The ADF Family Health Trial: What it means to you

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The ADF Family Health Trial What it means to you

• AIRCDRE Tracy Smart DG Corporate Health
  Management
• AF Health Services
• Ms Leonie MacphersonDirector ADF Family
  HealthCurrent as at 9 October 2009

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Background

• Government election promise
• responsive to needs of dependants difficulties
  in accessing GPs on postings
• retention initiative the Governments way of
  saying thank you to ADF families for the
  commitment and sacrifices you make every day
• Flexible medical solutions to suit locations
• Non-cosmetic dental services up to 300 per
  dependant per calendar year
• Trial only until 2012 will cover 22 of
  dependants

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Models Considered

• Extend function of existing base health
  facilities
• Lease/Build fit-for-purpose facility and recruit
  health professionals
• Partnership with Dept of Health Ageing GP Super
  Clinics in shared locations
• Purple Card, based on DVA White Card, with capped
  medical and dental benefits
• Gap payment (capped and uncapped benefit) after
  Medicare rebate has been claimed

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Trial Locations - Stage 1

• Sale (VIC)
• Singleton (NSW)
• Katherine (NT)
• Derby WA
• Cairns (QLD)
• Mt Isa, Weipa, Thursday Is.
• WA - the Pilbara region
• Karratha, Port Hedland, Carnarvon, Tom Price,
  Newman and Exmouth

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Trial Locations Stage 2

• Townsville
• Tully (QLD)
• Darwin
• Alice Springs Nhulunbuy (NT)
• Broome and Kununurra (WA)
• Puckapunyal (VIC)

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What is Basic Medical Care

• Basic visits to a doctor in a GP setting
• list of eligible item numbers in info pack
• dependants must present the ADF Family Health
  Card
• Further treatment required as a result of GP
  visit not covered by this trial
• specialist referrals, pathology, imaging/x-rays,
  prescriptions
• supported by existing Medicare or PBS
  entitlements
• Check with the clinic to determine if treatment
  is covered
• may request payment for medical treatments not
  covered
• may sometimes request payment for eligible items,
  or for after-hours services

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Medical Delivery Models

• Flexible models for delivery of medical benefits
  have been implemented to suit the demographic of
  each of the trial locations.
• When accessing medical treatment in the location
  in which you reside, you must utilise the model
  applicable to that location.
• When accessing medical treatment at other trial
  locations, you must use the model applicable to
  that location.

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Medical Delivery Models (cont)
Participating Doctors Medical benefits are only
available through participating medical
practitioners. When visiting a participating
medical practitioner, you will be bulk billed for
your basic medical services, and pay no out of
pocket gap fees.

• Townsville and Tully
• Cairns
• Darwin
• Alice Springs
• Karratha
• Mt Isa
• Newman
• Pt Hedland
• Puckapunyal
• Sale
• Singleton
• Tom Price

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Medical Delivery Models (cont)
Gap Reimbursement For those accessing medical
treatment in a Gap model location, you may
visit any medical practitioner in that location.
When visiting a medical practitioner you may
claim 100 reimbursement of the difference
between the medical practitioners fee and the
Medicare rebate.

• Broome
• Carnarvon
• Nhulunbuy
• Katherine
• Kununurra
• Weipa

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Medical Delivery Models (cont)
Public Health Facility Some locations do not have
a private medical centre in the area. In these
locations Defence families can continue to access
medical services at their public health facility.

• Derby
• Exmouth
• Thursday Island

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What dental care am I entitled to?

• Registered dependants will be covered for dental
  treatments up to 300 per dependant per calendar
  year
• Only non-cosmetic dental treatments, GST-free
• To determine if your requirements are covered,
  please consult with your dentist
• May be accessed anywhere in Australia no
  requirement to sign up dental practices

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Dental Benefits

• ADF Family Health Card enables electronic
  processing of most claims at the dentist
• Reduces out of pocket expenses
• Not all dentists will be able to process claims
  electronically
• Dependants will be expected to pay the account
  and
• Claim the benefit manually

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Who is eligible to participate?

• Dependants of permanent ADF members OR dependants
  of reservists on continuous full-time service,
  who meet the following criteria will be entitled
  to register
• reside in a trial location
• are a recognised ADF dependant
• are recognised for ADF housing purposes
• are accompanying the member who is posted to a
  trial location

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Who is defined as a dependant?

• Pay and Conditions Manual (PACMAN v2) (vol. 1,
  chap. 1, pt. 3, div. 2) definition of a
  recognised dependant
• Dependant data must be current in PMKeyS
• form AD160 Dependant Details
• Examples of dependants that may be included are
• Relatives assisting with families when ADF member
  deployed
• Foster children

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Participation

• Participation in the trial is voluntary
• You may elect to participate only in the medical
  or the dental, or both
• You may decide to only register certain members
  of your family
• You may opt out of the trial at any stage, or
  change your registration as required.
• a child with a Government issued Health Care Card
  may only require the dental component of the
  trial, with the remaining dependants requiring
  both medical and dental
• families already attending a bulk billing clinic,
  may elect not to register for medical

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What impact is there on my Private Health
Insurance?

• None

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How do I claim if I also have Private Health
Insurance?

• Electronic Claims
• Present private health insurance card at the
  dentist, then claim the gap against your
  remaining ADFFH benefit
• Any remaining charge is the responsibility of the
  patient
• Manual Claims
• If dental practice is unable to submit your claim
  electronically, you must pay the account in full
  and make your claim manually
• Use receipt to claim from your private health
  insurance
• Use the Benefit Statement from your claim, and
  the original receipt, to claim the gap amount
  from your remaining ADFFH benefit

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For example a 600 non-cosmetic treatment

• Claim against private health insurance 250
• Claim gap (350) against ADFFH benefit
• Assuming the full benefit of 300 is available,
  only pay the remaining 50 for your dental
  treatment.
• Claim forms and more information on
  claiminghttp//www.navyhealth.com.au/ADFFH/

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Beware!

• Claiming from your private health insurance as
  well as the ADF Family Health benefit, where the
  total amount payable by all sources exceeds the
  amount charged for the service, is a breach of
  the conditions of use

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Frequently Asked Questions

• Q. Can I access medical dental services on
  base?
• A. No, the services provided under this trial do
  not include services provided on base. These
  remain for the benefit of ADF members.
• Q. How will this initiative impact the wider
  community?
• A. There will be no additional impact to the
  wider community. Dependants will be accessing the
  same dental medical services within the
  community that they have always had access to.
• Q. I am living unaccompanied in a region
  included in this trial. Are my dependants covered
  if they live outside of this region?
• A. No, your dependants are only covered if they
  are residing in the entitled region.

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Frequently Asked Questions

• Q. I have been posted to a region not covered by
  this trial and will be unaccompanied. My
  dependants have elected to remain in the entitled
  region. Will they still be eligible to receive
  the benefits associated with this trial?
• Yes, if the dependants remain in the eligible
  region they will still be covered.
• Q. Will this trial impact the healthcare
  provided to ADF members?
• A. No, dependants will utilise services from
  within the community. This is a separately funded
  project.
• Q. Are there additional provisions for dependants
  with special needs?
• A. This trial has no additional provisions for
  dependants with special needs. The ADF
  acknowledges that members who have dependants
  with special needs (FWSN) may require particular
  assistance as a direct result of the members
  mobility and relocation. Additional support is
  available through existing programs.

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Frequently Asked Questions

• Q. I did not use the 300 allocated for dental
  last calendar year. Will it roll over to the
  next calendar year?
• A No, the allocation of 300 per dependant per
  calendar year does not roll over, nor does any
  unused component of the benefit.
• My child requires 600 worth of non-cosmetic
  dental treatment. Can my 300 benefit be used
  for my childs treatment.
• A. No, the allocation of 300 is allocated to a
  dependant each calendar year and cannot be
  transferred.

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Fringe Benefits Tax

• Benefits considered a fringe benefit under the
  Fringe Benefits Tax Assessment Act 1986
• Will be subject to Fringe Benefits Tax (FBT) FBT
  will be paid by ADF
• Depending on individual circumstances the
  "grossed-up" value of the benefits provided
  during the FBT year may be recorded on a member's
  annual Payment Summary
• We recommend you seek financial advice relevant
  to your individual circumstances before
  registering for the trial.
• As per fringe benefits reporting requirements, a
  record of visits will be kept provided to the
  ADF member responsible for the fringe benefit.
• The record will indicate that a fringe benefit
  was received, the value of the benefit and the
  date. No other detail will be provided
• Dependants who register for the trial, but do not
  utilise the benefits will not incur any FBT, as
  this is only linked to benefits received

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Take-up RatesStage 1 - as at 7 October 2009
(1) Approximate numbers based on Defence Census
2007
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Take-up RatesStage 2 - as at 7 October 2009
(1) Approximate numbers based on Defence Census
2007
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Registration

• Registration form (AD858-1)
• DRN through web forms
• ADF Family Health website
• Contact ADFFH team - [phone]
• Ensure PMKeyS information is current correct
• Read Conditions of Use and acknowledge on forms
  prior to submitting
• Receive ADF Family Health Card and Welcome Pack

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Registration Delays
The most common causes of registration delays are

• Dependant Details in the ADF Members PMKeyS
  record are incomplete, incorrect or out of date
• Registration forms are incomplete or incorrect
• Medicare Card information on registration form is
  incorrect or incomplete.

Access our Website Checklist to assist you with
Registering http//www.defence.gov.au/health/Depen
dant_Healthcare/docs/Checklist.pdf
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Additional Information

• Please visit the ADF Family Health website or
  contact the ADF Family Health Directorate for
  additional information
• Intranet http//intranet.defence.gov.au/VCDF/sit
  es/ADFDepHealth
• Website http//www.defence.gov.au/health/Dependan
  t_Healthcare/i-healthcare.htm
• EmailADF.DependantHealth_at_defence.gov.au

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Questions?