Doctors Health

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About Doctors Health

What is Doctors Health?

Doctors’ Health Fund (Doctors Health) is a private health insurer that operates as a restricted health fund. 

Background

Doctors Health was established by the NSW branch of the Australian Medical Association (AMA) in 1977 to serve the medical community. 

There used to be a convention that doctors did not charge colleagues or their colleagues’ families. When Medibank was set up in 1976, doctors began to charge their colleagues the amount of the Medibank rebate. Doctors Health was set up to solve the discomfort associated with doctors charging their colleagues fees.

Avant Mutual, Australia’s largest medical defence organisation, bought Doctors Health in 2012. It now has over 32,000 members.

Who can join Doctors Health?

You can join Doctors Health if you are a:

• current or former (including retired) registered medical practitioner (including overseas trained doctor registered for the Australian Medical Council exams)
• current or former:
  • optometrist
  • physiotherapist
  • psychologist
  • occupational therapist
  • dentist, dental therapist, dental hygienist, dental prosthetist and oral health therapist.
  • medical radiation practitioner, diagnostic radiographer, medical imaging technologist, radiographer, nuclear medicine scientist, nuclear medicine technologist or radiation therapist.
• student studying to become a medical practitioner or eligible health practitioner
• employee of a medical practitioner or eligible health practitioner (including practice managers and receptionists)
• employee of any member associations for medical practitioners or eligible health practitioners, such as the Australian Medical Association.
• member of the extended family (parent, children, grandchildren, spouse/partner (including former), sibling or niece/nephew. 

What products does Doctors Health offer?

Doctors Health offers:

• Hospital Cover
• Extras Cover.

The insurer’s Top Hospital Cover is unique because it pays a gap based on the AMA’s list of medical services and fees rather than the Medicare Benefits Schedule (MBS) fee. 

Do Doctors Health policies include Ambulance Cover?

Doctors Health includes Ambulance Cover with Hospital Cover and Combined Hospital and Extras Cover.

Under these policies, Ambulance Cover is not restricted to emergencies or limited to a number of services per year.

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Is Doctors Health a not-for-profit health insurer?

No. Doctors Health is a for-profit health insurer.

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Does Doctors Health operate in all Australian states and territories?

Yes. Doctors Health operates in all Australian states and territories.

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How does Doctors Health Hospital Cover compare with other insurers?

Benchmarks	Doctors Health	Industry average
Member retention for Hospital Cover	90.5%	88.6%
% hospital-related charges covered	91.9%	90.6%

Source: Private Health Insurance Ombudsman: State of the Health Funds Report: 2022

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Does Doctors Health have agreements with some private hospitals or day hospitals to provide services at low cost or with no out-of-pocket costs?

Yes. Doctors Health has agreements with a number of private hospitals that allow it to provide services to its members at low cost or with no out-of-pocket costs:

Location	Number of private Agreement Hospitals	Industry maximum
ACT	6	6
NSW	91	98
NT	2	2
QLD	49	60
SA	19	23
TAS	8	9
VIC	73	76
WA	21	24

Doctors Health also has agreements with a number of day hospitals so it can provide services at low cost or with no out-of-pocket costs:

Location	Number of day Agreement Hospitals	Industry maximum
ACT	8	9
NSW	86	103
NT	1	2
QLD	46	57
SA	23	30
TAS	4	8
VIC	68	79
WA	20	24

Source: Doctors Health: peformance

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How does Doctors Health Extras Cover compare with other insurers?

Benchmark	Doctors Health	Industry average
% Extras Cover charges covered	53.7%	52.0%

Source: Private Health Insurance Ombudsman: State of the Health Funds Report: 2022

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How does Doctors Health compare with other private health insurers?

Benchmarks	Doctors Health	Industry average
Market share	0.5%	–
% services with no gap	92.4%	88.8%
% services with no gap or where known gap payment made	98.5%	97.4%
Market share of complaints to the PHIO	0.4%	–
Percentage of complaints investigated by the PHIO	0.0%	–
Benefits as a % of contributions	82.3%	83.1%
Management expenses as a % of contribution income	11.4%	9.9%
Management expenses per average policy	$579	$375

Source: Private Health Insurance Ombudsman: State of the Health Funds Report: 2022

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Is Doctors Health a member of any industry associations? 

Yes. Doctors Health is a member of the Members Health Fund Alliance, an alliance of not-for-profit, member-owned, regional or community-based health insurers.

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Does Doctors Health let me claim online or via an app?

Yes. Doctors Health allows you to make a claim online using the member portal or the mobile app.

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How to contact Doctors Health

Phone:

1800 226 126

Website:

https://www.doctorshealthfund.com.au/

Email:

info@doctorshealthfund.com.au

Address:

Level 6
Darling Park Tower 3
201 Sussex Street
SYDNEY NSW 2000

Postal address:

PO Box Q1749
Queen Victoria Building
SYDNEY NSW 1230

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