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What are preferred health care providers?
Accessing treatment from one of your health fund’s participating health care providers can lead to big savings.
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*Prices updated October 2024, in line with Finder's database of health insurance policies. Prices reflect the cheapest available for a single individual with less than $97,000 income and living in Sydney with a $750 excess.
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If you want to make a health insurance claim for medical or services you have received, your health fund must recognize the provider of those services. Generally, any qualified provider will be fine, but some health funds also have a list of preferred providers. While preferred health care provider programs can offer a range of benefits to fund members, they do have a few drawbacks you should be aware of before choosing a health fund. Keep reading to find out more about preferred providers and how they work.
What are preferred providers?
Preferred providers are service providers with which a health fund has a special relationship or arrangement, and that you're encouraged to use. In some cases, this could even be a dental or optical centre that is owned and run by your health fund.
You can often get discounted treatment or agreed rates if you access treatment from a health care provider featured on your fund’s list of participating providers. You may also be able to access a higher rebate from your fund under your extras policy, allowing you to save money on the cost of treatment for a wide range of conditions.
Preferred providers can encompass the following services:
Dentists
Optometrists
Physiotherapists
Chiropractors
Massage therapists
Osteopaths
Podiatrists
Where to find your fund's preferred providers
If your health fund does have relationships with participating providers, you will usually be able to search for your nearest supported providers through the fund’s website. However, make sure you’re aware that your fund may label its preferred providers by other names, such as participating providers, members’ choice providers or members’ first providers.
Finder survey: What is most important to people when choosing a health fund?
Response
The fund is trusted
68.91%
The fund is not-for-profit
31.27%
The fund has good online reviews
23.97%
The fund is recommended by my friends or family
23.97%
The fund is popular
12.17%
None of the above
10.49%
The fund gives me reward points (e.g. Qantas, Frequent Flyer etc)
9.93%
The fund is good for the environment
9.55%
The fund is restricted to my industry (e.g. teachers, defence etc)
5.43%
Source: Finder survey by Pure Profile of 1006 Australians, December 2023
Which funds have preferred providers?
Most of the big health funds in Australia preferred providers, but the details can vary. Some funds, like ahm and HCF, maintain a network of partners. Other funds, like nib, also operate their own health centres. Click the drop down for a table that compares the details between health funds.
Defence Health members can get discounted treatment at selected dental and optical providers. However, you are also free to choose your own extras provider.
Peoplecare has a list of preferred optical and dental providers that offer member discounts. However, you can choose your own provider and still receive the same benefit amount.
Transport Health has preferred provider relationships with dentists, optometrists, physiotherapists, chiropractors, osteopaths, remedial therapists, pathology centres and more.
Yes
TUH provides access to a broad network of preferred dental and optical providers. You are also free to choose your own extras provider.
Unihealth's Member Wellbeing Network provides access to preferred providers of optical, dental, physiotherapy, chiropractic and remedial massage services around Australia.
What are the pros and cons of preferred providers?
Pros
Save money. You can typically access cheaper treatment if you use one of your health fund's preferred providers.
Higher rebates. You may be eligible to receive a higher rebate from your health fund if you undergo treatment from a participating provider.
Security. When you visit one of your health fund's preferred health care providers, you can usually enjoy the peace of mind of knowing exactly how much you will get back to cover the cost of treatment.
Easy claims. Because the provider has a relationship with your fund, you can rest assured that it should be quick and easy to make a claim for the treatment you have received.
Cons
Lack of choice. If your health fund has a list of preferred providers, you may not be able to choose the health care provider you wish.
Lack of continuity of care. If you change from your regular dentist, for example, to one of your health fund's preferred providers, you can no longer rely on your dentist's knowledge of your treatment history.
In the health fund's best interest. Preferred provider programs aim to help health funds save money, not to help you access the best possible care.
Taking all these factors into account, it's important that you're aware of all the benefits and drawbacks associated with preferred provider schemes before you choose a private health fund.
Can hospitals and doctors be preferred providers?
While the term “preferred providers” usually applies to extras cover and the providers of ancillary health care services, health funds also have agreements in place with hospitals and doctors around Australia.
In order to receive your full benefit entitlement when you undergo hospital treatment, you will need to attend a private hospital or day surgery with which your health fund has an agreement. Sometimes referred to as agreement hospitals, contracted hospitals, participating hospitals or even members’ hospitals, these are hospitals with which your health fund has an arrangement that includes an agreed-upon schedule of fees that are covered by your health fund.
If you’re treated in a hospital that doesn’t have an agreement with your health fund, you could end up with significant out-of-pocket expenses.
Your health fund may also have relationships with doctors around Australia as part of its gap cover scheme. When you receive treatment in hospital by a doctor or specialist that participates in your health fund’s gap cover scheme, your out-of-pocket expenses will be reduced or even eliminated.
Contact your health fund for details on its contracted hospitals and doctors that participate in its gap cover scheme.
Why compare health insurance with Finder?
We don't ask for your phone or email to see prices.
With 1 click, you can open your results to nearly every fund in Australia.
You pay the same price as going direct – we charge no fees.
Depending on your age, you may be eligible for an
aged-based discount. This is used to estimate your
rebate.
Under 65
65 - 69
70 or older
What's your household's taxable income?
This is the combined income you and your spouse earn before tax. It's needed to calculate the correct Australian government rebate.
$93,000 and under
$93,001 to $108,000
$108,001 to $144,000
$144,001 and over
What kind of health insurance do you need?
Combined (Extras + Hospitals)
Extras
Hospital
What level of hospital coverage would you like?
You can change this at any time later.
Legend
Covered
Restricted cover, You may be partially covered for
this category.
Not covered. Optional for insurer to include.
*Prices updated March 2024, in line with Finder's
database of health insurance policies. Prices are based
on a single individual with less than $93,000 income and
living in Sydney with a $750 excess.
What extras cover do you need? (Optional)
Select as many as you want or move to the next step
Preventative & general dental
Major dental & implants
Optical
Physiotherapy
Podiatry
Non-PBS pharmaceuticals
Chiropractic
Emergency ambulance
Remedial massage
Email me my results (optional)
To get a copy of your results for later, add your email below
You'll pay the same price as going direct - we don't
charge fees
We don't ask for your phone number to see prices
Hang tight - we're fetching policies just for you!
Comparing quotes from 40+ funds...
Frequently asked questions
Using a preferred provider is generally a good idea, at least financially. When using your extras, you'll generally receive a higher benefit from a preferred provider than a regular provider. When using hospital insurance, you will generally reduce your out-of-pocket expenses with a preferred hospital or GP.
No, proferred providers will nott neccessarily give you better service. In fact, some providers - like Tooth Dental in Queensland - say that preferred provide programs mean that providers get paid less, while patients are given less choice.
Most funds have a list of preferred providers, although some funds have longer lists than others. Some funds also offer heavier discounts with their preferred providers than others - make sure you check with your health fund.
Tim Falk is a writer for Finder, writing across a diverse range of topics. Over the course of his 15-year writing career, Tim has reported on everything from travel and personal finance to pets and TV soap operas. When he’s not staring at his computer, you can usually find him exploring the great outdoors. See full bio
Tim Bennett is a Finder insurance & utilities expert. For over 10 years he's reported on news, politics, finance and other topics as a journalist and radio presenter. Tim's roles have included radio news reader and breakfast at the ABC, news producer for SBS and producer for Fairfax Media. Tim regularly appears as a health insurance expert on programs like Sunrise and SBS news, as well as in the Australian, The Daily Telegraph, The Courier Mail and more. See full bio
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