How to claim
We recommend you contact Defence Health for a benefit estimate before commencing treatment. Benefits will not be payable for services that are claimable from another source such as Workers Compensation, a third party or other liability provision. For full claiming conditions see the claiming conditions page.
Hospital claims
In most cases when you are discharged from hospital, Defence Health will settle your account directly with the hospital.
If your hospital stay was subject to any limitations or waiting periods, or involved the payment of an excess as defined by your level of cover, or any personal expenses (phone calls, newspapers etc.), then you will be responsible for the expense and the hospital may require payment on admission.
In-hospital medical claims
You should encourage your doctor to use Access Gap Cover to help minimise or even avoid any out-of-pocket expenses on your doctors’ fees. In most cases your doctor will send the Access Gap Cover account directly to Defence Health. If for any reason, your doctor gives the Access Gap Cover account to you rather than sending directly to Defence Health, then please forward it to us.
No-Gap Agreement doctors will bill Defence Health directly.
All other in-hospital medical bills should be forwarded directly to Medicare. Following the Medicare assessment you should send the Medicare statement to Defence Health so we can cover the difference between the Medicare rebate and the Medicare Benefits Schedule (MBS) fee. Any amount above the MBS fee will need to be paid by you.