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Defence Health

ADF Family Health

Frequently Asked Questions - Eligibility

  1. Who is eligible to participate in the Program?
  2. Who is defined as a dependant?
  3. My dependants are not currently eligible for Medicare benefits, can they still register for the Program?
  4. If I need to travel to access medical services, will the cost of travel be covered?
  5. My child requires allied health services over $400. Can we use the money allocated for my spouse to cover this cost?
  6. I did not use the $400 allocated for allied health last Financial Year. Will it roll over to the next Financial Year?
  7. Are pharmaceuticals covered by the National ADF Family Health Program?
  8. Are visits to hospital covered by this Program?
  9. How many times can I visit a medical practitioner?
  10. Will I still be required to pay my Medicare Levy?
  11. If I have registered for the Program and do not access the benefits, do I incur any fringe benefits tax?
  12. Can I claim reimbursement for Specialist services?
  13. What is the difference between Private Health Insurance and the National ADF Family Health Program benefits?
  14. What if I have Private Health Insurance?
  15. How much does it cost to join?
  16. What if the allied health provider is within a general practice setting?
  17. What if there is a Medicare Benefit Schedule item number allocated to the allied health consultation?

1. Who is eligible to participate in the Program?

Answer: Dependants of all permanent ADF members or dependants of Reservists on Continuous Full-Time Service, who are recognised dependants in accordance with the ADF Pay and Conditions Manual (PACMAN).

It is the ADF members responsibility to ensure that their dependants continue to meet the definitions contained in ADF Pay and Conditions Manual (PACMAN) and ensure that their Dependant / Beneficiary section of PMKeyS is maintained accordingly.

2. Who is defined as a dependant?

Answer: The National ADF Family Health Program will utilise the ADF Pay and Conditions Manual (PACMAN) (Volume 1, Chap 1, Part 3, Division 2) definition of a recognised dependant. Dependant data must be current in the Dependant / Beneficiary area of PMKeyS. You can use form AD160 Dependant Details to add or update your dependant details in PMKeyS.

3. My dependants are not currently eligible for Medicare benefits, can they still register for the Program?

Answer: If your dependants are Defence recognised dependants, then they are eligible to register for the Program regardless of their eligibility for Medicare. For more information on Defence recognised dependants. Please refer to the Pay and Conditions Manual (PACMAN v2), (Vol 1, chap 1, part 3, division 2). Upon registration, your dependants will be issued with information on how to access and claim medical benefits. Please ensure you indicate on the [AD858-1 - ADF Family Health Registration] (provide link to new AD858-1) form that your dependants are not eligible for Medicare benefits by ticking the appropriate box. Refer to the "How To Claim" page for more information.

4. If I need to travel to access medical services, will the cost of travel be covered?

Answer: Travel is not covered under the National ADF Family Health Program. However, in some circumstances travel may be covered under other Defence conditions of service. Please refer to the Pay and Conditions Manual (PACMAN v2) to determine entitlements.

5. My child requires allied health services over $400. Can we use the money allocated for my spouse to cover this cost?

Answer: Yes, the allocation of $400 per dependant per Financial Year is a family allocation and can be utilised between registered dependants. For example, a family with 3 registered dependants will be allocated $1,200 per Financial Year.

6. I did not use the $400 allocated for allied health last Financial Year. Will it roll over to the next Financial Year?

Answer: No, the unused allocation of $400 per dependant per Financial Year does not roll over to the next year , nor does any unused component of the benefit.

7. Are pharmaceuticals covered by the National ADF Family Health Program?

Answer: No, pharmaceutical items are not covered by the Program.

8. Are visits to hospital covered by this Program?

Answer: The "gap" for services and procedures performed by a Specialist or Consultant Physician that have an MBS Item Number, performed in a hospital setting can be claimed for reimbursement. Dependants must claim the Medicare Rebate prior to claiming from ADF Family Health.

Hospital charges (such as bed fees) are not claimable.

9. How many times can I visit a medical practitioner?

Answer: There is no limit on how many times you visit your general practitioner and claim reimbursement.

10. Will I still be required to pay my Medicare Levy?

Answer: Yes. Only basic medical, specialist consultations and allied healthcare is included in the trial. Medicare Australia will continue to rebate your costs under the existing Medicare Benefits Schedule.

11. If I have registered for the Program and do not access the benefits, do I incur any fringe benefits tax?

Answer: No. Fringe Benefits Tax is linked to the medical, specialist or allied health benefits claimed and received. If you have not claimed any benefits, then there is no Fringe Benefits event recorded.

12. Can I claim reimbursement for Specialist services?

Answer: Specialist Medical Services are eligible for reimbursement under the National ADF Family Health program and are deducted from the $400 per dependant allocation.

13. What is the difference between Private Health Insurance and the National ADF Family Health Program benefits?

Answer: The Medical component of the National ADF Family Health Program only reimburses services provided in a general practice setting. These services are not usually covered by Private Health Insurance. However, Private Health insurance usually covers hospital services which are not included in the National ADF Family Health Program.

For families that have Extras or Ancillary Cover on their Private Health Insurance policy, the $400 Allied Health component of the ADF Family Health trial can provide additional coverage by allowing you to allocate the $400 benefit towards out of pocket expenses after your Private Health Insurance fund has reimbursed you. It could also be used to pay for services if you reach your yearly limit or for allied health services that may be excluded from your private health insurance policy.

14. What if I have Private Health Insurance?

Answer: Participating in the National ADF Family Health Program will not affect your private health insurance benefits. To maximise your ADF Family Health allied health benefit it is recommended that you claim from your private health insurer first and then claim any remaining gap from the National ADF Family Health Program.

15. How much does it cost to join?

Answer: It costs nothing to participate in the National ADF Family Health Program. The Program is an initiative of the Commonwealth Government.

16. What if the allied health provider is within a general practice setting?

Answer: Where an approved allied health provider provides services from a general practice setting, any benefits claimed for those consultations are deducted from the Allied Health Benefits component.

17. What if there is a Medicare Benefit Schedule item number allocated to the allied health consultation?

Answer: There are a limited number of occasions when an allied health consultation may have a Medicare Benefit Schedule item number allocated to it. For example, when a general practitioner refers a patient to a psychologist as part of a GP Mental Health Care Plan. In these cases the ADF

Dependant should claim the Medicare Rebate from Medicare prior to submitting a manual claim for reimbursement of any gap under ADFFH.

5 November, 2013