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.
This information is provided by the fund

Doctors' Health Fund provide further information regarding Gap cover doctors and Agreement hospitals .

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 view Agreement Hospitals for this fund in your region and further details are available from the fund.

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 in one of the following categories: medical, medical radiation, optometry, dental, occupational therapy, physiotherapy and psychology. o A person studying to become a medical practitioner or health practitioner as defined in the previous point, 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 health practitioner. o An employee of a medical practitioner or a health practitioner or an officer or employee of an incorporated practice of a medical practitioner or a health practitioner. o Employed in any role by an association, college or organisation whose members are medical practitioners or health practitioners. o The widow or widower of a member of Doctors' Health Fund or the AMA Health Fund. 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.


The Private Health Insurance Ombudsman prepares an annual report on the service delivery and performance of Australian health funds. The following is a selection of statistics about this health fund - the full report and an explanation of these figures is available from the Ombudsman's website. Please note information is not provided for some funds in some states, as there are insufficient numbers reported to APRA for states in which the fund does not have a large membership.

Performance Fund Industry
Benefits as a % of contributions 82.1% 87.1%
Management expenses (% cont) 11.4% 8.5%
Management expenses (average policy) $524 $276
Surplus 6.6% 4.4%
Member retention (%) 87.4% 84.8%
Hospital Related Charges Covered 91.1% 93.5% 93.8% 93.8% 93.7% 92.8% 92.7% 95.5%
Industry Result 82.4% 89.9% 93.0% 90.7% 95.1% 93.7% 93.8% 88.4%
Medical Services with No Gaps 78.5% 91.7% 95.0% 91.8% 94.0% 87.6% 92.4% 86.2%
Industry Result 77.6% 89.6% 89.5% 86.9% 90.8% 83.4% 89.3% 77.5%
Medical Services with No or Known Gaps 91.1% 95.2% 98.5% 95.8% 99.3% 93.6% 98.0% 94.4%
Industry Result 84.8% 91.7% 94.0% 90.2% 95.9% 94.2% 94.1% 87.9%
General Treatment (extras) Covered 56.4% 53.6% 55.8% 55.5% 59.3% 57.3% 61.5% 61.8%
Industry Result 47.5% 51.2% 52.5% 54.4% 56.1% 56.1% 53.5% 56.3%
Private Hospital Agreements 6 97 76 51 26 20 6 2
Industry Maximum 6 97 78 53 29 21 6 2
Day Hospital Agreements 7 86 73 42 25 23 7 1
Industry Maximum 9 91 73 47 25 24 7 1
Share of PHIO complaints Compared to fund's market share
Benefit Complaints - <0.5%
Service Complaints -
All Complaints 0.1%
Investigations 0%
Level 28, 580 George Street
NSW  2000

Phone: 1800 226 126

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