Conditions of Use
Eligibility
Dependants of permanent ADF members or dependants of Reservists on Continuous Full-time Service (CFTS) who meet the recognised ADF dependant criteria (as per The Pay and Conditions Manual) will be eligible to register for the ADF Family Health Program (the Program).
Dependants can only be registered by one ADF member. It is the ADF members’ responsibility to determine which ADF member the dependants are to be registered under. Both ADF members must agree which ADF member the dependant is to be registered under.
The ADF member is responsible for ensuring that:
a) His or her dependants meet the dependant criteria in PACMAN; and
b) Any changes to dependant status are notified to ADF Family Health and reflected in the Dependant/Beneficiary section of PMKeyS.
Note: In accordance with PACMAN, children aged 21 and over are not considered dependants unless they have been:
a) Defence recognised as Invalid or Infirm, or
b) CDF recognised as a dependant (documentary evidence required).
The ADF member may elect to register or deregister a dependant at any time. A dependant cannot register for the Program without the written acknowledgement of the ADF member.
Participation commences when you are notified of successful registration. Services accessed prior to the notified date of registration are not eligible for reimbursement. Registrations cannot be backdated, with the exception of newborns.
Newborns – The registration of newborns can be backdated to date of birth if they are registered within 3 months of their birthdate.
Services Included
General Practice – The general practice component allows registered dependants to be reimbursed the gap between the Medicare rebate and the general practice fee for all consultations provided in a general practice setting that have a Medicare Benefit Schedule item number.
Allied Health and Specialist – The allied health and specialist component can be used towards non-cosmetic and non-GST allied health services and/or used to offset the gap for Medicare recognised specialist services. Allied health vocational groups included in the Program are listed on the ADF Family Health website. The allocation is to the family unit and is pro-rated dependent on family size. The member is responsible for choosing what allied health or specialist services, and which family members the allocation is used towards. The allocation is per financial year and cannot be rolled over from one year to another.
Claim limitations – In order for claims to be accepted, they must be submitted within 12 months of the service being provided and the dependant must have been registered for the Program at the time of the services.
Provision of dependant information
Participation in the Program requires the provision of current and accurate dependant details in the Dependant/Beneficiary section of PMKeyS. Any discrepancies or inaccurate dependant details may result in a delay in processing the registration.
Notifying changes
Members are responsible for ensuring the accuracy, currency and completeness of all registration information. Any changes must be immediately notified to ADF Family Health on (02) 6266 3547 or via email.
Changes impacting eligibility that are not notified, and which result in the processing of a benefit, will be treated as a breach of the ‘Conditions of Use’.
The ADF member should update details for the ADF Family Health app if personal circumstances change. This will ensure the privacy and security of banking details and personal information. This can be done by contacting our Claims Administrators on 1300 561 454.