Doctors Health Fund

Information verified correct on December 7th, 2016

Are you a medical practitioner looking for health insurance? Compare options from Doctors Health Fund.

Doctors Health Fund provides a range of private health care solutions for health professionals and their families. With an extensive selection of policies to choose from, Doctors Health Fund ensures that its members always have access to the medical care they need.

Keep reading to find out more about the policies offered by Doctors Health Fund and find out if this is the heath provider for you.

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.

Why join 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 been doing just that, offering a broad range of cover options and a selection of unique benefits to its members. Membership of the fund is open to 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.

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

What are the different levels of cover available from Doctors Health Insurance?

Doctors Health Fund offers the following hospital cover options to its members:

  • Top Cover. This unique comprehensive cover option pays up to the AMA fees list, offering 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. This is another of Doctors Health Fund comprehensive hospital cover options and it 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 an excess up to $500, 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. 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.
Smart StarterPrime ChoiceTop Cover
All other in-hospital services where a Medicare benefit is payableYesYesYes
Cardiothoracic surgeryYes (Restricted)YesYes
Cataract and glaucomaNoYesYes
Excess Payable$500 per admission$500 per admission if you are on an excess policyNIL
Gap CoverAccess GapAccess GapAMA Gap
Gastric banding and obesity surgeryNoYesYes
Hip and Knee replacementsNoYesYes
In-hospital services where no Medicare benefit is payableNoYes (Restricted)Yes (Restricted)
PregnancyNoYesYes
Psychiatric servicesYes (Restricted)YesYes
Renal dialysisYes (Restricted)YesYes

Want extras cover? There are two options:

  • Total Extras. This is Doctors Health Fund’s premium extras cover option and it offers high limits across a wide range of benefits. It covers general dental with no annual limit, major dental, orthodontics, optical, non-PBS pharmaceuticals, hearing aids, physio, remedial massage, psychology, occupational therapy, speech therapy, podiatry, dietetics, midwifery services, home nursing and health aids and appliances.
  • Essential Extras. This policy offers 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.
Essential ExtrasTotal Extras
Aids & appliancesYesYes
General DentalYesYes
Home NursingNoYes
Major DentalYes (Orthodontics ONLY)Yes
Non-PBS pharmaceuticalsYesYes
Occupational therapy, Speech therapy, Orthoptics, Podiatry, Dietetics & Midwifery servicesYesYes
Optical ServicesYesYes
Physiotherapy and remedial massageYesYes
PsychologyYesYes

Are there any additional benefits?

  • 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 21% off at optical partners including OPSM, Budget Eyewear, Specsavers and more
  • Top Cover covers your hospital bills up to the AMA List fee

Doctors Health Fund general exclusions, waiting periods and excess

What exclusions are there?

Just like any other private health fund, Doctors Health won’t pay benefits in certain circumstances, including if your claim:

  • Is for a service which is specifically excluded from your cover. For example, Smart Starter Hospital Cover excludes things like pregnancy services, assisted reproductive services, and hip and knee replacements
  • Is for services or treatment received overseas
  • Is for a service for which Medicare does not offer a benefit, such as elective cosmetic surgery
  • Is for treatment received more than two years prior to the date you lodge your claim
  • Is for services received before you have served a waiting period
  • Is for services which you may be able to claim through some other form of insurance, such as workers’ compensation cover or third party insurance
  • Is for your personal expenses in hospital, such as TV rental and phone calls

What waiting periods apply?

When you join Doctors Health Fund (and you’ve not previously been a member of another health fund), there is a two-month waiting period before you’re eligible to receive most hospital and extras benefits.

However, there are some treatments and services that attract longer waiting periods, such as obstetrics services and treatment for pre-existing conditions, which Doctors Health Fund members are only eligible to receive cover for after a 12-month waiting period.

Premiums and other fiscal matters

There are several factors that impact upon the cost of your Doctors Health Fund Cover:

  • Premium increases. Doctors Health Fund notifies its members of any price increases in March.
  • Direct claiming. Electing to have your claims paid by direct credit is the fastest way for claims to be processed and for you to receive your benefits.
  • Payment options. Doctors Health Fund offers the following premium payment options: direct debit, MasterCard and Visa. Of these options, setting up a direct debit from your bank account is the most convenient way to pay your premiums.
  • In arrears. Your claim will not be paid if your premium contributions are in arrears.

Is there an excess?

The excess is the amount you pay as a contribution to the cost of your hospital accommodation, and it is paid when you are admitted to hospital. While Top Cover does not feature an excess, both Prime Choice and Smart Starter hospital covers allow you to choose an excess ranging from $0 to $500. The higher the level of excess you choose, the lower the cost of your premiums will be.

Switching health funds?

Want to join Doctors Health Fund from another health fund? Switching between health funds in Australia is actually quite easy. The Private Health Insurance Act features a range of "portability" provisions that mean that important features of your old cover transfer to your new cover with your new fund.

It’s the responsibility of your previous health fund to provide you with a transfer certificate when you leave the fund. This certificate provides details of the waiting periods you have served, the level of cover you have been on, your Lifetime Health Cover status and any extras claims you have made in the calendar year so far.

When filling out your Doctors Health Fund application, complete the transfer section and Doctors Health will take care of notifying your previous fund that you are leaving.

How do I make a claim with Doctors Health Fund?

Making a private health cover claim is simple and 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 claims, many providers offer the ease and convenience of electronic claiming using the HICAPS system. All you need to do is swipe your membership card when it comes time to pay your treatment bill. If electronic claiming is not offered you can download a claim form from the Doctors Health Fund website, fill it out and submit it to the health fund along with your receipt.

Do payments change depending on what I claim for?

Every provider will pay a different amount for specific treatments and conditions. The benefits that you will receive from the Doctor's Health Fund on claims for 22 medical services can be found below, along with Medicare's (MBS) amounts for comparison.

As a member of the Australian Health Service Alliance (AHSA), the Doctor's Health Fund is included under their title in this 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

FAQs Doctors Health Fund

Question: I’m an overseas medical student – how can I get cover?

  • Answer: Email your contact details to Doctors Health Fund for information on how you can get the private health cover you need.

Question: I’m young, fit and healthy – does Doctors Health Fund have hospital cover for me?

  • Answer: You may wish to consider Smart Starter Hospital Cover, which covers essential hospital accommodation but excludes treatment for things like pregnancy, IVF and hip replacements.

Question: Where can I find a list of Doctors Health Fund contracted hospitals?

  • Answer: This can be found on the Doctors Health Fund website. The fund has agreements in place with more than 95% of private hospitals and day surgeries around Australia.

Question: What should I do if I’m thinking of starting a family?

  • Answer: You should notify your health fund whenever your circumstances change and you are able to upgrade your cover at any time. However, keep in mind that you may need to serve a waiting period for certain benefits, such as a 12-month period before you are eligible for obstetrics cover.
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