Claiming conditions

  • A claim for benefits must be lodged within two years of the date of the service. Benefits will be refused if a claim is lodged after this period.
  • For Defence Health to assess your claim all account/receipts must be originals and on the provider’s letterhead or showing the provider’s official stamp (or provider endorsed duplicates) and include the:
 
  • appropriate item number or full description of the service or product
  • patient's name
  • date of service
  • fee charged
  • provider's name, qualifications and practice address, and
  • provider number (if applicable).
  • Tooth numbers are required on dental accounts where treatment has taken place on individual teeth.
  • Alternative therapy providers must be recognised by the Australian Regional Health Group at the time the service is provided.
  • Benefits and limits are assessed having regard to the date on which the services were rendered or product supplied except for courses of orthodontic treatment and first aid training.
  • Limits renew each financial year (1 July to 30 June).
  • Services must be provided by approved practitioners in private practice or salaried doctors in public hospitals.
  • All documents submitted in connection with a claim become the property of Defence Health, unless otherwise agreed by the Fund.
  • Benefits are not payable for claims for services rendered while premiums are in arrears or the membership is suspended.
  • Benefits are not payable, or may be payable at a reduced rate, during any applicable waiting periods.
  • Benefits are not payable for claims for services rendered outside Australia or for items purchased or hired from overseas suppliers.
  • Benefits are not payable on claims subject to compensation, third party or other liability provision.
  • Benefits are not payable for treatment rendered by a provider to:
 
  • the provider’s spouse, defacto, partner, dependants, or business partner, or
  • the spouse, defacto partner or dependants of the provider’s business partner.
  • Extras benefits are not payable for services rendered in a public hospital.
  • Extras benefits are not payable were Medicare has provided a benefit.
  • Extras benefits are not payable for pharmaceuticals not related to a medical condition; that can be purchased without a script; or that have been supplied to a hospital inpatient.
  • Medically prescribed health appliances are payable when recommended by a physiotherapist, chiropractor, osteopath, podiatrist, chiropodist, occupational therapist or medical practitioner for a medical condition. Custom-tailored foot orthoses are only claimable when supplied by an orthotist, podiatrist or chiropodist.
  • NSW and ACT members with hospital cover should forward their ambulance accounts to Defence Health for endorsement, then send them to the administrator of their State scheme.

 
 

Claiming conditions

  • A claim for benefits must be lodged within two years of the date of the service. Benefits will be refused if a claim is lodged after this period.
  • For Defence Health to assess your claim all account/receipts must be originals and on the provider’s letterhead or showing the provider’s official stamp (or provider endorsed duplicates) and include the:
 
  • appropriate item number or full description of the service or product
  • patient's name
  • date of service
  • fee charged
  • provider's name, qualifications and practice address, and
  • provider number (if applicable).
  • Tooth numbers are required on dental accounts where treatment has taken place on individual teeth.
  • Alternative therapy providers must be recognised by the Australian Regional Health Group at the time the service is provided.
  • Benefits and limits are assessed having regard to the date on which the services were rendered or product supplied except for courses of orthodontic treatment and first aid training.
  • Limits renew each financial year (1 July to 30 June).
  • Services must be provided by approved practitioners in private practice or salaried doctors in public hospitals.
  • All documents submitted in connection with a claim become the property of Defence Health, unless otherwise agreed by the Fund.
  • Benefits are not payable for claims for services rendered while premiums are in arrears or the membership is suspended.
  • Benefits are not payable, or may be payable at a reduced rate, during any applicable waiting periods.
  • Benefits are not payable for claims for services rendered outside Australia or for items purchased or hired from overseas suppliers.
  • Benefits are not payable on claims subject to compensation, third party or other liability provision.
  • Benefits are not payable for treatment rendered by a provider to:
 
  • the provider’s spouse, defacto, partner, dependants, or business partner, or
  • the spouse, defacto partner or dependants of the provider’s business partner.
  • Extras benefits are not payable for services rendered in a public hospital.
  • Extras benefits are not payable were Medicare has provided a benefit.
  • Extras benefits are not payable for pharmaceuticals not related to a medical condition; that can be purchased without a script; or that have been supplied to a hospital inpatient.
  • Medically prescribed health appliances are payable when recommended by a physiotherapist, chiropractor, osteopath, podiatrist, chiropodist, occupational therapist or medical practitioner for a medical condition. Custom-tailored foot orthoses are only claimable when supplied by an orthotist, podiatrist or chiropodist.
  • NSW and ACT members with hospital cover should forward their ambulance accounts to Defence Health for endorsement, then send them to the administrator of their State scheme.

 
  • Bookmark
  • Email
  • Print

Get covered today

Join now

Compare a product

Not sure what product to choose? Compare products to help you choose the right plan.

Compare a product

Get a quick quote

Not too sure what cover you need? Perform a quote to find cover suitable for you.

Get a quote