Submitting your claims

Depending on your doctor or medical provider, the process for submitting a claim for hospital and medical cover may vary.


Inpatient claims after a hospital admission

When you’re discharged from hospital, Defence Health will generally settle your account directly with the hospital. You should only be required to pay any applicable excess or incidentals during your admission.

The medical costs for your admission will depend on your medical provider. If your provider is participating in Access Gap, they should send the Access Gap account for your medical treatment directly to Defence Health. If it is sent to you, just forward it to us. 


How to claim with a non-Access Gap provider

If your doctor does not participate in Access Gap, you’ll need to have your claim assessed by Medicare first before claiming with us. This can be done by submitting a Medicare Two-way claim form or a Medicare Statement of Benefits by EFT, as outlined below.

If you're submitting a Medicare Two-way claim form

This is used when both Medicare and Defence Health are involved in your claim. Medicare processes the claim first, then sends it to us so we can assess and pay any remaining benefits.


  1. Complete a Medicare Two-way claim form
    • Tip: Select yes when asked if you want to claim the private health insurer medical gap benefit.
  2. Submit the Medicare Two-way claim form, along with your paid medical invoice to Medicare. To do this, you can:
    • Log in to your Medicare online account through myGov or the myGov app,
    • Visit your local Medicare service centre, or
    • Send your documents via Post to the address on the Medicare Two-way claim form.

      Please note: To submit your claim at a Medicare service centre or via Post, you also need to complete a Medicare Claim Form
  3. Medicare will process the claim, pay their benefit, and electronically send it to us for processing.
  4. You will receive two benefit payments into your nominated bank account. This will include a payment from Medicare and a payment from Defence Health.

If you're submitting a Medicare Statement of Benefits by EFT

This option applies when you’ve already paid for a medical service and want to claim your rebate from Medicare. You submit the claim yourself, and the rebate is paid directly to you.


  1. Submit your paid medical invoice to Medicare, with a signed Medicare claim form
  2. After Medicare assessment, download the Medicare Statement of Benefits by EFT from your myGov inbox. You must provide us with this document for your claim to be processed.
  3. Once you've downloaded your Medicare Statement of Benefits by EFT, you can:
  4. Your claim will be processed within 5-7 business days. For help submitting your claims, contact us on 1800 355 425.

Please note that inpatient claims cannot be submitted through the Member Portal.

Accidental injury claims

In the event of an accident, you may still be eligible for cover even if you're serving waiting periods or your treatment category isn't included in your level of cover. Check your Product Guide for more details. 

Follow the steps below to lodge your claim:

  1. Complete the Accident Questionnaire on page 2 of the Claim Form
  2. Ask your treating medical practitioner for a letter confirming the date of the accident, the date the treatment was sought, and that the treatment was directly related to the accident. Your initial treatment must occur within 72 hours of the accident, and your hospital admission must be within 180 days of the accident and a direct result of injuries sustained in the accident.
  3. Send us the completed Accident Questionnaire and letter from your medical practitioner via email at claims@defencehealth.com.au or post to Defence Health PO BOX 7518 Melbourne VIC 3004.



Outpatient claims

Consultations where you were not admitted to hospital are outpatient services and cannot be claimed under your hospital cover. Any eligible outpatient services with a Medicare item number can be claimed through Medicare.  

For more information, log into your Medicare portal through your myGov account or contact Medicare directly.