News from the ADF Family Health Program



Reprinted with permission from ADF Family Health

We have launched a refreshed ADF Family Health Program website. The website still contains useful information to assist you in understanding the program and to manage your family allowance. To view the new website please go to adffamilyhealth.com.

Dental Comparison Tool

Designed to assist you to manage your costs when you visit the dentist, the Dental Comparison tool allows you to compare quotes or costs dentists may charge for your treatment. The Dental Comparison Tool can be found on the ADF Family Health website.

This tool is a guide only. Please note your dentist has the ability to set their own costs for the treatments they provide. The ADF Family Health Program has no influence over those costs. 

Benefit Limits

Each dependant on a family ID is allocated $400 on the 1st of July each year. This amount can be used towards any dependant on the family ID for any eligible service and is known as a family allowance.

Example Family

John, James and Julie Smith are all listed dependants of a serving person. On 1 July 2020, each eligible dependant received $400 on their allocated family ID. That equates to a $1200 allowance that can be used on any eligible allied health service.  Scenario 1 – Collating the Funds

James is required to get orthodontia treatment and the total cost of the service is $1500. The Smith family decide to use the entire $1200 towards this orthodontia bill for James to reduce their out of pocket costs as much as possible. They swipe their HICAPS card at the provider and immediately claim the $1200 on the spot to pay towards the services. They will have no more allowance to use on Allied services until 1 July 2021 when the benefit resets. 

Scenario 2 – Dispersing the Funds

The Smith family are all receiving various forms of treatments. John is receiving physio on this knee, James is receiving ongoing dental treatment and Julie is getting spectacles. Throughout the year their bills come to varying amounts and due to the flexibility of the family allowance, the Smith family are able to allocate the allowance across all dependants to reduce their out of pocket expenses.  If you have received a service and have forgotten to claim, you have 1 year post the service date to submit your claim to receive reimbursement.

How to Claim with your Private Health Insurance

We recognise a lot of dependants may hold private health insurance and the ADF Family Health program is happy to work in line with your PHI to reduce your out of pocket expenses even further. To get the most out of your ADF Family Health allowance we suggest the following process be followed.  

If you have received a service and have forgotten to claim, you have 1 year post the service date to submit your claim to receive reimbursement.

Point of Sale (Paying with HICAPS as your provider)

1. Swipe your Private Health Insurance card first and claim your PHI benefit for the service. This will usually leave you with a gap payment (or out of pocket expense)

2. Swipe your ADF Family Health Program card next and claim the remaining gap amount only. Manual Claim (claiming app, online claim or mail)

1. Pay the provider in full for the services they have provided. Make sure you receive an itemised receipt that shows the treatment received and costs associated.

2. Send your claim to your Private Health Insurer to claim your PHI benefits. You will need to receive a remittance advice or statement of benefit from your PHI. 

3. Send the provider receipt and the remittance advice from your PHI to Navy Health for processing. You can send via the claiming app, Online Member Services or via a claim form.

4. Navy Health will assess your claim manually and direct deposit any benefits to your bank account. (Make sure we have your banking details or update via OMS).  If you are at your provider and unsure of what to do, please call us on 1300 561 454. 

To download the ADF Family Health app on your smart devices, please visit your relevant app store.
App Store
Google Play
 

Published by

Defence Families of Australia

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