industry Average: 90.2%
Defence Health Medical services with No or Known Gap: 98.2%
Industry Average: 96.7%
Defence Health Medical Services with No Gap: 88.7%
Industry Average: 84.2%
Defence Health Medical Services with No or Known gap: 96.4%
Industry Average: 93.8%
What Is Defence Health Ambulance Cover?
Defence Health includes ambulance coverage in all of its policies as a standard benefit.
You may not need to take out an Ambulance Cover depending on where you live.
All states and territories in Australia give Department of Veterans Affairs Health Card holders free state ambulance.
