Doctors' Health Fund (AMA)
Doctors' Health Fund is a private health insurer serving the medical community. The Fund offers a service that protects members from the impact of health care incidents in their lives. We offer convenience and flexibility with a choice of hospital and extras cover. Our top hospital cover offers the best gap cover in Australia. It delivers unrestricted choice of doctor and greater benefits which are based on the AMA List of Services and Fees.
Doctors' Health Fund provide further information regarding:
Agreement Hospitals
This fund has agreements with some private hospitals or day surgeries to provide services at low or no out-of-pocket costs. You can see Agreement Hospitals for this insurer and further details are available from the insurer.
Business Structure
This insurer operates on a for-profit basis and is owned by the Avant Mutual Group, a group that operates on a not-for-profit basis.
Doctors' Health Fund operates in all states and territories.
Membership restrictions
To be eligible to be a member of Doctors' Health Fund you must be: o A registered medical practitioner. o A registered health practitioner from the following list: medical, medical radiation, optometry, dental, occupational therapy, physiotherapy or psychology. o A person studying to become a medical practitioner or listed registered health practitioner, at an Australian educational institution. o An overseas qualified doctor who is registered for the AMC exams. o The spouse, child or grandchild of a medical practitioner or a listed registered health practitioner. o An employee of a medical practitioner or a listed registered health practitioner or an officer or employee of an incorporated practice of a medical practitioner or a listed registered health practitioner. o Employed in any role by an association, college or organisation whose members are medical practitioners or listed registered health practitioners. o The spouse or child of a member of the Fund or former member of the Doctors' Health Fund or the AMA Health Fund, or o Have been covered by Doctors' Health Fund or AMA Health Fund in the past either as a member or as the dependent of a member. Please contact us on 1800 226 126 if you would like help in determining your eligibility.
Performance
The Private Health Insurance Ombudsman prepares an annual report on the service delivery and performance of Australian health insurers. The following is a selection of statistics about this health insurer - the full report and an explanation of these figures is available from the Ombudsman's website. Please note information is not provided for some insurers in some states, as there are insufficient numbers reported to APRA for states in which the insurer does not have a large membership.
| Ombudsman complaints compared to market share | ||
|---|---|---|
| All complaints | 0.4% | 0.5% market share |
| Investigated complaints | 0% | |
| Health Insurer Retention and Finances | Industry result | |
|---|---|---|
| Member retention (hospital cover) | 90.5% | 88.6% |
| Benefits as % of contributions | 82.3% | 83.1% |
| Management expenses % of contribution income | 11.4% | 9.9% |
| Management expenses per average policy | $579 | $375 |
| Coverage | ACT | NSW | VIC | QLD | SA | WA | TAS | NT | Australia |
|---|---|---|---|---|---|---|---|---|---|
| Hospital Related Charges Covered | 90.0% | 91.1% | 93.2% | 92.2% | 90.4% | 92.1% | 87.5% | 89.2% | 91.9% |
| Industry Result | 82.9% | 89.4% | 91.5% | 89.7% | 93.4% | 92.7% | 92.9% | 89.3% | 90.6% |
| Medical Services with No Gaps | 91.2% | 91.6% | 93.8% | 93.0% | 91.9% | 89.1% | 80.5% | 82.2% | 92.4% |
| Industry Result | 76.9% | 89.7% | 88.0% | 88.8% | 89.7% | 88.5% | 91.4% | 87.5% | 88.8% |
| Medical Services with No or Known Gaps | 97.2% | 98.0% | 98.9% | 99.0% | 99.2% | 98.1% | 97.1% | 99.5% | 98.5% |
| Industry Result | 92.3% | 96.7% | 97.9% | 97.2% | 99.3% | 97.5% | 98.8% | 96.5% | 97.4% |
| General Treatment (extras) Covered | 55.2% | 52.6% | 53.6% | 55.1% | 57.4% | 53.8% | 51.9% | 54.5% | 53.7% |
| Industry Result | 47.0% | 49.1% | 50.8% | 52.5% | 56.4% | 56.6% | 52.6% | 58.4% | 52.0% |
| Private Hospital Agreements | 6 | 91 | 73 | 49 | 19 | 21 | 8 | 2 | - |
| Industry Maximum | 6 | 98 | 76 | 60 | 23 | 24 | 9 | 2 | - |
| Day Hospital Agreements | 8 | 86 | 68 | 46 | 23 | 20 | 4 | 1 | - |
| Industry Maximum | 9 | 103 | 79 | 57 | 30 | 24 | 8 | 2 | - |
Queen Victoria Building
NSW 1230