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Defence Health

ADF Family Health

Information for Healthcare Providers

This initiative recognises the service and sacrifices of our Australian Defence Force (ADF) members and their families, and the difficulties many ADF families experience accessing affordable healthcare upon relocation. The initiative aims to improve the retention and recruitment of the ADF.

Medical Providers

ADF families are able to attend any general practice and be reimbursed for gap expenses for all Medicare eligible services provided in a general practice setting. The process is summarised below:

  1. [Visit GP] »
  2. [Pay full GP invoice] »
  3. [Claim Medicare rebate] »
  4. [Submit Manual Claim Form to ADFFH] »
  5. [ADFFH pays gap $ to families bank account]
For general practices that have HICAPS terminals installed which enables automated processing of the gap payment directly to the general practice the process is summarised below:
  1. [Visit GP] »
  2. [Swipe ADFFH Card] »[ADFFH pays gap $ to GP] »
  3. [Pay the residual MBS amount] »
  4. [Swipe Medicare Card] »
  5. [MBS Amount reimbursed to families bank account]
Further enquiries should be directed to Defence's contracted claims administrator Navy Health Ltd on 1300 561 454.

Allied Health Providers

The Program is intended to cover non-cosmetic "GST" free allied health services to the value of $400 per financial year per ADF family member. The $400 benefit is transferable between family members however cannot be carried over into a new financial year.

ADF families who have registered for the program will be issued with the ADF Family Health Card.

Family Health Card

Eligible Allied Health Services

The vocational groups that are eligible for claims reimbursement are detailed here.

Electronic Claim Processing

The ADF Family Health Card can be used for electronic claiming via HICAPS. This initiative is not a private health insurance product. Defence has contracted with Navy Health Ltd for the administration of all claims processing functions for the ADFFH program. Eligible allied health claims can be made via HICAPS electronic processing.

The ADF Family Health Card can be used in conjunction with private health insurance. It is recommended that claims be electronically submitted to the private health insurer prior to processing the ADF Family Health Card. The ADF Family Health Card can then be used to claim the gap, up to the available limit. Any remaining amounts must be paid by the ADF family. The process is summarised below:M

  1. [Consultation] »
  2. [Swipe ADFFH Card] »
  3. [ADFFH pays provider invoice amount up to remaining ADFFH limit] »
  4. [ADF Families pay difference – if applicable]

NOTE: The ADF Family Health Card may not be compatible with all practice software. If the practice is unable to electronically process any claim. ADF families should pay for their visit and follow the manual claims processing procedures outlined below.

Manual Claims Processing

If electronic claims processing is not available, the ADF family member should pay for their visit and claim reimbursement from the program using the claim form.

Assistance

For information related to eligible services or payments please call Navy Health on 1300 561 454. For any other information related to the Program, please contact the ADF Family Health team on 02 6266 3547.

6 November, 2013