Defence Health Limited hospital cover policy review

Find out how you might be eligible for cover with Defence Health and choose from 4 hospital cover policies.

Defence Health Limited is 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.
Top 3 features
  1. Good for hospital substitute programs, helping cover the cost of health care providers coming to your home.
  2. Good for chronic care and risk factor management.
  3. Good for unlimited 100% ambulance cover with all hospital policies.

What hospital policies are available?

  • Ultimate Hospital Gold: This comprehensive policy includes all the clinical categories required for a gold rating and is best for the elderly, those with ongoing health issues and families that want the most protection. It offers comprehensive cover for everything Medicare includes as well as surgery like joint reconstructions, heart services, pregnancy IVF and psychiatric services.
  • Value Hospital Silver Plus: Value Silver Plus is a good one for families who want a high level of hospital cover but don't want to break the bank. With all 26 clinical categories required for a Silver rating included, Silver plus covers procedures and services like joint investigations, heart services, colonoscopies and cancer treatment.
  • Everyday Hospital Bronze Plus: This policy includes the 18 clinical categories required for a Bronze rating. 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.
  • Essentials Hospital Basic Plus: This basic policy includes ambulance and accidents. 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.
All 38 categoriesProduct Tier Inclusions
RehabilitationGold, Silver
Hospital psychiatric servicesGold
Palliative careGold, Silver
Brain and nervous systemGold, Silver, Bronze
Eye (not cataracts)Gold, Silver, Bronze
CataractsGold
Ear, nose and throatGold, Silver, Bronze
Tonsils, adenoids and grommetsGold, Silver, Bronze, Basic
Bone, joint and muscleGold, Silver, Bronze, Basic
Joint reconstructionsGold, Silver, Bronze, Basic
Joint replacementsGold
Back, neck and spineGold, Silver
Podiatric surgery (by a registered podiatric surgeon)Gold, Silver
Kidney and bladderGold, Silver, Bronze
Male reproductive systemGold, Silver, Bronze
GynaecologyGold, Silver, Bronze
Miscarriage and termination of pregnancyGold, Silver, Bronze
Pregnancy and birthGold, Silver
Assisted reproductive servicesGold
Digestive systemGold, Silver, Bronze
Hernia and appendixGold, Silver, Bronze, Basic
Gastrointestinal endoscopyGold, Silver, Bronze, Basic
Chemotherapy, radiotherapy and immunotherapy for cancerGold, Silver, Bronze
Pain managementGold, Silver, Bronze
SkinGold, Silver, Bronze
Breast surgery (medically necessary)Gold, Silver, Bronze
Diabetes management (excluding insulin pumps)Gold, Silver, Bronze
Heart and vascular systemGold, Silver
Lung and chestGold, Silver
BloodGold, Silver
Plastic and reconstructive surgery (medically necessary)Gold, Silver
Dental surgeryGold, Silver, Bronze, Basic
Implantation of hearing devicesGold, Silver
Dialysis for chronic kidney failureGold
Weight loss surgeryGold
Insulin pumpsGold, Silver
Pain management with deviceGold, Silver
Sleep studiesGold, Silver

Other benefits of Hospital Cover with Defence Health

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 Gold 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.

How do the costs work?

Hospital cover helps cover costs for services like hospital accommodation, theatre fees, intensive care and Medicare recognised treatments. It also pays towards the cost of the medical professionals who treat you in hospital.

Always look out for a hospital excess on your policy. This is the sum of money you agree to pay upfront before you can claim a benefit on hospital treatment. You only need to pay the excess when need to go hospital.

Depending on your coverage, you may also have some out of pocket costs. This is the money that isn't reimbursed by your insurer and can include deductibles, coinsurance, and co-payments for covered services as well as costs for services that aren't covered by your policy.

Waiting periods and limitations

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.

How 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.

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