Joint Health Command

ADF Family Health

Conditions of Use - Private Health Insurance

Page updated 21 January, 2010

ADF members, and their registered dependants, are permitted to claim from their private health insurance fund, and may then claim the gap amount against their remaining ADF Family Health benefit.

Most dental practices now have electronic claims processing.  If your dentist has electronic claims processing, simply present your private health insurance card to claim your private health insurance benefit.  You may then use your ADF Family Health card to electronically claim the difference against your remaining ADF Family Health benefit.  The $300 benefit is provided each calendar year for each registered dependant.  NOTE:  Not all dental practices with electronic claims processing will be able to process your ADF Family Health benefit, and a manual claim will need to be submitted to ADF Family Health.

In the event that the dental practice does not provide electronic claiming, you will be required to pay your account in full.  You may then claim from your private health insurance, before submitting a claim form to ADF Family Health for the gap.

Example:  $600 dental claim.  Claim against your private health insurance, which results in a $350 gap.  Claim the gap against the remaining ADF Family Health benefit.  Assuming the full benefit of $300 is available, only pay the remaining $50.

Note: 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. It is the participant's responsibility to check with their private health insurer to verify how their ADFFH entitlements may impact benefit claims against the fund. Benefits may be reduced where monies are payable from other sources for the same service.