Info for Healthcare Providers
This initiative recognises the service and sacrifices of our Australian Defence Force (ADF) members and their families, and the difficulties many ADF families experience accessing affordable healthcare upon relocation. The initiative aims to improve the retention and recruitment of the ADF.
ADF families are able to attend any general practice and be reimbursed for gap expenses for all Medicare eligible services provided in a general practice setting. The process is summarised below:
[Visit GP] » [Pay full GP invoice] » [Claim Medicare rebate] » [Submit Claim to National ADF Family Health Program] » [National ADF Family Health Program pays gap amount to families’ bank account]
For general practices that have HICAPS or HealthPoint terminals installed which enables automated processing of the gap payment directly to the general practice the process is summarised below:
[Visit GP] » [Swipe National ADF Family Health Program Card] » [National ADF Family Health Program pays gap $$ to GP] » [Pay the residual MBS amount] » [Swipe Medicare Card] » [MBS Amount reimbursed to families’ bank account]
You can locate a GP with HICAPS facilities by clicking here
Further enquiries should be directed to Defence’s contracted claims administrator Navy Health Ltd on 1300 561 454.
Allied Health, Medical Specialists, Diagnostic and Radiology Providers
The Program is intended to cover non-cosmetic “GST” free allied health, medical specialist and diagnostic and radiography services to the value of $400 per financial year per ADF family member. The $400 benefit is transferable between family members. This benefit can only be used in the financial year it is allocated and will reset at midnight 30 June each year.
ADF families who have registered for the program will be issued with the ADF Family Health Card.
Eligible Allied Health Services
The vocational groups that are eligible for claims reimbursement are detailed here.
Electronic Claim Processing
The ADF Family Health Card can be used for electronic claiming via HICAPS or HealthPoint. This initiative is not a private health insurance product. Defence has contracted with Navy Health Ltd for the administration of all claims processing functions for the National ADF Family Health Program. Eligible allied health claims can be made via HICAPS or HealthPoint electronic processing.
The ADF Family Health Card can be used in conjunction with private health insurance. It is recommended that claims be electronically submitted to the private health insurer prior to processing the ADF Family Health Card. The ADF Family Health Card can then be used to claim the gap, up to the available limit. Any remaining amounts must be paid by the ADF family. The process is summarised below:
[Consultation] » [Swipe Private Health Insurance Card] (if applicable) » [Swipe National ADF Family Health Program Card] » [National ADF Family Health Program pays provider invoice amount up to remaining National ADF Family Health Program limit] » [ADF Families pay difference – if applicable]
NOTE: The ADF Family Health Card may not be compatible with all practice software. If the practice is unable to electronically process any claim. ADF families should pay for their visit and follow the claims processing procedures available here.
For information related to eligible services or payments please call Navy Health on 1300 561 454. For any other information related to the Program, please contact the ADF Family Health team on 02 6266 3547