Benefit and premium changes

Benefits get better from April 2015.

We’re constantly looking at ways to enhance the flexibility, value and benefits of Defence Health membership. Sometimes that involves increasing the benefit payable on different treatment options. Sometimes we need to respond to changing claiming patterns. And sometimes it involves introducing new benefits.

From 1 April 2015 we’re making some changes in all of these areas.

Affordable access to dental treatment is a very important element of general health. This year we’ve increased many dental benefits across the board; boosted major dental limits on two of our new extras covers; and introduced a free mouthguard for children on our most popular family extras products.

We’re very excited about another two new benefits: a health and wellbeing quit smoking benefit on some of our combined hospital and extras covers; and if you have Premier Extras, a benefit for joint fluid replacement to assist people with chronic joint pain and osteoarthritis.

Online claiming recently had an overhaul. The process is now much easier, without the need to scan and upload receipts. So that will be a relief for many members. Just remember to file your receipts away for 2 years in case we need them later.

If you’d like more details of what’s changing specifically for you, please refer to the flyer we sent you in the post. If you need another copy send us an email at [email protected] or call us on 1800 335 425 and we’ll send one out to you.

We have put together a selection of frequently asked questions about the April 2015 premium and benefit changes. If you have any other questions please give us a call on 1800 335 425.


Premium change

  • 1. Why has my hospital premium increased again?

    The amount we pay in hospital and extras benefits is increasing. This reflects the rising cost of health care and medical technology in hospitals, as well as the benefits we pay for non-hospital treatment like dental, physio, chiro and optical.

    In addition to the increasing cost, more people are claiming and many are claiming more frequently.

  • 2. Why is my increase more than the inflation rate?

    The benefits paid by Australian health funds for private hospital treatment increased by 9.1% last year. And general treatment, such as dental and physio, increased by 9.6%. Specialists’ fees increased by 6.9%.

    These increases are much more than the inflation rate. But they are the costs that we must meet. We’ve done whatever we can to absorb some of the increase in cost. That’s why our premium rise is smaller than many other funds.

    Our premiums have increased by 5.62% on average, compared with the industry weighted average of 6.18%. This is an average and some members will have a higher or lower increase. The increase in your individual premium is also before the government rebate or Lifetime Health Cover loading is applied. See question 5 about how the rebate is calculated.

  • 3. Can I pay my premium in advance?

    Yes. Any amount you pay before 1 April 2015 will be applied at the old premium rate. Defence Health can only accept payments up to 12 months in advance.

  • 4. When does the increase take effect?

    From your first payment on or after 1 April 2015 the new premiums will apply. Any payments you make before this date will be treated under the old premium structure.

    If you have a payment due before 31 March, it is important that we receive it before then to ensure it is processed under the old rates.

  • 5. How is the rebate calculated?

    The government adjusts the rebate on 1 April each year, using a Rebate Adjustment Factor linked to the Consumer Price Index.

    As premiums tend to rise more than the inflation rate, the percentage of rebate you receive will decrease each year. This year the rebate most people will receive will drop from 29.040% to 27.820%.

    In last year’s budget the government announced that income thresholds for the Australian Government Rebate will be frozen for three years at the 2014-15 levels.

    Some members might receive a lower rebate as a result of ‘creeping’ into the next income tier.

  • 6. Can I elect a different tier of rebate?

    Yes. The level of rebate you are eligible for depends on your age and annual ‘income for surcharge purposes’.

    You can change your rebate tier according to your income or age bracket by logging on to the Member Area of our website. Or you can call us and we can change your rebate tier for you.

Benefit changes from 1 April 2015

  • 7. Have my benefits changed?

    All our members with extras cover will get more back when they visit the dentist. And family limits have been removed from all our physio, chiro, psychology and alternative therapy benefits.

    Any other changes to your cover are outlined in the brochure with your premium letter.  

  • 8. I want to quit smoking. What benefits are available to help me?

    All combined hospital and extras cover (except for ADF Essentials Package, Essentials Extras or Standard Extras) now includes a benefit to help smokers quit the habit.

    The benefit varies according to the level of cover, but will be payable for approved nicotine replacement therapies and quit smoking programs.

    These include:

    Nicotine replacement therapy:

    Nicotine patches, gum, lozenges, mouth spray and inhalators

    Claims must be made with an official, itemised pharmacy receipt which includes the patient name.

    Quit smoking programs:

    Allen Carr’s Easy Way to Stop Smoking


    Claims must be made with an official program receipt which includes the patient name.  Benefits are not payable for purchases such as books or CDs, or for nicotine replacements purchased from the supermarket.

    Benefits are not payable on medication subsidised under the Pharmaceutical Benefits Scheme. Prescribed non-PBS medications will continue to be claimable through your extras pharmacy benefits.

    The quit smoking benefit will help members make a healthy lifestyle change, as well as reduce the number of preventable hospital claims in the future.

  • 9. What is joint fluid replacement?

    It’s is an injection of liquid that helps lubricate and cushion a joint, and can provide up to six months of osteoarthritis pain relief.  It can also help delay the need for joint replacements and can help improve quality of life.

  • 10. Will I have to serve a waiting period before claiming the new benefits?

    On 1 April all members will be able to claim the higher benefits immediately, provided they have served the relevant waiting periods on their current level of cover. New members or upgrades after 1 April will have to serve the normal waiting periods to be entitled to the benefits.

  • 11. Why did you remove First Aid benefits (Top Extras only)?

    The Private Health Insurance Act only allows benefits for treatment of particular health conditions. First Aid is a valuable skill, but not viewed by the government as a treatment. We removed the first aid benefits to ensure our products comply with the Act.

Members Owned Health Fund