Defence Health Limited hospital cover

See what Defence Health hospital cover offers families of members of the ADF

Defence Health Limited is proud to be the health fund for members of the Australian Defence Force (ADF). Cover is also available for the families of ADF members and former members.

If you have connections to the ADF, you may be able to join. You can sign up if you meet the following criteria:

  • If you are currently serving as an ADF member or as a reservist who trains or serves 20 or more days a year.
  • If you have previously served in the ADF.
  • If you currently work, or have previously worked, in the Department of Defence and other related departments.
  • If you have worked for a defence supplier, or a company contracted by the Department of Defence, where you were involved in the supply of defence goods or services.

You can also join if you’re part of the extended family of a person who meets the above criteria. This includes partners, children, siblings, former spouses or partners or grandchildren of any of the above.

finder.com.au does not currently have access to this health insurance brand. You may wish to compare options available on the health insurance homepage.

What hospital cover does Defence Health Limited offer?

You have three hospital cover options to choose from: Essentials, Value and Premier cover. All of them entitle you to access affordable, high quality treatment at private hospitals with a doctor of your choice. The main differences are the specific procedures you can access under your plan.

Depending on your hospital cover

  • Some services will be restricted. Only the minimum Medicare amount is payable. When you go to a private hospital, or attend a public hospital as a private patient, you may end up with potentially significant out-of-pocket expenses, but not as many as if you didn’t have any health insurance at all.
  • Some services will be excluded. There will be some service that you cannot claim any reimbursement for.
Essentials HospitalValue HospitalPremier Hospital
Excess$200$200 or $400$200 or $400
Accidental injury
  • yes
  • yes
  • yes
Tonsil removal
  • yes
  • yes
  • yes
Adenoid removal
  • yes
  • yes
  • yes
Appendix removal
  • yes
  • yes
  • yes
Surgical tooth extraction
  • yes
  • yes
  • yes
Hernia repairs
  • yes
  • yes
  • yes
Joint investigations and minor repairs
  • yes
  • yes
  • yes
Joint reconstructions
  • yes
  • yes
  • yes
Colonoscopy
  • yes
  • yes
  • yes
Gastroscopy
  • yes
  • yes
  • yes
RehabilitationRestricted
  • yes
  • yes
Palliative careRestricted
  • yes
  • yes
Psychiatric treatmentRestrictedRestricted
  • yes
Cancer treatment
  • no
  • yes
  • yes
Stroke treatment
  • no
  • yes
  • yes
Brain surgery
  • no
  • yes
  • yes
Pregnancy and related services
  • no
  • yes
  • yes
Heart-related procedures
  • no
  • yes
  • yes
Assisted reproductive services
  • no
  • no
  • yes
Cataracts, glaucoma and laser eye surgery
  • no
  • no
  • yes
Dialysis for renal failure
  • no
  • no
  • yes
Obesity-related treatments
  • no
  • no
  • yes
Joint replacements
  • no
  • no
  • yes
Chronic care and risk factor programs
  • no
  • yes
  • yes
Hospital substitute programs
  • no
  • yes
  • yes
Midwifery
  • no
Up to $750 where not claimable under MedicareUp to $1,500 where not claimable under Medicare
Home nursing
  • no
$70 per day, up to $750$90 per day, up to $1,800
Services not covered by Medicare
  • no
  • no
  • no
All other Medicare services
  • no
  • yes
  • yes

Picking a plan

  • Essentials. This cover provides a limited range of the hospital services that a young and relatively healthy person is more likely to use. This plan gives you useful and affordable cover without the things you probably won’t need.
  • Value. This cover strikes a balance between cost and cover that delivers wide-ranging benefits while remaining affordable. It has most of what you’ll need, but might not be as much as you’d like if you’re looking for pregnancy cover or starting to experience some of the health concerns that come with age.
  • Premier. This cover provides comprehensive, high-level, wide-ranging protection that lets you enjoy high-quality medical care for years to come.

Are there any additional benefits?

The hospital substitute programs, available with mid- and top-level policies, can cover the cost of health care providers coming to your home. With this, you may be able to leave hospital sooner than you would otherwise be able to, reducing the risk of a hospital-acquired infection and letting you get back home sooner.

Similarly, the home nursing benefit can cover the cost of a professional coming to your home in order to provide ongoing services in the comfort of your own home.

Defence Health cover is also geared towards family protection. The Premier policy covers private hospital births and pays for midwife attendance. In addition to this, you will be able to access the following features:

  • No excess is payable in the event of your children’s hospital admissions.
  • Newborns can get covered under your policy with no waiting period as long as you register them on the policy before the age of two months.
  • Children can stay on your policy right up until the age of 21, or 25 if they’re single and studying full time, along with any other dependent children.

Other benefits available include the following:

  • Chronic care and risk factor management. This benefit allows you to access telephone support groups to help improve your quality of life and support existing treatments as well as manage risk factors. This benefit is available for a wide range of conditions, including diabetes, chronic heart disease, lung disease, osteoporosis, peripheral vascular disease, depression and anxiety.
  • Access Gap program. This program eliminates any gap or caps it at a reasonable amount. You can find participating Australian Defence no gap doctors online.
  • Unlimited 100% ambulance cover with all hospital policies. There is no limit on ambulance services, including both emergency and non-emergency dispatches, with this benefit. In addition, there is no limit on mobile intensive care or on air and sea ambulance transport services.
  • Defence Health recognises waiting periods already served. If you switch to Defence Health Limited from another fund, Defence Health Limited will recognise any waiting periods already served for cover included in your previous plan so you won’t have to start again.

Limitations, exclusions and waiting periods

You are not able to claim any non-Medicare treatments under your hospital plan, except where otherwise specified. For example, you can still claim laser eye surgery expenses under Premier cover, even though it’s not a Medicare treatment.

You are not covered for the following services:

  • Treatments provided at a hospital emergency department
  • Treatment that is not clinically necessary, such as purely cosmetic surgery, except where otherwise specified
  • Specialist tests as an outpatient
  • Experimental or high-cost drugs that aren’t covered under the PBS or your hospital contract
  • Accommodation in an aged care facility
  • Personal hospital expenses, such as newspapers, toiletries or TV
  • Hospital stays after 35 days where care is not agreed between the hospital and Defence Health
  • Surgery by non-accredited practitioners
  • Private midwifery fees where a doctor was required to intervene as a result of complications. The doctor’s in-hospital fees, however, will be payable.

Steps to make a claim

When you go to a hospital that’s part of the Australian Defence health network, remember to take your health card with you. The hospital will generally be able to use this to settle up with Defence Health Limited directly, so you won’t even see the bill.

Instead, all you’ll have to pay is the excess and any gap which might apply. By getting in touch with Defence Health’s team before going to hospital, you can find out whether there will be a gap, and how you might be able to avoid it.

Andrew Munro

Andrew writes for finder.com.au, comparing products, writing guides, sniffing out deals and looking for new ways to help people get the most out of their money.

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