Welcome to the December edition of the Member Update.
In this edition there’s a message from the CEO, the extra value of provider networks, how to talk to your doctor about out-of-pocket costs, the importance of switching to email and a link to our 2018 Annual report. There is also information on our annual Christmas Star competition, our opening hours over the festive season and some updates to our fund rules.
Thank you for being part of the family.
A message from the CEO
Extensive work has been underway this year to improve the transparency of health insurance products for all consumers. From April 2019, people with private hospital cover – and those considering taking out cover – will be able to compare products within gold, silver, bronze and basic tiers. The government has given funds until April 2020 to comply with the new framework.
The treatment covered in each tier and the terminology used will be consistent across all health funds. This will make it much easier to choose the right level of cover and to make like-for-like cost comparisons between funds.
Where will our hospital cover sit in the new framework?
The new framework sets the minimum standards of included treatment. The level of excess on a product does not change its tier. ‘Plus’ policies meet the standard, with some additional treatment included within the tier.
|Tier||Level of treatment|
|Gold||Gold is top cover, with everything (approved by Medicare) covered. This is where our current ADF Total Package, Ultimate Hospital, Premier Hospital, Top Hospital, ADF Top Hospital products will sit.|
|Silver||Silver is mid-level cover with some exclusions (such as joint replacements or weight loss surgery). With some further enhancement next year, our Value Hospital product will satisfy the ‘silver plus’ classification.|
|Bronze||Bronze is mid-level also, but with a few more exclusions (such as dental surgery and implantation of hearing devices). We will not immediately fill this category because of the attractiveness and competitiveness of the products we currently offer.|
|Basic||Basic includes basic treatment at a low price point. Our ADF Essentials Package, Essentials Hospital, ADF Public Hospital and Public Hospital products will satisfy the ‘basic plus’ classification.|
The government is also making changes that will affect some extras products. From 1 April 2019, health funds will be prohibited from paying benefits for aromatherapy, homeopathy, naturopathy or herbal medicine.
The government has based the removal of these alternative therapies on a lack of clinical efficacy, following an investigation and report in 2015.
We will send you detailed information about the changes that will affect you and an updated product guide in February.
Our focus is on value
Private health is of benefit to all Australians using the health system and is critical to the excellent standards of health care we all enjoy. The demands for health care continue to increase, as do the costs as we deliver more health care. We need further focused reform by the government to reduce the pressure on premiums and improve affordability.
When it comes time to use your private health insurance, it’s important to understand what it covers, and how to avoid unnecessary costs – such as out-of-pocket costs for medical specialists’ fees. As the Prime Minister’s Advisory Committee noted in June this year, “high fees do not necessarily represent better quality care.” There’s more on this topic later in this Member Update.
Our focus at Defence Health is to keep your premium as low as possible, while continuing to deliver meaningful benefits and value-for-money.
Extra value at provider networks
Extras cover contributes to the everyday health care that keeps you on top of your game. Dental and optical are where most extras benefits are paid. Of the $134 million we paid in extras benefits last financial year, 47% went to dental and 16% to optical claims.
Defence Health members who choose to use our dental or optical networks get even greater value from their extras benefits. Our dental network of smile.com.au dentists charge Defence Health members lower fees – which means more affordable access to quality dental care.
Our optical network of VSP Vision Care and Specsavers provides optical care for the whole family – and a great range of no-gap glasses and other member-only offers.
Please check your available benefits through your Online Member Services account. And remember that most extras benefit limits re-set on 1 July each year.
Talk to your doctor about out-of-pocket costs
It’s a conversation that must be had. If you need to go to hospital, ask your doctor for an estimate of the treatment fees and, importantly, whether the doctor will use our Access Gap cover.
Doctors and medical specialists may charge more than the Medicare Benefits Schedule fee for the treatment they provide to patients in hospital. Some charge significantly more, leaving the patient with an excessive out-of-pocket expense that an insurer is not permitted to cover.
Access Gap caps a doctor’s charge so there is no gap for the patient to pay, or a small known gap for the medical treatment.
Doctors can opt-in to Access Gap on a patient-by-patient basis. Many doctors automatically use our Access Gap cover because it simplifies the claims process for them. Others may only use it if you ask. A few will never consider using it and try to link their high fees with the quality of their treatment. There is no merit in this marketing tactic.
The Healthshare directory on our website can help you (or your GP) find a medical specialist who regularly uses Access Gap.
Specialists should not charge you ‘booking or administrative fees’ and such charges cannot be claimed through Medicare or Defence Health. Out-of-hospital consultation fees are legitimate, but only claimable through Medicare. The Commonwealth Ombudsman has a detailed guide about doctors’ bills. Or you can read the Access Gap brochure available on our website.
Pre-existing condition waiting period
If you’ve recently taken out hospital cover – or upgraded to a higher level of cover – a 12-month waiting period could apply for treatment of a pre-existing condition.
All insurers apply the 12-month waiting period for pre-existing conditions to make it fair for members who’ve been with a fund for a long time. It ensures that new members must contribute at least 12 months in premiums before seeking hospital treatment for conditions they were aware of (or suspected).
We understand that some people don’t even realise they’re not well when they take out hospital cover. That’s why an independent medical arbitrator is asked to assess whether it’s likely that symptoms were present in the six months prior to the member joining (or upgrading). The decision is based on the likelihood of signs or symptoms – not on whether the condition had been diagnosed or even whether a doctor had been consulted.
If you think this rule could affect you, please check with us before undertaking your treatment.
Research into PTSD
Defence Health Foundation funds medical research to benefit serving and ex-serving members of the ADF and their families.
The Foundation has provided a booster grant for a project from the University of Melbourne. The research is looking at the use of N-acetylcysteine (NAC) for treatment-resistant post-traumatic stress disorder (PTSD).
PTSD is hard to treat effectively – most patients who take the standard treatment still have symptoms afterwards. The study team from the University of Melbourne has found that NAC, which supports the body’s antioxidants, can help treat PTSD, as well as the depression and addictions many people with PTSD also have.
Change of name for counselling service
The Veterans and Veterans Families Counselling Service is changing its name. The acronym (VVCS) was not well recognised and didn’t convey the valuable service the organisation provides.
The service will continue to provide free and confidential support to current and former ADF members and families 24/7. But it will operate as Open Arms with the tagline veterans and families counselling.
The Open Arms logo is designed to represent soldiers in the Vietnam War who would stand in a field with ‘open arms’ as a signal to guide in their Huey helicopter pilots for landing. And of course, it’s symbolic of the welcome we all give to people who need support.
If you, or someone in your family, needs counselling or support services, Open Arms can be contacted at any time on 1800 011 046.
Switch to email
We’re currently writing to all members, informing you that from next year we’ll be sending most communications by email. When you receive your letter, please check that we have the best email address to contact you on. Emails will save significant printing and postage costs – and you’ll receive important information faster. You can check your email and communication preferences in your Online Member Services account. Members who wish to stick with posted mail will need to advise us.
Health HQ – tailor made content just for you
Health HQ is our blog which houses a wide range of health, wellness, nutrition and ADF community articles – with new content added regularly. Why not subscribe and have fresh articles delivered directly to your inbox each month? Check out Health HQ today.
Defence community events
Our Defence Community Relationship Officers will be out and about, lending their support to Defence family events between now and Christmas.
From Navy in the North Family Day in Darwin, to 22nd Engineer Regiment Family Day in Melbourne and the ever-popular RAAF Base Williamtown Christmas Treat, our team will be on the ground sharing in the fun and festivities.
If you’re attending an event and see the Defence Health banner flying, make sure you come and say ‘hi’.
Annual report online
Our 2018 Annual Report is now available online. It has some interesting information about how your fund performed in the last financial year. Here are a few fun facts:
- 96% of surveyed members say they are satisfied with their membership
- 90.6% of all in-hospital medical services are fully covered with ‘no-gap’ for members
- $0.94 in benefits to members for every $1.00 of premium received, compared with the industry average of around $0.86
- management expenses are kept low at 6.4% of premium revenue (compared to industry average 8.8%)
- on spontaneous recall, your fund was ranked 4th for trust out of all private health insurers in the Roy Morgan ‘net trust’ research
- we welcomed 1951 newborns to the fund – Charlotte and Ella were the most popular names for girls; William and Jack for boys.
Check out our performance and direction on the ‘about us’ page of our website.
Santa Claus is coming…
The summer holiday and festive season is knocking at the door. Wherever your travels or celebrations take you, please have fun and stay safe.
If you’re heading overseas (or ‘abroad’ as the Europeans like to say) don’t forget your travel insurance. It’s not about lost cameras or luggage – the main role of travel insurance is to cover any urgent medical care you might need while away (which neither Medicare nor Defence Health can cover).* You can get a super-quick travel insurance quote on our website.
If you need to get in touch with us during the Christmas and New Year period, our operating hours are below.
Monday 24 December 8:30am – 2:00pm
Tuesday 25 December Closed
Wednesday 26 December Closed
Thursday 27 December 8:30am – 6:00pm
Friday 28 December 8:30am – 6:00pm
Monday 31 December 8:30am – 4:00pm
Tuesday 1 January Closed
*Travel insurance is arranged by Defence Health Ltd ABN 80 008 629 481 AFSL 313890. This insurance is issued and managed by AGA Assistance Australia Pty Ltd ABN 52 097 227 177 AFSL 245631 trading as Allianz Global Assistance for the insurer Allianz Australia Insurance Ltd ABN 15 000 122 850 AFSL 234708. Terms, conditions, limits and exclusions apply. We do not provide any advice on this insurance based on any consideration of your objectives, financial situation or needs. Before making a decision please consider the Product Disclosure Statement. If you purchase a policy, Defence Health receives a commission that is 10-20% of your premium.
Share your Christmas Stars with us
We absolutely love hearing about the friend, colleague or extended family member who brings some extra sparkle to your life. Tell us why your Christmas Star is so special and he or she could be selected to win one of five $100 Coles Group & Myer Gift Cards. Visit our website for details on how to enter and view the terms and conditions.