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ADF Family Health > Provider Assistance > How to Claim

How to Claim

Navy Health Ltd is currently contracted by the Department of Defence to perform all claims processing for the National ADF Family Health Program.

There is an online claim limit of $1000. For amounts greater than $1000 a manual claim will be required.

All claims must be submitted within 12 months from date of service. Any claim received that is over 12 months from the service date will not be paid.

There are several ways you can claim your ADF Family Health benefits:

  • At the point of sale, using your ADF Family Health Card (if the provider has a HICAPS or HealthPoint terminal, you can locate a provider with HICAPS here);
  • By utilising the online claiming functionality
  • By using the ADF Family Health mobile claiming App:
  • By faxing or posting your receipts with a Manual Claim Form to Navy Health

The Quick Guide below provides more detail on how to claim your benefits. For further information on how to claim call 1300 561 454.

General Practice Specialist & Diagnostic and Radiology

1
Mobile Claiming – Claiming App
  1. Ensure your banking and contacts details have been provided in the Online Member Services Portal.
  2. Download the ADF Family Health App from the Apple App store or the Google Play store.
  3. Visit eligible health care provider and pay for visit/services.
  4. Claim Medicare Rebate.
  5. Open App and follow ‘Make a Claim’ instructions. (You will be able to take a photo of your Medicare receipts and upload).
  6. Money paid into your bank account within 2 business days.
Online Claiming
  1. Visit an eligible health care provider and pay for visit/services.
  2. Claim Medicare Rebate.
  3. Log onto Online Member Services website.
  4. Scan Medicare receipt.
  5. Follow instruction to upload Medicare receipt.
  6. Money is paid into your bank account within 2 business days.NOTE: When using the Online Claiming method, receipts must be uploaded within 10 days.
Manual Claiming
  1. Visit an eligible health care provider and pay for visit.
  2. Claim Medicare Rebate.
  3. Attach Medicare receipt to an ADF Family Health Medical & Specialist claim form.
  4. Fax, email or mail claim and receipts to: ADF Family Health, PO Box 172, Box Hill, Vic 3128 Fax 03 9880 7939 adffhclaims@navyhealth.com.au.
  5. Money paid into your bank account within 2 business days.
 Private Health Insurance

If you have private health insurance it is recommended that you claim your treatment from the private health insurance provider first and then claim any remaining amount via one of the above methods.

Please attach a copy of your private health insurer’s receipt before sending in your claim via manual or online methods.

When submitting manual claims for payment, where there is an associated MBS Item Number and Medicare Rebate, there is a requirement to send a copy of the Medicare ‘Statement of benefit and Payment’ with your claim form.

Medicare receipts

The following receipts will be accepted when making a claim for a medical service:

*Medicare statement of claim and benefit

*Medicare lodgement advice

*Medicare Claims history

The Medicare statement of claims and benefit/ Medicare lodgement advice, can be obtained at the time the service is provided. The Medicare claims history can be obtained from the Mygov website. If you do not have a Mygov account please click here to set up.

Allied Health Claiming

1
Point of Sale Claiming
  1. Visit eligible allied health provider.
  2. Provider swipes your ADF Family Health Card (where provider has HICAPS or HealthPoint).
  3. Provider paid directly for services (subject to family benefit balance).
  4. Pay provider any outstanding balance owing.
Online Claiming – Online Member Service Portal
  1. Visit eligible allied health provider and pay for visit/services.
  2. Log onto Online Member Services website.
  3. Scan original receipt.
  4. Follow instruction to upload receipt.
  5. Money is paid into your nominated bank account within 2 business days.
    NOTE: When using the Online Claiming method, receipts must be uploaded within 10 days.
Mobile Claiming – Claiming App
  1. Ensure your banking and contacts details have been provided in the Online Member Services Portal.
  2. Download the ADF Family Health App from the Apple App store or the Google Play store.
  3. Visit eligible allied health provider and pay for visit/services.
  4. Open App and follow ‘Make a Claim’ instructions. (You will be able to take a photo of your receipts and upload).
  5. Money paid into your bank account within 2 business days.
Manual Claiming
  1. Visit an eligible provider and pay for visit/services.
  2. Attach original receipt to an ADF Family Health Allied Health claim form.
  3. Fax, email or mail claim and receipts to: ADF Family Health, PO Box 172, Box Hill, Vic 3128 Fax 03 9880 7939 adffhclaims@navyhealth.com.au.
  4. Money is paid into your nominated bank account (subject to family benefit balance) within 2 business days.
Private Health Insurance

If you have private health insurance it is recommended that you claim your treatment from the private health insurance provider first and then claim any remaining amount via one of the above methods.

Please attach a copy of your private health insurer’s receipt before sending in your claim via manual or online methods.