Joint Health Command

ADF Family Health

Medical Benefits

New South Wales | Northern Territory | Queensland | Victoria | Western Australia

Page updated 2 February, 2010

Medical benefits included in the ADF Family Health Trial are those eligible medical treatments provided by a medical practitioner in a general practice setting, accessed from within the local community. 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. Details of how these models operate are listed below:

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.

Participating practitioners can be accessed by selecting your location from the links below.

• New South Wales
• Northern Territory
• Queensland
• Victoria
• Western Australia

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 back any out of pocket expense for basic medical services. Your medical benefit will be a 100% reimbursement of gap fees.

Government 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.

EXAMPLE 1 – A registered dependant visiting Darwin must visit a participating medical practitioner and eligible medical treatments will be bulk billed.

EXAMPLE 2 – A registered dependant visiting Broome must utilize the Gap model.  The Gap is the difference between the medical practitioner’s fee and the Medicare rebate, and this model provides full reimbursement of the Gap.  More information on claiming the Gap is included under the applicable locations.

EXAMPLE 3 – A registered dependant visiting Derby will be expected to utilize the existing public health facilities, as there are no private medical centres in this location.

To view the model applicable to a specific location, select the state from the list below and follow the links:

• New South Wales
• Northern Territory
• Queensland
• Victoria
• Western Australia

Medical Appointments:  Dependants are to identify themselves as trial participants when making initial contact with medical practitioners for an appointment.

Fringe Benefits Tax:  The benefits associated with the ADF Family Health Trial are considered a fringe benefit under the FBT Assessment Act 1986. Consequently, the benefit will be subject to FBT and the FBT will be paid by Defence. 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. For more information on Fringe Benefits Tax, click here.

Workers compensation or third party claims: Services provided to dependants that are for workers compensation or third party claims are excluded from this trial.

Note: Non-eligible services are not the responsibility of Defence. Medical practitioners participating in the ADF Family Health Trial may, in some circumstances, elect not to bulk bill an eligible service. Medical practitioners may also elect not to bulk bill for after-hours consultations. It is recommended that dependants (or their parent/guardian) consult with their medical practitioner prior to attendance to confirm bulk billing of eligible services.