Agreement private hospitals and your health cover

What is an agreement private hospital?

An agreement private hospital is a private hospital that has an agreement with your health fund to eliminate or reduce out-of-pocket expenses.

How do agreement private hospitals affect my health insurance?

Agreement private hospitals can affect your choice of health fund for a variety of reasons, including:

• if you have a particular private hospital in mind that you wish to attend, for example, if you are planning to have a child and wish to give birth in a particular hospital;
• if you live in a rural area, it is important to check how far you would need to travel to attend the nearest agreement private hospital.

Check the list of private agreement hospitals in your state now.

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What's covered in an agreement private hospital?

If you are admitted to an agreement private hospital, your health fund will cover the costs associated with your stay, depending on your level of cover. If your health insurance plan fully covers you for the procedure you have been admitted to hospital for, the health fund will pay your costs, including:

• hospital costs (accommodation, and in most cases also theatre costs if you require surgery)
• doctors' fees
• labour ward costs (if you are covered for pregnancy and birth-related services)
• intensive care
• coronary care (if you are covered for cardiac procedures)

Some health funds will also ensure that no Gap is payable for treatment in an agreement private hospital. Read more about the Gap.

Is anything not covered in an agreement private hospital?

Any Excess or Co-payment arrangements you have with your health fund will be payable by you, as this relates to your health insurance policy rather than the general policy of the health fund. Find out more about Excess and Co-payments.

Also, the cost of using telephones and televisions in hospital are typically not covered by health insurance.

What happens if I go to a non-agreement private hospital?

If you go to a non-agreement private hospital to receive treatment, you will likely incur extra costs during your stay. The cover you receive will depend on your health fund - some may pay only the basic rate set by the government, while others may pay a bit more.

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How do I find out which private hospitals have agreements with my health fund?

To find out which private hospitals have agreements with your (potential) health fund, click here to see the entire list.

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