Hospital and medical charges
If you go to hospital there will be a number of charges relating to your treatment. The hospital will charge for your accommodation and use of its facilities (even if you do not stay overnight). Your doctor and other practitioners (such as pathologists or anaesthetists) will charge for the medical services they provide while you are an admitted patient.
You should take your member card with you if you are going to hospital. In most cases when you are discharged from hospital Defence Health will settle your accommodation account directly with the hospital.
If your hospital stay:
- Was subject to any waiting periods, or
- Involved the payment of an excess, or
- Involved any personal expenses such as telephone calls or newspapers
then you will be responsible for these expenses and the hospital may ask you for payment on admission or discharge. If you have Public Hospital cover and choose to be treated in a private hospital, you will have significant out-of-pocket expenses.
If you have the ADF Essentials Package, Essentials Hospital or Value Hospital cover and your treatment is excluded, you will have to pay for the procedure yourself.
If you choose to be a private patient in a public hospital, you will have out-of-pocket expenses if the hospital charges are greater than the Defence Health benefit.
Your excess (if you have one) will vary depending on your product. Check your certificate of cover to find out if an excess will apply.
If you have an excess, it will apply to same day procedures as well as overnight admissions. No excess is payable for children. If you are unsure how your excess applies please give us a call.
Please note that you will not be covered for treatment in a hospital emergency department or treatment not provided in Australia.
As a private hospital patient, Medicare will pay 75% of your doctors’ fees, as determined on the Medicare Benefits Schedule (MBS) and Defence Health will pay the remaining 25% of the MBS fee. However, many doctors charge more than the MBS fee.
You should encourage your doctor to use Access Gap Cover to help minimise or avoid any out-of-pocket expenses on your in-hospital doctor’s fees.
Access Gap enables Defence Health to provide a higher benefit in return for your doctor agreeing to charge a no-gap or reduced-gap fee. If your doctor agrees, the most you will be out-of-pocket is $400 for each Medicare item number or $800 for obstetric services.
Your doctor must inform you, prior to treatment, of any amounts payable by you. Access Gap accounts must be sent directly to Defence Health.
If the doctor elects not to use Access Gap the claim should first be sent to Medicare and then forwarded, with the Medicare statement, to Defence Health.
Medical benefits are not payable for treatment by a family member or business partner.