Health insurance for ADF and active Reservists. We look after you like family.

Transcription

1 Health insurance for ADF and active Reservists We look after you like family. Issued April 2015

2 Contents Introduction 1 Members Own Health Fund 2 Who s eligible to join 3 Why you re better off with private health insurance Types of cover 6 Finding the right cover for you 7 Specially designed ADF packages for permanent ADF and active Reservists ADF Total Package 10 ADF Essentials Package 14 Hospital cover 16 Extras cover 21 Get the lowdown 29 Important information 33 Making the most of the Australian 34 Government s initiatives More ways we treat you like family 36 How to join the family Information in this brochure is current as at 1 April It replaces all earlier versions. Please read it carefully and retain with any other Defence Health documentation.

3 Visit defencehealth.com.au We re always here to help because that s what family is for At Defence Health, we put our members before profit. Because our members are more than just a name or number to us. They re just like family. In these pages you ll discover why over 235,000 Australians, all with connections to Defence, have joined our family. And if you decide to join us, you ll discover why they stay. Like any good family, we support each other through good times and bad, and always take the time to listen. To us, family is the most important thing. That s why we are not for profit and all for the benefit of our members. That s why we ll defend your right to the very best cover and protection. If you want great value health insurance from an insurer that cares about your wellbeing and always provides excellent service, you re in the right place. Read on and if you have any questions we re just a phone call away. Because that s what families are for. ADF and active Reservists 1

4 We exist to benefit members Members Own Health Funds is a group of not-for-profit and mutual health funds, who have come together to highlight a genuine choice for Australians when it comes to choosing their health fund. Members Own Health Funds, like Defence Health, exist to benefit members, not to profit investors or overseas owners. This means you ll be treated as a member, not a number. We deliver better service, have higher member satisfaction and loyalty and receive fewer complaints than for-profit and overseas owned funds.* For more than 60 years, Defence Health has been committed to looking after our members wellbeing by providing great value health insurance along with genuine care, support and expertise. We don t have shareholders so there s more to share with you. As the largest health insurer for ADF families and the wider Defence community, our members are our priority. It s this commitment to the entire Defence community that has seen Defence Health grow into the family we are today. We are uniquely Defence Health and being a Members Own Health Fund just emphasises this difference. *Refer for the detailed report supporting these facts. 2

5 Call us on Who s eligible to join ADF families ADF partners and families and active Reservists, their partners and families can all join Defence Health. If you re a member of the permanent ADF you don t need to cover yourself but you can cover your partner and/or child(ren). We have designed two hospital and extras packages just for you, which offer two levels of protection and the best value for money. But if these packages don t meet your needs you can mix and match from our standalone covers at special ADF prices. Go to Pg 9 to see the ADF packages. What does active Reservist mean? Active Reservist means a person who is actively serving in the Army Reserve, Air Force Reserve or Naval Reserve of Australia. This includes standby active Reservists who are engaged in 20 or more paid training days per financial year. Other Defence connections Your work colleagues and extended family may be eligible to join too if they fit within one of the following categories. Past Service All those who have previously served in the ADF (full-time or part-time) and their partners and children ADF supporters Anyone who works or has worked in the Dept of Defence and other Defence-related departments Anyone who works or has worked for a Defence supplier a company or agency contracted to the Department of Defence, where you are or were involved in the supply of goods and services to Defence Extended families of all above If you re the mum or dad, son or daughter, sister or brother, grandchild or ex-spouse/partner of a serving or ex-serving member of the ADF or of an ADF supporter (described above) We ve got a different brochure for those in the wider Defence community. Visit our website to download it or call us on and we ll send you a copy. ADF and active Reservists 3

6 Why you re better off with private health insurance Manage your health costs Manage the costs of hospital admissions and medical treatment and enjoy money back on extras. Control your care Choose your doctor, specialist and the hospital you re treated in. Skip the queues Avoid public hospital waiting lists and get the treatment you need sooner. Maximise Government incentives Access the Australian Government Rebate on private health insurance which can reduce the premium you pay. Avoid the Lifetime Health Cover loading Take out hospital cover by July 1 after turning 31 and you can avoid paying a Lifetime Health Cover loading. Reduce your taxes Higher income earners can avoid paying the Medicare Levy Surcharge by taking out hospital cover. Money back on extras Get money back when you visit dentists, physios, optometrists and others. 4

7 Visit defencehealth.com.au Why you re better off with Defence Health Special features for ADF and active Reservists Exclusive ADF packages with national pricing Our special packages offer national pricing which means that no matter where your posting takes you, your premium stays the same. And our ADF Total Package also offers higher benefits on dental, speech therapy, physiotherapy, psychology, antenatal and postnatal services and more. Special prices on mix and match range All permanent ADF and active Reservists get special pricing for our mix and match hospital and extras covers, just in case the ADF packages don t meet your needs. Suspension of health cover ADF personnel can suspend their cover for up to 24 months when they are sent overseas on an accompanied posting. Active Reservists on continuous full-time service (CFTS) for more than 28 days can also suspend their cover for the full duration of the service. Transition discount for discharging ADF Discharging permanent ADF personnel, who aren t becoming active Reservists, receive a 10% discount on hospital or hospital and extras from our mix and match range in their first year, as long as it s paid for by direct debit. No waiting periods for discharging ADF All waiting periods are waived for those who join within two months of discharging from the permanent ADF. Special features for our whole family Low management costs Because we have low management expenses, we can keep your premiums lower and return more in benefits. Not-for-profit To us, family is the most important thing. That s why we re not for profit and all for the benefit of our members. One of the largest hospital networks We have agreements with over 500 hospitals around the country. This significantly reduces your out-of-pocket expenses. So no matter where you are, your closest private hospital will almost certainly be contracted to us. Great optical benefits Members with extras cover can get no-gap glasses from our optical partners, Specsavers and VSP Vision Care. Our extensive optical network reaches far and wide with over 600 providers around the country. No waiting when you switch If you switch from another insurer with an equivalent level of cover, we recognise any waiting periods you ve already served. So you can make claims right away. Simple claiming You can claim your extras on the spot, online, or on your mobile or tablet with our free app. Over 60 years of service We were created to support the families of those who defend our country. After 60 years, as Defence has grown, our family has also grown. And now we embrace everyone with a Defence connection. Excellent service We never forget we re dealing with your health and wellbeing. We listen to you, and offer the protection you want. Our members are more than a name or a number: they re just like family. Supporting the Defence community We support the Defence community through sponsorships of Defence community groups and organisations like Defence Families of Australia and Defence Special Needs Support Group. Funding for medical research We established the Defence Health Foundation in 2010 to fund medical research aimed at helping ADF serving and ex-serving personnel and their families. Just another way we support the Defence community. Comprehensive ambulance cover Every policy includes 100% cover for ambulance services by state-appointed ambulance providers across Australia. And there s no limit on the number of times you can use the ambulance service when needed. ADF and active Reservists 5

8 Types of cover We offer ADF packages that combine hospital and extras, and a range of hospital covers and extras covers that can be mixed and matched to meet your needs. ADF packages Our ADF Total Package and ADF Essentials Package are just for permanent ADF and active Reservists, their partners and families. They offer different levels of protection based on your needs and are the best value for money options. Standalone cover for mixing and matching If the ADF packages don t meet your needs you can always choose from our mix and match hospital and extras covers. Permanent ADF and active Reservist members get special pricing on the mix and match range. Hospital cover Hospital cover helps lower or remove your costs when you re a private patient in hospital. We have three levels of hospital cover, Premier, Value and Essentials. The level you choose determines the number and types of procedures and services you re covered for. The higher your level of cover, the more you ll be covered for. Extras cover Extras cover helps lower or remove your costs when you visit health and wellbeing providers whose fees aren t covered by Medicare. They include dentists, chiropractors, physiotherapists, a range of alternative therapists and much more. We have three levels of extras cover Premier, Value and Essentials. The higher your level of cover, the more services you ll be covered for and the lower your out-of-pocket expenses will be. 6

9 Call us on Finding the right cover for you See if you can identify yourself in our guide below. Or you can read about all our covers in the pages ahead. Where you re at Need and wants Recommended product You might like to consider Young, fit and healthy singles and couples I just need basic cover I don t want to pay for services I don t need I want low cost cover ADF Essentials Package (Pg 14) Essentials Hospital (Pg 20) + Essentials Extras (Pg 28) I want to avoid government penalties No kids, none planned any time soon I want well priced cover with more than the basics I want good benefits ADF Total Package (Pg 10) Value Hospital (Pg 19) + Value Extras (Pg 26) Planning a family We want cover for pregnancy and assisted reproductive services We need cover that can protect a growing family ADF Total Package (Pg 10) Premier Hospital (Pg 18) + Value Extras (Pg 26) Young family on a tight budget We don t want to spend too much The health and wellbeing of our family is important but we re willing to have a few exclusions on unlikely treatments to keep premiums affordable ADF Total Package (Pg 10) Value Hospital (Pg 19) + Value Extras (Pg 26) Established family We need cover for a wide range of services We are looking for value for money ADF Total Package (Pg 10) Premier Hospital (Pg 18) + Value Extras (Pg 26) My health and the health of my family is not worth risking I want the best cover for total peace of mind Being in control of my health is vital to me ADF Total Package (Pg 10) Premier Hospital (Pg 18) + Premier Extras (Pg 24) My family s wellbeing is my priority Older and wiser I want to be well covered just in case We want to get the treatment we need as soon as we need it ADF Total Package (Pg 10) Premier Hospital (Pg 18) + Premier Extras (Pg 24) Get a quote Go to defencehealth.com.au or call us on ADF and active Reservists 7

10 Favourite features about our health insurance Excess options that lower your premium We ll reduce your premium if you choose to pay an excess when you go to hospital. The higher your excess, the lower your premium. Reduce your out-of-pocket expenses Agreement private hospitals Be treated in one of our agreement private hospitals to significantly reduce your out-of-pocket expenses. We have agreements with over 500 hospitals around the country that ensure the majority of hospital charges are covered when you re admitted either for day procedures or overnight. For a full list of agreement hospitals, visit defencehealth.com.au. Access Gap If your Doctor agrees to participate in our Access Gap scheme you can reduce or eliminate your medical out-ofpocket expenses. You can find doctors who participate at defencehealth.com.au This scheme works on the basis that Defence Health will pay your doctor more on the condition they agree to charge you a no-gap or capped gap fee. No-gap fees on a number of diagnostic services We ve negotiated no-gap agreements with a number of diagnostic service providers such as radiologists and pathologists. If you receive their services in hospital, there s no cost to you. They send their bill directly to us and we take care of it for you. Family favourites No excess for children If you have a policy that covers your family, you ll never have to pay the hospital excess for your children. No waiting periods for newborns We know there is a lot to think about when you re having a baby and sometimes, in all the excitement, it is easy to forget your health insurance. So as long as you contact us before your baby is 2 months old, we ll add them to your cover with no waiting periods. We even allow backdating of the policy to the day of your baby s birth so treatments within those first two months are covered. Cover for older kids We ll cover kids on your policy until they re 21. And if they re single and studying full-time, we ll cover them until they re 25. Young Adult Support Plan If your older kids are single and not studying full-time, they can remain on your family hospital policy until they re 25 if they take out their own Value Extras cover. Health programs Members with ADF Total Package, Value Hospital or Premier Hospital have access to a number of programs and services that help you look after your health and wellbeing. Hospital substitute treatments If your doctor agrees, you could avoid the hassle and inconvenience of going to hospital for certain treatments. Depending on where you live, they can arrange for health care providers to come to your home to deliver services such as wound management, intravenous therapy, and ambulatory sleep studies. Home nursing Where your doctor is able to substitute hospital admission with home nursing, we ll pay a benefit for a registered nurse to care for you in your home. Midwifery We ll pay a benefit for a registered midwife in private practice to attend the delivery of your baby. Midwifery benefits are not payable if a doctor is required to intervene in the delivery. Benefits will be payable for the doctor s in-hospital treatment instead. Chronic care Our chronic disease management programs provide telephone-based support for members who have had a hospital admission relating to heart disease or type 2 diabetes and meet program eligibility. Our program coordinators work with treating practitioners to support existing treatment and aid recovery. 8

11 Visit defencehealth.com.au Specially designed ADF packages for permanent ADF and active Reservists We ve combined the best of our hospital and extras covers and some into two convenient packages just for the partners and children of permanent ADF, and for active Reservists and their partners and children. You ll also enjoy national pricing which means that no matter where your posting takes you, your premium stays the same. ADF Total Package Our ADF Total Package gives you complete protection with comprehensive hospital cover and access to a wide range of extras services with generous annual limits. This package is perfect for those that want comprehensive cover at a great value price. The ADF Total Package has been specially designed with permanent ADF and active Reservist families in mind so you can be sure we re looking after you. ADF Essentials Package Our ADF Essentials Package provides cover for common treatments that young and healthy singles and couples are likely to need. This is a low cost package so it s great if you re on a budget or if you re looking for a basic hospital cover to avoid Government penalties but still want to get something back for your money. Comprehensive ambulance cover Both packages include 100% cover for ambulance services by state-appointed ambulance providers across Australia. And there s no limit on the number of times you can use the ambulance service when needed. ADF and active Reservists 9

12 ADF Total Package The ADF Total Package has been specially designed with permanent ADF and active Reservist families in mind. It gives you our best protection with comprehensive hospital cover and access to an extensive range of extras services with generous annual limits. Favourite features Comprehensive ambulance cover Enjoy peace of mind with comprehensive hospital cover National pricing means you pay the same great price no matter where you re posted No excess for kids No exclusions on any Medicare-approved treatment One free mouthguard, custom-fitted by a dentist, every year for kids No annual limit on general dental treatment No lifetime limit on orthodontics keep claiming every year for the full course 100% back on initial consultations for most extras therapies Great no-gap glasses deals through our optical network Specsavers or VSP Vision Care Cover for laser refractive eye surgery if you want to be glasses free Your kids stay covered to age 21. And if they re single and studying full-time to age 25 Your hospital cover What s covered Joint reconstructions and repairs Joint replacements Colonoscopies and arthroscopies Heart and artery related services Pregnancy related services Assisted reproductive services (e.g. IVF and GIFT) Psychiatric and rehabilitation services And all other Medicare-approved treatments Be there when your family needs you If you re a permanent ADF member and your child or partner goes into hospital, we ll pay your boarder fees so you can stay at the hospital too (boarder arrangements only available with selected hospitals). Excess options You can reduce your premium by electing to pay an excess if you go to hospital. Your excess options are $200 or $400 per adult. The excess applies once per adult per financial year on all same day and overnight admissions. No excess is payable for dependent children. Your hospital cover gives you Choice of doctor and hospital No exclusions on any Medicare-approved treatment 100% of agreement hospital charges (subject to your excess), including: Shared or private room Theatre fees, including labour ward Intensive care, critical care and high dependency unit Most drugs supplied in hospital 100% of public hospital charges (subject to your excess) Up to 100% of doctors fees if your doctor chooses to use Access Gap Up to 100% for prostheses on the Australian Government Prostheses List Health programs, for services not covered by Medicare, which include up to $2000 for midwife delivery services, and up to $100 per day for home nursing ($2000 max) Get hospital substitute treatment in your home for treatments such as wound management, and intravenous therapy, through selected hospitals Treatment in a non-agreement private hospital will incur significant out-of-pocket expenses. What s restricted No hospital services are restricted What s excluded Services where Medicare pays no benefit (e.g. most cosmetic surgery) When you join Defence Health or upgrade your existing cover, you may have a waiting period before you can claim benefits. Most waiting periods are 2 months but some, such as pre-existing conditions, are 12 months or more. To see all waiting periods and get more information about making the most of your hospital and medical cover and what your hospital cover will not pay for go to Pg

13 Call us on Your extras cover Dental Some dental items are limited in the number of times they can be claimed in a year. Some items are not payable in combination with others. And some may not attract a benefit at all. General dental Annual limit Unlimited Periodic oral exam (012) Up to $41.85 Removal of calculus (114) Up to $74.50 Bitewing x-ray (022) Up to $30.30 Adhesive filling to one surface Up to $85.85 of a rear tooth (531) Major dental Annual limit $950 per person Surgical tooth removal (323) Up to $ Root canal obturation (417) Up to $ Veneer indirect (583) Up to $ Full crown veneer indirect (615) Up to $ Endosseous implant (688) Up to $ Orthodontics Annual limit $800 per person Complete course of orthodontic Up to $ treatment (881) Unlike other funds there is no lifetime limit. You get $800 every financial year until your treatment is complete. Passive removable appliance (811) Up to $ Optical Annual limit $255 per person Optical network partners 100% Our optical network providers have extensive ranges of no-gap glasses. Visit specsavers.com.au or vsp-australia.com.au for locations. Specsavers VSP Vision Care Single vision glasses 2 pairs no-gap 1 pair no-gap Bi/Multifocal glasses 1 pair no-gap 1 pair no-gap Frames Discounted Discounted Contacts (in store) 10% off 15% off Benefits at non-network providers are limited: up to $90 for single vision lenses, up to $95 for ground single vision lenses, up to $105 for bi-focal lenses, up to $155 for multi-focal lenses, up to $95 for frames and up to $180 for contact lenses. A sight-correcting script must accompany the claim. The no-gap glasses deals are based on standard lens options. Other lens choices are likely to involve an out-of-pocket cost. For the two pairs no-gap glasses deal, the second pair must be from the same or lower priced range and must be for the same prescription. Ambulance treatment Annual limit Unlimited 100% cover for ambulance services by state-appointed ambulance providers across Australia. This includes emergency services, non-emergency dispatch, mobile intensive care and air and sea ambulance services. Transport services by Patient Transport vehicles are not ambulance services and are not claimable. Physiotherapy (including hydrotherapy) Annual limit $650 per person Initial consultation 100% Subsequent consultation Up to $40 Group therapy sessions Up to $15 and classes Chiropractic/Osteopathy Annual limit $450 per person Initial consultation 100% Subsequent consultation Up to $33 Chiropractic x-rays (max 2) Up to $40 Alternative therapies & exercise physiology Antenatal & postnatal services Annual limit $400 per person Antenatal course Up to $400 Antenatal consultations/classes Up to $40 Postnatal consultations/classes Up to $40 By a midwife or physiotherapist in private practice only. Treatment claimed through Medicare cannot be covered. Psychology Annual limit $300 per person Per consultation Up to $30 Where the provider is recognised by the Australian Regional Health Group the following alternative therapies are payable: acupuncture, homeopathy, aromatherapy, myotherapy, naturopathy, remedial massage, remedial therapy, Chinese herbal medicine and western herbal medicine. No benefit payable for any prescribed medications, herbal or dietary preparations. Annual limit $400 per person Initial consultation 100% Subsequent consultation Up to $70 Group therapy Up to $25 Couple/family therapy Up to $30 Treatment claimed through Medicare cannot be covered. ADF and active Reservists 11

14 Your extras cover Speech therapy Annual limit $500 per person Initial consultation 100% Subsequent consultation Up to $45 Group therapy sessions Up to $25 Occupational therapy Annual limit $500 per person Initial consultation 100% Subsequent consultation Up to $42 Group therapy sessions Up to $25 Podiatry/chiropody Annual limit $300 per person Initial consultation 100% Subsequent consultation Up to $33 Audiology Annual limit $200 per person Initial consultation 100% Subsequent consultation Up to $42 Eye therapy Annual limit $500 per person Initial consultation 100% Subsequent consultation Up to $42 Laser refractive eye surgery Dietitian Annual limit $1000 per person every 2 financial years Up to $1000 per person is payable for LASIK or PRK eye surgery in a recognised day surgery centre. Annual limit $250 per person Initial consultation 100% Subsequent consultation Up to $25 Pharmacy and vaccinations Annual limit $500 per person Per prescription or vaccination Up to $100 The benefit is payable on non-pbs pharmaceuticals only and applies to the cost in excess of the current PBS amount. School accidents No waiting period Annual limit $600 per person Up to $600 per person for health care gap costs resulting from a school accident to your child excluding Medicare services. Medically prescribed devices & supports 36 Annual limit $1000 per person 36 month waiting period per person Hearing aids* Up to $ month waiting period per person CPAP machine* for sleep apnoea Up to $1000 Blood glucose monitor* Up to $400 Foot orthotics Up to $300 custom-made or fitted by a podiatrist, chiropodist or orthotist Orthopaedic shoes Up to $300 custom-made by specialist shoemaker Splints and braces Up to $250 splints, knee/leg/spinal/lumbar/sacral/wrist/ ankle braces and surgical corsets only Mobility aids* Up to $1000 wheelchairs, crutches, walking frames, walking sticks, rolling walkers, seat riser cushions, reaches and adjustable canes only Non-cosmetic prostheses Up to $1000 Wig following a medical condition Up to $250 External breast prostheses Up to $250 following a mastectomy Artificial eye* Up to $1000 per policy Blood pressure monitor* Up to $250 TENS machine* Up to $250 Nebuliser* and spacer Up to $300 for breathing conditions per item Compression garments Up to $250 for purpose-made garments that aid burn management, post-surgical recovery, lymphoedema treatment and deep vein thrombosis prevention 2 month waiting period per person Non-sight correcting Irlen lenses Up to $90 EpiPen Up to $150 Hearing aids and foot orthoses repair Up to $100 Rental of appliances Up to $150 including oxygen cylinders, soft collars, toilet seat risers, shower chairs, Continuous Passive Movement machines or any other appliance listed above * Replacement or additional items are not claimable within 3 years of previous purchase. Quit smoking Annual limit $120 per person Benefits paid on approved programs and nicotine replacement therapies. Benefits will not be available for medicines/drugs subsidised by the Australian Government under the PBS. An itemised pharmacy receipt with the patient s name must be provided. 12

15 Visit defencehealth.com.au Premiums for the ADF Total Package start from $56.14 per fortnight to cover one person The table below sets out what the ADF Total Package will cost. The pricing is national and does not vary from state to state. The prices listed below are per fortnight. The premium after rebate calculation method is explained at the bottom of this page. ADF Total Package $0 excess ADF Total Package $200 excess ADF Total Package $400 excess Premium after rebate Gross premium Premium after rebate Gross premium Premium after rebate Gross premium One adult $65.43 $90.68 $59.62 $82.62 $56.14 $77.84 One adult & kids $99.64 $ $91.21 $ $86.19 $ Two adults $ $ $ $ $ $ Two adults & kids $ $ $ $ $ $ ADF Total Package Premium after rebate Gross premium One child $56.14 $77.84 Two or more kids $65.43 $90.68 Northern Territory residents National pricing is not as suitable for Northern Territory residents as it is for residents of other states. This is because the NT hospital costs are much lower than any other state or territory. The premium after rebate calculation method is explained at the bottom of this page. Permanent ADF and active Reservist members based in the Northern Territory will find a better deal if they mix and match the Hospital and Extras combinations available in the NT. The combinations most similar to the ADF Total package are shown below but you can check out other combinations on our website or call us to get a quote. NT Rates Premier Hospital (no Excess) and Value Extras Premier Hospital with $200 excess plus Value Extras Premier Hospital with $400 excess plus Value Extras Premium after rebate Gross premium Premium after rebate Gross premium Premium after rebate Gross premium One adult $50.74 $70.29 $46.06 $63.86 $41.40 $57.40 One adult & kids $83.61 $ $76.22 $ $68.77 $95.27 Two adults $ $ $92.21 $ $82.87 $ Two adults & kids $ $ $92.21 $ $82.87 $ The premiums listed above are for customers eligible for % Australian Government Rebate on private health insurance and nil Lifetime Health Cover Loading. Your actual rebate may vary depending on your age and income. The premium quoted is valid until 31 March Get a quote Go to defencehealth.com.au or call us on ADF and active Reservists 13

16 ADF Essentials Package The ADF Essentials Package is our low-cost package for permanent ADF and active Reservist singles and couples. It covers a limited range of hospital and extras treatments and helps you avoid Government penalties. Favourite features Comprehensive ambulance cover National pricing means you pay the same amount no matter where you re posted Don t pay for things you don t need you get cover for a limited range of hospital services that a young and healthy person is most likely to need Cover for the most popular extras to complement your active lifestyle Great no-gap glasses deals through our optical network Specsavers or VSP Vision Care Choice of doctor and hospital for treatment of the limited procedures covered Avoid or minimise Government penalties such as the Medicare Levy Surcharge and Lifetime Health Cover loadings Money back for travel vaccinations Great choice for your first health cover or if you re not planning on kids any time soon Your hospital cover Excess The ADF Essentials Package has a $200 per adult excess. The excess applies once per adult per financial year on all same day and overnight admissions. Your hospital cover gives you For the limited range of services listed under What s covered you get: Choice of doctor and hospital 100% of agreement hospital charges (subject to your excess), including: Shared or private room Theatre fees Intensive care, critical care and high dependency unit Most drugs supplied in hospital 100% of public hospital charges (subject to your excess) Up to 100% of doctors fees for services covered if your doctor chooses to use Access Gap Up to 100% for prostheses on the Australian Government Prostheses List for services covered Treatment in a non-agreement private hospital will incur significant out-of-pocket expenses. What s covered Accidental injuries Removal of tonsils Removal of adenoids Removal of appendix Surgical tooth extraction Hernia repairs Joint investigations (arthroscopies) and minor joint repairs Joint reconstructions Colonoscopies Gastroscopies What s restricted Psychiatric treatment Rehabilitation Palliative care For these treatments you will only be covered as a private patient in a public hospital shared room. If you are treated anywhere else you will be significantly out-of-pocket. What s excluded All other hospital treatments When you join Defence Health or upgrade your existing cover, you may have a waiting period before you can claim benefits. Most waiting periods are 2 months but some, such as pre-existing conditions, are 12 months or more. To see all waiting periods and get more information about making the most of your hospital and medical cover and what your hospital cover will not pay for go to Pg

17 Call us on Your extras cover General dental and surgical extractions Some dental items are limited in the number of times they can be claimed in a year. Some items are not payable in combination with others. And some may not attract a benefit at all. General and preventive dental Annual limit $500 per person Periodic oral exam (012) Up to $36.75 Removal of calculus (114) Up to $65.05 Bitewing x-ray (022) Up to $25.25 Adhesive filling to one surface Up to $70.70 of a rear tooth (531) Mouthguard (151) Up to $74.75 Surgical tooth removal 322 Up to $ Up to $ Up to $ Optical Annual limit $170 per person Optical network partners 100% Our optical network providers have extensive ranges of no-gap glasses. Visit specsavers.com.au or vsp-australia.com.au for locations. Specsavers VSP Vision Care Single vision glasses 2 pairs no-gap 1 pair no-gap Bi/Multifocal glasses 1 pair no-gap 1 pair no-gap Frames Discounted Discounted Contacts (in store) 10% off 15% off Benefits at non-network providers are limited: up to $80 for single vision lenses, up to $95 for ground single vision lenses, up to $105 for bi-focal lenses, up to $120 for multi-focal lenses, up to $95 for frames and up to $120 for contact lenses. A sight-correcting script must accompany the claim. The no-gap glasses deals are based on standard lens options. Other lens choices are likely to involve an out-of-pocket cost. For the two pairs no-gap glasses deal, the second pair must be from the same or lower priced range and must be for the same prescription. Ambulance treatment Annual limit Unlimited 100% cover for ambulance services by state-appointed ambulance providers across Australia. This includes emergency services, non-emergency dispatch, mobile intensive care and air and sea ambulance services. Transport services by Patient Transport vehicles are not ambulance services and are not claimable. Physiotherapy (including hydrotherapy), Chiropractic/Osteopathy Travel vaccinations Annual limit $350 per person Initial consultation Up to $35 Subsequent consultation Up to $26 Group therapy sessions Up to $10 and classes Alternative therapies & exercise physiology Annual limit $200 per person Per consultation Up to $20 Where the provider is recognised by the Australian Regional Health Group the following alternative therapies are payable: acupuncture, homeopathy, aromatherapy, myotherapy, naturopathy, remedial massage, remedial therapy, Chinese herbal medicine and western herbal medicine. No benefit payable for any prescribed medications, herbal or dietary preparations. Annual limit $100 per person Per travel vaccination prescription Up to $50 The benefit is payable on non-pbs travel vaccinations only and applies to the cost in excess of the current PBS amount. What does the ADF Essentials Package cost? For most people the ADF Essentials package will cost $31.73 per fortnight for singles and $63.46 for couples. This is a national price and assumes a rebate of %. Gross premiums (without rebate) are $43.98 and $87.96 per fortnight respectively. Your actual rebate may vary depending on your age and income. The premium quoted is valid until 31 March ADF members based in the Northern Territory will find a better deal if they take the mix and match rates for the Northern Territory. These are available on our website or by calling us. Get a quote Go to defencehealth.com.au or call us on ADF and active Reservists 15

18 Mix and match hospital cover Choose from three levels of hospital cover that can help take the pain out of hospital visits: Premier Hospital, Value Hospital and Essentials Hospital. We ve designed each level of cover to provide protection to meet different needs. And they can be added to your choice of three extras covers for more complete protection. Finding the right hospital cover Premier Hospital If your family s wellbeing is your priority and you want total peace of mind, then Premier Hospital is for you. Premier Hospital provides comprehensive cover in all agreement hospitals throughout Australia. That means treatment where and when you need it. Premier Hospital has no exclusions on any Medicareapproved treatment which means no costly surprises. You also get 100% cover for ambulance services by stateappointed ambulance providers across Australia. And there s no limit on the number of times you can use the ambulance service when needed. Value Hospital If you are happy to exclude some procedures that you might not need, then Value Hospital is for you. Value Hospital is priced for families who know the importance of health and wellbeing but are trying to keep things a little more affordable. Value Hospital provides comprehensive cover for most treatments but you don t have to pay for things you are less likely to need. 16 You also get 100% cover for ambulance services by state-appointed ambulance providers across Australia. And there s no limit on the number of times you can use the ambulance service when needed. Essentials Hospital If you re only interested in covering things a young and healthy person might need, and want to avoid Government penalties for not having hospital cover, then Essentials Hospital could be for you. Essentials Hospital cover is low-cost because it only covers you for a limited number of services most commonly used by young and healthy people. And the really great news is you even get 100% cover for ambulance services by state-appointed ambulance providers across Australia. And there s no limit on the number of times you can use the ambulance service when needed. Get a quote Go to defencehealth.com.au or call us on

19 Visit defencehealth.com.au Compare our hospital cover Which services are covered? Premier Hospital Value Hospital Essentials Hospital Accidental injury Removal of tonsils Removal of adenoids Removal of appendix Surgical extraction of teeth Hernia repairs Joint investigations and minor repairs Joint reconstructions Colonoscopy Gastroscopy Rehabilitation Palliative care Psychiatric treatment Cancer treatment Stroke treatment Brain surgery Pregnancy and pregnancy related services Heart related procedures Assisted reproductive services and infertility treatments Cataracts, Glaucoma and laser eye surgery Dialysis for renal failure Obesity related treatment (eg. gastric banding) Joint replacements All other services recognised by Medicare Treatment not recognised by Medicare incl. most cosmetic surgery Chronic care programs Hospital substitute programs Midwifery (confinement and delivery) $1,500 $750 Home nursing Maximum Per day $1,800 $90 $750 $70 Included Excluded Restricted You will be covered as a private patient in a public hospital shared room. If you are treated anywhere else you will be significantly out-of-pocket. ADF and active Reservists 17

20 Premier Hospital Premier Hospital is designed to give you peace of mind and no worries. Comprehensive hospital cover gives you our best protection. It covers everything Medicare does, including pregnancy and assisted reproductive services. So if you and your family s wellbeing is a priority then Premier Hospital is for you. Favourite features Comprehensive ambulance cover Enjoy peace of mind with comprehensive hospital cover No exclusions on any Medicare-approved treatment No excess for kids Your kids stay covered to age 21. And if they re single and studying full-time to age 25 Your hospital cover Excess options You can reduce your premium by electing to pay an excess if you go to hospital. Your excess options are $200 or $400 per adult. The excess applies once per adult per financial year on all same day and overnight admissions. No excess is payable for dependent children. Your hospital cover gives you Choice of doctor and hospital No exclusions on any Medicare-approved treatment 100% of agreement hospital charges (subject to your excess), including: Shared or private room Theatre fees, including labour ward What s covered Joint reconstructions and repairs Joint replacements Colonoscopies and arthroscopies Heart and artery related services Pregnancy related services Assisted reproductive services (e.g. IVF and GIFT) Psychiatric and rehabilitation services And all other Medicare-approved treatments What s restricted No hospital services are restricted What s excluded Services where Medicare pays no benefit (e.g. most cosmetic surgery) Comprehensive ambulance cover You get 100% cover for ambulance services by state-appointed ambulance providers across Australia. And there s no limit on the number of times you can use the ambulance service when needed, including emergency services, non-emergency dispatch, mobile intensive care and air and sea ambulance services. Transport services by Patient Transport vehicles are not ambulance services and are not claimable. Intensive care, critical care and high dependency unit Most drugs supplied in hospital 100% of public hospital charges (subject to your excess) Up to 100% of doctors fees if your doctor chooses to use Access Gap Up to 100% for prostheses on the Australian Government Prostheses List Health programs, for services not covered by Medicare, which include up to $1500 for midwife delivery services, and up to $90 per day for home nursing ($1800 max) Get hospital substitute treatment in your home for treatments such as wound management, and intravenous therapy, through selected hospitals Treatment in a non-agreement private hospital will incur significant out-of-pocket expenses. 18 When you join Defence Health or upgrade your existing cover, you may have a waiting period before you can claim benefits. Most waiting periods are 2 months but some, such as pre-existing conditions, are 12 months or more. To see all waiting periods and get more information about making the most of your hospital and medical cover and what your hospital cover will not pay for go to Pg 29. Get a quote Go to defencehealth.com.au or call us on

21 Call us on Value Hospital Value Hospital is designed for families who know the importance of health and wellbeing but are trying to keep things a little more affordable. If you are happy to exclude some procedures you might not need then Value Hospital is for you. Favourite features Comprehensive ambulance cover Hospital cover for a broad range of services with some exclusions No excess for kids Your kids stay covered to age 21. And if they re single and studying full-time to age 25 Excludes selected hospital services to help keep the cost down Your hospital cover Excess choices You can choose from a $200 or a $400 excess per adult. The excess applies once per adult per financial year on all same day and overnight admissions. No excess is payable for dependent children. Your hospital cover gives you For the services listed under What s covered you get: Choice of doctor and hospital 100% of agreement hospital charges (subject to your excess), including: Shared or private room Theatre fees, including labour ward Intensive care, critical care and high dependency unit Most drugs supplied in hospital 100% of public hospital charges (subject to your excess) Up to 100% of doctors fees if your doctor chooses to use Access Gap Up to 100% for prostheses on the Australian Government Prostheses List for services covered Health programs, for services not covered by Medicare, which include up to $750 for midwife delivery services, and up to $70 per day for home nursing ($750 max) Get hospital substitute treatment in your home for treatments such as wound management, and intravenous therapy, through selected hospitals Treatment in a non-agreement private hospital will incur significant out-of-pocket expenses. What s covered Joint investigations (arthroscopies), minor joint repairs and reconstructions Colonoscopies Gastroscopies Heart and artery related services Pregnancy related services Cancer treatments And all other Medicare-approved treatments that are not listed below What s restricted Psychiatric treatment For this treatment you will only be covered as a private patient in a public hospital shared room. If you are treated anywhere else you will be significantly out-of-pocket. What s excluded Assisted reproductive services (e.g. IVF and GIFT) Renal dialysis Obesity related treatment (eg. gastric banding) Joint replacements and revisions Cataracts, glaucoma and laser eye surgery Services where Medicare pays no benefit (e.g. most cosmetic surgery) Comprehensive ambulance cover You get 100% cover for ambulance services by state-appointed ambulance providers across Australia. And there s no limit on the number of times you can use the ambulance service when needed, including emergency services, non-emergency dispatch, mobile intensive care and air and sea ambulance services. Transport services by Patient Transport vehicles are not ambulance services and are not claimable. When you join Defence Health or upgrade your existing cover, you may have a waiting period before you can claim benefits. Most waiting periods are 2 months but some, such as pre-existing conditions, are 12 months or more. To see all waiting periods and get more information about making the most of your hospital and medical cover and what your hospital cover will not pay for go to Pg 29. ADF and active Reservists 19

22 Essentials Hospital Essentials Hospital is basic hospital cover for young, healthy singles and couples. It covers a limited range of hospital treatments and helps you avoid Government penalties. Favourite features Comprehensive ambulance cover Don t pay for things you don t need you get cover for a limited range of hospital services that a young and healthy person is most likely to need Accidental injury cover Choice of doctor and hospital for treatment of the limited procedures covered Avoid or minimise Government penalties such as the Medicare Levy Surcharge and Lifetime Health Cover loadings Great choice for your first health cover or if you re not planning on kids any time soon Your hospital cover Excess Essentials Hospital has a $200 per adult excess. The excess applies once per adult per financial year on all same day and overnight admissions. Your hospital cover gives you For the limited range of services listed under What s covered you get: Choice of doctor and hospital 100% of agreement hospital charges (subject to your excess), including: Shared or private room Theatre fees Intensive care, critical care and high dependency unit Most drugs supplied in hospital 100% of public hospital charges (subject to your excess) Up to 100% of doctors fees, for services covered, if your doctor chooses to use Access Gap Up to 100% for prostheses on the Australian Government Prostheses List for services covered Treatment in a non-agreement private hospital will incur significant out-of-pocket expenses. What s covered Accidental injuries Removal of tonsils Removal of adenoids Removal of appendix Surgical tooth extraction Hernia repairs Joint investigations (arthroscopies) and minor joint repairs Joint reconstructions Colonoscopies Gastroscopies What s restricted Psychiatric treatment Rehabilitation Palliative care For these treatments you will only be covered as a private patient in a public hospital shared room. If you are treated anywhere else you will be significantly out-of-pocket. What s excluded All other hospital treatments Comprehensive ambulance cover You get 100% cover for ambulance services by state-appointed ambulance providers across Australia. And there s no limit on the number of times you can use the ambulance service when needed, including emergency services, non-emergency dispatch, mobile intensive care and air and sea ambulance services. Transport services by Patient Transport vehicles are not ambulance services and are not claimable. When you join Defence Health or upgrade your existing cover, you may have a waiting period before you can claim benefits. Most waiting periods are 2 months but some, such as pre-existing conditions, are 12 months or more. To see all waiting periods and get more information about making the most of your hospital and medical cover and what your hospital cover will not pay for go to Pg

23 Visit defencehealth.com.au Mix and match extras cover Three levels of extras cover to make looking after your health and wellbeing more affordable: Premier Extras, Value Extras and Essentials Extras. Each can lower or even remove your costs when you visit health and wellbeing providers like the dentist, chiropractor, physiotherapist and a range of alternative therapists. You re free to choose who treats you, and if you visit one of our many optical partners, you ll receive even greater benefits. And they can be added to your choice of three hospital covers for more complete protection. Plus, all our extras covers include 100% cover for ambulance services by stateappointed ambulance providers across Australia. And there s no limit on the number of times you can use the ambulance service when needed. Essentials Extras Don t want to pay for services you don t need? If you re only looking for basic cover at a low cost, then Essentials Extras is for you. Essentials Extras is ideal for young and healthy people who just want cover for the basics including general dental, preventative dental, surgical extractions, physiotherapy, chiropractic/osteopathic, alternative therapies and travel vaccinations. And you ll get 100% back on glasses (up to $170 per person) at our optical partners. To help you decide which cover is best for you, take a closer look at what each level offers. Remember, the higher your level of cover, the more services you ll be covered for and the greater your benefits can be. Premier Extras Our Premier Extras cover gives you comprehensive cover on a wide range of services with our highest individual annual limits. If you have frequent or planned treatment, especially for complex dental services, then Premier Extras will give you the most money back. Plus there s no annual limit on general dental and no lifetime limit on orthodontic treatment. Premier Extras gives you 100% back on initial consultations for most therapies. You also get 100% back on glasses (up to $300 per person) at our optical partners and up to $1500 every 2 financial years for laser eye surgery to help you become glasses free. Get a quote Go to defencehealth.com.au or call us on Value Extras If you want to be covered for a wide range of services at a more affordable price, then Value Extras is for you. Value Extras is great value for money and perfect for those that want cover for more than just the basics. You ll get 100% back on glasses (up to $255 per person) at our optical partners. There s no annual limit on general dental and no lifetime limit on orthodontic treatment. ADF and active Reservists 21