Agreement private hospitals

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A guide to agreement private hospitals

Updated February 05, 2024
Written by Joshua Malin
Reviewed by Steven Spicer

What is an agreement hospital?

The term ‘agreement hospital’ typically refers to any hospital, day surgery, or health centre that has a contract with your private health insurer regarding what you pay for inpatient private hospital treatment. This contract is sometimes known as a gap cover scheme, and outlines whether you have to pay out-of-pocket expenses at a standard rate or an ‘agreed’ rate – which is typically lower.

With an agreed rate, the hospital charges a set fee based on their agreement with your health fund. Depending on the agreement and the treatment you receive, you might not have to pay any out-of-pocket expenses at all.

When you take out private hospital cover with a health insurer, you’ll be able to claim a benefit for admissions, provided the health service you’re claiming for is included on your policy. It is important to understand what you are covered for prior to a hospital admission. For instance, if a service is only included on a restricted basis on your policy, you will only be covered as a private patient in public hospitals and will face considerable out-of-pocket expenses in a private hospital.

All major health funds will typically have agreements with most private hospitals, but we recommend you check with your insurer before deciding where you’re treated. This is especially important if you have a hospital in mind prior to treatment or live in a rural area where the nearest agreement private hospital may be a fair distance away.

Private health insurance and agreement hospitals

Why go to a hospital with an agreement with my insurer?

What can I expect at an agreement private hospital?

Am I covered for day surgeries?

What if I choose to go to a non-agreement hospital?

What if I decide to go to a public hospital as a private patient?

Meet our health insurance expert, Steven Spicer

Steven Spicer
Executive General Manager – Health, Life & Energy

As the Executive General Manager of Health, Life and Energy, Steven Spicer is a strong believer in the benefits of private cover and knows just how valuable the peace of mind that comes with cover can be. He is passionate about demystifying the health insurance industry and advocates for the benefits of comparison when it comes to saving money on your premiums.

1 Private Health Ombudsman – Agreement hospitals. Accessed February 2024.