Health insurance for ADF and active Reservists. We look after you like family.

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Issued April 2015

We look after

you like family.

Health insurance

for ADF and active Reservists

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Introduction 1

Members Own Health Fund 2

Who’s eligible to join 3

Why you’re better off with private health insurance

4

Types of cover 6

Finding the right cover for you 7

Specially designed ADF packages for permanent ADF and active Reservists

9

ADF Total Package 10

ADF Essentials Package 14

Hospital cover 16

Extras cover 21

Get the lowdown 29

Important information 33

Making the most of the Australian Government’s initiatives

34

More ways we treat you like family 36

How to join the family 37

Members Own Health Funds, like Defence Health, exist to benefit members, not to profit investors or overseas owners. This means you’ll be treated as a member, not a number. We deliver better service, have higher member satisfaction and loyalty and receive fewer complaints than for-profit and overseas owned funds.*

For more than 60 years, Defence Health has been committed to looking after our members’ wellbeing by providing great value health insurance along with genuine care, support and expertise. We don’t have shareholders so there’s more to share with you.

As the largest health insurer for ADF families and the wider Defence community, our members are our priority. It’s this commitment to the entire Defence community that has seen Defence Health grow into the family we are today. We are uniquely Defence Health and being a Members Own Health Fund just emphasises this difference.

*Refer www.membersown.com.au for the detailed report supporting these facts.

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Who’s eligible

to join

ADF families

ADF partners and families and active Reservists, their partners and families can all join Defence Health. If you’re a member of the permanent ADF you don’t need to cover yourself but you can cover your partner and/or child(ren). We have designed two hospital and extras packages just for you, which offer two levels of protection and the best value for money. But if these packages don’t meet your needs you can mix and match from our standalone covers at special ADF prices.

Go to Pg 9 to see the ADF packages.

What does active Reservist mean?

Active Reservist means a person who is actively serving in the Army Reserve, Air Force Reserve or Naval Reserve of Australia. This includes standby active Reservists who are engaged in 20 or more paid training days per financial year.

Other Defence connections

Your work colleagues and extended family may be eligible to join too if they fit within one of the following categories.

Past Service

All those who have previously served in the ADF (full-time or part-time) and their partners and children

ADF supporters

Anyone who works or has worked in the Dept of Defence and other Defence-related departments

Anyone who works or has worked for a Defence supplier – a company or agency contracted to the Department of Defence, where you are or were involved in the supply of goods and services to Defence

Extended families of all above

If you’re the mum or dad, son or daughter, sister or brother, grandchild or ex-spouse/partner of a serving or ex-serving member of the ADF or of an ADF supporter (described above)

We’ve got a different brochure for those in the wider Defence community. Visit our website to download it or call us on 1800 335 425 and we’ll send you a copy.

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Why you’re better

off with private

health insurance

Manage your health costs

Manage the costs of hospital admissions and medical treatment and enjoy money back on extras.

Control your care

Choose your doctor, specialist and the hospital you’re treated in.

Skip the queues

Avoid public hospital waiting lists and get the treatment you need sooner.

Maximise Government incentives

Access the Australian Government Rebate on private health insurance which can reduce the premium you pay.

Avoid the Lifetime Health Cover loading

Take out hospital cover by July 1 after turning 31 and you can avoid paying a Lifetime Health Cover loading.

Reduce your taxes

Higher income earners can avoid paying the Medicare Levy Surcharge by taking out hospital cover.

Money back on extras

Get money back when you visit dentists, physios, optometrists and others.

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Why you’re better

off with Defence Health

Special features for ADF

and active Reservists

Exclusive ADF packages with national pricing

Our special packages offer national pricing which means that no matter where your posting takes you, your premium stays the same. And our ADF Total Package also offers higher benefits on dental, speech therapy, physiotherapy, psychology, antenatal and postnatal services and more.

Special prices on mix and match range

All permanent ADF and active Reservists get special pricing for our mix and match hospital and extras covers, just in case the ADF packages don’t meet your needs.

Suspension of health cover

ADF personnel can suspend their cover for up to 24 months when they are sent overseas on an accompanied posting. Active Reservists on continuous full-time service (CFTS) for more than 28 days can also suspend their cover for the full duration of the service.

Transition discount for discharging ADF

Discharging permanent ADF personnel, who aren’t becoming active Reservists, receive a 10% discount on hospital or hospital and extras from our mix and match range in their first year, as long as it’s paid for by direct debit.

No waiting periods for discharging ADF

All waiting periods are waived for those who join within two months of discharging from the permanent ADF.

Special features for our

whole family

Low management costs

Because we have low management expenses, we can keep your premiums lower and return more in benefits.

Not-for-profit

To us, family is the most important thing. That’s why we’re not for profit and all for the benefit of our members.

Comprehensive ambulance cover

Every policy includes 100% cover for ambulance services by state-appointed ambulance providers across Australia. And there’s no limit on the number of times you can use the ambulance service when needed.

One of the largest hospital networks

We have agreements with over 500 hospitals around the country. This significantly reduces your out-of-pocket expenses. So no matter where you are, your closest private hospital will almost certainly be contracted to us.

Great optical benefits

Members with extras cover can get no-gap glasses from our optical partners, Specsavers and VSP Vision Care. Our extensive optical network reaches far and wide with over 600 providers around the country.

No waiting when you switch

If you switch from another insurer with an equivalent level of cover, we recognise any waiting periods you’ve already served. So you can make claims right away.

Simple claiming

You can claim your extras on the spot, online, or on your mobile or tablet with our free app.

Over 60 years of service

We were created to support the families of those who defend our country. After 60 years, as Defence has grown, our family has also grown. And now we embrace everyone with a Defence connection.

Excellent service

We never forget we’re dealing with your health and wellbeing. We listen to you, and offer the protection you want. Our members are more than a name or a number: they’re just like family.

Supporting the Defence community

We support the Defence community through sponsorships of Defence community groups and organisations like Defence Families of Australia and Defence Special Needs Support Group.

Funding for medical research

We established the Defence Health Foundation in 2010 to fund medical research aimed at helping ADF serving and ex-serving personnel and their families. Just another way we support the Defence community.

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Types of cover

We offer ADF packages that combine hospital and extras, and a range of hospital covers and extras covers that can be mixed and matched to meet your needs.

ADF packages

Our ADF Total Package and ADF Essentials Package are just for permanent ADF and active Reservists, their partners and families. They offer different levels of protection based on your needs and are the best value for money options.

Standalone cover for mixing

and matching

If the ADF packages don’t meet your needs you can always choose from our mix and match hospital and extras covers. Permanent ADF and active Reservist members get special pricing on the mix and match range.

Hospital cover

Hospital cover helps lower or remove your costs when you’re a private patient in hospital. We have three levels of hospital cover, Premier, Value and Essentials. The level you choose determines the number and types of procedures and services you’re covered for. The higher your level of cover, the more you’ll be covered for.

Extras cover

Extras cover helps lower or remove your costs when you visit health and wellbeing providers whose fees aren’t covered by Medicare. They include dentists, chiropractors, physiotherapists, a range of alternative therapists and much more. We have three levels of extras cover – Premier, Value and Essentials. The higher your level of cover, the more services you’ll be covered for and the lower your out-of-pocket expenses will be.

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Where you’re at Need and wants Recommended product You might like to consider

Young, fit and healthy singles and couples

I just need basic cover

I don’t want to pay for services I don’t need I want low cost cover

I want to avoid government penalties

ADF Essentials Package (Pg 14)

Essentials Hospital (Pg 20) +

Essentials Extras (Pg 28)

No kids, none planned any time soon

I want well priced cover with more than the basics

I want good benefits

ADF Total Package

(Pg 10) Value Hospital (Pg 19) + Value Extras (Pg 26) Planning a family _{We want cover for pregnancy and assisted}

reproductive services

We need cover that can protect a growing family

ADF Total Package (Pg 10)

Premier Hospital (Pg 18) + Value Extras (Pg 26) Young family

on a tight budget We don’t want to spend too much The health and wellbeing of our family

is important but we’re willing to have a few exclusions on unlikely treatments to keep premiums affordable

Value Hospital (Pg 19) + Value Extras (Pg 26)

Established family _{We need cover for a wide range} of services

We are looking for value for money

Premier Hospital (Pg 18) + Value Extras (Pg 26) My health and the

health of my family is not worth risking

I want the best cover for total peace of mind

Being in control of my health is vital to me

My family’s wellbeing is my priority

ADF Total Package

(Pg 10) Premier Hospital (Pg 18) + Premier Extras (Pg 24)

Older and wiser _{I want to be well covered just in case} We want to get the treatment we need

as soon as we need it

Premier Hospital (Pg 18) + Premier Extras (Pg 24)

Finding the right cover for you

See if you can identify yourself in our guide below. Or you can read

about all our covers in the pages ahead.

Get a quote

Go to defencehealth.com.au

or call us on 1800 335 425

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Favourite features about

our health insurance

Excess options that lower

your premium

We’ll reduce your premium if you choose to pay an excess when you go to hospital. The higher your excess, the lower your premium.

Reduce your out-of-pocket

expenses

Agreement private hospitals

Be treated in one of our agreement private hospitals to significantly reduce your out-of-pocket expenses. We have agreements with over 500 hospitals around the country that ensure the majority of hospital charges are covered when you’re admitted either for day procedures or overnight. For a full list of agreement hospitals, visit defencehealth.com.au.

Access Gap

If your Doctor agrees to participate in our Access Gap scheme you can reduce or eliminate your medical out-of- pocket expenses. You can find doctors who participate at defencehealth.com.au

This scheme works on the basis that Defence Health will pay your doctor more on the condition they agree to charge you a no-gap or capped gap fee.

No-gap fees on a number of diagnostic services

We’ve negotiated no-gap agreements with a number of diagnostic service providers such as radiologists and pathologists. If you receive their services in hospital, there’s no cost to you. They send their bill directly to us and we take care of it for you.

Family favourites

No excess for children

If you have a policy that covers your family, you’ll never have to pay the hospital excess for your children.

No waiting periods for newborns

We know there is a lot to think about when you’re having a baby and sometimes, in all the excitement, it is easy to forget your health insurance. So as long as you contact us before your baby is 2 months old, we’ll add them to your cover with no waiting periods. We even allow backdating of the policy to the day of your baby’s birth so treatments within those first two months are covered.

Cover for older kids

We’ll cover kids on your policy until they’re 21. And if they’re single and studying full-time, we’ll cover them until they’re 25.

Young Adult Support Plan

If your older kids are single and not studying full-time, they can remain on your family hospital policy until they’re 25 if they take out their own Value Extras cover.

Health programs

Members with ADF Total Package, Value Hospital or Premier Hospital have access to a number of programs and services that help you look after your health and wellbeing.

Hospital substitute treatments

If your doctor agrees, you could avoid the hassle and inconvenience of going to hospital for certain treatments. Depending on where you live, they can arrange for health care providers to come to your home to deliver services such as wound management, intravenous therapy, and ambulatory sleep studies.

Home nursing

Where your doctor is able to substitute hospital admission with home nursing, we’ll pay a benefit for a registered nurse to care for you in your home.

Midwifery

We’ll pay a benefit for a registered midwife in private practice to attend the delivery of your baby. Midwifery benefits are not payable if a doctor is required to intervene in the delivery. Benefits will be payable for the doctor’s in-hospital treatment instead.

Chronic care

Our chronic disease management programs provide telephone-based support for members who have had a hospital admission relating to heart disease or type 2 diabetes and meet program eligibility. Our program coordinators work with treating practitioners to support existing treatment and aid recovery.

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Specially designed

ADF packages

for permanent

ADF and active

Reservists

We’ve combined the best of our hospital and extras covers – and some – into two convenient packages just for the partners and children of permanent ADF, and for active Reservists and their partners and children. You’ll also enjoy national pricing which means that no matter where your posting takes you, your premium stays the same.

ADF Total Package

Our ADF Total Package gives you complete protection with comprehensive hospital cover and access to a wide range of extras services with generous annual limits. This package is perfect for those that want comprehensive cover at a great value price.

The ADF Total Package has been specially designed with permanent ADF and active Reservist families in mind so you can be sure we’re looking after you.

ADF Essentials Package

Our ADF Essentials Package provides cover for common treatments that young and healthy singles and couples are likely to need.

This is a low cost package so it’s great if you’re on a budget or if you’re looking for a basic hospital cover to avoid Government penalties but still want to get something back for your money.

Comprehensive ambulance cover

Both packages include 100% cover for ambulance services by state-appointed ambulance providers across Australia. And there’s no limit on the number of times you can use the ambulance service when needed.

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ADF Total Package

The ADF Total Package has been specially designed with permanent ADF and active Reservist families in mind. It gives you our best protection with comprehensive hospital cover and access to an extensive range of extras services with generous annual limits.

Your hospital cover

What’s covered

Joint reconstructions and repairs Joint replacements

Colonoscopies and arthroscopies Heart and artery related services Pregnancy related services

Assisted reproductive services (e.g. IVF and GIFT) Psychiatric and rehabilitation services

And all other Medicare-approved treatments

Excess options

You can reduce your premium by electing to pay an excess if you go to hospital.

Your excess options are $200 or $400 per adult. The excess applies once per adult per financial year on all same day and overnight admissions. No excess is payable for dependent children.

Your hospital cover gives you

Choice of doctor and hospital

No exclusions on any Medicare-approved treatment 100% of agreement hospital charges (subject to your

excess), including: – Shared or private room

– Theatre fees, including labour ward

– Intensive care, critical care and high dependency unit – Most drugs supplied in hospital

100% of public hospital charges (subject to your excess) Up to 100% of doctors’ fees if your doctor chooses

to use Access Gap

Up to 100% for prostheses on the Australian Government Prostheses List

Health programs, for services not covered by Medicare, which include up to $2000 for midwife delivery services, and up to $100 per day for home nursing ($2000 max) Get hospital substitute treatment in your home

for treatments such as wound management, and intravenous therapy, through selected hospitals Treatment in a non-agreement private hospital will incur significant out-of-pocket expenses.

What’s restricted

No hospital services are restricted

What’s excluded

Services where Medicare pays no benefit (e.g. most cosmetic surgery)

When you join Defence Health or upgrade your existing cover, you may have a waiting period before you can claim benefits.

Most waiting periods are 2 months but some, such as pre-existing conditions, are 12 months or more. To see all waiting periods and get more information about making the most of your hospital and medical cover and what your hospital cover will not pay for go to Pg 29.

Favourite features

Comprehensive ambulance cover

Enjoy peace of mind with comprehensive hospital cover

National pricing means you pay the same great price no matter where you’re posted

No excess for kids

No exclusions on any Medicare-approved treatment One free mouthguard, custom-fitted by a dentist,

every year for kids

No annual limit on general dental treatment No lifetime limit on orthodontics – keep claiming

every year for the full course

100% back on initial consultations for most extras therapies

Great no-gap glasses deals through our optical network – Specsavers or VSP Vision Care

Cover for laser refractive eye surgery if you want to be glasses free

Your kids stay covered to age 21. And if they’re single and studying full-time to age 25

Be there when your family

needs you

If you’re a permanent ADF member and your child or partner goes into hospital, we’ll pay your boarder fees so you can stay at the hospital too (boarder arrangements only available with selected hospitals).

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Your extras cover

Some dental items are limited in the number of times they can be claimed in a year. Some items are not payable in combination

with others. And some may not attract a benefit at all.

General dental

Month waiting period Annual limit – Unlimited

Periodic oral exam (012) Up to $41.85

Removal of calculus (114) Up to $74.50

Bitewing x-ray (022) Up to $30.30

Adhesive filling to one surface of a rear tooth (531)

Up to $85.85

Major dental

Month waiting period Annual limit – $950 per person

Surgical tooth removal (323) Up to $151.50

Root canal obturation (417) Up to $113.65

Veneer indirect (583) Up to $492.40

Full crown – veneer indirect (615) Up to $757.50

Endosseous implant (688) Up to $950.00

Orthodontics

Complete course of orthodontic

treatment (881) Up to $800.00

Unlike other funds there is no lifetime limit. You get $800

every financial year until your treatment is complete.

Passive removable appliance (811) Up to $150.25

Dental

Optical network partners 100%

Our optical network providers have extensive ranges of

no-gap glasses. Visit specsavers.com.au or vsp-australia.com.au for locations.

Specsavers VSP Vision Care

Single vision glasses 2 pairs no-gap 1 pair no-gap Bi/Multifocal glasses 1 pair no-gap 1 pair no-gap

Frames Discounted Discounted

Contacts (in store) 10% off 15% off

Benefits at non-network providers are limited: up to $90 for single vision lenses, up to $95 for ground single vision lenses, up to $105 for bi-focal lenses, up to $155 for multi-focal lenses, up to $95 for frames and up to $180 for contact lenses.

A sight-correcting script must accompany the claim. The no-gap glasses deals are based on standard lens options. Other lens choices are likely to involve an out-of-pocket cost. For the two pairs no-gap glasses deal, the second pair must be from the same or lower priced range and must be for the same prescription.

Optical

100% cover for ambulance services by state-appointed ambulance providers across Australia. This includes emergency services, non-emergency dispatch, mobile intensive care and air and sea ambulance services.

Transport services by Patient Transport vehicles are not ambulance services and are not claimable.

Ambulance treatment

Initial consultation 100%

Subsequent consultation Up to $40

Group therapy sessions

and classes Up to $15

Physiotherapy (including hydrotherapy)

Chiropractic x-rays (max 2) Up to $40

Chiropractic/Osteopathy

Antenatal course Up to $400

Antenatal consultations/classes Up to $40

Postnatal consultations/classes Up to $40

By a midwife or physiotherapist in private practice only. Treatment claimed through Medicare cannot be covered.

Antenatal & postnatal services

Group therapy Up to $25

Couple/family therapy Up to $30

Treatment claimed through Medicare cannot be covered.

Psychology

Per consultation Up to $30

Where the provider is recognised by the Australian Regional Health Group the following alternative therapies are payable: acupuncture, homeopathy, aromatherapy, myotherapy, naturopathy, remedial massage, remedial therapy, Chinese herbal

medicine and western herbal medicine. No benefit payable for

any prescribed medications, herbal or dietary preparations.

Alternative therapies & exercise physiology

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Your extras cover

– ₃₆ Month waiting period Annual limit – $1000 per person

36 month waiting period per person

Hearing aids* Up to $1000

CPAP machine* for sleep apnoea Up to $1000

Blood glucose monitor* Up to $400

Foot orthotics

custom-made or fitted by a podiatrist,

chiropodist or orthotist

Up to $300 Orthopaedic shoes

custom-made by specialist shoemaker Up to $300

Splints and braces

splints, knee/leg/spinal/lumbar/sacral/wrist/ ankle braces and surgical corsets only

Up to $250 Mobility aids*

wheelchairs, crutches, walking frames, walking sticks, rolling walkers, seat riser cushions, reaches and adjustable canes only

Up to $1000

Non-cosmetic prostheses Up to $1000

– Wig following a medical condition Up to $250 – External breast prostheses

following a mastectomy Up to $250

– Artificial eye* Up to $1000

per policy

Blood pressure monitor* Up to $250

TENS machine* Up to $250

Nebuliser* and spacer

for breathing conditions Up to $300

per item

Compression garments Up to $250

for purpose-made garments that aid burn management, post-surgical recovery, lymphoedema treatment and deep vein thrombosis prevention

Non-sight correcting Irlen lenses Up to $90

EpiPen Up to $150

Hearing aids and foot orthoses repair Up to $100

Rental of appliances Up to $150

including oxygen cylinders, soft collars, toilet seat risers, shower chairs, Continuous Passive Movement machines or any other appliance listed above

* Replacement or additional items are not claimable within 3 years of previous purchase.

Medically prescribed devices & supports

Group therapy sessions Up to $25

Speech therapy

Group therapy sessions Up to $25

Occupational therapy

Podiatry/chiropody

Audiology

Eye therapy

Dietitian

Month waiting period Annual limit $1000 per person every 2 financial years

Up to $1000 per person is payable for LASIK or PRK eye surgery in a recognised day surgery centre.

Laser refractive eye surgery

No waiting period Annual limit – $600 per person

Up to $600 per person for health care gap costs resulting from a school accident to your child excluding Medicare services.

School accidents

Benefits paid on approved programs and nicotine replacement therapies.

Benefits will not be available for medicines/drugs subsidised

by the Australian Government under the PBS. An itemised pharmacy receipt with the patient’s name must be provided.

Quit smoking

Per prescription or vaccination Up to $100

The benefit is payable on non-PBS pharmaceuticals only and

applies to the cost in excess of the current PBS amount.

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Premiums for the ADF Total Package start from $56.14 per fortnight

to cover one person

The table below sets out what the ADF Total Package will cost. The pricing is national and does not vary from state to state. The prices listed below are per fortnight. The premium after rebate calculation method is explained at the bottom of this page.

ADF Total Package $0 excess

ADF Total Package $200 excess

ADF Total Package $400 excess Premium

after rebate Gross premium Premium after rebate Gross premium Premium after rebate Gross premium

One adult $65.43 $90.68 $59.62 $82.62 $56.14 $77.84

One adult & kids $99.64 $138.04 $91.21 $126.36 $86.19 $119.44

Two adults $130.91 $181.36 $119.24 $165.24 $112.35 $155.70

Two adults & kids $130.91 $181.36 $119.24 $165.24 $112.35 $155.70

ADF Total Package Premium

after rebate

Gross premium

One child $56.14 $77.84

Two or more kids $65.43 $90.68

Northern Territory residents

National pricing is not as suitable for Northern Territory residents as it is for residents of other states. This is because the NT hospital costs are much lower than any other state or territory. The premium after rebate calculation method is explained at the bottom of this page.

Permanent ADF and active Reservist members based in the Northern Territory will find a better deal if they mix and match the Hospital and Extras combinations available in the NT. The combinations most similar to the ADF Total package are shown below but you can check out other combinations on our website or call us to get a quote.

NT Rates

Premier Hospital

(no Excess) and Value Extras

Premier Hospital with $200 excess plus Value Extras

Premier Hospital with $400 excess plus Value Extras Premium

after rebate Gross premium Premium after rebate Gross premium Premium after rebate Gross premium

One adult $50.74 $70.29 $46.06 $63.86 $41.40 $57.40

One adult & kids $83.61 $115.86 $76.22 $105.62 $68.77 $95.27

Two adults $101.43 $140.58 $92.21 $127.76 $82.87 $114.82

Two adults & kids $101.43 $140.58 $92.21 $127.76 $82.87 $114.82

The premiums listed above are for customers eligible for 27.820% Australian Government Rebate on private health insurance and nil Lifetime Health Cover Loading. Your actual rebate may vary depending on your age and income. The premium quoted is valid until 31 March 2016.

Get a quote

Go to defencehealth.com.au

or call us on 1800 335 425

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ADF Essentials Package

The ADF Essentials Package is our low-cost package for permanent ADF and active Reservist singles and couples. It covers a limited range of hospital and extras treatments and helps you avoid Government penalties.

Your hospital cover

Excess

The ADF Essentials Package has a $200 per adult excess. The excess applies once per adult per financial year on all same day and overnight admissions.

Your hospital cover gives you

For the limited range of services listed under What’s covered you get:

100% of agreement hospital charges (subject to your excess), including:

– Shared or private room – Theatre fees

100% of public hospital charges (subject to your excess) Up to 100% of doctors’ fees for services covered if your

doctor chooses to use Access Gap

Up to 100% for prostheses on the Australian Government Prostheses List for services covered Treatment in a non-agreement private hospital will incur significant out-of-pocket expenses.

What’s covered

Accidental injuries Removal of tonsils Removal of adenoids Removal of appendix Surgical tooth extraction Hernia repairs

Joint investigations (arthroscopies) and minor joint repairs

Joint reconstructions Colonoscopies Gastroscopies

What’s restricted

Psychiatric treatment Rehabilitation Palliative care

For these treatments you will only be covered as a private patient in a public hospital shared room. If you are treated anywhere else you will be significantly out-of-pocket.

What’s excluded

All other hospital treatments

Favourite features

National pricing means you pay the same amount no matter where you’re posted

Don’t pay for things you don’t need – you get cover for a limited range of hospital services that a young and healthy person is most likely to need

Cover for the most popular extras to complement your active lifestyle

Great no-gap glasses deals through our optical network – Specsavers or VSP Vision Care Choice of doctor and hospital – for treatment

of the limited procedures covered

Avoid or minimise Government penalties – such as the Medicare Levy Surcharge and Lifetime Health Cover loadings

Money back for travel vaccinations

Great choice for your first health cover or if you’re not planning on kids any time soon

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What does the ADF Essentials

Package cost?

For most people the ADF Essentials package will cost $31.73 per fortnight for singles and $63.46 for couples. This is a national price and assumes a rebate of 27.820%. Gross premiums (without rebate) are $43.98 and $87.96 per fortnight respectively. Your actual rebate may vary depending on your age and income. The premium quoted is valid until 31 March 2016. ADF members based in the Northern Territory will find a better deal if they take the mix and match rates for the Northern Territory. These are available on our website or by calling us.

Your extras cover

Get a quote

Go to defencehealth.com.au

or call us on 1800 335 425

General and preventive dental

Up to $70.70

Mouthguard (151) Up to $74.75

Surgical tooth removal

Month waiting period

322 Up to $113.15

323 Up to $141.40

324 Up to $155.55

General dental and surgical extractions

Our optical network providers have extensive ranges of

no-gap glasses. Visit specsavers.com.au or vsp-australia.com.au for locations.

Specsavers VSP Vision Care

Optical

Ambulance treatment

Per travel vaccination prescription Up to $50

The benefit is payable on non-PBS travel vaccinations only

and applies to the cost in excess of the current PBS amount.

Travel vaccinations

Where the provider is recognised by the Australian Regional Health Group the following alternative therapies are payable: acupuncture, homeopathy, aromatherapy, myotherapy, naturopathy, remedial massage, remedial therapy, Chinese

herbal medicine and western herbal medicine. No benefit payable

for any prescribed medications, herbal or dietary preparations.

Alternative therapies & exercise physiology

Initial consultation Up to $35

Group therapy sessions and classes

Up to $10

Physiotherapy (including hydrotherapy),

Chiropractic/Osteopathy

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Finding the right hospital cover

Premier Hospital

If your family’s wellbeing is your priority and you want total peace of mind, then Premier Hospital is for you. Premier Hospital provides comprehensive cover in all agreement hospitals throughout Australia. That means treatment where and when you need it.

Premier Hospital has no exclusions on any Medicare-approved treatment which means no costly surprises. You also get 100% cover for ambulance services by state-appointed ambulance providers across Australia. And there’s no limit on the number of times you can use the ambulance service when needed.

Value Hospital

If you are happy to exclude some procedures that you might not need, then Value Hospital is for you. Value Hospital is priced for families who know the importance of health and wellbeing but are trying to keep things a little more affordable.

Value Hospital provides comprehensive cover for most treatments but you don’t have to pay for things you are less likely to need.

You also get 100% cover for ambulance services by state-appointed ambulance providers across Australia. And there’s no limit on the number of times you can use the ambulance service when needed.

Essentials Hospital

If you’re only interested in covering things a young and healthy person might need, and want to avoid Government penalties for not having hospital cover, then Essentials Hospital could be for you.

Essentials Hospital cover is low-cost because it only covers you for a limited number of services most commonly used by young and healthy people.

And the really great news is you even get 100% cover for ambulance services by state-appointed ambulance providers across Australia. And there’s no limit on the number of times you can use the ambulance service when needed.

Get a quote

Go to defencehealth.com.au

or call us on 1800 335 425

Mix and match

hospital cover

Choose from three levels of hospital cover that can help take the pain out of hospital visits: Premier Hospital, Value Hospital and Essentials Hospital.

We’ve designed each level of cover to provide protection to meet different needs. And they can be added to your choice of three extras covers for more complete protection.

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Compare our hospital cover

Which services are covered? _HospitalPremier _HospitalValue Essentials _Hospital

Accidental injury Removal of tonsils Removal of adenoids Removal of appendix Surgical extraction of teeth Hernia repairs

Joint investigations and minor repairs Joint reconstructions

Colonoscopy Gastroscopy Rehabilitation Palliative care Psychiatric treatment Cancer treatment Stroke treatment Brain surgery

Pregnancy and pregnancy related services Heart related procedures

Assisted reproductive services and infertility treatments Cataracts, Glaucoma and laser eye surgery

Dialysis for renal failure

Obesity related treatment (eg. gastric banding) Joint replacements

All other services recognised by Medicare

Treatment not recognised by Medicare incl. most cosmetic surgery Chronic care programs

Hospital substitute programs

Midwifery (confinement and delivery) $1,500 $750

Home nursing – Maximum Per day

$1,800 $90

$750 $70 Included

You will be covered as a private patient in a public hospital shared room. If you are treated anywhere else you will be significantly out-of-pocket.

Restricted Excluded

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Premier Hospital

Premier Hospital is designed to give you peace of mind and no worries. Comprehensive hospital cover gives you our best protection. It covers everything Medicare does, including pregnancy and assisted reproductive services. So if you and your family’s wellbeing is a priority then Premier Hospital is for you.

Your hospital cover

Excess options

You can reduce your premium by electing to pay an excess if you go to hospital.

Your excess options are $200 or $400 per adult. The excess applies once per adult per financial year on all same day and overnight admissions. No excess is payable for dependent children.

Your hospital cover gives you

No exclusions on any Medicare-approved treatment 100% of agreement hospital charges (subject to your

excess), including: – Shared or private room

to use Access Gap

Up to 100% for prostheses on the Australian Government Prostheses List

Health programs, for services not covered by Medicare, which include up to $1500 for midwife delivery services, and up to $90 per day for home nursing ($1800 max) Get hospital substitute treatment in your home

What’s covered

Joint reconstructions and repairs Joint replacements

Colonoscopies and arthroscopies Heart and artery related services Pregnancy related services

Assisted reproductive services (e.g. IVF and GIFT) Psychiatric and rehabilitation services

And all other Medicare-approved treatments

What’s restricted

No hospital services are restricted

What’s excluded

Get a quote

Go to defencehealth.com.au

or call us on 1800 335 425

Favourite features

Enjoy peace of mind with comprehensive hospital cover

No exclusions on any Medicare-approved treatment No excess for kids

Comprehensive

ambulance cover

You get 100% cover for ambulance services by state-appointed ambulance providers across Australia. And there’s no limit on the number of times you can use the ambulance service when needed, including emergency services, non-emergency dispatch, mobile intensive care and air and sea ambulance services. Transport services by Patient Transport vehicles are not ambulance services and are not claimable.

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Value Hospital

Value Hospital is designed for families who know the importance of health and wellbeing but are trying to keep things a little more affordable. If you are happy to exclude some procedures you might not need then Value Hospital is for you.

Your hospital cover

Excess choices

You can choose from a $200 or a $400 excess per adult. The excess applies once per adult per financial year on all same day and overnight admissions. No excess is payable for dependent children.

Your hospital cover gives you

For the services listed under What’s covered you get: Choice of doctor and hospital

– Shared or private room

to use Access Gap

Up to 100% for prostheses on the Australian Government Prostheses List for services covered Health programs, for services not covered by Medicare,

which include up to $750 for midwife delivery services, and up to $70 per day for home nursing ($750 max) Get hospital substitute treatment in your home

What’s covered

Joint investigations (arthroscopies), minor joint repairs and reconstructions

Colonoscopies Gastroscopies

Heart and artery related services Pregnancy related services Cancer treatments

And all other Medicare-approved treatments that are not listed below

What’s restricted

Psychiatric treatment

For this treatment you will only be covered as a private patient in a public hospital shared room. If you are treated anywhere else you will be significantly out-of-pocket.

What’s excluded

Assisted reproductive services (e.g. IVF and GIFT) Renal dialysis

Obesity related treatment (eg. gastric banding) Joint replacements and revisions

Cataracts, glaucoma and laser eye surgery

Favourite features

Hospital cover for a broad range of services with some exclusions

No excess for kids

Excludes selected hospital services to help keep the cost down

Comprehensive

ambulance cover

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Essentials Hospital

Essentials Hospital is basic hospital cover for young, healthy singles and couples. It covers a limited range of hospital treatments and helps you avoid Government penalties.

Your hospital cover

Excess

Essentials Hospital has a $200 per adult excess. The excess applies once per adult per financial year on all same day and overnight admissions.

Your hospital cover gives you

For the limited range of services listed under What’s covered you get:

– Shared or private room – Theatre fees

100% of public hospital charges (subject to your excess) Up to 100% of doctors’ fees, for services covered, if your

doctor chooses to use Access Gap

Up to 100% for prostheses on the Australian Government Prostheses List for services covered Treatment in a non-agreement private hospital will incur significant out-of-pocket expenses.

What’s covered

Accidental injuries Removal of tonsils Removal of adenoids Removal of appendix Surgical tooth extraction Hernia repairs

Joint investigations (arthroscopies) and minor joint repairs

Joint reconstructions Colonoscopies Gastroscopies

What’s restricted

Psychiatric treatment Rehabilitation Palliative care

For these treatments you will only be covered as a private patient in a public hospital shared room. If you are treated anywhere else you will be significantly out-of-pocket.

What’s excluded

All other hospital treatments

Favourite features

Don’t pay for things you don’t need – you get cover for a limited range of hospital services that a young and healthy person is most likely to need

Accidental injury cover

Choice of doctor and hospital – for treatment of the limited procedures covered

Avoid or minimise Government penalties – such as the Medicare Levy Surcharge and Lifetime Health Cover loadings

Great choice for your first health cover or if you’re not planning on kids any time soon

Comprehensive

ambulance cover

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Mix and match extras cover

Three levels of extras cover to make looking after your health and wellbeing more affordable: Premier Extras, Value Extras and Essentials Extras.

Each can lower or even remove your costs when you visit health and wellbeing providers like the dentist, chiropractor, physiotherapist and a range of alternative therapists. You’re free to choose who treats you, and if you visit one of our many optical partners, you’ll receive even greater benefits. And they can be added to your choice of three hospital covers for more complete protection.

Premier Extras

Our Premier Extras cover gives you comprehensive cover on a wide range of services with our highest individual annual limits.

If you have frequent or planned treatment, especially for complex dental services, then Premier Extras will give you the most money back. Plus there’s no annual limit on general dental and no lifetime limit on orthodontic treatment. Premier Extras gives you 100% back on initial consultations for most therapies. You also get 100% back on glasses (up to $300 per person) at our optical partners and up to $1500 every 2 financial years for laser eye surgery to help you become glasses free.

Value Extras

If you want to be covered for a wide range of services at a more affordable price, then Value Extras is for you. Value Extras is great value for money and perfect for those that want cover for more than just the basics.

You’ll get 100% back on glasses (up to $255 per person) at our optical partners.

There’s no annual limit on general dental and no lifetime limit on orthodontic treatment.

Essentials Extras

Don’t want to pay for services you don’t need? If you’re only looking for basic cover at a low cost, then Essentials Extras is for you.

Essentials Extras is ideal for young and healthy people who just want cover for the basics including general dental, preventative dental, surgical extractions, physiotherapy, chiropractic/osteopathic, alternative therapies and travel vaccinations.

And you’ll get 100% back on glasses (up to $170 per person) at our optical partners.

To help you decide which cover is best for you, take a closer look at what each level offers. Remember, the higher your level of cover, the more services you’ll be covered for and the greater your benefits can be.

Get a quote

Go to defencehealth.com.au

or call us on 1800 335 425

Plus, all our extras covers include 100%

cover for ambulance services by

state-appointed ambulance providers across

Australia. And there’s no limit on the

number of times you can use the

ambulance service when needed.

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But wait

there’s more

Our Optical Network

We’ve joined forces with Specsavers and VSP Vision Care to deliver better optical cover for our members.

Our optical network is available to all our members with extras cover and provides better optical benefits and an extensive range of no-gap glasses.

VSP Vision Care is a network of 500 independent optometrists. VSP Vision Care providers are conveniently located close to where you live or work.

Specsavers is already a household name with more than 280 optical stores around Australia.

You can still get benefits back at any optical store you choose. But if you do use the optical network you will receive better value optical benefits, coupled with a wide selection of stylish, fashionable frames.

Visit specsavers.com.au or vsp-australia.com.au to find your nearest optical network provider.

A reason to smile

If you have kids, they’re eligible for one free mouth guard, custom-fitted by a dentist, every year if you have the ADF Total Package, Premier Extras or Value Extras.

Goodbye to family limits

There’s no family or policy limit on any extras treatment including dental, optical, physiotherapy, chiropractic/ osteopathy and alternative therapies. Only some devices and appliances include policy maximums. That means every member of your family can now claim up to their personal limit for those extras. And that means more money back for the things that matter most.

Quit smoking

We’ve introduced a new per person benefit to help members quit smoking. Reducing the incidence of preventable smoking-related illness will ease the pressure on premiums. That’s good news for all our members. We will pay a benefit for approved programs and nicotine replacement therapies. Benefits are only available to members who have the ADF Total Package, or Premier Extras or Value Extras cover in combination with hospital cover and a 2 month waiting period applies. Benefits will not be available for medicines/drugs subsidised by the Australian Government under the PBS. An itemised pharmacy receipt with the patient’s name must be provided.

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Compare our extras cover

Service Premier Extras Value Extras Essentials Extras

per person limit per person limit per person limit

Ambulance treatment Unlimited Unlimited Unlimited

Preventive dental Unlimited Unlimited

$500 Preventive dental, general

dental and surgical extractions only

General dental Unlimited Unlimited

Major dental $1100 $900

Orthodontics $1000 $800

Optical $300 $255 $170

Physiotherapy (including hydrotherapy) $850 $600

$350

Chiropractic/Osteopathy $550 $450

Antenatal and postnatal services $500 $200

Pharmacy and vaccinations

$600 $500

Travel vaccinations $100

Alternative therapies

$400 $300 $200

Exercise physiology

Psychology $500 $400

Podiatry/chiropody $400 $300

Occupational therapy $600 $500

Speech therapy $600 $500

Eye therapy $600 $500

Dietitian $350 $250

Audiology $350 $200

Medically prescribed devices, aids and supports $1500 $1000

School accidents $800 $600

Laser refractive eye surgery (claimable once every 2 years) $1500

Quit smoking (when combined with hospital cover) $180 $100

Not covered

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Premier Extras

Premier Extras provides comprehensive cover for a wide range of services with our highest individual annual limits.

General dental

Up to $101.00

Major dental

Surgical tooth removal (323) Up to $202.00

Root canal obturation (417) Up to $151.50

Veneer indirect (583) Up to $656.50

Full crown – veneer indirect (615) Up to $1010.00

Endosseous implant (688) Up to $1100.00

Course of non-surgical periodontal

treatment (281) Up to $606.00

Orthodontics

Complete course of orthodontic treatment (881)

Up to $1000.00

Unlike other funds there is no lifetime limit. You get $1000

every financial year until your treatment is complete.

Passive removable appliance (811) Up to $176.75

Dental

Our optical network providers have extensive ranges of no-gap

glasses. Visit specsavers.com.au or vsp-australia.com.au for locations. Specsavers VSP Vision Care

Optical

Ambulance treatment

Group therapy sessions and classes Up to $20

Physiotherapy (including hydrotherapy)

Chiropractic x-rays (max 2) Up to $60

Chiropractic/Osteopathy

Favourite features

One free mouthguard, custom-fitted by a dentist, every year for kids

No annual limit on general dental treatment, up to $1000 back on orthodontics and no lifetime limit, and up to $1100 back on major dental per person No-gap glasses deals through our optical network 100% back on initial consultations for most therapies Generous benefits for a wide range of alternative therapies Cover for laser refractive eye surgery with up to $1500

back per person every 2 financial years

Up to $1500 back per person per year on health appliances such as hearing aids, blood glucose monitors and CPAP machines

Where the provider is recognised by the Australian Regional Health Group the following alternative therapies are payable: acupuncture, homeopathy, aromatherapy, myotherapy, naturopathy, remedial massage, remedial therapy, Chinese herbal

medicine and western herbal medicine. No benefit payable for

any prescribed medications, herbal or dietary preparations.

Alternative therapies & exercise physiology

Antenatal course Up to $500

Antenatal consultations/classes Up to $50

Postnatal consultations/classes Up to $50

By a midwife or physiotherapist in private practice only. Treatment claimed through Medicare cannot be covered.

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– ₃₆ Month waiting period Month waiting period Annual limit – $1500 per person Annual limit – $1500 per person

Hearing aids* Up to $1500

CPAP machine* for sleep apnoea Up to $1250 Blood glucose monitor* Up to $500 Foot orthotics

custom-made or fitted by a podiatrist, chiropodist or orthotist

Up to $300

Orthopaedic shoes

custom-made or fitted by specialist shoemaker Up to $300

Splints and braces

splints, knee/leg/spinal/lumbar/sacral/wrist/ ankle braces and surgical corsets only

Up to $300

Mobility aids*

wheelchairs, crutches, walking frames, walking sticks, rolling walkers, seat riser cushions, reaches and adjustable canes only

Up to $1000

Joint fluid replacement injections

eg. Synvisc, OsteoArtz, Hyalgan Up to $300

Non-cosmetic prostheses Up to $1250 – Wig following a medical condition Up to $300 – External breast prostheses following

a mastectomy Up to $300 – Artificial eye* Up to $1250

per policy

Blood pressure monitor* Up to $300 TENS machine* Up to $300 Nebuliser* and spacer for breathing conditions Up to $300

per item

Compression garments

for purpose-made garments that aid burn management, post-surgical recovery, lymphoedema treatment and deep vein thrombosis prevention

Up to $300

Non-sight correcting Irlen lenses Up to $100

EpiPen Up to $150

Hearing aids and foot orthoses repair Up to $100 Rental of appliances Up to $200

including oxygen cylinders, soft collars, toilet seat risers, shower chairs, Continuous Passive Movement machines or any other appliance listed above

* Replacement or additional items are not claimable within 3 years of previous purchase

Medically prescribed devices & supports

Couple/family therapy Up to $60

Treatment claimed through Medicare cannot be covered.

Psychology

Speech therapy

Occupational therapy

Podiatry/chiropody

Audiology

Eye therapy

Per prescription or vaccination Up to $120

The benefit is payable on non-PBS pharmaceuticals only

and applies to the cost in excess of the current PBS amount.

Pharmacy and vaccinations

No waiting period Annual limit – $800 per person

Up to $800 per person for health care gap costs resulting from a school accident to your child excluding Medicare services.

School accidents

Month waiting period Annual limit – $1500 per person every 2 financial years

Up to $1500 per person is payable for LASIK or PRK eye surgery in a recognised day surgery centre.

Laser refractive eye surgery

Dietitian

Quit smoking

Benefits paid on approved programs and nicotine replacement therapies.

Benefits available to members who have Premier Extras in combination with hospital cover. Benefits will not be available for medicines/drugs

subsidised by the Australian Government under the PBS. An itemised pharmacy receipt with the patient’s name must be provided.

Health insurance for ADF and active Reservists. We look after you like family.

Issued April 2015

We look after

you like family.

Health insurance

for ADF and active Reservists

Contents

We’re always here

to help because

that’s what family

is for

At Defence Health, we put our

members before profit. Because

our members are more than just

a name or number to us. They’re

just like family.

We exist

to benefit

members

Who’s eligible

to join

ADF families

What does active Reservist mean?

Other Defence connections

Past Service

ADF supporters

Extended families of all above

Why you’re better

off with private

health insurance

Manage your health costs

Control your care

Skip the queues

Maximise Government incentives

Avoid the Lifetime Health Cover loading

Reduce your taxes

Money back on extras

Why you’re better

off with Defence Health

Special features for ADF

and active Reservists

Exclusive ADF packages with national pricing

Special prices on mix and match range

Suspension of health cover

Transition discount for discharging ADF

No waiting periods for discharging ADF

Special features for our

whole family

Low management costs

Not-for-profit

Comprehensive ambulance cover

One of the largest hospital networks

Great optical benefits

No waiting when you switch

Simple claiming

Over 60 years of service

Excellent service

Supporting the Defence community

Funding for medical research

Types of cover

ADF packages

Standalone cover for mixing

and matching

Hospital cover

Extras cover

Finding the right cover for you

See if you can identify yourself in our guide below. Or you can read

about all our covers in the pages ahead.

Get a quote

Go to defencehealth.com.au

or call us on 1800 335 425

Favourite features about

our health insurance

Excess options that lower

your premium

Reduce your out-of-pocket

expenses

Agreement private hospitals

Access Gap

No-gap fees on a number of diagnostic services