ADF Family Health and Private Health Insurance

Alison Berlioz-Nott from Defence Health explains how the ADF Family Health Program and private health insurance can work together for ADF families.

Support for your health

The ADF Family Health Program provides valuable support towards the health of ADF family dependants. It is separate to private health insurance (PHI), but if used in combination with PHI, it can dramatically reduce the cost of a family’s health services.

What does the ADF Family Health Program cover?

GP visits

If your GP charges family members more than the Medicare Benefit Schedule (MBS) fee, the ADF Family Health Program will reimburse the ‘gap’ payment.

  • GP gap payments cannot be claimed through private health insurance.

Annual allowance for allied health, specialists and diagnostic services

Each family member is provided a $400 allowance, per financial year, to offset the gap on a range of health services. The allowance is allocated according to the number of registered dependants in the family – however it may be transferred between family members. 

Allied health includes services such as audiology, dental, physiotherapy, occupational therapy, psychology and speech pathology. The full list of allied health services that can be claimed under the allowance can be found at adffamilyhealth.com/claiming/eligible-services/

  • Family members with private health insurance can make their allowance go further. Claim first through health insurance then top-up with ADF Family Health benefit.

Specialist visits and in-hospital treatment

Visits to a medical specialist’s consulting rooms or specialist treatment in hospital can be claimed against the ADF Family Health Program allowance. These services must have an MBS item number and should be claimed firstly through Medicare.

  • Members with private hospital cover can claim for in-hospital treatment through their insurer and may then claim any gap through the ADF Family Health Program.
  • The allowance cannot be used towards private hospital accommodation or theatre fees – only PHI can cover these charges.

Radiology and diagnostic tests

Out-patient X-rays, blood tests, MRI and ultrasound investigations can really add up – even after a Medicare benefit has been paid. The gap expense for these services can be claimed up to the annual ADF Family Health Program allowance.

  • These gap charges can only be claimed through the ADF Family Health Program.

PHI and ADF Family Health Program working together

Private health insurance and the ADF Family Health Program can complement each other to cut the cost of health care for ADF families. The family allowance can cover costs that PHI cannot – such as GP gap fees and out-patient consultations and tests. And PHI gives families timely access to a bed in a private hospital – something the allowance cannot do.  

The ADF Family Health allowance goes further when used in combination with private extras cover. Families who use both are in the best position to optimise the value of the program across all dependants.

It should also be noted that benefits claimed through the ADF Family Health Program are considered a fringe benefit under the Fringe Benefits Tax Assessment Act 1996. And it’s up to each family to ensure they appropriately register their dependants. 

There’s more information on this available on this at http://adffamilyhealth.com/tell-me-more-about/fringe-benefits-tax/.

Published by

Defence Families of Australia

National Advocacy body for current ADF families. We are all partners of current serving members.

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