Frequently Asked Questions - Eligibility
It is the ADF members responsibility to ensure that their dependants continue to meet the definitions contained in ADF Pay and Conditions Manual (PACMAN) and ensure that their Dependant / Beneficiary section of PMKeyS is maintained accordingly.
3. My dependants are not currently eligible for Medicare benefits, can they still register for the Program?Answer: If your dependants are Defence recognised dependants, then they are eligible to register for the Program regardless of their eligibility for Medicare. For more information on Defence recognised dependants. Please refer to the Pay and Conditions Manual (PACMAN v2), (Vol 1, chap 1, part 3, division 2). Upon registration, your dependants will be issued with information on how to access and claim medical benefits. Please ensure you indicate on the [AD858-1 - ADF Family Health Registration] (provide link to new AD858-1) form that your dependants are not eligible for Medicare benefits by ticking the appropriate box. Refer to the "How To Claim" page for more information.
5. My child requires allied health services over $400. Can we use the money allocated for my spouse to cover this cost?Answer: Yes, the allocation of $400 per dependant per Financial Year is a family allocation and can be utilised between registered dependants. For example, a family with 3 registered dependants will be allocated $1,200 per Financial Year.
6. I did not use the $400 allocated for allied health last Financial Year. Will it roll over to the next Financial Year?Answer: No, the unused allocation of $400 per dependant per Financial Year does not roll over to the next year , nor does any unused component of the benefit.
Hospital charges (such as bed fees) are not claimable.
11. If I have registered for the Program and do not access the benefits, do I incur any fringe benefits tax?Answer: No. Fringe Benefits Tax is linked to the medical, specialist or allied health benefits claimed and received. If you have not claimed any benefits, then there is no Fringe Benefits event recorded.
13. What is the difference between Private Health Insurance and the National ADF Family Health Program benefits?Answer: The Medical component of the National ADF Family Health Program only reimburses services provided in a general practice setting. These services are not usually covered by Private Health Insurance. However, Private Health insurance usually covers hospital services which are not included in the National ADF Family Health Program.
For families that have Extras or Ancillary Cover on their Private Health Insurance policy, the $400 Allied Health component of the ADF Family Health trial can provide additional coverage by allowing you to allocate the $400 benefit towards out of pocket expenses after your Private Health Insurance fund has reimbursed you. It could also be used to pay for services if you reach your yearly limit or for allied health services that may be excluded from your private health insurance policy.
17. What if there is a Medicare Benefit Schedule item number allocated to the allied health consultation?Answer: There are a limited number of occasions when an allied health consultation may have a Medicare Benefit Schedule item number allocated to it. For example, when a general practitioner refers a patient to a psychologist as part of a GP Mental Health Care Plan. In these cases the ADF
Dependant should claim the Medicare Rebate from Medicare prior to submitting a manual claim for reimbursement of any gap under ADFFH.
5 November, 2013