General information

What has happened?

Despite extensive negotiations, ACHA has been unable to agree fair commercial terms with Bupa and the health funds which are members of the Australian Health Service Alliance (AHSA).  We have given Bupa and AHSA health funds notice that our contracts with them will terminate.

Transitional arrangements will apply to these health fund contracts from  21 February 2025 for Bupa and from 4  March 2025 for AHSA health funds. 
See table below for further detail on transitional arrangements for patients

We are aware of the impact this is likely to have for our patients who are Bupa or AHSA health fund members. The last thing we want to do is impose any additional costs on patients during a cost of living crisis.  We remain ready as always to negotiate a fair funding agreement with both Bupa and the AHSA health funds that properly and sustainably addresses the rising costs facing private hospitals moving forward with Bupa and the AHSA to avoid their members having to pay additional fees for treatment in our hospitals.​

 

Why has this happened?

This is a disappointing outcome, and certainly not our preferred option. Unfortunately, Bupa and the AHSA health funds were not offering funding that is sufficient for ACHA to sustainably offer quality health care going forward.

There is a viability crisis impacting private hospitals across the country. Hospitals are losing money and it is becoming increasingly hard for them to attract new investment. Private health insurers are banking record profits – Bupa, in particular, has delivered enormous profits to its UK parent, but is not offering funding that would allow ACHA to sustainably offer quality healthcare for its Australian members going forward.

We will continue to negotiate with Bupa and AHSA health funds in the hope of reaching an agreement that removes the need for their members to pay additional out-of-pocket costs, and that fairly and sustainably funds our hospitals now and into the future.​

This issue only affects Bupa and AHSA health fund members. Patients who are members of other funds are not impacted. ACHA has agreements in place with all other major Australian health insurers including HCF, Medibank, NIB and St Lukes Health.

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Transition arrangements:

During the transitional period, the hospital and the health funds have agreed that the terms of the contract will continue to apply to certain patients and for a certain duration (these are sometimes referred to as transitional arrangements)The below table outlines the circumstance and the duration in which the transitional period will apply to Bupa and AHSA health fund members.

_{*Course of treatment: all patients undertaking a course of treatment (e.g., chemotherapy, dialysis, psychiatric rehabilitation) for a continuous period of up to six months. Course of treatment is not limited to the examples listed here.}

_{*Maternity pre-bookings: if a booking has been received by the hospital prior to the contract termination date, including bookings notified by the doctor. If a pre-booked mother has a baby or multiple babies requiring admission to a special care nursery, this would be covered at the current contract rates. There may be exceptions where the baby requires ongoing treatment after being discharged from hospital. This would be deemed a separate admission and the rates payable would need to be confirmed with the AHSA.}

_{**Non-maternity pre-bookings: if a booking is received by the hospital prior to the contract expiration date, including bookings notified by the doctor or where the patient has completed the necessary forms. Admission must occur within six months of the contract expiration date.}

 

If you are a patient who is a Bupa or AHSA health fund member and you:

• meet the criteria in the table above, you will not be required to pay additional out of pocket fees;
• do not meet the criteria in the table above, it is likely that you will be required to pay additional out of pocket fees. 

 

How can patients avoid extra fees?

Australia’s private health insurance laws allow members to move their cover to another health fund without re-serving waiting periods when transferring to a comparable product. Bupa and AHSA health fund members can avoid additional fees if they switch to a comparable product with another fund that has the same level of benefits and same conditions as their current product. * ACHA has agreements in place with all other major Australian health insurers including HCF, Medibank, NIB and St Lukes Health.

* Private health insurance is complex and it can be difficult to compare health insurance products. You should discuss your health insurance needs with the fund you are proposing to switch to so that you understand the new product, how it differs from your current product and can confirm that the product is right for you.

Make sure you consider the products excess, co-payment, full cost and all out of pocket expenses that will apply in the event you require treatment at a hospital. You should also consider if you are obtaining a comparable product.  If you switch to a comparable product with another fund that has the same level of benefits and same conditions as your current product, you will not have to re-serve any waiting periods that have already been served.

You can compare funds for free at www.privatehealth.gov.au and choose a fund that is not affected.