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The ADF Family Health Trial: What it means to you


Flexible medical solutions to suit locations ... DRN through web forms. ADF Family Health website. Contact ADFFH team - (02) 6266 3547 ... – PowerPoint PPT presentation

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Title: The ADF Family Health Trial: What it means to you

The ADF Family Health Trial What it means to you
  • AIRCDRE Tracy Smart DG Corporate Health
  • AF Health Services
  • Ms Leonie MacphersonDirector ADF Family
    HealthCurrent as at 9 October 2009

  • 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

Models Considered
  • Extend function of existing base health
  • 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

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

Trial Locations Stage 2
  • Townsville
  • Tully (QLD)
  • Darwin
  • Alice Springs Nhulunbuy (NT)
  • Broome and Kununurra (WA)
  • Puckapunyal (VIC)

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
  • Further treatment required as a result of GP
    visit not covered by this trial
  • specialist referrals, pathology, imaging/x-rays,
  • supported by existing Medicare or PBS
  • Check with the clinic to determine if treatment
    is covered
  • may request payment for medical treatments not
  • may sometimes request payment for eligible items,
    or for after-hours services

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.

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

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

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

What dental care am I entitled to?
  • Registered dependants will be covered for dental
    treatments up to 300 per dependant per calendar
  • 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

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
  • Dependants will be expected to pay the account
  • Claim the benefit manually

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

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
  • Foster children

  • 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

What impact is there on my Private Health
  • None

How do I claim if I also have Private Health
  • 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
  • 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
  • Use the Benefit Statement from your claim, and
    the original receipt, to claim the gap amount
    from your remaining ADFFH benefit

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
  • Claim forms and more information on

  • 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

Frequently Asked Questions
  • Q. Can I access medical dental services on
  • 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
  • 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.

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
  • 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.

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

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

Take-up RatesStage 1 - as at 7 October 2009
(1) Approximate numbers based on Defence Census
Take-up RatesStage 2 - as at 7 October 2009
(1) Approximate numbers based on Defence Census
  • Registration form (AD858-1)
  • DRN through web forms
  • ADF Family Health website
  • Contact ADFFH team - (02) 6266 3547
  • 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

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//
Additional Information
  • Please visit the ADF Family Health website or
    contact the ADF Family Health Directorate for
    additional information
  • Intranet http//
  • Website http//

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