Doctors Health Fund Review 2024

Doctors' Health Fund is Australia’s only private health insurer established exclusively for doctors, members of the medical community and their families. 

In 2012, it officially became part of the Avant Mutual Group and currently covers over 15,000 Australians. Doctors’ Health Fund aims to provide members with freedom of choice, clinical independence and personalised service.

Hospital cover

Nobody chooses to go to hospital. But when you do, appropriate hospital cover will help you get the treatment you need, where and when you want it. 

It also helps to pay the bills, as fees for hospital rooms and specialists can add up.

Think about what services you’re likely to need, in line with your budget. If you earn over $90,000 individually or $180,000 as a couple, taking out appropriate hospital cover may help you avoid paying the Medicare Levy Surcharge (MLS).

Doctors' Health Fund offers three types of hospital cover, ranging from essential to comprehensive. The Smart Starter Bronze Plus is their most basic, yet generous, hospital cover, whereas the Top Cover Gold policy offers the most coverage. What’s more, all Doctors’ Health Fund hospital policies include palliative care.

Smart Starter Bronze Plus

Smart Starter Bronze Plus is Doctors’ Health Fund’s entry-level option. It’s specifically designed for young singles and couples, and covers more than your average  bronze-level hospital cover.

Key inclusions:

• Palliative care

• Lung and chest treatments

• Plastic surgery (medically necessary)

Prime Choice Gold

Prime Choice Gold covers all inpatient services eligible for Medicare benefits, with no restrictions or exclusions. You will have to pay an excess on admission. This is limited to a maximum of $750 per person and $750 per policy per year.

Key inclusions:

• Assisted reproductive services

• Treatment related to the vascular system and heart conditions

• Cataract treatment

Top Cover Gold

Top Cover Gold provides a similar level of cover as Prime Choice Gold, the only differences being that on Top Hospital Gold, a medical gap benefit is paid to the member based on the AMA list of medical services and fees, and no hospital excess is payable. 

There is also no requirement for doctors to opt in to the medical gap scheme, meaning members have complete freedom over who treats them. However, members will need to serve a waiting period before they can claim the AMA benefit.

Key inclusions:

• Weight loss surgery

• Joint replacements

• Back, neck and spine

Ambulance Cover 

All Doctors’ Health Fund hospital products cover you for ambulance services nationwide, whether it’s for an emergency or otherwise medically necessary, except where there is an entitlement to Benefits under a State Government ambulance transport scheme or any other source.

When eligible, ambulance cover includes:

• An ambulance is called to attend but you’re not subsequently taken to hospital

• It’s medically necessary for you to be transported by an ambulance to be admitted to hospital

• You need immediate medical attention at a hospital or another approved facility

• You are an admitted patient and need to be transferred to another hospital.

Extras Cover 

From dental, to optical, to chiro and more, extras insurance helps cover the bills for routine treatments with rebates of up to 100%.

Doctors’ Health extras reset on January 1 every year.

While we’ve summarised the key points of Doctors' Health Fund extras policies below, it’s always worth reading the fine print on things like gap fees, how much you can claim back, and whether your preferred healthcare provider is recognised by the health fund.

Take the time to work out what you need and what you’re prepared to pay. If this feels a bit overwhelming, you can speak to one of our experts.

Doctors' Health offers three extras policies, ranging from Starter Extras to cover the essentials and Total Extras with a wide range of premium benefits.

Starter Extras

As Doctors’ Health Fund’s entry-level option, Starter Extras is a great option for young singles and couples on a budget – and it features more inclusions than most basic extras policies on the market. This policy is only available when taken with Smart Starter Bronze Plus hospital.

Key inclusions:

• General dental

• Mental health services

• Optical

Essential Extras

The Essential Extras cover provides a superior mid-range option for those wanting cover for a broad range of services

Key inclusions:

• Health management

• Hearing aids

• Pregnancy care

Total Extras

Total Extras offers higher benefits and annual claim limits per person compared to lower-level covers. You also have complete choice of your extras provider.

Key inclusions:

• Home nursing

• Extensive dental cover

• Bone density, mole mapping

Waiting Periods

Waiting periods are there to stop people from signing up, claiming and then cancelling their cover. It means once you take out a new plan, you may have to wait a certain amount of time before receiving your benefit.

When you switch to Doctors' Health Fund from another provider, your waiting periods may be waived unless your new policy covers something you didn’t have before.

Hospital Waiting Periods

• 12 months for pre-existing conditions, pregnancy & birth related services

• 2 months for psychiatric, rehabilitation and palliative care as well as all other hospital services

• 1 day for ambulance

• No waiting period for accidents

Extras Waiting Periods

• 24 months for hearing aids

• 12 months for major dental services, aids and appliances

• 2 months for all other services

Member benefits

Members with Total Extras or Essential Extras cover have access to health management programs. This can include treatments for specific health conditions, so long as the condition has been diagnosed by a registered medical practitioner. 

Examples of treatments include exercise physiology, quit smoking, acupuncture, gym, weight loss classes and class physiotherapy.

Doctors’ Health Fund members are also entitled to discounts at certain retailers, including OPSM and Specsavers.

How to claim

Hospital

Simply tell the hospital you hold a Doctors' Health Fund policy. Your hospital account will be sent directly to Doctors' Health Fund for assessment.

It can be a good idea to call your fund before your admission date to check which benefits you’re entitled to and if there may be any out-of-pocket expenses or excess.

Extras

To make an Extras claim, you can swipe your membership card to claim directly on the spot with your health care provider’s HICAPS or iSOFT terminal.

Members can also claim after the treatment via the Doctors' Health Fund mobile app or through email, fax or mail.

Hospital agreements

Doctors' Health has agreements with a large number of hospital and day surgery providers across Australia.

When comparing policies, it’s worth checking if your preferred local hospitals and clinics are covered. Our specialists at Health Insurance Comparison can help you find out.

Customer service

Doctors' Health received 0.3% of all complaints in 2020. They have a market share of <0.5%¹.

Frequently Asked Questions

Is Doctors' Health Fund a not-for-profit fund?

No. Doctors’ Health Fund is owned by Avant Mutual Group and operates on a for-profit basis.

Who can apply? Are there restrictions? 

Doctors' Health Fund is a restricted fund and only available to doctors, members of the medical community and their close relations. 

Is it easy to switch to Doctors' Health Fund?

Doctors' Health Fund isn’t on our panel, so to switch it’s best to contact them directly. We’re confident the Compare Club team can find you a great deal from the insurers on our panel.

Do I need to re-serve waiting periods?

If you switch to an equivalent or lower level of cover, you generally won’t have to serve new waiting periods. However, you may need to serve new waiting periods if your new policy includes additional services or higher benefits

Can I change my level of cover?

Yes, you can choose a lower or higher level of cover. If you move to a higher level of cover, you will usually need to serve waiting periods on the extra services/higher benefits

Do I get the government rebate?

For every dollar of private health insurance premiums, the Australian Government provides eligible Australians with a rebate of up to 33.4% (depending on your age and income). To learn what you’re entitled to, read our rebate guide.

Do I have to pay the Lifetime Health Cover loading?

If you’re 31 or over, you usually need to pay 2% loading for each year you’ve gone without hospital cover since the 1st July following your 31st birthday. You can find out more here.

Up to what age are children covered?

Children are automatically covered under family cover until the day before they turn 21. If they are full-time students, they’ll be covered until the day before they turn 25 or cease full-time study (whichever comes first) at no extra cost.

^privatehealth.gov.au, Doctors’ Health Fund Performance, September 2021