Frequently Asked Questions
1. Who is eligible to participate in the Program?
Please visit the eligibility page in the following link to determine your eligibility.
2. How do I add a dependant to the program?
To add a dependant, including a newborn to the ADF Family Health Program an AD858-1 registration needs to be submitted to adf.familyhealth@defence.gov.au.
Registration can only occur once PMKeyS has been updated.
Newborns can be backdated to their DOB if an ADF Family Health registration form is receive within 3 months of their DOB.
3. How do I update my address?
You can update your address on the ADF Family Health Claiming App or by calling 1300 561 454.
4. My name and/or birthdate are incorrect
Your personal details are provided directly from the Defence personnel system (PMKeyS). For any changes to occur the ADF member must submit an AD150.
5. I am now married. How do I update my name?
Your personal details are provided directly from the Defence personnel system (PMKeyS). For any changes to occur the ADF member must submit an AD150.
6. How do I find out my benefit balance?
To view your family’s benefit allocation balance please log in to our claiming app and click on the ‘Benefits’ button. Alternatively please call 1300 561 454 and our friendly claims team will be able to provide you this information.
7. What Medicare information is required when I submit my claim?
To ensure your claim is processed on time please ensure you attach your Statement of Claim and Benefit Payment, a Medicare Lodgement advice or a Medicare Claim History, along with your receipt of payment. Failing to provide this supporting evidence may result in a delay in processing your claim. Please also ensure your claim is supported with the correct receipts.
8. How do I check if my claim has been processed?
You can check on your claim status by:
- Looking at your claims history in the ADF Family Health Claiming App
- Calling 1300 561 454
9. When is the $800 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.
10. How do I find out what services are available under the ADF Family Health Program?
Please see our “What can you claim” page for a comprehensive list of services that are covered under the Program.
11. What Pharmacy items can I claim under the ADF Family Health Program?
We will reimburse pharmaceutical items that are not listed on the Pharmaceutical Benefits Scheme (PBS) and are over $31.60 per script (effective 01/01/2024). Medication must be on a private script from your doctor and submitted with an official pharmacy receipt.
12. One of our family members requires allied health services over $800. Can we use the money allocated for my spouse to cover this cost?
The $800 per person allied health/specialist amount is combined as a family amount and is automatically transferred between family members.
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?
No, the payment comes out of the financial year in which the services were provided. If you have no funds left in the financial year the claim cannot be paid.
14. My Dependants are not currently eligible for Medicare benefits, can they still register for the program?
If your dependants are Defence recognised dependants they are eligible to register for the ADF Family Health Program regardless of their eligibility for Medicare. 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.
15. 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 $800 per dependant towards the cost of allied health and medical specialist services. It does not cover costs associated with hospitalisation.
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.
16. Can I use my ADF Family Health benefit and my Private Health Insurance together to further reduce my out of pocket expenses?
Yes! To maximise your ADF Family Health benefit, you can request your provider swipe your Private Health Insurance membership card first to claim that benefit; the provider will then be able claim the remaining balance on your ADF Family Health card.
If your provider does not have a HICAPS machine for instant claiming, you will need to submit your receipts to your private health insurer to claim your benefit first, you will then need to upload your receipts (from the provider) and the remittance advice (from your private health insurance) to the mobile app or complete a claim form and submit to ADFFH.claims@navyhealth.com.au
17. How long do I have to submit my receipts to receive my benefits?
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.
18. 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.
19. Claiming eligibility whilst posted overseas:
Health services accessed overseas are not eligible for reimbursement as part of the Program. Services accessed in Australia, and claimed under the Program cannot contribute to the overseas minimal threshold amount. Additionally, the annual allocation of $800 per dependant to be used for approved allied health services must be provided in Australia.