| Defence Health | |
|---|---|
| Registered insurer | Defence Health Limited |
| Who can join | Restricted: current or former members of the ADF and the Defence community and their families. |
| Business structure | Member-owned mutual, not-for-profit |
| Hospital policies (30 June 2025) | 126,899 (2.1% of all hospital policies), covering 265,163 people |
| Hospital tiers on sale (1 September 2026) | Gold, Silver Plus, Bronze Plus, Basic Plus |
| Excess options on open hospital policies | $250, $500, $750 |
| Age-based discount (18-29) | Offered on some of its open hospital policies |
| Ambulance | Emergency and non-emergency ambulance included on its open hospital policies |
| Question | What the official data shows |
|---|---|
| Out-of-pocket costs in hospital | 89.4% of in-hospital medical services had no gap for the member (industry 87.1%), and 89.3% of hospital charges were covered (industry 89.0%), 2024-25 |
| Waiting periods and pre-existing conditions | The legal maximums apply: 12 months for a pre-existing condition (signs or symptoms in the 6 months before you joined or upgraded) and for pregnancy and birth, 2 months for other hospital treatment. Every hospital policy open to new members in the Government's data at 1 October 2026, at every fund, used the 12-month pre-existing wait |
| Switching from another fund | Waits you've already served on the same or a lower level of cover carry across to Defence Health, and from it. Ask your old fund for a clearance certificate and keep the break between policies short |
| The Medicare Levy Surcharge | Excess options on its open hospital policies go up to $750, so all are within the $750 singles limit, and every policy was flagged as meeting the surcharge rules in the Government's data at 1 October 2026 |
| Adult children (dependants) | Up to age 30, studying or not, in the fund's own record (Government data, 1 October 2026). Adult dependants often need an extended family option |
| Claims experience | 10.3% of Ombudsman complaints about insurers on a 1.9% market share (ratio 5.42), and 3.6% of the complaints the Ombudsman investigated, 2024-25 |
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Who can join Defence Health
According to its PrivateHealth.gov.au record, eligibility covers permanent ADF members and Reservists serving 20 or more training days in a financial year, with their partners and children; anyone who has previously served in the ADF (permanent or Reserve); people who work or have worked for the Department of Defence and other Defence-related departments, or for a Defence supplier involved in supplying goods and services to Defence; and the parents, children, siblings, grandchildren and partners or ex-spouses of any of those people.
PrivateHealth.gov.au describes Defence Health as a mutual organisation operating on a not-for-profit basis.
Complaints: well above its market share
Defence Health accounted for 10.3% of all Ombudsman complaints about health insurers in 2024-25 against a market share of 1.9%, the largest gap between complaints and size of any insurer that year. Its share of investigated complaints was 3.6%, also above its market share. The figures don't explain the cause; the Ombudsman's State of the Health Funds report and its quarterly bulletins are the place to look, and prospective members can ask the fund directly what has changed.
Despite that, retention was 90.1%, well above the industry's 85.0%. Members largely stayed.
Benefits and gaps
Defence Health paid 85.1% of premium income as benefits (industry 84.5%), with management expenses of 13.3% (industry 10.9%). 89.3% of hospital charges were covered and 89.4% of in-hospital medical services had no gap (industry 89.0% and 87.1%), and 98.4% had no gap or a known gap.
What Defence Health sells
Its open hospital policies at 1 September 2026 cover Gold, Silver Plus, Bronze Plus and Basic Plus, with $250, $500 and $750 excess options. Some were listed with the age-based discount. All include emergency and non-emergency ambulance, which its fund record describes as covering state-appointed ambulance providers across Australia, including air and sea ambulance.
Serving ADF members on continuous full-time service usually receive their health care through the ADF and are treated as holding hospital cover for Lifetime Health Cover purposes, so Defence Health cover is most relevant to families, Reservists, veterans and people leaving the ADF.
Defence Health against the industry: 2024-25 data
Every year the Private Health Insurance Ombudsman compares all insurers on the same measures, and PrivateHealth.gov.au republishes the results on each insurer's profile. The table below is Defence Health's, with the industry result beside each figure. Its complaints-to-market-share ratio was 5.42: a figure of 1.00 means complaints exactly in proportion to size.
| Measure | Defence Health | Industry | Reading |
|---|---|---|---|
| Share of all Ombudsman complaints | 10.3% | Market share 1.9% | More complaints than its size |
| Share of investigated complaints | 3.6% | Market share 1.9% | |
| Member retention (hospital cover) | 90.1% | 85.0% | Better than industry |
| Benefits paid as % of premiums | 85.1% | 84.5% | Better than industry |
| Management expenses % of premium income | 13.3% | 10.9% | Weaker than industry |
| Hospital charges covered | 89.3% | 89.0% | In line with industry |
| Medical services with no gap | 89.4% | 87.1% | Better than industry |
| Medical services with no gap or a known gap | 98.4% | 97.1% | Better than industry |
| Extras (general treatment) charges covered | 43.3% | 50.7% | Weaker than industry |
How to read it: complaint share is the fairest single comparison of service across funds of different sizes, because it's measured against market share. Benefits as a % of premiums shows how much of the premium pool went back to members as claims; a mutual that returns more is not necessarily cheaper, and a fund can move this figure by changing prices. The gap measures show how often members avoided an out-of-pocket medical bill after a hospital stay, which is what most people mean by "good cover".
Hospital agreements
| ACT | NSW | VIC | QLD | SA | WA | TAS | NT | |
|---|---|---|---|---|---|---|---|---|
| Private hospitals | 5 | 82 | 64 | 51 | 17 | 21 | 7 | 1 |
| Most held by any insurer | 7 | 95 | 73 | 63 | 17 | 23 | 7 | 1 |
| Day hospitals | 8 | 89 | 58 | 46 | 26 | 22 | 9 | 2 |
| Most held by any insurer | 11 | 109 | 73 | 58 | 35 | 28 | 12 | 2 |
What to check before you join Defence Health
- Complaints were more than five times its market share in 2024-25. Ask how the fund handles claims and service issues now.
- Leaving the ADF after your LHC base day? You have 1,094 days from discharge to take out hospital cover without a loading.
- Eligibility extends to extended family, but confirm yours before you apply.
- Over 31 and joining for the first time? Work out your Lifetime Health Cover loading first, and if you earn over the threshold, check the Medicare Levy Surcharge you'd avoid.
Common questions about Defence Health
Who can join Defence Health?
Serving and former ADF members (permanent, and Reservists with 20 or more training days a year), people who work or worked for Defence or a Defence supplier, and their partners, children, parents, siblings and grandchildren.
Is Defence Health not-for-profit?
Yes. PrivateHealth.gov.au lists Defence Health as a mutual organisation operating on a not-for-profit basis.
Does Defence Health include ambulance cover?
Yes. All its hospital policies open to new members included emergency and non-emergency ambulance in the Government's product data at 1 September 2026.
Other fund reviews
See every registered health insurer compared on complaints and benefits, or read how the private health insurance rebate and hospital cover tiers work.
General advice only. It doesn't consider your circumstances. Read the PDS and TMD before you decide.
This review is general information based on published government and regulator data. We don't rate or rank funds, and it doesn't consider your circumstances. Check a policy's Private Health Information Statement before you buy.