Despite extensive negotiations, ACHA has been unable to agree fair commercial terms with the HCF group* (“HCF”).

We have given HCF notice that we will not be proceeding with a new agreement. The current agreement and payments arrangements will end on January 31, 2023.

We are aware of the impact this is likely to have for our patients who are HCF members and we are doing all we can to provide continuity of care. We remain willing to negotiate with HCF to avoid this.

*The HCF group includes HCF, rt health and Transport Health

This is a disappointing outcome, and certainly not our preferred option. Unfortunately, HCF were not prepared to fund the cost of providing private hospital care for their members, meaning HCF members will be required to make up the funding gap.

The cost of providing quality hospital care continues to rise quickly, and is impacting both public and private hospitals, especially in the wake of the COVID pandemic.

We have been challenged by health insurers not adequately funding the real and rising costs of our private hospital services, including rising interest rates, food, energy and power, insurance, nurse wages, PPE, maintenance and cleaning costs. These cost pressures have been well documented throughout the pandemic, and are now being exacerbated by the highest levels of inflation seen in decades.

We will continue to negotiate with HCF in the hope of reaching a fair agreement that removes the need for their members to pay additional out-of-pocket costs.

Please note that this issue affects only HCF fund members, patients who are members of other funds are not impacted. ACHA has agreements in place with all other major Australian health insurers.

For emergency admissions, the current contract arrangements and payment schedules continue to apply for a continuous period of three months. Emergency admission will include any of the following:

• At risk of serious morbidity or mortality and requiring urgent assessment and resuscitation; or
• Suffering from suspected acute organ or system failure; or
• Suffering from an illness or injury where the viability of function of a body part or organ is acutely threatened; or
• Suffering from a drug overdose, toxic substance or toxin effect; or
• Experiencing severe psychiatric disturbance whereby the health of the patient or other people is at immediate risk; or
• Suffering from severe pain where the viability or function of a body part or organ is suspected to be acutely threatened; or
• Suffering acute significant hemorrhaging and requiring urgent assessment and treatment; or
• Patient requires immediate admission to avoid imminent morbidity or mortality and where a transfer to another facility is impractical.

This only impacts members of HCF group - this includes HCF, rt health and Transport Health.

We have current agreements in place with all other major private health insurers.

Yes, Australia’s private health insurance regulations allow members of all health insurers to move their cover to another health insurer. As long as you obtain a comparable product with another health fund you will not have to re-serve waiting periods.

HCF members looking to understand their insurance options can contact other health funds they might be interested in joining, or have a look at the Right to Change Brochure - Health Insurers located on the Ombudsman website.

Any questions regarding specific health fund products can only be answered by the relevant health fund. They will be able to provide you with information about product coverage, waiting periods, exclusions, restrictions and comparable products.

We welcome all patients in ACHA hospitals and you can still be treated with us. Given HCF’s latest contract offer does not cover the costs we incur to deliver services to you in our hospitals, once the current contract with HCF expires on January 31, 2023, you may face some additional out of pocket costs to cover the difference. We remain willing to negotiate with HCF to avoid this.

HCF is required to let you know about the impacts of this situation occurring and you can discuss with them the specific implications on your cover and fees by calling HCF on 13 13 34.

ACHA has agreements in place with most major Australian health funds. While we cannot provide advice or recommendations regarding private health funds, Australia's private health insurance laws allow members to move their cover to another health fund with no impact on waiting periods when transferring to a comparable product.

Australia’s private health insurance regulations allow members to move their cover to a comparable product with another health fund without having to re-serve waiting periods. HCF members looking to understand their insurance options can visit Right to Change Brochure - Health Insurers

Health funds can provide you with personalised information regarding their products, coverage, waiting periods, exclusions and restrictions.

ACHA cannot comment on how PHI’s premiums are calculated. We recommend you discuss this with HCF directly by calling 13 13 34.

You may expect that by paying your health insurance premium your health fund will cover your hospital costs (apart from your excess). Unfortunately, with HCF’s latest offer not covering the increased cost of care, HCF patients will be required to pay additional out-of-pocket costs after the transition dates in the table above.

The exact additional out of pocket expenses you may need to pay will be confirmed once we receive the non-contract rates from HCF and we recommend you call them on 13 13 34 to find out the exact details.

Doctors, hospitals and health funds work together to provide information to patients about the costs associated with treatment, and any private health insurance benefits payable, prior to your admission to hospital.