What Can You Claim?
The ADF Family Health Program will pay an amount towards your treatment for many services to assist you to lessen the out-of-pocket expenses you may experience.
If you are not sure if your service is eligible for reimbursement, contact 1300 561 454 for clarification.
General Practice Service (GP)
As part of the Program, eligible general practice (GP) services are unlimited and are in addition to your family’s benefit allocation (i.e. $800 per registered dependant).
Eligible GP services are those conducted by, or on behalf of, your general practitioner within their general practice setting (e.g. a general practice nurse changing a wound dressing or removing stitches).
To be eligible for claiming, all services must have a Medicare Benefits Schedule (MBS) item number assigned on the paid invoice/receipt. All approved claims for a GP service must be accompanied by a Medicare Statement of Benefits before they are submitted to ADF Family Health for approval.
Specialist Services
Specialist services are provided by Specialists or Consultant physicians within their consulting rooms or a hospital setting.
To be eligible for claiming, services must have an MBS item number assigned on the paid invoice/receipt. All approved claims for a specialist service must be accompanied by a Medicare Statement of Benefits before they are submitted to ADF Family Health for approval. These benefits will be deducted from your family’s allocation of funds (i.e. $800 per registered dependant).
Diagnostic and Radiology Services
All diagnostic and radiology services, where there is an MBS item number, are eligible. Services include X-rays, MRIs, pathology, and ultrasounds.
All approved claims will be deducted from your family’s allocation of funds (i.e. $800 per registered dependant).
Allied Services
Allied Health Services provide a broad range of treatments to improve the health and wellbeing of the patients they support. The ADF Family Health Program will pay the gap on the below Allied Health services when they are provided by a certified practitioner.
All approved claims for an allied service will be deducted from your family’s allocations of funds (i.e. $800 per per registered dependant).
If you have private health insurance, click here to learn how to reduce your out of pocket expenses further.
Allied Service | Description of Services |
Ambulance Subscription | The cost of the subscription to any state or territory-based ambulance service, or an ambulance-only health insurance policy. Please be aware that ambulance services, trips or call-out fees cannot be claimed. To be eligible, the receipt must show the name of a person listed on the ADF Family Health policy. |
Audiology | All services conducted by a certified practitioner |
Cancer Prevention | You may claim reimbursement for the cost of mole mapping, skin cancer clinic appointments and bowel screening kits.
We ask that you submit your claim with an official receipt showing:
|
Chiropractic | All services conducted by a certified practitioner |
Dietician | All services conducted by a certified practitioner |
Dental |
|
Exercise Physiology | All services conducted by a certified practitioner |
Healthy Diet | Dietician led Program Subscriptions
Please note the program cannot pay towards any books, food, meal replacements, We ask that you submit your claim with an official receipt showing:
|
Immunisations | You may claim for reimbursement of the cost of a vaccine, administering vaccinations not covered under the National Immunisation Program, or vaccinations by a non-GP provider.
Please note that vaccinations issued on prescription are covered under the pharmacy benefit. Your claim must include an official doctor’s or pharmacy receipt showing:
|
Medically Prescribed Appliances (MPA) | Medically Prescribed Appliances (MPA) – claims must be accompanied by a written recommendation/prescription from a certified practitioner. |
Occupational Therapy | All services conducted by a certified practitioner |
Optical | All prescriptions lenses, frames when accompanied with prescription lenses, contact lenses and lens coatings on prescription lenses. |
Osteopathy | All services conducted by a certified practitioner |
Pharmacy |
You may claim reimbursement for the costs of medications that are above the Pharmaceutical Benefits Scheme (PBS) co-contribution amount. As of the 1st January 2024, the PBS amount has been adjusted from $30 to $31.60. All medications must have been provided on a private script from your doctor, and be submitted with an official pharmacy receipt with the below information included:
|
Physical Activity | You may claim the cost of gym or aquatic memberships and fitness classes. Fitness classes may be provided as part of a membership or by a private provider with a registered ABN. These include:
Note that swimming lessons, club training and sporting club memberships are not included. We ask that you submit your claim with an official receipt showing:
|
Physiotherapy |
|
Podiatry and Chiropody | All services conducted by a certified practitioner |
Psychology | All services conducted by a certified practitioner, including;
|
Remedial Massage | All services conducted by a certified practitioner |
Speech Therapy | All services conducted by a certified practitioner |
Tobacco and Nicotine Addiction | Quit Smoking Courses
The cost of an online or in-person course is claimable with a course completion certificate and payment receipt from one of the above foundations. Nicotine Replacement
Your claim must be accompanied with a recognised pharmacy receipt clearly showing:
|
Other Services |
|