1. Who is eligible to participate in this trial?
Answer: Dependants of permanent ADF members, or dependants of reservists on continuous full-time service, who meet the following criteria will be entitled to register to receive the benefits associated with this trial:
- reside in a trial region;
- are recognised ADF dependant;
- are recognised for ADF housing purposes.
2. Who is defined as a dependant?
Answer: This trial will utilise the Pay and Conditions Manual (PACMAN v2) (volume 1, chap 1, part 3, division 2) definition of a recognised dependant. Dependant data must be current in the Dependant / Beneficiary area of PMKeyS. You can use form AD160 Dependant Details to add or update your dependant details in PMKeyS.
3. I am living unaccompanied in a region covered by this trial. Are my dependants covered if they live outside of this region?
Answer: No, your dependants are only covered if they are residing in the trial region.
4.My dependants are not currently eligible for Medicare benefits, can they still register for the trial?
Answer: If your dependants are CDF recognised dependants, then they are eligible to register for the trial regardless of their eligibility for Medicare. For more information on CDF 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 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. If I need to travel to access medical services, will the cost of travel be covered?
Answer: Travel is not covered under this trial. However, in some circumstances travel may be covered under other Defence conditions of service. Please refer to the Pay and Conditions Manual (PACMAN v2) to determine entitlements.
6. My child requires allied health services over $330. Can we use the money allocated for my spouse to cover this cost?
Answer: No, the allocation of $330 per dependant per year is linked to the individual dependant.
7. I did not use the $330 allocated for allied health last calendar year. Will it roll over to the next calendar year?
Answer: No, the unused allocation of $330 per dependant per calendar year does not roll over to the next year , nor does any unused component of the benefit.
8. Are pharmaceuticals covered by this service?
Answer: No, pharmaceutical items are not covered by the trial.
9. Are visits to hospital covered by this trial?
Answer: No, hospital visits, or procedures performed in the hospital are not covered by the ADF Family Health trial.
10. How many times can I visit a medical practitioner?
Answer: There is no limit on how many times you visit your general practitioner.
11. Will I still be required to pay my Medicare Levy?
Answer: Yes. Only basic medical and allied healthcare is included in the trial. Medicare Australia will continue to rebate your costs under the existing Medicare Benefits Schedule.
12. If I have registered for the trial and do not access the benefits, do I incur any fringe benefits tax?
Answer:No. Fringe Benefits Tax is linked to the medical or allied health benefits claimed and received. If you have not claimed any benefits, then there is no FBT.
13. Can I claim reimbursement for Specialist services?
Answer: Specialist Medical Services are not eligible for reimbursement under the trial.
14. What is the difference between Private Health Insurance and the ADF Family Health trial benefits?
Answer:The Medical component of the ADF Family Health trial 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 ADF Family Health trial.
For families that have Extras Coverage on their Private Health Insurance policy, the $330 Allied Health component of the ADF Family Health trial can provide additional coverage by allowing you to allocate the $330 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 policy.
15. What if I have Private Health Insurance?
Answer: Participating in the ADF Family Health Trial will not affect your private health insurance benefits. To maximise your ADF Family Health allied health benefit it is recommended that you claim from your private health insurer first and then claim any remaining gap from the ADF Family Health Trial.
16. How much does it cost to join?
Answer: It costs nothing to participate in the ADF Family Health Trial. The trial is an initiative of the Commonwealth Government as outlined in Labor’s Plan for Defence, November 2007.
17. What if the allied health provider is within a general practice setting?
Answer: Where an approved allied health provider provides services from a general practice setting, any benefits claimed for those consultations are deducted from the Allied Health Benefits component.
18. 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.
