A Health Insurance Review of The Doctors Health Fund

Published: November 27, 2018

A private health insurance company specifically designed to protect the health of medical professionals and their families.

This private health insurer offers clinical independence and freedom of choice by placing no restrictions on your preferred provider networks for your general treatment services.

If you're a current or past licensed medical or health practitioner or a student studying to become one, you might be eligible to join the Dr's health fund.

ComparingExpert does not currently have access to this provider. Visit www.doctorshealthfund.com.au to request a quote and compare their price and benefits to the Australian private health insurance companies we have access to.

About the Doctor's Health Fund

The Australian Doctors Health Fund was established over 40 years ago, created by doctors to provide quality private health insurance for doctors and the medical community of Australia.

This private health insurance company changed its name to the Doctors Health Fund in 2005 reflecting its separation from AMA (the Australian Medical Association).

In 2012, the fund was acquired by the Avant group, Australia’s largest Medical Defence Organisation, with the aim of increasing its client base, averaging a 10% per year growth since joining. As part of Avant Mutual, the fund is owned by doctors only and not shareholders.

Who can join?

To gain Doctors Health Fund eligibility, you generally need to qualify as one of the below:

  • Current or previous registered medical practitioners
  • Current or former health practitioners, for example, dentist, occupational therapist, psychologists, and physiotherapists.
  • Anyone employed by a medical or health practitioner.
  • Anyone employed by a state of the federal chapter of the AMA.
  • Anyone employed by a member association for medical or health practitioners.
  • Students studying to become a medical or health practitioner.
  • Family members of any of the above. For example, spouse (current and former), children, parents, siblings, nieces and nephews, and grandchildren.

Once you're a member, you can continue your membership even when you’ve switched jobs or your relationship status has changed.

Your Doctors Health Fund review

If you’re part of the medical community, you can choose to buy any of the 3 Hospital or 2 Extras health insurance options available or combine Hospital and Extras into a combo package.

In 2018 the Drs Health Fund had the lowest premium increase of all health funds, and when you pay annually in advance, you can receive 2.5% off your premiums. Furthermore, as a member, you'll also usually receive a 30% discount on QBE's travel insurance products.

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Need help? Call us on 1300 786 328

Hospital cover

When logged into the fund's members' portal, you can quickly find and choose one of the many hospitals that the fund has an existing agreement with by using their Contracted Hospital Search. There are 3 Hospital only cover options to choose from; Smart Starter, Prime Choice and Top Hospital and all 3 options cover you for ambulance services nationwide.

Smart Starter Prime Choice Top Hospital
Entry-level cover, designed for singles and couples on a tight budget. Comprehensive hospital coverage that provides for a wide range of services. Premium cover that pays a medical gap benefit up to the AMA list of medical services and fees.
$115.95 $201.92 to $230.27 $307.73
$500 Excess $500 or $0 Excess Zero Excess
  • Gastroscopy and colonoscopy
  • Cancer-related services
  • Joint reconstruction
  • Removal of tonsils or adenoids.
  • Dialysis
  • Heart surgery
  • Psychiatry
  • Rehabilitation
  • IFV & pregnancy-related services
  • Eye treatments
  • Obesity surgery
  • Hearing loss services
  • Hip and knee replacement
  • Sterilisation
  • Spinal surgery
  • Joint reconstruction
  • Cosmetic surgery
  • Gastroscopy and colonoscopy
  • Cancer-related services
  • Joint reconstruction
  • Removal of tonsils or adenoids.
  • Dialysis
  • Heart surgery
  • Psychiatry
  • Rehabilitation
  • IFV & pregnancy-related
    services
  • Eye treatments
  • Obesity surgery
  • Hearing loss services
  • Hip & knee replacement
  • Sterilisation
  • Spinal surgery
  • Joint reconstruction
  • Cosmetic surgery

The main difference between these two options is that the Top Hospital cover requires no Excess and your doctors' services, as an in-patient, is covered by the Unique Premium Gap Cover. Meaning, the fund pays the rest of the benefits Medicare does not include, up to the AMA list.

Fully covered Restricted cover Not covered

Source: privateheath.covg.au
Prices above are based on a single adult, without an LHC loading, living in NSW, November 2018 (excludes the Government Rebate).

Hospital waiting periods

  • Ambulance: 1 day
  • Hip & knee replacements: 2 months
  • Joint reconstruction: 2 months
  • Pregnancy-related services: 12 months
  • Assisted reproductive services: 2 months
  • Psychiatric services: 2 months

Doctors Health Fund extras

The private health fund offers you the choice of 2 Extras options; Essential and Total. While each option has a different benefit limit, they both exclude non-medically proven therapies (chiropractic and natural therapies) and include:

General treatment & Waiting periods Essential Extras
Annual benefit
Total Extras
Annual benefit
Monthly premium $69.11 $113.47
General dental: 2 month waiting period $1,600 per policy
Sub-limits apply
No annual limit
Major dental: 12 month waiting period $3,200 per policy
Optical: 2 month waiting period $500 over 2 years $600 over 2 years
Physiotherapy: 2 month waiting period $900 per policy.
Sub-limits apply
$700 per policy. Sub-limits apply
Remedial massage: 2 month waiting period
Psychology: 2 month waiting period $600 per policy
Podiatry: 2 month waiting period $1000 per policy
Hearing aids: 24 month waiting period $500 per policy. 1 Appliance every 3 years. $1000 per policy. 1 Appliance very 5 years.
Blood glucose monitors: 12-month waiting periods 75% of charge per monitor.
Non-PBS pharmaceuticals: 2 month waiting period $300 per policy $600 per policy
Source: privateheath.covg.au. Prices above are based on a single adult, without the LHC loading, living in NSW, November 2018 (excluding the Government Rebate).

The Total Extras option also includes access to the fund’s Health Management Programs and home nursing services. Their Health Management Programs are designed to help you manage specific health conditions, like high Body Mass Index (BMI), arthritis and asthma.

Cover combos

If you want both Hospital and Extras cover, you can combine them into one package. For example, as a young and healthy single adult, you might want to mix the Smart Starter Hospital with Essential Extras cover. However, if you're a couple with young children you might want to invest in a more comprehensive package, for example, Prime Choice Hospital and Total Extras.

Carefully consider your health and stage of life before choosing a policy. You might want to shop around and compare premiums and benefits from some of Australia’s major health insurers.

Frequently asked questions and answers

Who owns Doctors Health Fund?

The fund is a member of the Avant Mutual Group and policies are issued by The Doctors’ Health Fund Pty Limited, ABN 68 001 417 527.

Can nurses join Doctors Health Fund?

Yes, all members of the medical community, including nurses and their families, can join this private health insurer.

How do you claim?

To claim Extras, you can swipe your member card on the spot at a participating HICAPS provider, or you can use your smartphone and claim via the Drs Health Fund Member app by simply taking a picture of your claims receipt and submitting it through the app.

Alternatively, you can also scan and email you receipts and completed claim forms to the fund directly.

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Need help? Call us on 1300 786 328

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