If you are not sure if your service is eligible for reimbursement contact 1300 561 454 for clarification.
The Program provides benefits toward eligible services detailed below:
General Practice Services
Defence will reimburse your gap expenses when you visit your general practice. Services must have a Medicare Benefit Schedule (MBS) Item Number.
You do not do not need to show your ADF Family Health Card when visiting the general practice. The exception will be if your general practice allows you to claim the ADF Family Health rebate electronically.
In most cases you will be required to pay for your general practice visit up front; you then claim the Medicare rebate before submitting a claim for gap reimbursement from ADF Family Health via one of the How to Claim methods. Unfortunately we cannot accept credit card statements as proof of payment.
Allied Health, Specialists Services & Diagnostic and Radiology
Defence will provide $400 per family member per financial year to use towards non-cosmetic allied health series and/or used to offset the gap expenses when you visit a medical specialist or diagnostic and radiology services. This amount is a family allocation. Benefits are only payable for recognised services delivered by an Australian certified provider.
Eligible Specialist services and procedures are defined as services with an applicable Medicare Benefit Schedule (MBS) Item Number provided by a Specialist or Consultant Physician as recognised by the Health Insurance Act 1973.
Services and procedures can be provided from within the Specialists consulting rooms or from within a hospital setting provided there is an eligible MBS Item Number.
Dependants are required to claim the Medicare Rebate prior to submitting a claim for gap expense reimbursement.
Diagnostic and Radiology
All diagnostic and radiology services, where there is an MBS item number, are eligible. Services can include, X-Ray, MRI, pathology and ultrasound.
For more information on MBS Item Numbers please discuss with your treating practitioner or contact our Customer Service Team on 1300 561 454.
Allied Health Services
|Audiology||Services by a certified provider|
|Chiropractic/Osteopathy||Services by a certified provider|
|Dental||All items listed by the Australian Dental Association (ADA)|
|Exercise Physiology||Services by a certified provider|
|Medically Prescribed Appliances||Costs for purchase of Medically Prescribed Appliance where there is no GST applied. Claims must include a copy of the written recommendation / prescription from registered practitioner|
|Occupational Therapy||Services by a certified provider|
|Optical||All prescription eye wear, lenses, frames, contact lenses and repairs provided by and Australian recognised provider|
|Physiotherapy||Services by a certified physiotherapist, ante/post natal classes provided by a registered physiotherapist or midwife|
|Podiatry and Chiropody||Services by a certified provider|
|Psychology||Services by a certified provider|
|Remedial Massage||Services by a certified provider registered with the Australian Regional Health Group|
|Speech Therapy||Services by a certified provider|
Please note: services that attract GST are excluded from reimbursement.
In most cases, allied health providers will be able to process your claim on the spot.
You will be responsible for any amount greater than your ADF Family Health benefit balance.
In addition to the table above, the below services will also be covered
- Psychometric testing conducted by psychologist
- Cognitive behavioural assessment by psychologist
- Medicare eye test within a 2 year period (Medicare will not pay again)
- Psychology service with a social worker (when an item number is provided)
- Psychology service via Skype/video link (when an item number is provided)
- Emergency department consultation (GP not in a GP setting)
- Midwife conducting obstetrics services when an MBS item is used
- Dental items conducted at school (no ADA codes)
- Medically prescribed appliances