Defence Health Health Insurance

Find out if you can save with the help of Defence Health – Compare cover and find the right policy.

You don’t want to take shortcuts when it comes to looking after your health and the wellbeing of your family, so private health cover is a must for every Australian. There’s an abundance of private health funds in Australia and they all offer hospital cover and extras cover, allowing you to tailor a policy to suit your health needs. Defence Health offers a range of health insurance options to more than 235,000 Australians with Defence connections. With hospital and extras cover to suit everyone from the young and healthy to those who need comprehensive protection, it provides affordable cover and peace of mind.

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.

Who can join Defence Health?

This not-for-profit health fund offers membership to the following people:

  • Anyone who has previously served in the ADF, regardless of whether they served part-time or full-time, as well as their partners and children
  • Anyone who works in the Department of Defence or a related department
  • Anyone who currently works or has previously worked for a Defence supplier
  • Anyone who is the extended family member of anyone listed above. This includes parents, children, siblings, grandchildren, ex-spouses and partners
  • ADF Partners and families
  • Active reservists (anyone serving in the Army Reserve, Air Force Reserve or Naval Reserve), their partners and families.

Permanent ADF members are not required to take out cover for themselves but can cover their partners and children.

How do I choose the right cover?

In order to decide which cover option suits your needs and budget, consider the following questions:

  • Are you young, fit and healthy?
  • Do you just want basic cover or are you looking for something that provides complete peace of mind for you and your family?
  • Are you planning on starting a family soon?
  • Are you on a tight budget or can you afford to spend a little extra?
  • Do you want cover for a wide range of general treatments or only the ones you’re sure you will use?
  • Do you want to get the treatment you need as soon as it is required?

Answering these questions will help you decide on the right health fund and cover option for you.

What is covered?

Hospital cover

Defence Health offers the following hospital cover options to suit different insurance needs and household budgets:

Defence Health Premier Hospital
  • If you want complete peace of mind when it comes to your health, this policy could be for you. It offers comprehensive cover for everything Medicare covers, including everything from joint reconstructions and heart services to pregnancy IVF and psychiatric services. You can enjoy comprehensive ambulance cover, your choice of doctor and hospital, and 100% cover for agreement private hospital charges and public hospital charges.
Defence Health Value Hospital
  • Value Hospital Cover is Defence Health’s mid-range offering and is designed for families who want a decent level of health cover but don’t want to have to spend too much to get it. It offers comprehensive ambulance cover and cover for the cost of a range of procedures like joint investigations, colonoscopies, heart services, cancer treatments, pregnancy and more. However, certain hospital services such as joint replacements and gastric banding are excluded from cover in order to keep costs to a minimum.
Defence Health Essential Hospital
  • This is a basic hospital cover option for applicants who are young, fit and have no major health concerns. If you want cover for a selection of basic hospital treatments or simply to avoid being slugged with levies and loadings by the government, this policy is designed with you in mind. It gives you your choice of doctor and hospital, accommodation in a shared or private room, and cover for theatre fees, intensive care and most drugs supplied in hospital. However, many procedures are excluded from cover.

Extras cover

These can be taken out as standalone cover or paired with one of the following extras cover options:

Defence Health Premier Extras
  • This offers top-level extras protection for a range of general treatments including ambulance, preventative dental, general dental, major dental, orthodontics, optical, physio, chiropractic, antenatal and postnatal services, pharmacy and vaccinations, alternative therapies, exercise physiology, psychology, podiatry, speech therapy, occupational therapy, dietitian and more.
Defence Health Value Extras
  • This mid-range policy covers a similarly wide range of treatments but offers lower benefit limits than a Premier Extras policy. Features include comprehensive ambulance cover, no annual limit on general dental treatment, no-gap glasses deals and much more.
Defence Health Essential Extras
  • This option is designed to offer wallet-friendly cover on the general treatments you’re most likely to use. This includes cover for general and preventative dental, ambulance treatment, optical, physio, travel vaccinations and alternative therapies.

Packaged options

ADF Total package
  • The ADF Total Package provides you with comprehensive hospital cover and allows you to take advantage of a range of extras treatments with generous annual limits.
ADF Essentials Package
  • The ADF Essentials Package is its entry level combined policy, which covers a limited range of hospital and extras treatments.
Which services are covered?Premier HospitalValue HospitalEssentials Hospital
Accidental injuryYesYesYes
All other services recognised by MedicareYesNoNo
Assisted reproductive services and infertility treatments Cataracts, Glaucoma and laser eye surgeryYesNoNo
Brain surgeryYesYesNo
Cancer treatmentYesYesNo
Chronic care programsYesYesNo
ColonoscopyYesYesYes
Dialysis for renal failureYesNoNo
GastroscopyYesYesYes
Hernia repairsYesYesYes
Home nursing – Maximum$1,800$750No
Per day$90$70No
Hospital substitute programsYesYesNo
Joint investigations and minor repairsYesYesYes
Joint reconstructionsYesYesYes
Joint replacementsYesNoNo
Midwifery (confinement and delivery)$1,500$750No
Obesity related treatment (eg. gastric banding)YesNoNo
Palliative careYesYesYes (Restricted)
Pregnancy and pregnancy related services Heart related proceduresYesYesNo
Psychiatric treatmentYesYes (Restricted)Yes (Restricted)
RehabilitationYesYesYes (Restricted)
Removal of adenoidsYesYesYes
Removal of appendixYesYesYes
Removal of tonsilsYesYesYes
Stroke treatmentYesYesNo
Surgical extraction of teethYesYesYes
Treatment not recognised by Medicare incl. most cosmetic surgeryNoNoNo

When am I not covered?

There are certain circumstances under which Defence Health will not pay your claim, including if:

  • It is for a hospital service specifically listed as an exclusion on your policy
  • It is for treatment you receive while you are serving a waiting period
  • It is for treatment provided at a hospital’s emergency department
  • It is for treatment for which a Medicare benefit is not payable (except for things like psychiatric treatments and palliative care)
  • It is for treatment that is not medically necessary, for example cosmetic surgery
  • It is for doctors’ fees in excess of the Medicare Benefits Schedule fee, unless those fees are covered by Access Gap Cover
  • It is for treatment you receive from your GP or as an outpatient
  • It is for discharge pharmaceuticals
  • It is for exceptionally expensive drugs
  • It is for personal items such as newspapers and TV hire
  • It is for the cost of accommodation in an aged care facility
  • You stay in hospital for more than 35 days and your claim is not supported by an Acute Care Certificate
  • It is for services that could be claimed from another source, for example workers’ compensation insurance
  • It is for private midwifery fees when a doctor is required to intervene in the pregnancy.

How much does cover cost?

The cost of your Defence Health health insurance will be impacted by a range of factors, including:

  • The level of cover you choose
  • Whether you select a single or family policy
  • Whether you choose standalone cover or combined hospital and extras cover
  • The age at which you take out cover. You will be slugged with a premium loading for every year after you turn 31 that you do not have private health cover in place
  • Whether you are eligible for the Australian Government Rebate
  • The excess you choose. Premier Hospital Cover, for example, allows you to choose the amount of excess you would like to pay. The higher the excess, the lower your premiums will be.

Defence Health Health Insurance excess

You can lower the amount of the premium you will have to pay if you choose to pay an excess when you are admitted to hospital The excess is the amount that you contribute to the cost of your hospital stay. For example, Premier Hospital Cover allows you to choose between an excess of $200 or $400 per adult. This excess applies once per adult every financial year and is paid upon your admission to hospital. However, no excess is payable for dependent children on your policy.

Ways you can save on your policy

  • Enjoy a range of discounts on glasses, lenses and frames with Defence Health’s optical network partners
  • Transition discount. If you’re discharging from the permanent ADF and aren’t becoming an active reservist, you’ll receive a 10% discount in the first year of your hospital cover or combined hospital and extras cover if you pay by direct debit
  • Take out cover before your 31st birthday to avoid a premium loading.

Does Defence Health offer a loyalty benefit?

Defence Health is a member-owned health fund that is designed to serve the needs of the Defence community. Rather than being run to benefit shareholders or a big corporation, Defence Health is run in the interests of its members. This means it can offer affordable and competitive cover to Australians with Defence connections – no matter what their health insurance needs are.

How do I make a claim?

In many cases, extras claims can be lodged and paid on the spot using electronic claiming; all you have to do is swipe your Defence Health membership card. For all other claims, you will need to claim through Defence Health’s mobile claiming app on your smartphone or tablet, online through the member area of the Defence Health website, or by completing a claim form and emailing, faxing or mailing it back to Defence Health.

Use Defence Health claims app

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Frequently asked questions about Defence Health

Q. When will I have to serve a waiting period?

  • A. Private health cover waiting periods apply if you are taking out cover for the first time, if you have been without cover for more than two months, if you are upgrading to a higher level of cover or if you are deemed to have a pre-existing condition.

Q. What waiting periods will I have to serve?

  • A. A two-month waiting period applies to most hospital and extras treatments. However, other treatments such as major dental will require you to sit out a longer waiting period.

Q. Will I need to pay an excess if my kid is admitted to hospital?

  • A. No excess is payable for dependent children on a Defence Health policy.

Q.  A certain treatment I need is listed as restricted on my cover – what does that mean?

  • A. This means that the benefit you will be paid for the treatment is equivalent to what Medicare would pay if you received your treatment in a shared room in a public hospital.

Q.  How can I apply to become a member of Defence Health?

  • A. This can be done online or over the phone.

Q. My partner and I have just divorced. He is a member of the ADF but I am not – can I still receive cover as part of my membership?

  • A. Yes, you are still eligible to receive private health cover from Defence Health.

Q. I’ve been posted overseas – can I suspend my cover during this time?

  • A.  Yes. You can contact Defence Health and suspend your cover for up to 12 months under certain circumstances. These include if you have been posted overseas or are travelling overseas, if you’re a reservist on continuous full-time service, or if you are experiencing financial hardship.

Q. I’ve just had a baby – what should I do?

  • A. Inform Defence Health of this exciting development within the first two months to receive cover for your newborn from birth and with no waiting period.

Q. How can I be covered when I go overseas?

  • A. Defence Health also offers travel insurance to offer essential or comprehensive protection when you head overseas for a holiday.

Q. Do I need to serve a waiting period when I switch to Defence Health from another fund?

  • A. As long as you’ve already served the waiting periods for an equivalent level of cover from another provider, you won’t have to re-serve those periods when you join Defence Health.

Can I compare benefit payments with other funds?

The Australian Medical Association publishes a Private Health Insurance Report Card annually, which compares the benefit amounts for specific treatments and conditions offered by Australia's largest health funds. The results of Defence Health is represented in this report card below under the title AHSA, of which it is a member, and also includes the Medicare (MBS) benefit amounts for comparison. More information on the AHSA can be found at the bottom of the table:

ProcedureMBSAHSA*
Appendicectomy$445.40$632.10
Basal Cell Carcinoma or Squamous Cell Carcinoma removal from nose, eyelid, lip, ear, digit or genitalia$221.35$366.10
Breast, benign lesion surgical biopsy of excision$260.05$356.40
Carpal Tunnel Release$276.80$440.20
Cataract Surgery$760.55$1,239.70
Cholecystectomy$739.35$1,091.90
Colonoscopy$334.35$435.00
Complicated Delivery (of baby)$1,629.35$1,855.90
Coronary Artery Bypass$2,200.00$3,783.30
Craniotomy$1,586.75$2,420.80
Cytotoxic Chemotherapy$97.95$107.80
Femoral on Inguinal Hernia$464.50$909.70
Haemorrhoidectomy$367.75$602.90
Hip Replacement$1,317.80$2,214.50
Knee Replacement$2,047.60$2,563.40
Overnight investigation for sleep apnoea$588.00$682.20
Tonsils or Tonsils and Adenoid$295.70$513.90
Uncomplicated Delivery (of baby)$693.95$1,484.50
Vaginal Hysterectomy$674.70$1,066.20
Varicose Veins$109.80$164.80
Vasectomy$229.85$343.80

*NSW, #AHM

I recognise most of these funds except for the AHSA, what is that?

The Australian Health Service Alliance is a management services organisation that represents a number of small to medium sized health insurance funds, allowing them to combine resources to deliver a higher quality of service to their members. The funds represented by the ASHA are:
  • ACA Health Benefits Fund
  • Australian Unity Health Limited
  • CBHS Health Fund Limited
  • CUA Health Limited
  • Defence Health
  • GMF Health
  • GMHBA
  • Budget Direct Health Insurance
  • Frank Health Insurance
  • GU Health
  • HBF Health Ltd
  • Health Care Insurance Limited
  • health.com.au
  • Health Insurance Fund of Australia Limited
  • Health Partners
  • Navy Health
  • onemedifund
  • Peoplecare Health Insurance
  • Phoenix Health Fund
  • Police Health Limited
  • Queensland Country Health Fund Limited
  • Reserve Bank Health Society Ltd
  • rt health fund
  • Teachers Health Fund > UniHealth Insurance
  • Teachers Union Health
  • The Doctors' Health Fund Pty Ltd
  • Transport Health
  • Westfund
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2 Responses to Defence Health Health Insurance

  1. Default Gravatar
    Colleen | March 9, 2016

    My husband served in the Army Reserve during his National Service, can we join Defence Health?
    Regards
    Colleen

    • Staff
      Richard | March 10, 2016

      Hi Colleen,

      Thanks for your question. finder.com.au is a comparison service and not an insurer. Looking at the Defence Health website, it looks like active Reservists and their families are eligible to join. Unfortunately, it makes no mention of ex-reservists. You may wish to contact them directly for clarification by calling 1800 335 425.

      I hope this was helpful,
      Richard

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