Member Update December 2015

Welcome to our special edition Member Update. This issue is dedicated to empowering you to make the most of your hospital cover. If you need to go to hospital, we want you to feel confident about your rights, your treatment options and how to optimise your benefits.

When you’re not feeling well


Your General Practitioner is normally the first port of call when you’re not well. Let your GP know all your symptoms so he or she can make an accurate diagnosis of your condition. The GP might advise a non-invasive treatment plan – or refer you to a specialist for further investigation.

You don’t have to see the first specialist the GP suggests. Ask for a couple of referrals so you can choose a doctor that suits your location and availability.

Visiting a specialist

The specialist you choose to see will review your GP’s diagnosis and might arrange for some further tests before advising on proposed treatment. The specialist should inform you of the pros and cons of the recommended treatment – and any alternatives to surgery.

There are some important questions you should ask your specialist.

  • What hospitals does the specialist operate from? At an ‘Agreement Hospital’ we have agreed charges and can cover 100% of your accommodation and theatre fees.
  • Ask the specialist to itemise all the costs involved in the treatment – including charges from other specialists such as anaesthetists, assistant surgeons or the cost of a prosthesis. You need to know this to give your informed financial consent to the treatment.
  • Ask the specialist if they, and other specialists such as anaesthetists and assistant surgeons, will use Access Gap. This will either remove or reduce your out-of-pocket medical costs.
  • What is the timeframe for treatment and recovery? What support will you need on discharge from hospital?

If you have any doubt about your level of cover, or whether the treatment is excluded or restricted please call us. Or check your product guide here.

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Access Gap

Doctors’ charges can vary greatly – and it really is up to the individual doctor to determine the fee. Access Gap is a billing system that caps the fee and reduces or removes the out-of-pocket expense you could face. We encourage you to ask your doctor to use Access Gap. If your doctor doesn’t want to use Access Gap, you have the right to select a doctor who will.

Learn more

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Pre-existing conditions

When you first take out hospital cover, there is a 12-month waiting period for treatment of a pre-existing condition. The waiting period also applies when you upgrade cover or remove or reduce an excess.

-The pre-existing condition rule applies only in the first 12 months after
taking out hospital cover for the first time
upgrading to a higher level of cover from another insurer or existing Defence Health cover
removing or reducing an excess
-The condition does not need to have been formally diagnosed
-If there were signs or symptoms in the six months before joining or upgrading, the pre-existing condition waiting period will apply.

It’s quite a complicated section of law. So it’s best to check with us about any hospital treatment you’re planning in the first 12 months.

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Time for hospital


Your doctor will confirm your admission date and the hospital will send you some pre-admission forms. The early completion and return of the forms will ensure a smooth process on your date of admission.

Remember to take your Defence Health member card with you to hospital.

If you have an excess on your cover, most hospitals will ask you to pay this at the time of admission – even for a same-day procedure. The excess only applies to adult admissions.

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What happens in an emergency?

A private hospital admission is normally very orderly. You’ve had time to plan and prepare – and the hospital knows you’re coming.

What about when you arrive at hospital in an emergency?

If an ambulance has been called, you’ll be taken to the nearest public hospital emergency department. Most private hospitals are not staffed to handle emergencies.

But if you do arrive at a private hospital in an emergency, the hospital will call Defence Health to check your level of cover. If it’s out-of-hours, tell the hospital staff you’re a Defence Health member. It’s important that you know your level of cover and your right to private patient admission.

Private hospital cover does not cover emergency department treatment in either a private or public hospital. You will have out-of-pocket expenses if treated in a private hospital emergency care clinic even if you are not admitted.

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What if I’m admitted to a public hospital?

Let’s imagine for a moment you’ve had an accident. You’re taken to the emergency department of a public hospital and you’re told you need to be admitted for further treatment.

You’re in a public hospital, does that mean you can be a public patient?

Yes it does. You’re entitled to the same treatment and 100% Medicare funding as every other patient in the public hospital. No more. No less.

If you’re asked to use your private health insurance in a public hospital, ask the hospital staff the following questions.
1. Can I choose my own doctor?
2. Can I have a private room?
3. Will all my costs be covered?
4. Will electing to be a private patient get me admitted quicker?

If the answer to any of these questions is ‘no’ then while you’re perfectly entitled to be admitted as a private patient, the reality is, you will receive the same treatment as all the other patients. It might actually cost you more (through an excess or private patient medical fee) without any of the benefits or comfort of being a private patient. It’s also likely to put pressure on your future premiums.

It’s your choice. You are entitled to full cover through Medicare as a public patient, or to access your Defence Health cover as a private patient. But please do not feel pressured or obliged to use your private health insurance for public hospital treatment. We’re happy to talk to you about your rights if you’re placed in this situation.

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What next after hospital?


After your hospital treatment, your doctor will monitor you to ensure your recovery is on track. Some of your recovery might take place at a location other than the hospital – or at home.

Your doctor will advise you on when you can drive or return to exercise, what medication you require and who to contact if you need help.

Depending on your level of hospital cover, you might have some other recovery options.

  • The Rehabilitation at Home program gives you access to a range of rehabilitation and healthcare services from the privacy, safety and comfort of your home following procedures and conditions such as joint replacements, fractures and neurological conditions.
  • Hospital substitute programs deliver services such as wound management and intravenous therapy in the comfort of your home.
  • Home nursing by a registered nurse could aid your recovery. Your doctor will arrange this with us if it’s suitable for you.
  • Our Health Programs deliver over-the-phone support to help manage a number of chronic conditions. We will contact you if we have a program that could help you.

More information

We’ve got two brochures available with more details about Going to Hospital and how to reduce your out-of-pocket expenses with Access Gap. You can view them online, or give us a call and we’ll send them to you.

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Holiday hours

All of us here send our very best wishes to you and your family for the festive season. Whether at home, or overseas, at work or on holidays, please stay safe. Our contact hours during the holiday period are:

Thursday 24 December 8:30am – 2pm
Friday 25 December Closed
Monday 28 December Closed
Tuesday 29 December 8:30am – 5pm
Wednesday 30 December 8:30am – 5pm
Thursday 31 December 8:30am – 4pm
Friday 1 January Closed – Happy New Year!

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