we look after you like family. - defence health · the families of adf members (permanent, and...

40
Issued April 2016 We look after you like family. Health Insurance for ADF members

Upload: others

Post on 30-May-2020

12 views

Category:

Documents


0 download

TRANSCRIPT

Page 1: We look after you like family. - Defence Health · The families of ADF members (permanent, and reservists serving 20 or more training days in a financial year) are eligible to join

Issued April 2016

We look after you like family.

Health Insurance for ADF members

Page 2: We look after you like family. - Defence Health · The families of ADF members (permanent, and reservists serving 20 or more training days in a financial year) are eligible to join

Contents

Information in this brochure is current as at 1 April 2016. It replaces all earlier versions. Please read it carefully and retain with any other Defence Health documentation.

Introduction 1

Why you’re better off with Defence Health 2

Favourite Features 4

Who’s eligible to join 5

Why you’re better off with private health insurance

6

Members Own Health Fund 6

Types of cover 7

Finding the right cover for you 8

Specially designed ADF packages for ADF members

9

ADF Total Package 10

ADF Essentials Package 14

Hospital cover 16

Extras cover 21

Get the lowdown 29

Maximise your benefits 30

Making the most of your hospital cover 30

Making the most of your extras cover 31

Claiming made easy 32

Important information 33

Making the most of the Australian Government’s initiatives

34

More ways we treat you like family 36

The right insurance solution for you 37

Page 3: We look after you like family. - Defence Health · The families of ADF members (permanent, and reservists serving 20 or more training days in a financial year) are eligible to join

We’re always here to help because that’s what family is for

At Defence Health, we put you before profit. Our members are more than just a name or number to us. You’re just like family.In these pages you’ll discover why over 249,000 Australians, all with connections to Defence, have joined our family. And if you decide to join us, you’ll discover why they stay. Like any good family, we support each other through good times and bad, and always take the time to listen.

To us, family is the most important thing. That’s why we are not-for-profit and all for the benefit of our members.

That’s why we’ll defend your right to the very best cover and protection.

If you want great value health insurance from an insurer that cares about your wellbeing and always provides excellent service, you’re in the right place.

If you have any questions we’re just a phone call away.

Visit defencehealth.com.au

1ADF members

Page 4: We look after you like family. - Defence Health · The families of ADF members (permanent, and reservists serving 20 or more training days in a financial year) are eligible to join

Why you’re better off with Defence Health

Special features for ADF membersADF families are the most important part of our family.

We’ve included these features just for the families of ADF members (permanent, and reservists serving 20 or more training days in a financial year).

Exclusive ADF packagesOur special packages offer national pricing, which means that no matter where your posting takes you, your premium stays the same. And our ADF Total Package also offers higher benefits on dental, speech therapy, physiotherapy, psychology, antenatal and postnatal services and more.

Special premiums on mix and match rangeAs an ADF member you get special premiums on our mix and match hospital and extras covers, just in case the ADF packages don’t meet your needs.

Suspension of health coverYou can suspend your cover for up to 24 months when you are sent overseas on an accompanied posting. If you are a Reservist on continuous full-time service (CFTS) for more than 28 days you can also suspend your cover for the full duration of the CFTS.

No waiting periods for discharging ADFAll waiting periods are waived if you join within two months of discharging from the permanent ADF.

Transition discount for discharging ADFIf you are discharging from the permanent ADF, and not becoming a Reservist, you will receive a 10% premium reduction on hospital or hospital and extras from our mix and match range in your first year, as long as it’s paid for by direct debit.

Special premiums for DVA card holdersDVA White or Gold card holders receive a 5% premium reduction on our mix and match range.

Special features for our whole familyLow management costsBecause we have low management expenses, we can keep your premiums lower and return more in benefits. Last year, 95 cents of every premium dollar went back to our members in benefits.

Comprehensive ambulance coverEvery policy includes 100% cover for ambulance services by state-appointed ambulance providers across Australia. So there’s no need for a separate subscription, and there’s no limit on the number of times you can use the ambulance service when needed.

One of the largest hospital networks

We have agreements with over 500 hospitals around the country. This significantly reduces your out-of-pocket expenses. So no matter where you are, your closest private hospital will almost certainly be contracted to us.

Savings on dental

With our dental network, members with extras cover will save a guaranteed minimum of 15% off the usual dental fee at over 1,000 network dentists throughout Australia. And with many covers you will also get no-gap on preventive dental within limits.

Great optical benefits

With extras cover you can get no-gap glasses from our optical network, at over 600 providers around the country.

No waiting when you switch

If you switch from another insurer with an equivalent level of cover, we recognise any waiting periods you’ve already served. So you can make claims right away.

Simple claiming

You can claim your extras on the spot using your member card, online at defencehealth.com.au/members, or on your mobile or tablet with our free Mobile Claiming App, available to download in the App Store and Google Play Store.

2 ADF members

Page 5: We look after you like family. - Defence Health · The families of ADF members (permanent, and reservists serving 20 or more training days in a financial year) are eligible to join

Over 60 years of service

We were created to support the families of those who defend our country. With more than 60 years experience it’s fair to say, we know what we’re doing. We understand what you want from your health insurance.

Excellent service

We never forget we’re dealing with your health and wellbeing. We listen to you, and offer the protection you want. To us members are more than a name or a number: they’re just like family.

Not-for-profit

We’re all for the benefit of members. We give more back in benefits and resources. That means better service and lower out-of-pocket expenses on your health needs.

Supporting the Defence community

We are proud to support the Defence community through sponsorships of Defence community groups and organisations like Defence Families of Australia and Defence Special Needs Support Group.

Funding for medical research

We established the Defence Health Foundation in 2010 to fund medical research that responds to the needs of ADF serving and ex-serving members and their families.

ADF members 3

Talk to us on 1800 335 425

Page 6: We look after you like family. - Defence Health · The families of ADF members (permanent, and reservists serving 20 or more training days in a financial year) are eligible to join

Favourite features about our health insurance

Reduce your out-of-pocket expensesAgreement private hospitalsBe treated in one of our agreement private hospitals to significantly reduce your out-of-pocket expenses. We have agreements with over 500 hospitals around the country that ensure the majority of hospital charges are covered when you’re admitted for day procedures or overnight. For a full list of agreement hospitals, visit defencehealth.com.au/hospital.

Access Gap If your Doctor agrees to participate in our Access Gap scheme you can reduce or eliminate your medical out-of-pocket expenses. You can find doctors who participate at defencehealth.com.au/accessgap.

This scheme works on the basis that Defence Health will pay your doctor more on the condition they agree to charge you a no-gap or capped gap fee.

No-gap fees on a number of diagnostic servicesWe’ve negotiated no-gap agreements with a number of diagnostic service providers such as radiologists and pathologists. If you receive their services in hospital, there’s no cost to you. They send their bill directly to us and we take care of it for you.

Claim on-the-spot extras benefitsYour Defence Health member card enables your extras benefit to be paid directly to your provider at their practice. You can use our dental and optical networks or choose your own provider. Find a provider at defencehealth.com.au/extrasprovider.

Family favouritesNo excess for kidsIf you have a policy that covers your family, you’ll never have to pay the hospital excess for your kids.

No waiting periods for newbornsWe know there is a lot to think about when you’re having a baby and sometimes, in all the excitement, it is easy to forget your health insurance. So as long as you contact us before your baby is 2 months old, we’ll add them to your cover with no waiting periods. We even allow backdating of the policy to the day of your baby’s birth so treatments within those first two months are covered.

Cover for older kids

We’ll cover kids on your policy until they’re 21. And if they’re single and studying full-time, we’ll cover them until they’re 25.

Young Adult Support PlanIf your older kids are single and not studying full-time, they can remain on your family hospital policy until they’re 25 if they take out their own Value or Premier Extras cover.

Health programsIf you have ADF Total Package, Premier Hospital or Value Hospital cover you have access to a number of programs and services that help you look after your health and wellbeing.

Hospital substitute treatmentsIf your doctor agrees, you could avoid the hassle and inconvenience of going to hospital for certain treatments. Depending on where you live, your doctor can arrange for health care providers to come to your home to deliver services such as wound management, intravenous therapy and ambulatory sleep studies. Which means you could have the option of leaving hospital early and recovering at home.

Home nursingWhere your doctor is able to substitute hospital admission with home nursing, we’ll pay a benefit for a registered nurse to care for you in your home.

Rehabilitation at home Rehabilitation at home gives you access to a range of rehabilitation and healthcare services from the privacy, safety and comfort of your home. We cover the costs of the program on your behalf. There will be no cost to you, either directly or through your premiums.

MidwiferyWe’ll pay a benefit for a registered midwife in private practice to attend the delivery of your baby. Midwifery benefits are not payable if a doctor is required to intervene in the delivery. Benefits will be payable for the doctor’s in-hospital treatment instead.

Chronic care and risk factor managementOur chronic disease management and risk factor management programs provide telephone-based support for members with serious health challenges to achieve better health, wellness and quality of life. The programs will help invited members with: chronic heart disease, diabetes, lung disease, peripheral vascular disease, osteoporosis and bone health, complex and integrated care, anxiety and depression, falls prevention and safety in the home as well as risk factor management. Our program coordinators work with treating practitioners to support existing treatment and aid long term management and recovery.

Excess options that lower your premiumWe’ll reduce your premium if you choose to pay an excess when you go to hospital. The higher your excess, the lower your premium.

4

Page 7: We look after you like family. - Defence Health · The families of ADF members (permanent, and reservists serving 20 or more training days in a financial year) are eligible to join

Can you join the family?We were created to support you, the families of ADF members who defend our country, to manage your personal and family health care.

The families of ADF members (permanent, and reservists serving 20 or more training days in a financial year) are eligible to join.

ADF familiesThe partners and dependent kids of ADF members can all join Defence Health. If you’re a member of the permanent ADF you don’t need to cover yourself but you can cover your partner and/or dependent kids.

We have designed two hospital and extras packages just for you, which offer two levels of protection and the best value for money. But if these packages don’t meet your needs you can mix and match from our standalone covers at special ADF premiums.

View the details of the ADF packages on page 9.

If you have other Defence connections you are eligible too.The Defence community is a far-reaching group. At its core are ADF members and their partners and their children. But there are others in the Defence community whose contributions to the security of the nation are less obvious.

Your work colleagues and extended family may be eligible to join too.

Past service

If they have previously served in the ADF (permanent or reserve)

ADF supporters

If they currently work or have worked in the Department of Defence and other Defence-related departments

If they work or have worked for a Defence supplier – a company or agency contracted to the Department of Defence, where they are or were involved in the supply of goods and services to Defence

Extended families of all above

If you’re the mum or dad, son or daughter, sister or brother, grandchild or partner/ex-spouse of a serving or ex-serving ADF member or of an ADF supporter

If you’re part of the wider Defence community, we have cover options more relevant to your needs. Visit defencehealth.com.au or talk to us on 1800 335 425 for more information.

Talk to us on 1800 335 425

5ADF members

Page 8: We look after you like family. - Defence Health · The families of ADF members (permanent, and reservists serving 20 or more training days in a financial year) are eligible to join

Why you’re better off with private health insurancePrivate Health Insurance helps look after your family’s most valuable asset – their health.

Peace of mind

Manage the costs of hospital admissions and medical treatment and get access to the best care when you need it.

Choose your care

The doctor, specialist and the hospital you’re treated in are all selected by you.

Skip the queues

Avoid public hospital waiting lists and get the treatment you need sooner.

Avoid the Lifetime Health Cover loading

Take out hospital cover by July 1 after turning 31 and you can avoid paying a Lifetime Health Cover loading on your premium.

Avoid government surcharges

Higher income earners can avoid paying the Medicare Levy Surcharge by taking out hospital cover.

Get money back on extras

When you visit dentists, physios, optometrists and others we’ll cover some of the costs.

We exist to benefit membersMembers Own Health Funds is a group of not-for-profit and mutual health funds, who have come together to highlight a genuine choice for Australians when it comes to choosing their health fund.

Members Own Health Funds, like Defence Health, exist to benefit members, not to profit investors or overseas owners. We deliver better service, have higher member satisfaction and loyalty and receive fewer complaints than for-profit and overseas owned funds.*

For more than 60 years, Defence Health has been committed to looking after our members’ wellbeing by providing great value health insurance along with genuine care, support and expertise. We don’t have shareholders so there’s more to

share with you, in fact 95 cents of every premium dollar went back to our members in benefits last year.

As the largest health insurer for ADF families and the wider Defence community, our members are our priority. It’s this commitment to the entire Defence community that has seen Defence Health grow into the family we are today.

We are uniquely Defence Health and being a Members Own Health Fund just emphasises this difference.

*Refer to www.membersown.com.au for the detailed report supporting these facts.

6

Page 9: We look after you like family. - Defence Health · The families of ADF members (permanent, and reservists serving 20 or more training days in a financial year) are eligible to join

Types of coverWe offer ADF packages that combine hospital and extras, and a range of hospital and extras covers that can be mixed and matched to meet your needs.

ADF packagesOur ADF Total Package and ADF Essentials Package are just for ADF members, their partners and families. They offer different levels of protection based on your needs and are the best value for money options.

Standalone cover for mixing and matchingIf the ADF packages don’t meet your needs you can always choose from our mix and match hospital and extras covers. As an ADF member you get special premiums on the mix and match range.

Hospital cover

Hospital cover helps lower or remove your costs when you’re a private patient in hospital. We have three levels of hospital cover: Premier, Value and Essentials. The level you choose determines the number and types of procedures and services you’re covered for. The higher your level of cover, the more you’ll be covered for.

Extras cover

Extras cover helps lower or remove your costs when you visit health and wellbeing providers whose fees aren’t covered by Medicare. They include dentists, chiropractors, physiotherapists, a range of alternative therapists and much more. We have three levels of extras cover: Premier, Value and Essentials. The higher your level of cover, the more services you’ll be covered for and the lower your out-of-pocket expenses will be.

Visit defencehealth.com.au

7ADF members

Page 10: We look after you like family. - Defence Health · The families of ADF members (permanent, and reservists serving 20 or more training days in a financial year) are eligible to join

Where you’re at Need and wantsRecommended product

You might like to consider

Young, fit and healthy singles and couples

I just need limited cover

I don’t want to pay for services I don’t need

I want low cost cover

I want to avoid government penalties

ADF Essentials Package (Pg 14)

Essentials Hospital (Pg 20) + Essentials Extras (Pg 28)

No kids, none planned any time soon

I want well priced cover with more than the basics

I want good benefits

ADF Total Package (Pg 10)

Value Hospital (Pg 19) + Value Extras (Pg 26)

Planning a family We want cover for pregnancy and assisted reproductive services

We need cover that can protect a growing family

ADF Total Package (Pg 10)

Premier Hospital (Pg 18) + Value Extras (Pg 26)

Young family on a tight budget

We don’t want to spend too much

The health and wellbeing of our family is important but we’re willing to have a few exclusions on unlikely treatments to keep premiums affordable

ADF Total Package (Pg 10)

Value Hospital (Pg 19) + Value Extras (Pg 26)

Established family We need cover for a wide range of services

We are looking for value for money

ADF Total Package (Pg 10)

Premier Hospital (Pg 18) + Value Extras (Pg 26)

My health and the health of my family is not worth risking

I want the best cover for total peace of mind

Being in control of my health is vital to me

My family’s wellbeing is my priority

ADF Total Package (Pg 10)

Premier Hospital (Pg 18) + Premier Extras (Pg 24)

Older and wiser I want to be well covered just in case

We want to get the treatment we need as soon as we need it

ADF Total Package (Pg 10)

Premier Hospital (Pg 18) + Premier Extras (Pg 24)

Finding the right cover for you

Use our quick guide below to identify the right cover for you, or read about all our covers in the pages ahead.

Get a quote or explore your options

Visit defencehealth.com.au

Talk to us on 1800 335 425

8

Page 11: We look after you like family. - Defence Health · The families of ADF members (permanent, and reservists serving 20 or more training days in a financial year) are eligible to join

Specially designed ADF packages for ADF members We’ve combined the best of our hospital and extras covers into two convenient packages just for your partner and children (and you, if you are a reservist). You’ll enjoy great value cover no matter where you are posted as your premium stays the same.

ADF Total PackageOur ADF Total Package gives you our best protection with comprehensive hospital cover and access to a wide range of extras services with generous annual limits.

This package is perfect for those that want comprehensive cover at a great value price.

The ADF Total Package has been specially designed with ADF families in mind so you can be sure we’re looking after you.

ADF Essentials PackageOur ADF Essentials Package provides cover for a limited number of common treatments that young and healthy singles and couples are likely to need.

This is a low cost package so it’s great if you’re on a budget or if you’re looking for a basic hospital cover to avoid Government penalties but still want to get something back for your money.

Comprehensive ambulance coverBoth packages include 100% cover for ambulance services by state-appointed ambulance providers across Australia. So there’s no need for a separate subscription and there’s no limit on the number of times you can use the ambulance service when needed.

Visit defencehealth.com.au

9ADF members

Page 12: We look after you like family. - Defence Health · The families of ADF members (permanent, and reservists serving 20 or more training days in a financial year) are eligible to join

ADF Total PackageOur ADF Total Package has been specially designed with ADF families in mind. It gives you our best value protection with comprehensive hospital cover and access to an extensive range of extras treatments with generous annual limits.

What’s covered

Joint reconstructions and repairs

Joint replacements

Colonoscopies and arthroscopies

Heart and artery related services

Pregnancy related services

Assisted reproductive services (e.g. IVF and GIFT)

Psychiatric and rehabilitation services

And all other Medicare-approved treatments

What’s restricted No hospital services are restricted

What’s excluded Services where Medicare pays no benefit (e.g. most

cosmetic surgery)

Your hospital coverExcess options

You can reduce your premium by electing to pay an excess if you go to hospital.

Your excess options are $200 or $400 per adult. The excess applies once per adult per financial year on all same day and overnight admissions. No excess is payable for dependent children.

Your hospital cover gives you

Choice of doctor and hospital

No exclusions on any Medicare-approved treatment

100% of agreement hospital charges (subject to your excess), including:

– Shared or private room

– Theatre fees, including labour ward

– Intensive care, critical care and high dependency unit

– Most drugs supplied in hospital

100% of public hospital charges (subject to your excess)

Up to 100% of doctors’ fees if your doctor chooses to use Access Gap

Up to 100% for prostheses on the Australian Government Prostheses List

Up to $100 per day for home nursing (up to $2000 per person)

Up to $2000 for midwifery delivery services, where not claimable through Medicare

Hospital substitute treatment in your home for treatments such as wound management and intravenous therapy through selected hospitals

Health programs for members with specific health risks

Rehabilitation in the home with access to a range of rehabilitation and healthcare services

Treatment in a non-agreement private hospital will incur significant out-of-pocket expenses.

See all waiting periods and get more information about making the most of your hospital and medical cover and what your hospital cover will not pay for on pages 29 and 30.

Favourite features Comprehensive ambulance cover, so there’s no need for a separate subscription

Enjoy peace of mind with comprehensive hospital cover

A national premium means you get great value cover no matter where you are posted

No excess for kids

No exclusions on any Medicare-approved treatment

No-gap preventive dental at our network dentists and a minimum 15% off their usual fee for other treatment

One free mouthguard, custom-fitted by any dentist, every financial year for kids

No annual limit on general dental treatment

No lifetime limit on orthodontics

100% back on initial consultations for most extras therapies

No-gap glasses deals through our optical network

Cover for laser refractive eye surgery if you want to be glasses free

Your kids stay covered to age 21. And if they’re single and studying full-time to age 25

Be there when your family needs youAs an ADF member if your child or partner goes into hospital, we’ll pay your boarder fees so you can stay at the hospital too (boarder arrangements only available with selected hospitals).

10

Page 13: We look after you like family. - Defence Health · The families of ADF members (permanent, and reservists serving 20 or more training days in a financial year) are eligible to join

Your extras cover

Get a minimum of 15% off the usual dental fee at our network dentists. Visit defencehealth.com.au/dental for locations. Some dental items are limited in the number of times they can be claimed in a year. Some are not payable in combination with others. And some may not attract a benefit at all.

General and preventive dental Month waiting period Annual limit – Unlimited

Periodic oral exam (012) Up to $43.00Removal of calculus (114) Up to $76.40Bitewing x-ray (022) Up to $30.80Adhesive filling to one surface of a rear tooth (531)

Up to $87.40

Major dental Month waiting period Annual limit – $950 per person

Surgical tooth removal (323) Up to $153.20Root canal obturation (417) Up to $114.80Veneer indirect (556) Up to $497.40Full crown – veneer indirect (615) Up to $765.20Endosseous implant (688) Up to $950.00

Orthodontics Month waiting period Annual limit – $800 per person

Orthodontic treatment Up to $800.00

Unlike other funds there is no lifetime limit. You get $800 every financial year until your treatment is complete. If you pay for your treatment up front you will only be able to claim your benefit once.

Dental

Month waiting period Annual limit – $255 per person

Optical network partners 100%Our optical network providers have extensive ranges of no-gap glasses. Visit specsavers.com.au or vsp-australia.com.au for locations.

Specsavers VSP Vision CareSingle vision glasses 2 pairs no-gap 1 pair no-gapBi/Multifocal glasses 1 pair no-gap 1 pair no-gapFrames Discounted DiscountedContacts (in store) 10% off 15% off

Benefits at non-network providers are limited: up to $90 for single vision lenses, up to $95 for ground single vision lenses, up to $105 for bi-focal lenses, up to $155 for multi-focal lenses, up to $95 for frames and up to $180 for contact lenses.A sight-correcting script must accompany the claim. The no-gap glasses deals are based on standard lens options. Other lens choices are likely to involve an out-of-pocket cost. For the two pairs no-gap glasses deal, the second pair must be from the same or lower priced range and must be for the same prescription.

Optical

Month waiting period Annual limit – Unlimited

100% cover for ambulance services by state-appointed ambulance providers across Australia. This includes emergency services, non-emergency dispatch, mobile intensive care and air and sea ambulance services.

Transport services by Patient Transport vehicles are not ambulance services and are not claimable.

Ambulance treatment

Month waiting period Annual limit – $650 per person

Initial consultation 100%Subsequent consultation Up to $40Group therapy sessions and classes

Up to $15

Physiotherapy (including hydrotherapy)

Month waiting period Annual limit – $450 per person

Initial consultation 100%Subsequent consultation Up to $33Chiropractic x-rays (max 2) Up to $40

Chiropractic/Osteopathy

Month waiting period Annual limit – $400 per person

Antenatal course Up to $400Antenatal consultations/classes Up to $40Postnatal consultations/classes Up to $40

By a midwife or physiotherapist in private practice only. Treatment claimed through Medicare cannot be covered.

Antenatal & postnatal services

Month waiting period Annual limit – $400 per person

Initial consultation 100%Subsequent consultation Up to $70Group therapy Up to $25Couple/family therapy Up to $30

Treatment claimed through Medicare cannot be covered.

Psychology

Month waiting period Annual limit – $300 per person

Per consultation Up to $30

Where the provider is recognised by the Australian Regional Health Group the following alternative therapies are payable: acupuncture, homeopathy, aromatherapy, myotherapy, naturopathy, remedial massage, remedial therapy, Chinese herbal medicine and western herbal medicine. No benefit payable for any prescribed medications, herbal or dietary preparations.

Alternative therapies & exercise physiology

ADF members 11

Talk to us on 1800 335 425

Page 14: We look after you like family. - Defence Health · The families of ADF members (permanent, and reservists serving 20 or more training days in a financial year) are eligible to join

– Month waiting period Annual limit – $1000 per person

12 month waiting period per person

Hearing aids* Up to $1000

PAP machine* for sleep apnoea Up to $1000

Blood glucose monitor* Up to $400

Foot orthotics Up to $300Custom-made or fitted by specialist orthotic practitioner. Excludes over the counter orthotics.

Orthopaedic shoes Up to $300Custom-made by specialist shoemaker

Splints and braces Up to $250Splints, knee/leg/spinal/lumbar/sacral/wrist/ankle braces and surgical corsets

Mobility aids* Up to $1000Wheelchairs, crutches, walking frames, walking sticks, rolling walkers, seat riser cushions, reaches and adjustable canes

Non-cosmetic prostheses Up to $1000– Wig following a medical condition up to $250– External breast prostheses following a mastectomy

up to $1000– Artificial eye up to $1000*

Blood pressure monitor* Up to $250

TENS machine* Up to $250

Nebuliser* and spacer for breathing conditions

Up to $300

Compression garments Up to $1000Up to $250 per item for purpose-made TGA approved garments that aid burn management, post-surgical recovery, lymphoedema treatment and deep vein thrombosis prevention

2 month waiting period per person

Non-sight correcting Irlen lenses Up to $90

EpiPen Up to $150

Appliance maintenance Up to $100For the repair of hearing aids and foot orthoses or for the purchase of appliance accessories like PAP machine masks

Rental of appliances Up to $150Including oxygen cylinders, soft collars, toilet seat risers, shower chairs, Continuous Passive Movement machines or any other appliance listed above

* Replacement or additional items are not claimable within 3 years of previous purchase.

Medically prescribed devices & supports

Month waiting period Annual limit – $500 per person

Initial consultation 100%Subsequent consultation Up to $45Group therapy sessions Up to $25

Speech therapy

Month waiting period Annual limit – $500 per person

Initial consultation 100%Subsequent consultation Up to $42Group therapy sessions Up to $25

Occupational therapy

Month waiting period Annual limit – $300 per person

Initial consultation 100%Subsequent consultation Up to $33

Podiatry/chiropody

Month waiting period Annual limit – $200 per person

Initial consultation 100%Subsequent consultation Up to $42

Audiology

Month waiting period Annual limit – $500 per person

Initial consultation 100%Subsequent consultation Up to $42

Eye therapy

Month waiting period Annual limit – $250 per person

Initial consultation 100%Subsequent consultation Up to $25

Dietitian

Month waiting period Annual limit $1000 per person every 2 financial years

Up to $1000 per person is payable for LASIK or PRK eye surgery in a recognised day surgery centre.

Laser refractive eye surgery

No waiting period Annual limit – $600 per person

Up to $600 per person in additional benefits for costs resulting from a school accident to your child. To cover the gaps after your extras benefits have been provided, excludes Medicare services.

School accidents

Month waiting period Annual limit – $120 per person

Benefits are available for approved health screening tests (bowel screening, kidney check, mole mapping, bone density tests, mammograms and specialist eye tests), approved quit smoking programs and nicotine replacement therapies.Benefits will not be available for treatments claimed through Medicare or for medicines/drugs subsidised by the Australian Government under the PBS. An itemised pharmacy receipt with the patient’s name must be provided.

Health and wellbeing

Month waiting period Annual limit – $500 per person

Per prescription or vaccination Up to $100

The benefit is payable on non-PBS pharmaceuticals only and applies to the cost in excess of the current PBS amount.

Pharmacy and vaccinations

12

Page 15: We look after you like family. - Defence Health · The families of ADF members (permanent, and reservists serving 20 or more training days in a financial year) are eligible to join

Premiums for our ADF Total Package start from $69.36 per fortnight to cover one personThe table below sets out what our ADF Total Package will cost. The premium is national and does not vary from state to state. The prices listed below are per fortnight. The premium after rebate calculation method is explained at the bottom of this page*.

ADF Total Package $0 excess

ADF Total Package $200 excess

ADF Total Package $400 excess

Premium after rebate

Gross premium

Premium after rebate

Gross premium

Premium after rebate

Gross premium

One person $69.36 $94.76 $63.84 $87.24 $60.00 $82.00

One adult & kids $105.61 $144.26 $97.63 $133.38 $92.08 $125.78

Two adults $138.72 $189.52 $127.73 $174.48 $120.07 $164.02

Two adults & kids $138.72 $189.52 $127.73 $174.48 $120.07 $164.02

ADF Total Package

Premium after rebate

Gross premium

One child $60.00 $82.00

Two or more kids $69.36 $94.76

Northern Territory residentsA national premium is not as suitable for you if you’re a resident of the Northern Territory. This is because the NT hospital costs are much lower than any other state or territory.

If you’re an ADF member based in the Northern Territory you will find a better deal if you mix and match the Hospital and Extras combinations available in the NT. The combinations most similar to our ADF Total package are shown below but you can check out other combinations on our website or call us to get a quote. The premium after rebate calculation method is explained at the bottom of this page*.

NT Rates

Premier Hospital (no Excess) and Value Extras

Premier Hospital with $200 excess plus Value Extras

Premier Hospital with $400 excess plus Value Extras

Premium after rebate

Gross premium

Premium after rebate

Gross premium

Premium after rebate

Gross premium

One adult $51.44 $78.10 $46.71 $70.96 $42.00 $63.78

One adult & kids $84.81 $128.74 $77.32 $117.36 $69.72 $105.86

Two adults $102.88 $156.20 $93.51 $141.96 $84.02 $127.58

Two adults & kids $102.88 $156.20 $93.51 $141.96 $84.02 $127.58

*The premiums listed above are for customers eligible for 26.791% Australian Government Rebate on private health insurance and nil Lifetime Health Cover Loading. Your actual rebate may vary depending on your age and income. The premium quoted is valid until 31 March 2017.

Get a quote or explore your options

Visit defencehealth.com.au

Talk to us on 1800 335 425

Visit defencehealth.com.au

13ADF members

Page 16: We look after you like family. - Defence Health · The families of ADF members (permanent, and reservists serving 20 or more training days in a financial year) are eligible to join

ADF Essentials PackageOur ADF Essentials Package is our low-cost package for ADF members who are singles and couples. It covers a limited range of hospital and extras treatments and helps you avoid Government penalties such as the Medicare Levy Surcharge and Lifetime Health Cover loading.

Your hospital coverExcess

Our ADF Essentials Package has a $200 per adult excess.

The excess applies once per adult per financial year on all same day and overnight admissions.

Your hospital cover gives you

Choice of doctor and hospital

100% of agreement hospital charges (subject to your excess), including:

– Shared or private room

– Theatre fees

– Intensive care, critical care and high dependency unit

– Most drugs supplied in hospital

100% of public hospital charges (subject to your excess)

Up to 100% of doctors’ fees for services covered if your doctor chooses to use Access Gap

Up to 100% for prostheses on the Australian Government Prostheses List

Treatment in a non-agreement private hospital will incur significant out-of-pocket expenses.

What’s covered

Accidental injuries

Removal of tonsils

Removal of adenoids

Removal of appendix

Surgical tooth extraction (hospital fees only)

Hernia repairs

Joint investigations (arthroscopies) and minor joint repairs

Joint reconstructions

Colonoscopies

Gastroscopies

What’s restricted Psychiatric treatment

Rehabilitation

Palliative care

Benefits for restricted treatment will cover the cost of a private patient in a shared room of a public hospital. If you are treated elsewhere, such as a private hospital, you will incur additional and significant out-of-pocket expenses.

What’s excluded All other hospital treatments

To see all waiting periods and get more information about making the most of your hospital and medical cover and what your hospital cover will not pay for go to pages 29 and 30.

Favourite features Comprehensive ambulance cover, so there’s no need for a separate subscription

A national premium which means you get great value cover no matter where you are posted

Don’t pay for things you don’t need – you get cover for a limited range of hospital services that a young and healthy person is most likely to need

Cover for the most popular extras to complement your active lifestyle

Guaranteed minimum 15% off the usual fee for treatment by a network dentist

No-gap glasses deals through our optical network

Choice of doctor and hospital – for treatment of the limited procedures covered

Money back for travel vaccinations

Comprehensive ambulance coverYou get 100% cover for ambulance services by state-appointed ambulance providers across Australia. There’s no need to get a separate subscription and there’s no limit on the number of times you can use the ambulance service when needed, including emergency services, non-emergency dispatch, mobile intensive care and air and sea ambulance services.

Transport services by Patient Transport vehicles are not ambulance services and are not claimable.

14

Page 17: We look after you like family. - Defence Health · The families of ADF members (permanent, and reservists serving 20 or more training days in a financial year) are eligible to join

What does the ADF Essentials Package cost?For most people our ADF Essentials package will cost $33.88 per fortnight for singles and $67.78 for couples. This is a national price and assumes a rebate of 26.791%. Gross premiums (without rebate) are $46.28 and $92.58 per fortnight respectively. Your actual rebate may vary depending on your age and income. The premium quoted is valid until 31 March 2017. If you’re an ADF based in the Northern Territory you will find a better deal if you take the mix and match rates for the Northern Territory. These are available on our website or by calling us.

Your extras cover

Annual limit – $500 per person

Get a minimum of 15% off the usual dental fee at our network dentists. Visit defencehealth.com.au/dental for locations. Some dental items are limited in the number of times they can be claimed in a year. Some items are not payable in combination with others. And some may not attract a benefit at all.

General and preventive dental Month waiting period

Periodic oral exam (012) Up to $37.80Removal of calculus (114) Up to $66.80Bitewing x-ray (022) Up to $25.80Adhesive filling to one surface of a rear tooth (531)

Up to $72.00

Mouthguard (151) Up to $76.00

Surgical tooth removal Month waiting period

322 Up to $114.40323 Up to $143.00324 Up to $157.20

General dental and surgical extractions

Month waiting period Annual limit – $170 per person

Optical network partners 100%Our optical network providers have extensive ranges of no-gap glasses. Visit specsavers.com.au or vsp-australia.com.au for locations.

Specsavers VSP Vision CareSingle vision glasses 2 pairs no-gap 1 pair no-gapBi/Multifocal glasses 1 pair no-gap 1 pair no-gapFrames Discounted DiscountedContacts (in store) 10% off 15% off

Benefits at non-network providers are limited: up to $80 for single vision lenses, up to $95 for ground single vision lenses, up to $105 for bi-focal lenses, up to $120 for multi-focal lenses, up to $95 for frames and up to $120 for contact lenses.

A sight-correcting script must accompany the claim. The no-gap glasses deals are based on standard lens options. Other lens choices are likely to involve an out-of-pocket cost. For the two pairs no-gap glasses deal, the second pair must be from the same or lower priced range and must be for the same prescription.

Optical

Month waiting period Annual limit – Unlimited

100% cover for ambulance services by state-appointed ambulance providers across Australia. This includes emergency services, non-emergency dispatch, mobile intensive care and air and sea ambulance services.

Transport services by Patient Transport vehicles are not ambulance services and are not claimable.

Ambulance treatment

Month waiting period Annual limit – $100 per person

Per travel vaccination prescription Up to $50The benefit is payable on non-PBS travel vaccinations only and applies to the cost in excess of the current PBS amount.

Travel vaccinations

Month waiting period Annual limit – $200 per person

Per consultation Up to $20

Where the provider is recognised by the Australian Regional Health Group the following alternative therapies are payable: acupuncture, homeopathy, aromatherapy, myotherapy, naturopathy, remedial massage, remedial therapy, Chinese herbal medicine and western herbal medicine. No benefit payable for any prescribed medications, herbal or dietary preparations.

Alternative therapies & exercise physiology

Month waiting period Annual limit – $350 per person

Initial consultation Up to $35Subsequent consultation Up to $26Group therapy sessions and classes

Up to $10

Physiotherapy (including hydrotherapy), Chiropractic/Osteopathy

Get a quote or explore your options

Visit defencehealth.com.au

Talk to us on 1800 335 425

ADF members 15

Talk to us on 1800 335 425

Page 18: We look after you like family. - Defence Health · The families of ADF members (permanent, and reservists serving 20 or more training days in a financial year) are eligible to join

Finding the right hospital cover

Premier HospitalIf your family’s wellbeing is your priority and you want complete peace of mind, then Premier Hospital is for you.

Premier Hospital provides comprehensive cover in all agreement hospitals throughout Australia. That means treatment where and when you need it.

Premier Hospital has no exclusions on any Medicare-approved treatment which means no surprises.

You also get 100% cover for ambulance services by state-appointed ambulance providers across Australia. So there’s no need for a separate subscription.

Value HospitalIf you are happy to exclude some procedures that you might not need, then Value Hospital is for you.

Value Hospital is priced for families who know the importance of health and wellbeing and are trying to keep things a little more affordable.

Value Hospital provides comprehensive cover for most treatments with your choice of doctor and hospital.

You also get 100% cover for ambulance services by state-appointed ambulance providers across Australia. So there’s no need for a separate subscription.

Essentials HospitalIf you’re only interested in covering a limited number of things a young and healthy person might need, and want to avoid Government penalties for not having hospital cover, then Essentials Hospital could be for you.

Essentials Hospital covers you for services most commonly used by young and healthy people.

And the really great news is you even get 100% cover for ambulance services by state-appointed ambulance providers across Australia. So there’s no need for a separate subscription.

Mix and match hospital coverChoose from three levels of hospital cover that can help take the pain out of hospital visits: Premier Hospital, Value Hospital and Essentials Hospital.

We’ve designed each level of cover to provide protection to meet different needs. And they can be added to your choice of three extras covers for more complete protection.

Get a quote or explore your options

Visit defencehealth.com.au or talk to us on 1800 335 425

16

Page 19: We look after you like family. - Defence Health · The families of ADF members (permanent, and reservists serving 20 or more training days in a financial year) are eligible to join

Compare our hospital cover

Which services are covered?Premier Hospital

Value Hospital

Essentials Hospital

Accidental injury

Removal of tonsils

Removal of adenoids

Removal of appendix

Surgical extraction of teeth

Hernia repairs

Joint investigations and minor repairs

Joint reconstructions

Colonoscopy

Gastroscopy

Rehabilitation

Palliative care

Psychiatric treatment

Cancer treatment

Stroke treatment

Brain surgery

Pregnancy and pregnancy related services

Heart related procedures

Assisted reproductive services and infertility treatments

Cataracts, Glaucoma and laser eye surgery

Dialysis for renal failure

Obesity related treatment (e.g.. gastric banding)

Joint replacements

All other services recognised by Medicare

Treatment not recognised by Medicare incl. most cosmetic surgery

Chronic care and risk programs

Hospital substitute programs

Midwifery (confinement and delivery) $1,500 $750

Home nursing – Maximum

Per day

$1,800

$90

$750

$70

Included Benefits for restricted treatment will cover the cost of a private patient in a shared room of a public hospital. If you are treated elsewhere, such as a private hospital, you will incur additional and significant out-of-pocket expenses.

Restricted Excluded

Visit defencehealth.com.au

17ADF members

Page 20: We look after you like family. - Defence Health · The families of ADF members (permanent, and reservists serving 20 or more training days in a financial year) are eligible to join

Premier HospitalPremier Hospital is designed to give you peace of mind. Comprehensive hospital cover gives you our best protection. It covers everything Medicare does, including pregnancy and assisted reproductive services. So if you and your family’s wellbeing is a priority then Premier Hospital could be right for you.

Your hospital coverExcess options

You can reduce your premium by electing to pay an excess if you go to hospital.

Your excess options are $200 or $400 per adult. The excess applies once per adult per financial year on all same day and overnight admissions. No excess is payable for dependent kids.

Your hospital cover gives you

Choice of doctor and hospital

No exclusions on any Medicare-approved treatment

100% of agreement hospital charges (subject to your excess), including:

– Shared or private room

– Theatre fees, including labour ward

– Intensive care, critical care and high dependency unit

– Most drugs supplied in hospital

100% of public hospital charges (subject to your excess)

Up to 100% of doctors’ fees if your doctor chooses to use Access Gap

Up to 100% for prostheses on the Australian Government Prostheses List

Up to $90 per day for home nursing (up to $1800 per person)

Up to $1500 for midwifery delivery services, where not claimable through Medicare

Hospital substitute treatment in your home for treatments such as wound management and intravenous therapy through selected hospitals

Health programs for members with specific health risks

Rehabilitation in the home with access to a range of rehabilitation and healthcare services

Treatment in a non-agreement private hospital will incur significant out-of-pocket expenses.

What’s covered Joint reconstructions and repairs

Joint replacements

Colonoscopies and arthroscopies

Heart and artery related services

Pregnancy related services

Assisted reproductive services (e.g. IVF and GIFT)

Psychiatric and rehabilitation services

And all other Medicare-approved treatments

What’s restricted No hospital services are restricted

What’s excluded Services where Medicare pays no benefit

(e.g. most cosmetic surgery)

See all waiting periods and get more information about making the most of your hospital and medical cover and what your hospital cover will not pay for on pages 29 and 30.

Get a quote

Visit defencehealth.com.au or talk to us on 1800 335 425

Favourite features Comprehensive ambulance cover, so there’s no need for a separate subscription

Enjoy peace of mind with comprehensive hospital cover

No exclusions on any Medicare-approved treatment

No excess for kids

Your kids stay covered to age 21. And if they’re single and studying full-time to age 25

Comprehensive ambulance coverYou get 100% cover for ambulance services by state-appointed ambulance providers across Australia. So there’s no need for a separate subscription and there’s no limit on the number of times you can use the ambulance service when needed, including emergency services, non-emergency dispatch, mobile intensive care and air and sea ambulance services.

Transport services by Patient Transport vehicles are not ambulance services and are not claimable.

18

Page 21: We look after you like family. - Defence Health · The families of ADF members (permanent, and reservists serving 20 or more training days in a financial year) are eligible to join

Value HospitalValue Hospital is designed for families who know the importance of health and wellbeing and are trying to keep things a little more affordable. If you are happy to exclude some procedures you might not need then Value Hospital could be best for you.

Your hospital coverExcess options

Your excess choices are $200 or $400 per adult.

The excess applies once per adult per financial year on all same day and overnight admissions. No excess is payable for dependent kids.

Your hospital cover gives you

Choice of doctor and hospital

100% of agreement hospital charges (subject to your excess), including:

– Shared or private room

– Theatre fees, including labour ward

– Intensive care, critical care and high dependency unit

– Most drugs supplied in hospital

100% of public hospital charges (subject to your excess)

Up to 100% of doctors’ fees if your doctor chooses to use Access Gap

Up to 100% for prostheses on the Australian Government Prostheses List

Up to $70 per day for home nursing (up to $750 per person)

Up to $750 for midwifery delivery services, where not claimable through Medicare

Hospital substitute treatment in your home for treatments such as wound management and intravenous therapy through selected hospitals

Health programs for members with specific health risks

Rehabilitation in the home with access to a range of rehabilitation and healthcare services

Treatment in a non-agreement private hospital will incur significant out-of-pocket expenses.

What’s covered Joint investigations (arthroscopies) and minor

joint repairs

Joint reconstructions

Colonoscopies

Gastroscopies

Heart and artery related services

Pregnancy related services

Cancer treatments

And all other Medicare-approved treatments that are not listed below

What’s restricted Psychiatric treatment

Benefits for this treatment will cover the cost of a private patient in a shared room of a public hospital. If you are treated elsewhere, such as a private hospital, you will incur additional and significant out-of-pocket expenses.

What’s excluded Assisted reproductive services (e.g. IVF and GIFT)

Renal dialysis

Obesity related treatment (e.g. gastric banding)

Joint replacements and revisions

Cataracts, glaucoma and laser eye surgery

Services where Medicare pays no benefit (e.g. most cosmetic surgery)

Favourite features Comprehensive ambulance cover, so there’s no need for a separate subscription

Hospital cover for a broad range of services with some exclusions

No excess for kids

Your kids stay covered to age 21. And if they’re single and studying full-time to age 25

Excludes selected hospital services to help keep the cost down

See all waiting periods and get more information about making the most of your hospital and medical cover and what your hospital cover will not pay for on pages 29 and 30.

Comprehensive ambulance coverYou get 100% cover for ambulance services by state-appointed ambulance providers across Australia. So there’s no need for a separate subscription and there’s no limit on the number of times you can use the ambulance service when needed, including emergency services, non-emergency dispatch, mobile intensive care and air and sea ambulance services.

Transport services by Patient Transport vehicles are not ambulance services and are not claimable.

ADF members 19

Talk to us on 1800 335 425

Page 22: We look after you like family. - Defence Health · The families of ADF members (permanent, and reservists serving 20 or more training days in a financial year) are eligible to join

Essentials HospitalEssentials Hospital is basic hospital cover for young, healthy singles and couples. It covers a limited range of hospital treatments and helps you avoid Government penalties such as the Medicare Levy Surcharge and Lifetime Health Cover loading.

Your hospital coverExcess

Essentials Hospital has a $200 per adult excess.

The excess applies once per adult per financial year on all same day and overnight admissions.

Your hospital cover gives you

Choice of doctor and hospital

100% of agreement hospital charges (subject to your excess), including:

– Shared or private room

– Theatre fees

– Intensive care, critical care and high dependency unit

– Most drugs supplied in hospital

100% of public hospital charges (subject to your excess)

Up to 100% of doctors’ fees, for services covered, if your doctor chooses to use Access Gap

Up to 100% for prostheses on the Australian Government Prostheses List

Treatment in a non-agreement private hospital will incur significant out-of-pocket expenses.

What’s covered

Accidental injuries

Removal of tonsils

Removal of adenoids

Removal of appendix

Surgical tooth extraction (hospital fees only)

Hernia repairs

Joint investigations (arthroscopies) and minor joint repairs

Joint reconstructions

Colonoscopies

Gastroscopies

What’s restricted Psychiatric treatment

Rehabilitation

Palliative care

Benefits for restricted treatment will cover the cost of a private patient in a shared room of a public hospital. If you are treated elsewhere, such as a private hospital, you will incur additional and significant out-of-pocket expenses.

What’s excluded All other hospital treatments

See all waiting periods and get more information about making the most of your hospital and medical cover and what your hospital cover will not pay for on pages 29 and 30.

Favourite features Comprehensive ambulance cover, so there’s no need for a separate subscription

Don’t pay for things you don’t need – you get cover for a limited range of hospital services that a young and healthy person is most likely to need

Accidental injury cover

Choice of doctor and hospital – for treatment of the limited procedures covered

Comprehensive ambulance coverYou get 100% cover for ambulance services by state-appointed ambulance providers across Australia. So there’s no need for a separate subscription and there’s no limit on the number of times you can use the ambulance service when needed, including emergency services, non-emergency dispatch, mobile intensive care and air and sea ambulance services.

Transport services by Patient Transport vehicles are not ambulance services and are not claimable.

20

Page 23: We look after you like family. - Defence Health · The families of ADF members (permanent, and reservists serving 20 or more training days in a financial year) are eligible to join

Mix and match extras coverWe offer three levels of extras cover to make looking after your health and wellbeing more affordable: Premier Extras, Value Extras and Essentials Extras.

Each can lower or even remove your costs when you visit health and wellbeing providers like the dentist, chiropractor, physiotherapist and a range of alternative therapists. You’re free to choose who treats you, and if you visit one of our many optical partners or use our dental network, you’ll receive even greater benefits.

Each extras cover can be added to your choice of three hospital covers for more complete protection.

Premier ExtrasOur Premier Extras cover gives you comprehensive cover on a wide range of services with our highest individual annual limits.

If you have frequent or planned treatment, especially for complex dental services, then Premier Extras will give you the most money back.

Through our dental network you get no-gap preventive dental within limits. And you’ll get a guaranteed minimum of 15% off the usual dental fee for all treatments performed by any of our network dentists. Plus there’s no annual limit on general dental and no lifetime limit on orthodontic treatment.

Premier Extras gives you 100% back on initial consultations for most therapies. You also get 100% back on glasses (up to $300 per person) at our optical partners and up to $1500 every 2 financial years for laser eye surgery to help you become glasses free.

Value ExtrasIf you want to be covered for a wide range of services at a more affordable price, then Value Extras is for you.

Value Extras is great value for money and perfect for those that want cover for more than just the basics.

Through our dental network you get no-gap preventive dental within limits. And you’ll get a guaranteed minimum of 15% off the usual dental fee for all treatments performed by any of our network dentists. There’s no annual limit on general dental and no lifetime limit on orthodontic treatment.

You’ll get 100% back on glasses (up to $255 per person) at our optical partners.

Essentials ExtrasIf you’re only looking for limited cover at a low cost, then Essentials Extras is for you.

Essentials Extras is ideal for young and healthy people who just want cover for the basics including general dental, preventive dental, surgical extractions, physiotherapy, chiropractic/osteopathic, alternative therapies and travel vaccinations.

Through our dental network you get a guaranteed minimum of 15% off the usual dental fee for treatments performed by any of our network dentists.

And you’ll get 100% back on glasses (up to $170 per person) at our optical partners.

To help you decide which cover is best for you, take a closer look at what each level offers. Remember, the higher your level of cover, the more services you’ll be covered for and the greater your benefits will be.

Get a quote or explore your options

Visit defencehealth.com.au or talk to us on 1800 335 425

No family limitsThere’s no family or policy limit on any extras treatment. That means every member of your family can claim up to their personal limit for those extras. And that means more money back for the things that matter most.

Plus, all our extras covers include 100% cover for ambulance services by state-appointed ambulance providers across Australia. So there’s no need for a separate subscription and there’s no limit on the number of times you can use the ambulance service when needed.

Visit defencehealth.com.au

21ADF members

Page 24: We look after you like family. - Defence Health · The families of ADF members (permanent, and reservists serving 20 or more training days in a financial year) are eligible to join

Our Optical Network

We’ve joined forces with Specsavers and VSP Vision Care to deliver better optical cover for our members.

Our optical network is available to all our members with extras cover and provides better optical benefits and an extensive range of no-gap glasses.

VSP Vision Care is a network of 520 independent optometrists. VSP Vision Care providers are conveniently located close to where you live or work.

Specsavers is already a household name with 319 optical stores around Australia.

You can still get benefits back at any optical store you choose. But if you do use our optical network you will receive better value optical benefits, coupled with a wide selection of stylish, fashionable frames.

Visit specsavers.com.au or vsp-australia.com.au to find your nearest optical network provider.

Health and wellbeing

We want to support your overall health and wellbeing, and that includes preventive measures so we’ve introduced health screening benefits to support you managing your health. Members with Premier or Value Extras when combined with Hospital cover can reduce the cost of health screening like mole mapping, mammograms and kidney checks.

Our new per person benefits also help you quit smoking. Reducing the incidence of preventable smoking-related illness will ease the pressure on premiums. That’s good news for all our members.

But wait there’s more

Our Dental Network

We’ve joined forces with smile.com.au to provide a dental network that’s available to all members with extras cover.

Through our dental network, you’ll get a guaranteed minimum of 15% off the usual fee for all treatments performed by any network dentist. And there’s over 1,000 network dentists across Australia so we’ve got you covered.

If you have the ADF Total Package, Premier or Value Extras you’ll also get no-gap preventive dental, including your annual scale and clean. Some preventive treatments are limited in the number of times they can be claimed in a financial year.

You can still get benefits back at any dentist you choose. But if you use our dental network you’ll benefit by combining lower dental charges with your extras cover.

More for kids

If you have kids, they’re eligible for one free mouth guard, custom-fitted by any dentist, every year if you have our ADF Total Package, Premier Extras or Value Extras.

Visit defencehealth.com.au/dental to find your nearest network dentist.

22

Page 25: We look after you like family. - Defence Health · The families of ADF members (permanent, and reservists serving 20 or more training days in a financial year) are eligible to join

Compare our extras coverTo help you decide which cover is best for you take a look at what each level offers, full details are on the following pages.

Service Premier Extras (Page 24)

Value Extras (Page 26)

Essentials Extras (Page 28)

per person limit per person limit per person limit

Ambulance treatment Unlimited Unlimited Unlimited

Preventive dental Unlimited Unlimited$500

Preventive dental, general

dental and surgical

extractions only

General dental Unlimited Unlimited

Major dental $1100 $900

Orthodontics $1000 $800

Optical $300 $255 $170

Physiotherapy (including hydrotherapy) $850 $600$350

Chiropractic/Osteopathy $550 $450

Antenatal and postnatal services $500 $200

Pharmacy and vaccinations$600 $500

Travel vaccinations $100

Alternative therapies$400 $300 $200

Exercise physiology

Psychology $500 $400

Podiatry/chiropody $400 $300

Occupational therapy $600 $500

Speech therapy $600 $500

Eye therapy $600 $500

Dietitian $350 $250

Audiology $350 $200

Medically prescribed devices, aids and supports $1500 $1000

School accidents $800 $600

Laser refractive eye surgery (claimable once every 2 years) $1500

Health and wellbeing (when combined with hospital cover) $180 $100

Not covered

ADF members 23

Talk to us on 1800 335 425

Page 26: We look after you like family. - Defence Health · The families of ADF members (permanent, and reservists serving 20 or more training days in a financial year) are eligible to join

Premier ExtrasPremier Extras provides comprehensive cover for a wide range of services with our highest individual annual limits.

Get a minimum of 15% off the usual dental fee at our network dentists. Visit defencehealth.com.au/dental for locations. Some dental items are limited in the number of times they can be claimed in a year. Some are not payable in combination with others. And some may not attract a benefit at all.

General and preventive dental Month waiting period Annual limit – Unlimited

Periodic oral exam (012) Up to $50.40Removal of calculus (114) Up to $89.00Bitewing x-ray (022) Up to $36.00Adhesive filling to one surface of a rear tooth (531)

Up to $102.60

Major dental Month waiting period Annual limit – $1100 per person

Surgical tooth removal (323) Up to $204.20Root canal obturation (417) Up to $153.20Veneer indirect (556) Up to $663.20Full crown – veneer indirect (615) Up to $1020.20Endosseous implant (688) Up to $1100.00

Orthodontics Month waiting period Annual limit – $1000 per person

Orthodontic treatment Up to $1000Unlike other funds there is no lifetime limit. You get $1000 every financial year until your treatment is complete. If you pay for your treatment up front you will only be able to claim your benefit once.

Dental

Month waiting period Annual limit – $300 per person

Optical network partners 100%Our optical network providers have extensive ranges of no-gap glasses. Visit specsavers.com.au or vsp-australia.com.au for locations.

Specsavers VSP Vision CareSingle vision glasses 2 pairs no-gap 1 pair no-gapBi/Multifocal glasses 1 pair no-gap 1 pair no-gapFrames Discounted DiscountedContacts (in store) 10% off 15% off

Benefits at non-network providers are limited: up to $100 for single vision lenses, up to $105 for ground single vision lenses, up to $115 for bi-focal lenses, up to $175 for multi-focal lenses, up to $125 for frames and up to $200 for contact lenses.A sight-correcting script must accompany the claim. The no-gap glasses deals are based on standard lens options. Other lens choices are likely to involve an out-of-pocket cost. For the two pairs no-gap glasses deal, the second pair must be from the same or lower priced range and must be for the same prescription.

Optical

Month waiting period Annual limit – Unlimited

100% cover for ambulance services by state-appointed ambulance providers across Australia. This includes emergency services, non-emergency dispatch, mobile intensive care and air and sea ambulance services. Transport services by Patient Transport vehicles are not ambulance services and are not claimable.

Ambulance treatment

Month waiting period Annual limit – $850 per person

Initial consultation 100%Subsequent consultation Up to $50Group therapy sessions and classes Up to $20

Physiotherapy (including hydrotherapy)

Month waiting period Annual limit – $550 per person

Initial consultation 100%Subsequent consultation Up to $42Chiropractic x-rays (max 2) Up to $60

Chiropractic/Osteopathy

Favourite features Comprehensive ambulance cover, so there’s no need for a separate subscription

No-gap preventive dental at a network dentist and a minimum 15% off their usual fee for other treatment

One free mouthguard, custom-fitted by any dentist, every financial year for kids

No annual limit on general dental treatment and no orthodontics lifetime limit

No-gap glasses deals through our optical network

100% back on initial consultations for most therapies

Generous benefits for alternative therapies

Cover for laser refractive eye surgery

Month waiting period Annual limit – $400 per person

Per consultation Up to $38

Where the provider is recognised by the Australian Regional Health Group the following alternative therapies are payable: acupuncture, homeopathy, aromatherapy, myotherapy, naturopathy, remedial massage, remedial therapy, Chinese herbal medicine and western herbal medicine. No benefit payable for any prescribed medications, herbal or dietary preparations.

Alternative therapies & exercise physiology

Month waiting period Annual limit – $500 per person

Antenatal course Up to $500Antenatal consultations/classes Up to $50Postnatal consultations/classes Up to $50

By a midwife or physiotherapist in private practice only. Treatment claimed through Medicare cannot be covered.

Antenatal & postnatal services

24

Page 27: We look after you like family. - Defence Health · The families of ADF members (permanent, and reservists serving 20 or more training days in a financial year) are eligible to join

– – Month waiting period Month waiting period Annual limit – $1500 per person Annual limit – $1500 per person

12 month waiting period per personHearing aids* Up to $1500PAP machine* for sleep apnoea Up to $1250Blood glucose monitor* Up to $500Foot orthoticsCustom-made or fitted by specialist orthotic practitioner. Excludes over the counter orthotics

Up to $300

Orthopaedic shoesCustom-made or fitted by specialist shoemaker

Up to $300

Splints and braces Splints, knee/leg/spinal/lumbar/sacral/wrist/ankle braces and surgical corsets

Up to $300

Mobility aids*Wheelchairs, crutches, walking frames, walking sticks, rolling walkers, seat riser cushions, reaches and adjustable canes

Up to $1000

Joint fluid replacement injectionse.g.. Synvisc, OsteoArtz, Hyalgan

Up to $300

Non-cosmetic prostheses Up to $1250– Wig following a medical condition

up to $300– External breast prostheses following

a mastectomy up to $300– Artificial eye up to $1250*

Blood pressure monitor* Up to $300TENS machine* Up to $300Nebuliser* and spacer for breathing conditions Up to $300Compression garmentsUp to $300 per item for purpose-made TGA approved garments that aid burn management, post-surgical recovery, lymphoedema treatment and deep vein thrombosis prevention

Up to $1500

2 month waiting period per personNon-sight correcting Irlen lenses Up to $100EpiPen Up to $150Appliance maintenanceFor the repair of hearing aids and foot orthoses or for the purchase of appliance accessories like PAP machine masks

Up to $100

Rental of appliances Up to $200Including oxygen cylinders, soft collars, toilet seat risers, shower chairs, Continuous Passive Movement machines or any other appliance listed above* Replacement or additional items are not claimable within 3 years of previous purchase

Medically prescribed devices & supports

Month waiting period Annual limit – $500 per person

Initial consultation 100%Subsequent consultation Up to $100Group therapy Up to $40Couple/family therapy Up to $60Treatment claimed through Medicare cannot be covered.

Psychology

Month waiting period Annual limit – $600 per person

Initial consultation 100%Subsequent consultation Up to $55Group therapy Up to $30

Speech therapy

Month waiting period Annual limit – $600 per person

Initial consultation 100%Subsequent consultation Up to $55Group therapy Up to $30

Occupational therapy

Month waiting period Annual limit – $400 per person

Initial consultation 100%Subsequent consultation Up to $42

Podiatry/chiropody

Month waiting period Annual limit – $350 per person

Initial consultation 100%Subsequent consultation Up to $60

Audiology

Month waiting period Annual limit – $600 per person

Initial consultation 100%Subsequent consultation Up to $45

Eye therapy

Month waiting period Annual limit – $600 per person

Per prescription or vaccination Up to $120The benefit is payable on non-PBS pharmaceuticals only and applies to the cost in excess of the current PBS amount.

Pharmacy and vaccinations No waiting period Annual limit – $800 per person

Up to $800 per person in additional benefits for costs resulting from a school accident to your child. To cover the gaps after your extras benefits have been provided, excludes Medicare services.

School accidents

Month waiting period Annual limit – $1500 per person every 2 financial years

Up to $1500 per person is payable for LASIK or PRK eye surgery in a recognised day surgery centre.

Laser refractive eye surgery

Month waiting period Annual limit – $350 per person

Initial consultation 100%Subsequent consultation Up to $40

Dietitian

Month waiting period Annual limit – $180 per person

Health and wellbeing

Benefits are available for approved health screening tests (bowel screening, kidney check, mole mapping, bone density tests, mammograms and specialist eye tests), approved quit smoking programs and nicotine replacement therapies. Benefits are available to members who have Premier Extras in combination with hospital cover. Benefits will not be available for treatments claimed through Medicare or for medicines/drugs subsidised by the Australian Government under the PBS. An itemised pharmacy receipt with the patient’s name must be provided.

Visit defencehealth.com.au

25ADF members

Page 28: We look after you like family. - Defence Health · The families of ADF members (permanent, and reservists serving 20 or more training days in a financial year) are eligible to join

Value ExtrasValue Extras covers a wide range of extras with great annual limits at a value for money price.

Get a minimum of 15% off the usual dental fee at our network dentists. Visit defencehealth.com.au/dental for locations. Some dental items are limited in the number of times they can be claimed in a year. Some are not payable in combination with others. And some may not attract a benefit at all.

General and preventive dental Month waiting period Annual limit – Unlimited

Periodic oral exam (012) Up to $43.00Removal of calculus (114) Up to $75.80Bitewing x-ray (022) Up to $30.60Adhesive filling to one surface of a rear tooth (531)

Up to $87.20

Major dental Month waiting period Annual limit – $900 per person

Surgical tooth removal (323) Up to $153.20Root canal obturation (417) Up to $114.80Veneer indirect (556) Up to $497.40Full crown – veneer indirect (615) Up to $765.20Endosseous implant (688) Up to $900.00

Orthodontics Month waiting period Annual limit – $800 per person

Orthodontic treatment Up to $800.00Unlike other funds there is no lifetime limit. You get $800 every financial year until your treatment is complete. If you pay for your treatment up front you will only be able to claim your benefit once.

Dental

Month waiting period Annual limit – $255 per person

Optical network partners 100%Our optical network providers have extensive ranges of no-gap glasses. Visit specsavers.com.au or vsp-australia.com.au for locations.

Specsavers VSP Vision CareSingle vision glasses 2 pairs no-gap 1 pair no-gapBi/Multifocal glasses 1 pair no-gap 1 pair no-gapFrames Discounted DiscountedContacts (in store) 10% off 15% off

Benefits at non-network providers are limited: up to $90 for single vision lenses, up to $95 for ground single vision lenses, up to $105 for bi-focal lenses, up to $155 for multi-focal lenses, up to $95 for frames and up to $180 for contact lenses.A sight-correcting script must accompany the claim. The no-gap glasses deals are based on standard lens options. Other lens choices are likely to involve an out-of-pocket cost. For the two pairs no-gap glasses deal, the second pair must be from the same or lower priced range and must be for the same prescription.

Optical

Month waiting period Annual limit – Unlimited

100% cover for ambulance services by state-appointed ambulance providers across Australia. This includes emergency services, non-emergency dispatch, mobile intensive care and air and sea ambulance services. Transport services by Patient Transport vehicles are not ambulance services and are not claimable.

Ambulance treatment

Month waiting period Annual limit – $600 per person

Initial consultation Up to $48Subsequent consultation Up to $40Group therapy sessions and classes Up to $15

Physiotherapy (including hydrotherapy)

Month waiting period Annual limit – $200 per person

Antenatal course Up to $200Antenatal consultations/classes Up to $20Postnatal consultations/classes Up to $20

By a midwife or physiotherapist in private practice only. Treatment claimed through Medicare cannot be covered.

Antenatal & postnatal services

Month waiting period Annual limit – $450 per person

Initial consultation Up to $43Subsequent consultation Up to $33Chiropractic x-rays (max 2) Up to $40

Chiropractic/Osteopathy

Month waiting period Annual limit – $300 per person

Per consultation Up to $30

Where the provider is recognised by the Australian Regional Health Group the following alternative therapies are payable: acupuncture, homeopathy, aromatherapy, myotherapy, naturopathy, remedial massage, remedial therapy, Chinese herbal medicine and western herbal medicine. No benefit payable for any prescribed medications, herbal or dietary preparations.

Alternative therapies & exercise physiology

Favourite features Comprehensive ambulance cover, so there’s no need for a separate subscription

No-gap preventive dental at a network dentist and a minimum 15% off their usual fee for other treatment

One free mouthguard, custom-fitted by any dentist, every financial year for kids

No annual limit on general dental and no orthodontics lifetime limit

No-gap glasses deals through our optical network

Cover for physiotherapy, chiropractic, osteopathy, psychology, speech/eye/occupational therapy, dietetics, audiology, podiatry and more

Generous benefits for alternative therapies

26

Page 29: We look after you like family. - Defence Health · The families of ADF members (permanent, and reservists serving 20 or more training days in a financial year) are eligible to join

Month waiting period Annual limit – $500 per person

Per prescription or vaccination Up to $100

The benefit is payable on non-PBS pharmaceuticals only and applies to the cost in excess of the current PBS amount.

Pharmacy and vaccinations

Month waiting period Annual limit – $400 per person

Initial consultation Up to $75Subsequent consultation Up to $65Group therapy Up to $20Couple/family therapy Up to $25

Treatment claimed through Medicare cannot be covered.

Psychology

Month waiting period Annual limit – $500 per person

Initial consultation Up to $70Subsequent consultation Up to $40Group therapy Up to $20

Speech therapy

Month waiting period Annual limit – $500 per person

Initial consultation Up to $65Subsequent consultation Up to $35Group therapy Up to $20

Occupational therapy

Month waiting period Annual limit – $300 per person

Initial consultation Up to $43Subsequent consultation Up to $33

Podiatry/chiropody

Month waiting period Annual limit – $200 per person

Initial consultation Up to $60Subsequent consultation Up to $35

Audiology

Month waiting period Annual limit – $500 per person

Initial consultation Up to $60Subsequent consultation Up to $35

Eye therapy

Month waiting period Annual limit – $250 per person

Initial consultation Up to $35Subsequent consultation Up to $25

Dietitian

– Month waiting period Annual limit – $1000 per person

12 month waiting period per personHearing aids* Up to $1000PAP machine* for sleep apnoea Up to $1000Blood glucose monitor* Up to $400Foot orthoticsCustom-made or fitted by specialist orthotic practitioner. Excludes over the counter orthotics

Up to $250

Orthopaedic shoesCustom-made by specialist shoemaker

Up to $250

Splints and braces Splints, knee/leg/spinal/lumbar/sacral/wrist/ankle braces and surgical corsets

Up to $250

Mobility aids*Wheelchairs, crutches, walking frames, walking sticks, rolling walkers, seat riser cushions, reaches and adjustable canes

Up to $1000

Non-cosmetic prostheses Up to $1000– Wig following a medical condition

up to $250– External breast prostheses following

a mastectomy up to $250– Artificial eye up to $1000*

Blood pressure monitor* Up to $250TENS machine* Up to $250Nebuliser* and spacer for breathing conditions

Up to $250

Compression garmentsUp to $250 per item for purpose-made TGA approved garments that aid burn management, post-surgical recovery, lymphoedema treatment and deep vein thrombosis prevention

Up to $1000

2 month waiting period per personNon-sight correcting Irlen lenses Up to $90EpiPen Up to $100Appliance maintenanceFor the repair of hearing aids and foot orthoses or for the purchase of appliance accessories like PAP machine masks

Up to $100

Rental of appliances Up to $150Including oxygen cylinders, soft collars, toilet seat risers, shower chairs, Continuous Passive Movement machines or any other appliance listed above

*Replacement or additional items are not claimable within 3 years of previous purchase

Medically prescribed devices & supports

No waiting period Annual limit – $600 per person

Up to $600 per person in additional benefits for costs resulting from a school accident to your child. To cover the gaps after your extras benefits have been provided, excludes Medicare services.

School accidents

Month waiting period Annual limit – $100 per person

Benefits are available for approved health screening tests (bowel screening, kidney check, mole mapping, bone density tests, mammograms and specialist eye tests), approved quit smoking programs and nicotine replacement therapies. Benefits are available to members who have Value Extras in combination with hospital cover. Benefits will not be available for treatments claimed through Medicare or for medicines/ drugs subsidised by the Australian Government under the PBS. An itemised pharmacy receipt with the patient’s name must be provided.

Health and wellbeing

ADF members 27

Talk to us on 1800 335 425

Page 30: We look after you like family. - Defence Health · The families of ADF members (permanent, and reservists serving 20 or more training days in a financial year) are eligible to join

Essentials ExtrasEssentials Extras is budget-friendly cover on the extras services most people use.

Annual limit – $500 per person

Get a minimum of 15% off the usual dental fee at our network dentists. Visit defencehealth.com.au/dental for locations. Some dental items are limited in the number of times they can be claimed in a year. Some are not payable in combination with others. And some may not attract a benefit at all.

General and preventive dental Month waiting period

Periodic oral exam (012) Up to $35.20Removal of calculus (114) Up to $62.40Bitewing x-ray (022) Up to $23.60Adhesive filling to one surface of a rear tooth (531)

Up to $66.80

Mouthguard (151) Up to $70.80

Surgical tooth removal Month waiting period

322 Up to $106.20323 Up to $132.80324 Up to $146.00

Dental – general and surgical extractions

Month waiting period Annual limit – $170 per person

Optical network partners 100%Our optical network providers have extensive ranges of no-gap glasses. Visit specsavers.com.au or vsp-australia.com.au for locations.

Specsavers VSP Vision CareSingle vision glasses 2 pairs no-gap 1 pair no-gapBi/Multifocal glasses 1 pair no-gap 1 pair no-gapFrames Discounted DiscountedContacts (in store) 10% off 15% off

Benefits at non-network providers are limited: up to $80 for single vision lenses, up to $95 for ground single vision lenses, up to $105 for bi-focal lenses, up to $120 for multi-focal lenses, up to $95 for frames and up to $120 for contact lenses.A sight-correcting script must accompany the claim. The no-gap glasses deals are based on standard lens options. Other lens choices are likely to involve an out-of-pocket cost. For the two pairs no-gap glasses deal, the second pair must be from the same or lower priced range and must be for the same prescription.

Optical

Month waiting period Annual limit – $100 per person

Per travel vaccination prescription Up to $50The benefit is payable on non-PBS travel vaccinations only and applies to the cost in excess of the current PBS amount.

Travel vaccinations

Month waiting period Annual limit – $200 per person

Per consultation Up to $20Where the provider is recognised by the Australian Regional Health Group the following alternative therapies are payable: acupuncture, homeopathy, aromatherapy, myotherapy, naturopathy, remedial massage, remedial therapy, Chinese herbal medicine and western herbal medicine. No benefit payable for any prescribed medications, herbal or dietary preparations.

Alternative therapies & exercise physiology

Favourite features Comprehensive ambulance cover, so there’s no need for a separate subscription

Guaranteed minimum 15% off the usual fee for treatment by a network dentist

No-gap glasses deals through our optical network

Cover for essential services like general dental, preventive dental, surgical extractions, physiotherapy, chiropractic and osteopathy

Money back for a wide range of alternative therapies

Money back for travel vaccinations

Month waiting period Annual limit – Unlimited

100% cover for ambulance services by state-appointed ambulance providers across Australia. So there’s no need for a separate subscription. This includes emergency services, non-emergency dispatch, mobile intensive care and air and sea ambulance services.

Transport services by Patient Transport vehicles are not ambulance services and are not claimable.

Ambulance treatment

Month waiting period Annual limit – $350 per person

Initial consultation Up to $35Subsequent consultation Up to $26Group therapy sessions and classes

Up to $10

Physiotherapy (including hydrotherapy), Chiropractic/Osteopathy

28

Page 31: We look after you like family. - Defence Health · The families of ADF members (permanent, and reservists serving 20 or more training days in a financial year) are eligible to join

What you need to know about joining Defence Health

Waiting periodsWhen you join Defence Health or upgrade your existing cover, you may have a waiting period before you can claim benefits. Waiting periods apply when:

You are taking up health insurance for the first time or have had a break in cover of two or more months

You transfer from another fund before completing equivalent waiting periods

You upgrade to a higher level of cover at Defence Health, including by reducing or removing an excess

The waiting periods you will need to serve when you join Defence Health are:

12 months for pre-existing conditions (excluding psychiatric, rehabilitation and palliative care)

12 months for pregnancy related treatment

2 months for psychiatric, rehabilitation and palliative care

2 months for all other hospital services

12 months for major dental and orthodontic treatment

12 months for laser refractive eye surgery

12 months for most devices, aids and appliances

2 months for all other services

Cover for an accident is immediate where it is not claimable from another source such as workers compensation or third party insurance

Pre-existing conditionsA pre-existing condition is an illness, ailment or condition where signs or symptoms existed in the six months prior to you joining or upgrading to a higher level of cover; whether you or your doctor knew of them or not.

Only a medical or other health professional appointed by Defence Health is authorised to determine whether you have a pre-existing condition.

If you need treatment in the first 12 months of joining for a condition that could be pre-existing, we may ask your doctor to complete a medical report. This will help our appointed medical advisor to assess if your condition was pre-existing. You should talk to us before going into hospital.

Cooling off periodIf you change your mind within 30 days of taking out cover, and have not made a claim, we’ll cancel your membership and refund any premiums you’ve paid. All you have to do is give us a call or write to us.

How to join?If you are taking out health insurance for the first time, waiting periods will apply. If you are switching from another health insurer, we’ll recognise the waiting periods you have served with the previous insurer.

It is easy to join Defence Health:

Give us a call on 1800 335 425 and we’ll make sure you’re getting the right cover for your needs. We can even complete your application over the phone.

Join online at defencehealth.com.au

Switching from another fundThere is no waiting period if you transfer from another fund on the same level of cover. If you transfer to Defence Health within two months of leaving another fund, any waiting periods already served under your previous cover for equivalent benefits will be honoured.

If you transfer to a higher level of cover at Defence Health than you were on at your previous fund, you will need to serve the applicable Defence Health waiting period (for the higher level of benefit). If you’re changing to a higher level of cover, you’ll still be entitled to benefits at the level of your previous cover while you’re serving your waiting periods. This includes any excess or co-payments applicable on your previous cover.

Get the lowdownWe know health insurance can be a lot to get your head around. This section should help clarify some important information for you. If you have any questions, we’re just a phone call away.

Visit defencehealth.com.au

29ADF members

Page 32: We look after you like family. - Defence Health · The families of ADF members (permanent, and reservists serving 20 or more training days in a financial year) are eligible to join

Making the most of your hospital cover

Where you’re treated affects your benefitsOur agreements with over 500 hospitals around the country mean you can get access to care when and where you need it. By choosing to be treated in an agreement private hospital, you can ensure the majority of hospital charges are covered when you’re admitted for day procedures or overnight. If you choose a hospital that does not have an agreement with Defence Health, you may have significant out-of-pocket expenses.

Our agreement hospital listing is one of the largest in Australia. Search the list at defencehealth.com.au/hospital

Reduce your medical costs with Access Gap Your doctor, surgeon, anaesthetist, pathologist and radiologist will all charge for their services separately.

With Defence Health cover and the Medicare benefit 100% of the Medicare Benefits Schedule (MBS) fee for in-hospital services is covered. But some doctors charge above the MBS fee and this can result in significant out-of-pocket medical costs.

Defence Health can help reduce or eliminate these extra medical costs if your doctor agrees to use our Access Gap scheme. Always ask your doctor what they will charge and if they will participate in our Access Gap scheme to reduce or eliminate the medical costs.

You can search for doctors who may participate in our Access Gap scheme at defencehealth.com.au/accessgap

Claiming hospital benefitsIn most cases, we will settle your account directly with the hospital when you are discharged. If you have an excess or are still serving a waiting period, the hospital will require you to pay the additional charge either at admission or on discharge.

What’s not covered

Situations where you will not be covered include:

Hospital services listed as an exclusion on your policy

Treatment received while serving a waiting period

Treatment provided at an emergency department of a hospital

Treatment for which a Medicare benefit is not payable (apart from rehabilitation, psychiatric treatments and palliative care)

Treatment not clinically necessary such as cosmetic surgery

Treatment in doctors’ rooms or specialist tests as an outpatient

Doctors’ fees in excess of the MBS fee, unless covered by Access Gap

Pharmaceuticals provided on discharge or unrelated to the reason for hospitalisation

High cost drugs that aren’t covered under the PBS or hospital contract

Personal items such as newspapers, toiletries or TV

Accommodation in an aged care facility

Services claimable from another source such as workers compensation or third party insurance

Hospital stays beyond 35 days where care is not agreed between the hospital and Defence Health (this will incur out-of-pocket expenses)

Surgery by a non-accredited surgeon (when provided by an accredited podiatric surgeon, hospital benefits will be paid at the insured rates and a limited benefit is payable for the podiatric surgeon’s fees)

Private midwifery fees if a doctor is required to intervene in the delivery (benefits will be payable for the doctor’s in-hospital treatment).

Our hospital covers are not suitable for overseas visitors who do not have full Medicare entitlements.

RestrictionsBenefits for restricted treatment will cover the cost of a private patient in a shared room of a public hospital. If you are treated elsewhere, such as a private hospital, you will incur additional and significant out-of-pocket expenses. Please call us before you commence any hospital treatment to ensure you are covered.

ExcessIf your hospital cover has an excess, each adult on your policy is required to pay it when admitted to a public or private hospital, whether it’s a same day procedure or overnight admission. The excess is only payable once per adult per financial year. And remember there’s no excess for kids.

Accidental injury benefitOur ADF Essentials Package and Essentials Hospital provides you with a benefit for injuries you sustain in an accident that occurred after joining this cover. An accident means an unplanned or unforeseen event leading to bodily injuries caused solely and directly by external means and requiring urgent treatment from a registered practitioner. To be covered you must provide documented proof from your registered practitioner that you sought treatment within 48 hours of the accident. If treatment in hospital is needed as an admitted patient, you will need to be admitted within 90 days of the initial treatment. After this 90-day period, any hospital treatment will be paid as per the level of benefits on your cover (that is, some benefits may be excluded or restricted).

Exclusions You won’t receive any benefits from us for treatments not covered under your policy.

30

Page 33: We look after you like family. - Defence Health · The families of ADF members (permanent, and reservists serving 20 or more training days in a financial year) are eligible to join

Making the most of your extras cover

Knowing your annual limitsAll of the goods or services claimable under extras cover have annual per person limits. Some devices and appliances may include policy maximums.

Once the annual limit has been reached, no further benefits are payable in that year. Limits are re-set on 1 July each year. Benefit payments will resume for treatment received after the beginning of the next financial year.

You can easily monitor your available limits on our website at defencehealth.com.au/members.

Claiming conditionsThe most common claiming conditions are:

All services must be provided by an approved practitioner in private practice

Claims must be lodged within 2 years of receiving the service

Benefits are only payable on goods and services purchased in Australia

Benefits are only payable where Medicare benefits are not payable

Benefits are not payable when they can be claimed from another source

We recognise all those extras providers who are registered with their professional body and in the case of approved alternative therapies, those recognised by the Australian Regional Health Group.

If you are unsure whether a practitioner is registered with us, visit defencehealth.com.au/extrasprovider or just give us a call.

Full claiming conditions are available at defencehealth.com.au/claim.

Get a quote or explore your options

Visit defencehealth.com.au

Talk to us on 1800 335 425

ADF members 31

Talk to us on 1800 335 425

Page 34: We look after you like family. - Defence Health · The families of ADF members (permanent, and reservists serving 20 or more training days in a financial year) are eligible to join

Claiming made easyWhatever your preference, we offer a range of easy ways to claim.

On-the-spot claimingMany health care providers (like dentists, optometrists and physiotherapists) can swipe your member card on-the-spot through an electronic terminal. The benefit payable is automatically credited to them and you then settle any outstanding amount. A list of providers who offer on-the-spot claiming is available at defencehealth.com.au/extrasprovider.

Simple claimingIt’s easy to claim using our Mobile Claiming App, available to download in the App Store and Google Play Store. If you have an Apple or Android device you can claim from your couch.

We’ve made the app quick and convenient to use. With a couple of taps of the screen

and a quick photo of your account, your claim is on its way to us. Just make sure you keep your receipt for 2 years in case we need it.

Fastest refundFor the fastest refund claim securely online at defencehealth.com.au/members. There’s no need to scan and send us your account or receipt, just keep your receipt for 2 years in case we need it.

Put pen to paperDownload a claim form from our website, complete and it then:

Email it with a copy of your receipts to [email protected]

Fax it and a copy of your receipts to 1800 241 581

Post it and your original accounts or receipts to us:

Defence Health, PO Box 7518, Melbourne, Victoria 3004

32

Page 35: We look after you like family. - Defence Health · The families of ADF members (permanent, and reservists serving 20 or more training days in a financial year) are eligible to join

Our commitment to you

Our purpose is to support you, the members of the ADF and wider Defence community to manage your personal and family health care.

Trust

We will earn your trust by consistently delivering a personal experience for your needs. We are as good as our word – every time.

Excellence

Our people are proud to serve you. They will provide service and experience others won’t, or can’t. We actively seek ways to continuously improve our offer to you.

Ownership

We’re part of the ADF family. We accept responsibility, act with initiative, and follow through. We won’t let you down.

Respect

We are friendly people, here to help you make good choices. We listen with intent and offer clear explanations, to provide you with peace of mind and support.

Community

We’re here for people, not profit. We are committed to making a positive difference to the health and wellbeing of the Defence community.

Tell us how we are doingOur aim is to get things right the first time and we value your feedback. Compliments or complaints can be made by phone on 1800 335 425 or via defencehealth.com.au. Your experience is our priority so we will deal with your concerns efficiently and consistently.

If we are unable to satisfy you, you can contact the Commonwealth Ombudsman on 1300 362 072. The Ombudsman provides free information and assistance to resolve disputes.

Defence Health Fund RulesYour cover will be provided and benefits paid in accordance with the Fund Rules of Defence Health Limited. You can download a copy of the latest Fund Rules from defencehealth.com.au/fund-rules or call us and we’ll send you one.

Your privacy is important to us.Defence Health has a legal obligation to comply with the Commonwealth Privacy Act 1988 and the Australian Privacy Principles. The Defence Health privacy statement informs you about how your personal information will be collected, held, used and disclosed, how you may gain access and seek correction of that information, and how you may complain about possible breaches of privacy. A copy of the full Privacy Policy is available at defencehealth.com.au. We will always endeavour to collect your personal information directly from you, but in some circumstances, for instance where you are a dependant on the policy, we will collect your personal information from the policy holder.

We will generally collect and use your information to approve your transactions/claims, to provide services you have requested and to inform you of products, benefits and services we think may be of interest to you.

We may use or disclose your personal information for another purpose, but only if we have your prior consent, or we are required to do so to fulfil our obligations as a private health insurer, or for any other reasonably expected purpose related to the provision of your health benefits. For example, we may disclose your information to other service providers we have arrangements with or who provide services to us, or where otherwise permitted or required by law.

Policy holders will have access to certain personal information about dependants on the policy. Policy holders have an obligation to make dependants aged 16 years and over aware that they may contact us if they do not wish us to share their personal information with the policy holder or others on the policy.

If you do not provide the information requested or do not consent to us requesting it from third parties, we may be unable to provide our health benefit services to you.

You can view our privacy policy on our website, defencehealth.com.au/privacy.

Code of conductWe want to make sure you get the right cover to meet your needs. We are committed to the Private Health insurance Code of Conduct to support you in making informed decisions about your family’s private health insurance.

You can download a copy of the code at defencehealth.com.au/code-of-conduct.

Visit defencehealth.com.au

33ADF members

Page 36: We look after you like family. - Defence Health · The families of ADF members (permanent, and reservists serving 20 or more training days in a financial year) are eligible to join

Making the most of the Australian Government’s initiativesThe Australian Government has a number of initiatives in place to encourage people to take out private health insurance. There are benefits for taking out cover and penalties if you don’t. The better you understand these initiatives the better off you could be so let’s take a closer look.

Australian Government RebateReduces the amount you have to pay for health insurance

The Australian Government Rebate on private health insurance may reduce the amount you pay for private health insurance. The rebate amount is based on the age of the oldest person covered by the policy (the older the better) and your annual earnings (the lower the better).

Most people choose to take the Australian Government rebate in the form of a premium reduction. Alternatively, you could choose to claim the rebate as a tax offset when you lodge your tax return.

If you choose to take the rebate as a premium reduction, tell us which rebate tier you fall within and we’ll automatically apply the relevant rebate to your premium. And don’t worry if you choose the wrong rebate tier. If you receive too much, or too little, it will be reconciled by the ATO when you submit your tax return.

How is the rebate calculated?

The Government indexes the rebate on 1 April each year using a calculation which represents the difference between the Consumer Price Index and the industry weighted average premium increase. This means that the percentage of Government rebate as a proportion of your premium will diminish over time.

If you have a Lifetime Health Cover loading, the rebate won’t apply to this component of your premium.

Medicare Levy SurchargeMore tax for high income earners without hospital cover

The Medicare Levy Surcharge (MLS) is an additional tax on higher income earners who don’t have hospital cover for themselves and their family. The surcharge is in addition to the Medicare Levy of 2.0% that applies to most taxpayers. No MLS is payable if you take out any of our ADF packages or any other Defence Health hospital cover.

Permanent ADF members should note that although you do not need private health cover yourself, if your combined family income is above the base tier threshold your family will need to take out private hospital cover to avoid the MLS.

A single person earning $136,000 with no private hospital cover pays

1.25% Medicare Levy Surcharge

That means they’ll pay an additional $1,700 in tax.

Reduce what you payA single earning up to $90,000 aged under 65 years of age is entitled to a 26.791% rebate.

A couple/family earning up to $180,000 aged under 65 years of age is entitled to a 26.791% rebate.

SinglesIncome thresholds*

Up to $90,000

$90,001 to $105,000

$105,001 to $140,000

More than $140,000

Income tiers Base Tier Tier 1 Tier 2 Tier 3

Rebate

Under 65 years old 26.791% 17.861% 8.930% 0%

Aged 65-69 years 31.256% 22.326% 13.395% 0%

Aged 70 years and older 35.722% 26.791% 17.861% 0%

Medicare Levy Surcharge if no hospital cover

All age groups 0% 1% 1.25% 1.5%

*Income thresholds are determined by the Australian Taxation Office and will remain unchanged until 30 June 2018. The ATO has specific rules for calculating your Income for Medicare Levy Surcharge purposes’. For more information, please go to www.ato.gov.au

34

Page 37: We look after you like family. - Defence Health · The families of ADF members (permanent, and reservists serving 20 or more training days in a financial year) are eligible to join

Lifetime Health CoverEveryone needs to consider the impact of Lifetime Health Cover

If you are 30 or over, and you are not a permanent member of the ADF, you will need to consider the impact of Lifetime Health Cover legislation. It is designed to encourage people to take out hospital cover earlier in life and to penalise people who don’t.

If you take out hospital cover later than the 1 July following your 31st birthday, you will pay a loading of 2% on your premium for each year you are aged over 30. And it won’t be removed until you have maintained hospital cover for a continuous 10-year period.

To cover small gaps, such as switching from one insurer to another or discharging from the ADF, you are permitted to be without hospital cover for up to two years and 364 days during your lifetime. If you are without hospital cover longer than that, you will attract a loading of 2% on the first day of your third year, and every year after that.

The Australian Government Rebate on private health insurance cannot be applied to the loading amount.

Special provisions for discharging ADF

Permanent ADF members are considered to have hospital cover while serving. If you’ve just left the permanent ADF, then you are no longer exempt from the impact of Lifetime Health Cover. If you discharge after your 31st birthday, you can take out hospital cover without a loading, unless you already had a loading when you enlisted. However, if you don’t take out hospital cover on discharge, you’ll start using the two years and 364 days you are permitted to be without hospital cover.

If you discharge from the ADF before your 31st birthday, then the normal Lifetime Health Cover conditions apply.

A person who first takes out hospital cover at age 40 will pay 20% more in premiums each year than someone who takes out hospital cover at age 30.

The longer you leave it, the higher the loading. The maximum loading is 70%.

Couples and familiesCombined income thresholds*

Up to $180,000

$180,001 to $210,000

$210,001 to $280,000

More than $280,000

Income tiers Base Tier Tier 1 Tier 2 Tier 3

Rebate

Under 65 years old 26.791% 17.861% 8.930% 0%

Aged 65-69 years 31.256% 22.326% 13.395% 0%

Aged 70 years and older 35.722% 26.791% 17.861% 0%

Medicare Levy Surcharge if no hospital cover

All age groups 0% 1% 1.25% 1.5%

Single parents and couples are considered families. For families with children, the thresholds are increased by $1,500 for each child after the first. Age ranges relate to the oldest person covered on the policy.

*Income thresholds are determined by the Australian Taxation Office and will remain unchanged until 30 June 2018. The ATO has specific rules for calculating your Income for Medicare Levy Surcharge purposes’. For more information, please go to www.ato.gov.au

ADF members 35

Talk to us on 1800 335 425

Page 38: We look after you like family. - Defence Health · The families of ADF members (permanent, and reservists serving 20 or more training days in a financial year) are eligible to join

More ways we treat you like family

Travel insurance

Special rates for ADF and Defence Health members

Every traveller, every trip

Whether you’re exploring near or far, Defence Health Travel Insurance can help provide peace of mind for your travels. Flexible cover is available for:

International travel

Travel within Australia

Frequent travellers

Singles, couples or families

Additional options – snow, golf, cruise, adventure packs

All ages

Specially for ADF

ADF members on deployment or overseas posting can be covered for leisure travel from their overseas base. The same flexibility applies to their family if they are living overseas with the ADF member. Return travel is covered back to the overseas post or to Australia.

Leave cancellation insurance is also available for ADF members and their families if a holiday booking has to be cancelled because the ADF member has received notice of deployment.

Flexible options for every traveller

No Age Restriction Age shouldn’t get in the way of adventure. We simply require a pre-existing medical condition check for travellers aged 75 or over for our Comprehensive and Domestic plans.

Flexible Standard Excess Our $200 standard excess can be increased to $300 or $500 which will reduce your premium on our Comprehensive and Multi-Trip plans. You can also remove the standard excess on all plans with an increased premium.

Increased Item Limits Cover your important possessions by purchasing extra cover for them. A wide range of qualifying items is available.

Rental Vehicle Excess You can opt to increase your rental vehicle excess cover up to an additional $6,000 in case of an accident.

Get a travel quote

Visit defencehealth.com.au or talk to us on 1800 622 499Travel insurance is arranged by Defence Health Ltd ABN 80 008 629 481 AFSL 313890. This insurance is issued and managed by AGA Assistance Australia Pty Ltd ABN 52 097 227 177 AFSL 245631 trading as Allianz Global Assistance for the insurer Allianz Australia Insurance Limited ABN 15 000 122 850 AFSL 234708. Terms, conditions, limits and exclusions apply. We do not provide any advice on this insurance based on any consideration of your objectives, financial situation or needs. Before making a decision please consider the Product Disclosure Statement. If you purchase a policy, Defence Health receives a commission that is 10% to 20% of your premium.

Personal Accident InsuranceIf you’re about to be deployed consider Personal Accident Insurance. We offer D-Pax Personal Accident Insurance for Defence personnel. It provides lump sum payments for accidental death and injuries, permanent disabilities, fractures and burns caused by an accident. For an additional premium it has an optional extension for cover in a warzone, with reduced benefits, that can be taken at the time of deployment and then removed upon your return.

To get a quote for personal accident insurance

Talk to us on 1800 676 465D-Pax insurance in this brochure is of a general nature and does not take into account your personal objectives, financial situation or needs. Defence Health is not the issuer of these products and does not warrant that they are suitable for you. You may wish to obtain Personal Advice. You should consider the relevant Product Disclosure Statement (PDS) in deciding whether to acquire these products. A PDS can be obtained by calling 1800 335 425 or by downloading it from the Defence Health website.

D-Pax insurance is issued and underwritten by AIG Australia Limited (ABN 93 004 727 753, AFSL 381686) trading in Australia as AIG and distributed by Defence Health Ltd. Defence Health receives a payment of 13% (exclusive of GST) for each premium paid to AIG.

36

Page 39: We look after you like family. - Defence Health · The families of ADF members (permanent, and reservists serving 20 or more training days in a financial year) are eligible to join

The right insurance solution for youIt’s important to find the right insurance solution for you. Defence Health has partnered with ClearView LifeSolutions to provide an extensive range of tailored insurances including some specially designed for ADF members.

Life CoverThere are moments in life that can take us by surprise. And some of those surprises can have serious financial implications.

Life Cover provides a lump sum benefit in the event of death or terminal illness. The level of cover you need will be determined by your circumstances and budget. The lump sum could be used to repay debts such as a mortgage, invested to create a future income stream, or to meet education or childcare expenses.

Trauma CoverTraumatic events can strike at any time. But with Trauma Cover you could receive a lump sum benefit to take the pressure off while you get back on your feet. Or you might need the benefit to access medical treatment for your condition, or to pay off debt and cover daily living expenses.

Benefits are paid if you suffer one of 44 specified trauma conditions. The Trauma Plus Option provides cover for an additional 13 conditions.

Especially for permanent ADF members

War zone cover – cover must be in force before you know you are to be deployed

Continuation of cover after discharge

Accident CoverAccident Cover is a practical alternative for people with existing health conditions or injuries that could be too costly to insure under other cover.

ClearView LifeSolutions has a comprehensive range of accident cover to ensure your family’s financial future is secure in the event of a serious accident.

Accident Cover is simple to purchase and does not require a medical assessment. The variations on Accident Cover include:

Accidental Death Cover pays a lump sum benefit if you die as a result of an accident.

Accidental TPD Cover pays a lump sum benefit if you’re totally and permanently disabled as a result of an accident and unlikely to ever work again.

Accidental Income Protection Cover pays an ongoing monthly benefit if you are totally or partially disabled as a result of an accident and unable to work.

Income protectionYour ability to earn an income is one of your most valuable assets – if not the most valuable.

If you are dependent on your income to pay your bills and maintain your standard of living, then you may want to consider Income Protection cover.

Income Protection cover pays an ongoing monthly benefit of up to 75% of your income if you are unable to work as a result of sickness or injury. The benefit will continue to be paid for a specified period while you remain totally (or partially) disabled. Premiums are usually tax deductible.

Accident Cover and Income Protection Cover are not available to permanent ADF members.*

Talk to us about your needs and we’ll structure the cover that will keep you and your family protected.

Get a life insurance quote Visit defencehealth.com.au or talk to us on 1800 676 465

Features to suit you Worldwide cover – you are fully covered, 24 hours a day anywhere in the world.

Guaranteed renewable – your cover will not be cancelled or your premium increased due to a change in your health, occupation or pastimes.

Guaranteed upgrade of benefits – premium-neutral product enhancements are automatically added to your policy.

Indexation Benefit – annual indexation of your benefit amount maintains real value.

Future Increase Benefit – as life changes you can increase your cover without the need to provide further medical information. This makes it easier for you to maintain the right level of cover for your needs.

This information is intended to provide general information only and has been prepared without taking into account any particular person’s objectives, financial situation and needs. Before acting on such information, you should consider the appropriateness of the information having regard to your personal objectives, financial situation and needs. You should read the relevant Product Disclosure Statement (PDS) and Policy Document before making any decision about a product, which can be accessed from defencehealth.com.au. If you purchase a policy Defence Health receives a commission that is 10% to 20% of your premium.ClearView Life Solutions issued by ClearView Life Assurance Limited ABN 12 000 021 581 AFSL 227682ClearView Life Solutions Super issued by ClearView Life Nominees Pty Limited ABN 37 003 682 175 AFSL 227683, as trustee of the ClearView Retirement Plan ABN 45 828 721 007*For further terms and conditions please refer to the LifeSolutions PDS and Policy Documents which can be accessed at defencehealth.com.au

Visit defencehealth.com.au

37ADF members

Page 40: We look after you like family. - Defence Health · The families of ADF members (permanent, and reservists serving 20 or more training days in a financial year) are eligible to join

Defence Health Limited ABN 80 008 629 481 AFSL 313890

DH0974/1202/04-16

Contact Us

Phone

1800 335 425

Monday to Thursday 8:30 am to 8:00 pm AEDT/AEST

Friday 8:30 am to 6:00 pm AEDT/AEST

Web

defencehealth.com.au

/DefenceHealth

healthhq.defencehealth.com.au

Email

[email protected]

Fax

1300 665 096

Post/Street Address

PO Box 7518 Melbourne, Victoria 3004

Level 4, 380 St Kilda Road Melbourne, Victoria 3004