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Doctors Health Fund

Doctors Health Fund is a not-for-profit health funds that provides cover for the medical community, with three levels for hospital and extras policies.

What you need to know

  • Doctors Health Fund is available for current or former medical practitioners and their families
  • It offers three levels of hospital cover and three levels of extras cover
  • Doctors Health Fund may not be right for you if you are after a lower level of cover and premiums

Who is Doctors Health Fund?

Doctors Health Fund was created by doctors to meet the health care needs of the wider medical community. Since 1977 it has offered a broad range of cover options and a selection of unique benefits to its members.

Who can join Doctors Health Fund?

Doctors Health Fund is a restricted fund, with membership only open to current or former medical practitioners and their families. More specifically, you can join if you are a current or former:

  • Registered medical practitioners in the fields of medicine
  • Medical radiation
  • Optometry
  • Dental
  • Occupational therapy
  • Physiotherapy
  • Psychology
  • Students studying to become a medical practitioner
  • Employees of medical practitioners
  • Overseas qualified doctors
  • Australian Medical Association (AMA) employees

In addition, the partner, child, parent, sibling, grandchild, former partner or partner of an adult child of any of eligible members can also qualify for cover.

What health insurance options are available?

The fund offers products tailored to suit the unique needs of its members, with three levels of hospital cover and three levels of extras cover available. These can be taken out as standalone cover or paired together to offer a higher level of protection.

Hospital

  • Top Cover Gold. This unique comprehensive cover option offers the highest level of hospital cover available. With no preferred provider networks and a medical gap scheme that doesn't require your doctor to opt in, you can choose who treats you. No excess is payable and there are no exclusions or restrictions on services for which a Medicare benefit is payable. National ambulance cover is also included.
  • Prime Choice Gold. Another comprehensive hospital cover option that uses the Access Gap Scheme to help reduce or even eliminate your out-of-pocket medical expenses. There are no exclusions or restrictions on services for which Medicare pays a benefit. Ambulance cover is included nationwide. Available with the choice of a $0, $500, or $750 excess, this policy covers all your accommodation costs in a contracted private hospital or day surgery, or treatment as a private patient in a public hospital.
  • Smart Starter Bronze Plus. Designed for young singles and couples who are taking out their first private health insurance policy, Smart Starter is designed to cover some essential treatments and also offer affordable premiums.

Extras

  • Total Extras. This is Doctors Health Fund's premium extra cover option and it offers high limits across a wide range of benefits. It covers health management, hearing aids, physio, remedial massage, psychology, occupational and speech therapy, podiatry, dietetics, pregnancy care, home nursing and health aids and appliances.
  • Essential Extras. Superior mid-range extras cover, providing a combination of a wide range of benefits with affordable premiums. It covers general dental and orthodontics, optical, non-PBS pharmaceuticals, physio, remedial massage, psychology, occupational therapy, speech therapy, podiatry, dietetics and midwifery services.
  • Starter Extras. Entry-level extras cover perfectly suited to singles and couples when combined with Smart Starter Bronze Plus hospital cover.

Doctors Health Fund youth discount

Under new government reforms for private health insurance, insurers may now provide a discount for young people. Doctors Health Fund will give members the option for the discount, which is allowable between 2% and 10% per annum; depending on when a person purchases health insurance between the ages of 18 and 29. For couples and family policies, it will apply individually to the two adults on the policy.

Members will retain that discount until they turn 41, after which it reduces at 2% per annum until they are 45 years old.

Member offers

  • Doctors Health Fund doesn't have any preferred providers, giving you the freedom to choose the provider you want
  • Australia-wide ambulance cover is included in all hospital policies
  • Extras packages cover 100% of your dental check-up costs twice a year
  • 97% member satisfaction rate
  • Doctors Health Fund members receive discounts of up to 25% off at optical partners including Clearly.com.au, Eyebenefit, OPSM, Laubman & Pank and Specsavers.
  • Top Cover covers your hospital bills up to the AMA List fee

How to make a claim?

Making a private health cover claim is very straightforward. For hospital cover claims, the hospital will usually send your bill straight to your health fund. Any excess or co-payment that applies to your policy will need to be made directly to the hospital.

For extras, the most convenient way to submit a claim is through HICAPS. This allows your claim to be processed on the spot so you can simply pay the difference, provided that your health provider is signed up to HICAPS.

Alternatively, you can submit a claim by logging into the Doctors Health Fund Member Portal​ and downloading the claim form. You can them email it info@doctorshealthfund.com.au or post it to

PO Box Q1749, Queen Victoria Building, Sydney NSW 1230, or fax it to 02 9260 9958.

In order for your claim to be considered valid and processed as quickly as possible, it needs to:

  • Be filled out by you or other authorised person
  • Include the valid tax invoice
  • Include any relevant receipts

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