Doctor Information

ACHA and HCF* have been unable to reach an agreement on a new contact, impacting HCF insured-members accessing an ACHA facility. The current agreement will end on January 31, 2023.

*The HCF group includes HCF, rt health and Transport Health, any references to HCF or HCF members includes rt health and Transport Health members.

How are HCF-insured patients impacted if accessing an ACHA facility?

  • ACHA will absorb the gap between its increased costs of delivering care and the benefits paid by HCF for a short time.
  • Unless benefits paid by HCF increase to cover ACHA's increased costs of delivering care, additional out-of-pocket costs will apply according to the dates below:
Treatment Type (irrespective of when booked) No additional out of pockets for patients until:
Emergency (note inclusions/exclusions outlined in FAQ) May 1, 2023
Rehabilitation and mental health that started on or before January 31, 2023 August 1, 2023
Treatment commenced on or before January 31, 2023 Covered until discharge
Oncology and renal that started on or before January 31, 2023 August 1, 2023
Other Treatments (including elective surgery) No additional out of pockets for patients until:
Pre-booked on or before January 31, 2023 Pregnancy and birth – November 1, 2023
Pre-booked on or before January 31, 2023 Other procedures/services – August 1, 2023

Does this additional out-of-pocket cost apply to all health funds?

  • No. ACHA has agreements with all other major private health funds in Australia, where this additional out-of-pocket cost won’t apply.
  • If considering changing health funds, the Ombudsman's Right to Change brochure explains ‘portability’ rules, which means consumers changing funds to an insurance policy to a comparable product won’t have to re-serve waiting periods  before benefits can be paid.* 

*You may have to serve waiting periods for any extra benefits or better conditions under the new cover.

Frequently asked questions

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.

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.

ACHA has given notice to HCF that the current agreement and associated payment arrangements will be ending unless a suitable new agreement can be reached.

During this period, the current contract remains in place, and there is no change or impact for patients during this time.

Once the notice period ends on January 31, 2023, transitional arrangements will come into place. These aim to reduce any impact on patients and members.

During the notice period which ends on January 31, 2023, HCF members are not impacted and it is business as usual. Patient admissions (subject to eligibility checks) are fully covered by the current contract and payment schedules.

VMOs can reduce the impact on their patients by pre-booking their procedure before the notice period expires.

For emergency admissions, the current contractarrangements and payment schedules continue to apply for a further three months after the current agreementends on January 31 2023. 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.

You may expect that by paying their health insurance premium that patients’ health fund would cover their hospital costs (apart from their 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 in our hospitals after the transition dates in the table above.

The exact costs would be confirmed once we receive the non-contracted rates from HCF. 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 their admission to hospital.

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