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.
Medical providers with Access Gap
If your doctor is participating in Access Gap, they should send the Access Gap account for your medical treatment directly to Defence Health.
If your doctor sends the account to you, just forward it to us.
Medical providers paid in advance
If your provider requests that you pay the full cost of your procedure upfront, you must first submit your claim to Medicare.
For more information on how to submit your claim, please visit the Medicare website.
Medical providers not participating in Access Gap
If your doctor is not participating in Access Gap, follow the steps below to submit your inpatient medical claim.
- Submit your claim to Medicare.
- After Medicare assessment, download the Statement of Benefits via myGov.
- Download the Defence Health app.
- Send us your Medicare Statement of Benefits via the app.
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. You must also send us your Medicare Statement of Benefits for your claim to be processed.
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:
- Complete the Accident Questionnaire on page 2 of the Claim Form
- 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.
- 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.