Agreement Hospitals are private hospitals that have an agreement in place with your health fund for hospital accommodation and theatre fees.
Most private hospitals in Australia have agreements with health funds, helping reduce or avoid some hospital related out-of-pocket costs for services included under your policy.
Understanding how Agreement Hospitals work can help you better understand your hospital cover and potential treatment costs before going to hospital.
Key Points
- Agreement Hospitals are private hospitals that have an agreement in place with your health fund
- These agreements help reduce or avoid some hospital related out-of-pocket costs
- Most private hospitals in Australia have agreements with health funds
- Medical gaps from doctors or specialists can still apply at an Agreement Hospital
What are Agreement Hospitals?
Using your hospital cover when you’re admitted to a private hospital, there are separate costs associated with your treatment. This includes hospital accommodation, theatre fees and medical costs charged by your doctor or specialist.
An Agreement Hospital is a private hospital that has an agreement in place with your health fund to cover hospital accommodation and theatre fees for included services under your policy.
This helps provide greater certainty around hospital costs for treatments included under your policy, however medical gaps from doctors or specialists can still apply.
How do Agreement Hospitals work?
When you’re treated at an Agreement Hospital for a service included under your policy, your health fund pays benefits towards your hospital accommodation and theatre fees in line with the agreement in place with the hospital.
This helps reduce or avoid some of the large hospital costs associated with a private hospital admission.
Depending on your policy, you may still need to pay things like an excess or co-payment.
Do Agreement Hospitals reduce out-of-pocket costs?
Yes. When you’re treated at an Agreement Hospital for a service included under your policy, your health fund covers hospital accommodation and theatre fees in line with the agreement in place with the hospital.
If you choose to be treated at a non-Agreement Hospital, you will have significant out-of-pocket expenses for your hospital admission.
Can doctors still charge out-of-pocket costs at an Agreement Hospital?
Yes. Agreement Hospitals only relate to hospital accommodation and theatre fees.
Doctors, surgeons, anesthetists and other specialists are separate to the hospital and set their own fees for treatment.
You can learn more about medical gaps and out-of-pocket expenses in our article on out-of-pocket costs.
What happens if a hospital isn’t an Agreement Hospital?
If a private hospital doesn’t have an agreement in place with your health fund, it is considered a non-Agreement Hospital.
When treated at a non-Agreement Hospital, your health fund won’t fully cover the hospital accommodation and theatre fees associated with your admission.
Where possible, we recommend receiving treatment at an Agreement Hospital to help avoid the significant out-of-pocket expenses you’ll have to pay at a non-Agreement Hospital.
How do you check if a hospital is an Agreement Hospital?
Most health funds provide a hospital search tool or hospital list on their website that allows you to check whether a hospital is an Agreement Hospital.
Before booking treatment, it’s important to confirm both that the hospital has an agreement with your health fund and that the treatment is included under your policy.
You can view Phoenix Health Fund’s Agreement Hospitals using our Find a Provider tool.
Need help understanding your Phoenix Health cover?
If you’re planning treatment or preparing for a hospital admission, our team can help you understand your cover, check whether a hospital is an Agreement Hospital and explain any excesses or potential out-of-pocket costs that may apply.
Call us on 1800 028 817 if you’d like help understanding your cover before going to hospital.
Why do health funds have Agreement Hospitals?
Agreement Hospitals help provide greater certainty around hospital costs for both members and health funds.
By having agreements in place with private hospitals, health funds can help reduce large hospital accommodation and theatre costs for treatments included under a member’s policy.
These agreements are a standard part of how private health insurance works in Australia and are used by health funds and private hospitals across the industry.
