Division 4: Claiming health costs

15.5.20   Purpose

The purpose of this Division is to provide a member with information about making health care claims and seeking reimbursement.

15.5.21   Claims for health costs

This table outlines how to submit claims for this Part. 

Item	If the member is serving in a country...	then claims should be forwarded to the...
1.	with an Australian diplomatic mission	Post Administration Section of the Australian diplomatic mission in the country of posting.
2.	without an Australian diplomatic mission	Embassy or High Commission where the controlling Defence Attache is located.

15.5.22   Assignment of rights to recover costs

To be reimbursed costs under this Part, the member and any eligible person must assign to the Commonwealth the legal rights to recover costs from another person.

15.5.23   Payment for health service instead of reimbursement

1.	A member may request the CDF to approve payment of costs to the provider, instead of reimbursing the member.
2.	This clause does not apply to ancillary services or pharmaceutical products.
3.	The member must have paid the Commonwealth any amount in excess of entitled amounts under this Part. Example: After an accident, the member incurs costs of USD 20,000 for emergency transport and hospital treatment. The hospital facilities are of a similar standard to those for a public hospital patient in Australia. There is no member contribution under Division 2 clause 15.5.8. The CDF approves payment of the full amount direct to the hospital.

Persons who can make the decision under subclause 15.5.23.1 on behalf of the Secretary/CDF:

A person not below WO2/APS 5 who is authorised to manage Defence personnel administration at the overseas post

Senior ADF Representative at the overseas post

A person working in the Personnel Administration Centre in Southern Victoria who is:

- Overseas Administration Team Leader

- Personnel Administration Manager Specialist

- Civilian and Overseas Personnel Administration Centre Manager

- Director Personnel Administration Centre

15.5.23A   Private health insurance (This clause is policy guidance)

1.

There is no Commonwealth requirement for members on long-term posting to hold private health insurance. Members wishing to keep private health insurance during their posting should discuss this with their own health fund.

2.

APS employees and dependants are not entitled to the costs outlined in this Part while they are in Australia. Unless they have private health insurance they will only have Medicare cover while in Australia. Exception: A dependant who is also an ADF member has standard ADF health policy cover while in Australia. Example: A member's dependant child becomes ill while at the overseas post. The family decides that the child should return to Australia for treatment. The family does not have private health insurance. The child only has Medicare cover for the treatment in Australia.

PACMAN                                                             AL12 (October 2011)                             Chapter 15 – Part 5 Division 4 – 1