We’re proud to be a not-for-profit health fund, driven by the needs of our members to deliver the best possible health insurance.
How we choose hospitals
We have agreements with most private and day hospitals across Australia. We choose the hospitals we believe you are most likely to use, and the contracts we have with them are designed to give you transparency and certainty.
In general, we establish a fixed schedule of fees for common items such as theatre, special unit accommodation and in-patient accommodation fees.
We pay those fees for you. The level of payment depends on your level of health insurance cover, type of cover and other factors.
If you choose to be treated by a hospital that doesn’t have an agreement with us, you might need to pay out-of-pocket expenses, even if you have a very comprehensive level of cover.
ADVANTAGES OF HOSPITAL AGREEMENTS
Here’s why it’s in your interest to choose a hospital that has an agreement with us.
Certainty and planning
With an ‘agreement’ hospital you know exactly what will be covered well in advance of your hospital stay. You can more effectively plan the cost of your stay, knowing which services will be covered. In general, you can claim benefits for accommodation, theatre and labour ward fees, intensive care and coronary care fees, subject to your level of cover.
Lower out-of-pocket expenses
Choosing an agreement hospital means lower or no out-of-pocket expenses for you and your family (with the exception of any applicable co-payments). For example, if you get treated at a non-agreement hospital, the benefits you receive will usually be restricted, regardless of your level of cover. With Comprehensive Hospital (Gold) cover you can access benefits for private hospital services such as major eye surgery, joint replacement, heart and vascular surgery and much more by choosing an agreement private hospital (or day surgery).
Your level of cover can have an impact on your out-of-pocket costs. So can your choice of hospital.
If you are treated in a public hospital, as an in-patient, you may be able to claim benefits for items such as private room accommodation, shared room accommodation and intensive care. Basic Plus Hospital offers minimum benefits for private rooms and benefits for accommodation in a shared room. Note that if you choose a public hospital, you may be placed on a waiting list, even if you are admitted as a private patient.
In non-agreement private hospitals, benefits may be similar to those in a public hospital.
In agreement hospitals the benefits are greater. These include accommodation for private or shared rooms, theatre and labour ward fees in private hospitals (not including restricted services), Access Gap Cover, medical expenses, pharmacy and much more. Check your level of cover for more details.
SEARCH FOR A HOSPITAL
Find your nearest agreement hospital using the search tool below*.
*We try to ensure the agreement hospital database is as up to date as reasonably possible. However, there could be instances where search results list hospitals whose contract may not be renewed in the near future. This reflects the fact that we are constantly reviewing our hospital agreements to guarantee our members exceptional value and service.