Frequently Asked Questions

1. Who is eligible to participate in the Program?

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?

The National ADF Family Health Program will utilise the ADF Pay and Conditions Manual (PACMAN)  definition of a recognised dependant. Dependant data must be current in the Dependant / Beneficiary area of PMKeyS. You can use WebForm AD150 Dependant Details to add or update your dependant details in PMKeyS.

 

3. How do I add a dependant to my membership?

New dependants must have accurate details listed in the Dependant/Beneficiary section of the ADF members PMKeyS prior to registration. Dependants can be added to PMKeyS by the ADF Member completing and submitting webform AD150.

Once PMKeyS has been updated please submit the ADF Family Health Registration form AD858-1 to the ADF Family Health team at

ADF Family Health Program
Department of Defence
CP2-7-163 PO Box 7911
CANBERRA BC ACT 2610

Fax: 02 6266 4292
Email: adf.dependanthealth@defence.gov.au

 

4. How do I check if my claim has been processed?

Our contracted claims administrators Navy Health Ltd process all claims. You can check on your claim status by:

  • calling 1300 561 454 (this number is also on the back of your Family Health card),

 

5. How do I update my address?

We do not get address changes directly from PMKeyS please contact ADF Family Health at:

  • Phone: 02 6266 3547
  • Email: dependnathealth@defence.gov.au
  • Template: Address Update

 

6. My name and/or birthdate are wrong on my membership, how do I fix it?

The information for your membership is directly uploaded from the Dependant/Beneficiary section of PMKeyS (Defence personnel system). Once the ADF member has updated PMKeyS we can update your membership and send out a new card if required.

 

7. I am now married how do I update my name?

Once the ADF Member has updated your details in the Dependant/Beneficiary section of PMKeyS (Defence personnel system). Please call us on 02 6266 3547, or email us at: adf.dependanthealth@defence.gov.au and we can arrange for a new card to be sent.

 

8. When is the $400 allied health/specialist allocation renewed?

There is a new allocation at the beginning of each financial year (1 July). Any funds remaining from the previous financial year do not rollover.

 

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

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), 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 form that your dependants are not eligible for Medicare benefits by ticking the appropriate box.

 

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

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.

 

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

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.

 

12. I did not use the $400 allocated for allied health last calendar year. Will it roll over to the next calendar year?

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.

 

13. If I have no available funds left for the financial year can I wait and submit the claim when I get my new allocation?

Unfortunately, the payment comes out of the financial year in which the services were accessed. If you have no funds left in the financial year the claim cannot be paid.

 

14. Do I still need my Private Health insurance?

The ADF Family Health Program is not designed to replace your private health insurance. The Program covers some basic health services, it provides $400 per dependant towards the cost of allied health and medical specialist services. It does not cover costs associated with hospitalisation. The Program does cover the gap expenses for general practice services which most health funds do not cover.

For maximum benefit you can use your Program benefits in conjunction with your private health insurance, it is recommended that you claim from your health insurer first then claim the gap from the Program.

 

15. Does the ADF Family Health Program cover ambulance services ?

Ambulance services are not covered by the Program. The requirement for Ambulance coverage varies between States, most private health insurers provide nationwide coverage. Please be aware the cost of ambulance services, if not insured can be very expensive. The cost of coverage is reasonable.

 

16. How long do I have to submit my receipts to receive my benefit?

ADF dependants have 1 year from the date of service to submit their receipts to receive their benefit. If a receipt is submitted in a new financial year for a service in the previous financial year, the benefit will be deducted from any remaining funds at the date of service and will not affect the new allocation that starts on 1 July.

 

17. I am not sure if the services I require are claimable under the Program?

Please refer to the Eligible Services section on this website, or contact our claims administrators on 1300 561 454.

 

18. My card is not working, how can I get a new one?

The ADF Family Health card should work with allied health providers that have a HICAPS machine installed. If you need a replacement card you can call 1300 561 454 or simply log on to your Online Member Services account, and select the ‘Useful Tool’s tab. You will find the option to order a new card here. Simply follow the prompts and a new card will be sent out to you within two business days.

 

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

No, pharmaceutical items are not covered by the Program.

 

20. Are visits to hospital covered by this Program?

Partially, hospital charges are not eligible for reimbursement, however, the procedures performed in the hospital by an eligible service provider may be covered by the National ADF Family Health Program up to any remaining entitlement. It is recommended you contact 1300 561 454 to confirm eligibility prior to accessing the service.

 

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

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

 

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

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.

 

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

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.

 

24. Can I claim reimbursement for Specialist services?

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

 

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

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.

 

26. What if I have Private Health Insurance?

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.

 

27. How much does it cost to join?

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

 

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

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.

 

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

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 the National ADF Family Health Program.

 

30. My child is 21 years old and a fulltime student can they be registered for the Program?

Regretfully, student or employment status, or recognition of special needs has no bearing on the PACMAN dependant definition where the child is 21 years of age or over.

If your dependant meets the following PACMAN description, we would be happy to register them for the Program, or continue eligibility:

  • The dependant is recognised as an invalid, or infirm; and/or
  • Dependant is CDF recognised. (Please note that documentary evidence from an approved decision maker will be required).

This may differ from Private health insurers, where in some cases a dependant child can remain under your policy until the age of 25.

 

 

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