Tell us your experience with Defence Health Fund

Edit: New readers to the topic can join as of August 2023 by clicking here.

Do you have something to say about Defence Health? Tell us your good experiences, bad experiences or otherwise and help inform the CHOICE Community.

Read our review of Defence Health

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I have been a member of Defence Health Fund for a number of years and have always found their Hospital insurance very good value for money. As a dialysis patient for 15 months I was a heavy user as they were paying out $700 a week. the plan also included ambulance cover. The plan I am on is no longer available but they did not force me to change to the replacement plan which I assumed might be less generous. My Extras cover which was Top Level at the time I purchased it was not so generous for dental work but covered items such as a blood pressure monitor and some non PBS medications. I have never needed to talk to them by phone as all claims have been handled promptly. So only positive dealings with them, nothing negative.

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I have been with Defence Health (previously called Army Health Benefits Society) over 40 years continuously. I worked for the Army in a clerical role for 3 months when I was 16, joined and stayed - reliable, good communicators and no more expensive than comparable schemes (I have always had Top Extras cover). Easy claims.

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Noted a raft of “Tell us your experience with …” have popped up. Defence Health is one that seems to always miss out. Yes it is selective membership, but it’s not that restrictive and has around 120,000 members:

  1. Partners and kids of permanent ADF members (permanent SERCAT 6-7)- if you’re a member of the permanent ADF you don’t need to cover yourself but you can cover your partner and/or child(ren)
  2. Reservists (SERCAT 3-5 serving 20 or more training days in a financial year), their partners and kids
  3. All those who have previously served in the ADF (full-time or part-time) and their partners and children
  4. ADF supporters
  5. Anyone who works or has worked in the Department of Defence and other Defence-related departments
  6. Anyone who works or has worked for a Defence supplier - a company or agency contracted to the Department of Defence, where you are or were involved in the supply of goods and services to Defence
  7. Extended families
  8. You are the mum or dad, son or daughter, sister or brother, grandchild or ex-spouse/partner of a serving or ex-serving member of the ADF or of an ADF supporter (described above)

That’s a fairly big segment of the community eligible to join … and it’s not for profit and comes under the “Members Own” group.

And for what it’s worth - I think they are great!

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I agree! I have been with Defence Health for thirty odd years and find that they are very willing to speak to you, to advise and to suggest options. They do not suggest one surgeon over another but give a list of surgeons who accept Defence Health patients…this is how I found a surgeon who replaced both my hip joints at $2,000 less than the one recommended by my doctor! I did, in fact, ring three surgeons from the list and am very pleased with the surgeon I chose. My choice was determined by price but I have no complaints with the surgery after two years!

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I am a long term member of Defence Health Fund. About a month ago they upgraded their website and since then it has not been possible to make a claim, either by card or by submitting the receipt. A phone call takes about three hours to get answered. Yet they seem to have the technology to take my monthly fees…should we be getting a discount as compensation.

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About three months ago Defence Health closed their site on the basis they were upgrading to a new system. Since then they do not answer their phone or pay refunds….is anyone else having this problem?

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Yes the website isn’t functioning as it should and often my HICAPPS card doesn’t work at my usual extras providers. I tried to claim online - my extras claim date was the same date coincidently that my monthly payment was due. The claim was rejected with a message about me not having paid the member fees! I emailed and didn’t get a personal response just a general email to say they had received my monthly payment. They are trying to make a new website maybe in the wake of the Medibank hack? Now I’m making excuses for them…

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Evidence is they have had an IT upgrade fail causing all sorts of issues since July 2023. Has Defence Health timely paid claims since? Are their benefits competitive? Are their premiums competitive? Have their ‘x-ADF members’ been well served? Have they done comparison shopping for alternatives? Is there some reason they are still with what appears to be an under performing fund, at least as far as responsiveness to their customers?

Filtering them on ‘claims made’ is not flattering. Many anecdotal posts reflect those where they are not contactable.

This Choice report does not follow good practices since it is undated, although nothing may have changed since it was originally posted to start this topic.

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It appears their goal is to deliver the benefits their customers should have had without the dramas, with some ‘apologies’ for the trouble to their membership. If the corporate KPI was to make the QF call centre look good during COVID they seem to have made that hurdle.

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I’ve been with Defence Health for many years and have found them good when I needed them - unfortunately living in remote locations the ability to use private health extras is limited. I haven’t made a claim with them this year.

The recent issues with their IT changes appear to be epic, and they have communicated that to their members. Whether that has been reassuring is another thing.

On 9 August 2023 the following:

Technology transformation update

You’re probably aware that we’ve made the move to the new Defence Health website and membership platform. The system is the first of its kind in Australia and sets us up for the long term to better serve our members.

Unfortunately, the transition caused significant disruption to our operations and a higher number of calls than anticipated. I’m truly sorry for the frustration members have had in trying to contact us, or to access the Member Portal.

We still have some features to add to the new system and when it is fully functional, it will give you greater control over your membership. The updated system also strengthens our protection of your personal information.

I want to assure you there are large and dedicated teams of people working to resolve the remaining technical issues; to answer your calls and emails; and to make outstanding benefit payments on claims. And we’re hiring additional people to improve response times.

I’m sorry if our service level let you down in recent weeks. It was not part of the plan. I sincerely thank you for your patience while we embed the new technology and I’m confident we’ll be back on track very soon.

Kind regards

Joanne Kadlecik
Chief Executive Officer

on 23 August 2023:

I am writing to inform you of a temporary change of leadership at Defence Health.

Our Chief Executive Officer, Joanne Kadlecik, has been diagnosed with a serious medical condition and requires a period of leave for treatment. Former CEO, Gerard Fogarty, has agreed to the Board of Directors’ request to return as Acting CEO while Joanne attends to her health.

The Directors and I want Joanne to focus on making a full recovery. We look forward to welcoming Joanne back as Chief Executive Officer of Defence Health when she is well again. Yours sincerely

Alan Beckett Chairman,

Defence Health Limited

on 13 September 2023:

I’m writing to let you know that in light of recent system issues, we have delayed our premium rate review and any associated increase from 1 October to 1 April 2024.

We have made this decision with your experience in mind, as a number of our members have been inconvenienced as we transition to our new membership platform. This transition has caused a series of unforeseen disruptions, resulting in a backlog of claims and flow-on of increased calls and delays in responding to members. I’m truly sorry for this.

I am pleased to share that our online connections with hospitals and extras providers such as dentists and physios, are operating smoothly again. However, there remains a small number of issues that need to be fixed. If you’ve been affected by a payment failure, I apologise, this will be rectified.

I’m aware we are still experiencing lengthy phone queues in our contact centre, and can assure you we are making significant progress in processing the backlog of claims. Last week we dedicated a significant amount of additional resources and our team processed 58 per cent more claims than the average week. We also provided cover for approximately 2,000 members who required hospital admission.

We still have some features to add to our new system and when it is fully functional, it will give you greater control over your membership. You can now update your premium payment details once you log into the Member Portal. For faster extras payment, Policy holders can claim through the Member Portal, with benefits paid into the Policy holder’s account usually within two to three business days.

I would prefer our service was not disrupted by the changeover, however, when complete, the new system will improve the control you have of your membership and enhance your user experience. Thank you for your patience while we navigate this major change.

Kind regards
Major General Gerard Fogarty, AO (Ret’d)
Acting Chief Executive Officer

and finally on 5 October 2023:

I understand that the lack of service to our members has made things far from easy. There is no denying it has been difficult and frustrating for many members over the last few months. I want to extend my heartfelt apologies for this challenging period, which I must admit, stands as one of the most trying times in our 70-year history.

As we progressively fix issues in the system, we’re still receiving more calls than normal and call wait times are currently around an hour. Plus, we’re receiving an increase in emails, resulting in a cascading effect of delays beyond our usual response times to your queries.

The backlog of claims is another challenge we are actively addressing by adding more temporary agents to our normal claims team. The claims are in a queue and being processed and paid as quickly as possible. I know you depend on prompt payment of claims, and I am sorry for the significant delays. We anticipate clearing this backlog by the end of October. While we do want to talk to our members, if you call us now to check on your claims progress, unfortunately, you will still encounter extended wait times.

I’ve spoken with many members and heard your feedback. To make it easier for you to log in and make a claim, our team has created some helpful video tutorials which you can access by clicking below:

  1. Register and log in
  2. Make an Express Claim via the Member Portal

Once again, I want to express my sincere apologies for the immense frustration this situation has caused. We are committed to making things right and restoring your trust in the quality of service we provide. Your loyalty and patience mean the world to us as we work to resolve these issues.

Kind regards

Major General Gerard Fogarty, AO (Ret’d)
Acting Chief Executive Officer

For some that might be TLDR, but might fill in some blanks.

I’d hate to be on their technology transformation team :rofl:

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Wouldn’t be many of those.

The new platform would be some industry solution from the likes of Oracle or SAP ( Oracle I believe) with application support in Asia. The system probably cloud-based running who knows where.
The business transformation team a bunch of consultants from one of the big firms (EY I believe).

Once a commitment is made to go forward and cutover to a new system, there is no going back to the old one because the data has changed so much.

A company just has accept how much they are willing to pay as to how much testing is done before cutover. One example of that was the Census fail of 2016. The ABS paid peanuts for testing and got what they deserved.

Unlikely to provide any comfort or resolution for the members struggling to get the services the fund agreed to provide.

Nothing to see here?

Although this was in 2019.
There’s more to be found in the 2022 Annual report.
Google failed to locate a 2023 Annual Report

Enough said!

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Indeed. To be the first Australian health insurer to try an unproven IT system, and all that entails with customisation for Australia, would be considered a courageous management decision.
Wonder how they feel now? Treating their customers as guinea pigs.

Still, the next to try Oracle Health will have a system with most or all the bugs fixed, thanks to DHF.

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Another update from Defence Health on 02 November 2023:

Dear xxxxxx,

I know that over the last three months, our service levels have been poor.

For that, I am sorry.

I’ve recorded a short video message to share what we are doing to restore your trust in our service.

I am confident we will emerge from our recent challenges and provide a better experience for all of you.

I hear you, I know we have let you down; we will recover from this.

Kind regards

Major General Gerard Fogarty, AO (Ret’d)
Acting Chief Executive Officer

Major General Gerard Fogarty, AO (Ret’d) video message to members

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Need to update now expired credit card details but can’t find anything on their website. I assume until update occurs no claims will be processed.
Tried “chat” but it is turned off.
Tried phoning three times but after holding for 30 minutes gave up in frustration.
Have sent a letter pleading them to contact me but having been a bit caustic about the inability to contact them I wonder if they will get the huff?

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They are an absolute epic fail. One can understand a couple of glitches with a new IT platform, but not having a capability to fix it quickly (or even roll back) is unforgivable. Then not fixing it, or even answering phone calls, emails, contact forms or physical mail for an extended period (nearly five months and counting) is service so substandard it is verging on no service. And this from an insurer that pre Covid would answer the phone pretty much straight away. You can’t contact them, can’t do a lot of things online. Complaints to the Commonwealth Ombudsman don’t seem to achieve much - all the Ombudsman says is that they have asked DH to make contact with urgency to resolve the issues. But still they don’t call.

I believe we are past the stage where APRA should commence enforcement, as DH is clearly in breach of at least two of the published regulatory standards. There was short online article on the ABC website earlier last month, but that is the extent of the advocacy I have found. Perhaps Choice should become involved?

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Yes I agree, hear horror stories of peoples experience, particularly those entering hospital. And as for trying to confirm coverage for particular items, well as you say they do not answer the phone. Found it less stressful not to use extras but why have them. Would be much appreciated if Choice became involved.

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hmmm …

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Interesting that while reading The Guardian online on Sunday an advert for the Fund popped up in one of the articles I was reading.

Interesting profiling if nothing else - one would wonder at the funds capacity at this time to take on any new members!

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