What Can You Claim?

ADF Family Health > Claiming > What Can You Claim?

The ADF Family Health Program will pay an amount towards your treatment of many services to assist you to lessen the out-of-pocket expenses you may experience.

General Practice Service (GP)

GP services are conducted by your general practitioner within their general practice setting. To be eligible for claiming, all services must have been allocated a Medicare Benefits Schedule item number at the time of payment.

All approved claims for a GP service will be deducted from your family’s unlimited allocations for these services.

Specialist Services

Specialist services are provided by Specialists or Consultant physicians within their consulting rooms or a hospital setting. Specialist services must have been allocated a Medicare Benefits Schedule item number at the time of payment.

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 and the benefit will be deducted from your families allocations of funds i.e. $400 per Dependant.

Diagnostic and Radiology Services

All diagnostic and radiology services, where there is an MBS item number, are eligible. Service can include, X-rays, MRI, pathology and ultrasound.

All approved claims will be deducted from your families allocations of funds i.e. $400 per Dependant.

Allied Services

Allied Health Services provide a broad range of treatments to improve th ehealth 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 families allocations of funds i.e. $400 per Dependant.

If you have private health insurance, click here to learn how to reduce your out of pocket expenses.

Allied Service	Description of Services
Ambulance Subscription	The cost of the subscription to any state or territory-based ambulance service. 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
Chiropractic	All services conducted by a certified practitioner
Dietician	All services conducted by a certified provider
Dental	All items that listed by the Australian Dental Association (ADA) (items will be paid in line with ADA and independent reasonability rules) Dental items provided at school
Exercise Physiology	All services conducted by a certified practitioner
Immunisations	You may claim for reimbursement of vaccinations not covered under the National Immunisation Program, or vaccinations by a non-GP provider. Please note that vaccinations reimbursable under the Pharmaceutical Benefit Scheme are not covered under this modality. Your claim must include an official doctor’s or pharmacy receipt showing: Patient name Name and cost of vaccination Date the vaccination was administered
Medically Prescribed Appliances (MPA)	Medically Prescribed Appliances (MPA) – MPA must not have a GST applied and 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 of costs above the Pharmaceutical Benefits Scheme (PBS) co-payment threshold amount for pharmaceuticals that meet the following criteria: Cost over the current PBS amount. Are fully approved by the TGA (therapeutic goods administration). Are not experimental drugs or are part of a drug trial. Prescribed by an Australian registered medical practitioner, including dentists and nurses. Supplied by a registered Australian Pharmacist and are schedule 4 or 8 medicines only. Are not vitamins, herbal medicines, over the counter pharmaceuticals or non-prescription drugs. Your claim must be accompanied with an official pharmacy receipt listing the following details: Name and cost of medication Date of supply Strength Quantity Confirmation that the medication was not subsidised by the Australian Government (PBS) Pharmacist’s name, address, and prescription number Customer’s name and address
Physiotherapy	All services ; Ante/Post – Natal classes provided by a registered physiotherapist or midwife
Podiatry and Chiropody	All services conducted by a certified practitioner
Psychology	All services conducted by a certified practitioner, including; Psychometric testing, cognitive behavioural assessment Psychology service with a social worker when an item number is provided Psychology service via video link when an item number is provided
Remedial Massage	All service conducted by a certified practitioner
Speech Therapy	All services conducted by a certified provider
Tobacco and Nicotine Addiction	Quit Smoking Courses Alan Carr Quit Smoking Seminar Smokenders Program 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. The program does not pay towards any books or additional resources purchased. Nicotine Replacement Nicotine patches Nicotine gum Nicotine lozenges Nicotine inhalers Nicotine mouth spray Your claim must be accompanied with a recognised pharmacy receipt clearly showing: Name and cost of the product Date of purchase
Other Services	Medicare eye test within a two year period Emergency department consultation (GP not in a GP setting) Midwife conducting obstetrics services when an MBS item is used.