Benefit changes April and July 2021

Changes from 1 April

New treatment included in Core Hospital Silver – now Core Hospital Silver Plus 

From 1 April 2021, we’re boosting the clinical treatment categories included in Core Hospital Silver. We’re adding cover for sleep studies and insulin pumps; and moving rehabilitation to palliative care, in a private hospital, to unrestricted. Rehabilitation and palliative care were previously restricted under this cover - meaning members would only be partially covered for hospital costs as a private patient in a public hospital. Because of the new treatment categories the cover will be renamed to Core Hospital Silver Plus. No additional waiting periods apply to new treatment categories. 

 

New treatment included in Everyday Hospital Bronze Plus

We’re adding more value into Everyday Hospital Bronze Plus cover. From 1 April 2021, members will be covered for five additional treatment categories: lung and chest; sleep studies; blood; back, neck and spine; and podiatric surgery (provided by a registered podiatric surgeon). No additional waiting periods apply to new treatment categories.

 

Orthodontic benefit increase 

From 1 April 2021, we're lifting the benefits for two orthodontic item numbers to allow you to claim up to your orthodontic annual limit for a course of treatment - regardless of whether you pay upfront or in instalments.

The two items are 825: sequential plastic aligners – per arch; and 831: full arch banding per arch.

Benefits for an appliance (such as a retainer) are payable once per item, per person each financial year. We’re correcting a system error that allowed some members to claim multiple benefits for the same orthodontic appliance in the one year.

 

ADF Total Package Gold is moving to state-based pricing

To ensure we're providing fair and equitable support to all currently serving members, we are changing the premium on the ADF Total Package Gold cover to be state-based, rather than national pricing.

This means if you're posted or relocate to a different state your premium may change in line with the health care costs in that state.

Depending on where you live, your premium change from 1 April 2021 may be slightly higher or lower than the premium you're currently paying. 

 

COVID-19 Member Support Program: Telehealth benefit consultations

Part of our pandemic response was to introduce telehealth consultation benefits. We’re pleased to say telehealth consultations will be permanently added to the benefit schedule for speech therapy, psychology and dietetics on eligible covers. Members can continue to claim telehealth consultation benefits for physiotherapy, exercise physiology and occupational therapy as part of our COVID-19 Member Support Program until 30 September 2021.  

We will also continue to cover all members with hospital cover – regardless of their level of cover – for COVID-19 related treatment in a private hospital.

Changes from 1 July

Changes to the flexi-limit category

Physiotherapy, chiropractic/osteopathy and pharmacy benefits are moving out of the flexi-limit tent and into their own standalone limits. From 1 July 2021, members on our ADF Total Package Gold, Premier Extras and Value Extras will have new annual limits for these important health services.

Consultation benefits for the above treatment categories and those remaining in the flexi-limit category will decrease (by $3 per consultation for most services and $20 per pharmacy prescription), though the flexi-limit annual limit will not change.

Benefit change summary:

.

ADF Total Package Gold

Premier Extras

Value Extras

Existing flexi-limit $1000 $1300 $900
New physio limit $850  $850 $600
New chiro/osteo limit $750  $750 $550
New pharmacy limit $400  $500 $400
Benefits payable reduction from 1 July
  • $3 per consultation for most services
  • $20 per pharmacy script

Please review change summary here

  • $3 per consultation for most services
  • $20 per pharmacy script

Please review change summary here.

  • $3 per consultation for most services
  • $20 per pharmacy script

Please review change summary here.

1 July 2021
product guide 
 ADF Total Package Gold  Premier Extras  Value Extras 

 

Changes to Top Extras consultation benefits

From 1 July, some of the benefits payable on Top Extras will reduce by $1–$2 per consultation. The benefit payable for non-PBS pharmacy claims will decrease by $20 per script.

Click here to view a summary of the consultation benefits and here to view the 1 July Top Extras product guide.