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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.
However, some health funds also have a list of preferred providers. These are dentists, optometrists, physiotherapists and a wide range of other health care professionals with which private health funds have special payment arrangements. By receiving treatment from a participating provider, you can ensure that your health fund will pay a rebate and in some cases you will potentially be able to enjoy discounted treatment.
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.
Preferred providers are service providers with which a health fund has a special relationship or arrangement. In some cases, this could even be a dental or optical centre that is owned and run by your health fund.
If you access treatment from a health care provider featured on your fund’s list of participating providers, you can access discounted treatment or agreed rates. You may also be able to access a higher rebate from your fund under your extras cover policy, allowing you to save money on the cost of treatment for a wide range of conditions.
Preferred providers can encompass the following services:
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.
The main benefit of participating provider arrangements is that you can access discounted health care and potentially enjoy higher rebates from your health fund. On the flip side, being restricted to preferred providers can limit your choice and possibly affect the quality of treatment you receive.
Does your health fund offer a list of preferred health care providers for treatments included in extras cover? Check the table below to find out:
Health fund | Does it have a preferred provider program? | Details | More info |
---|---|---|---|
![]() | No | You are free to choose your own extras provider. | More info |
![]() | Yes | ahm's preferred providers. | More info |
![]() | Yes | HCF's network of preferred providers includes dental, optical, physio, podiatry, chiro and osteo services. | Go to Site |
![]() | Yes | Medibank Members' Choice network includes dental, optical, physio, chiro, podiatry, acupuncture, naturopathy, remedial massage and hearing aid services. | Go to Site |
![]() | Yes | The nib First Choice Network includes dentists, GPs and a range of medical specialists around Australia. | |
![]() | Yes | Dental, optical and physiotherapy Providers who have agreed to a set fee or discounted rate for our members. | Go to Site |
![]() | No | You are free to choose your own extras provider. | More info |
![]() | Yes | Dental, optical and physiotherapy providers who have agreed to a set fee or discounted rate for their members. | More info |
![]() | Yes | Bupa has relationships with dental, physio, chiropractic, optical and podiatry providers through its Members First network. | More info |
![]() | Yes | The CBHS Choice Network offers access to preferred providers who waive the gap on selected dental and optical procedures. | More info |
![]() | No | You are free to choose your own extras provider. | More info |
![]() | Yes | Defence Health members can get discounted treatment at selected dental and optical providers. However, you are also free to choose your own extras provider. | More info |
![]() | No | You are free to choose your own extras provider. | More info |
![]() | No | You are free to choose your own extras provider. | More info |
![]() | No | You are free to choose your own extras provider. | More info |
![]() | Yes | Preferred service provider arrangements are in place with dentists, optometrists and chiropractors, but you are also free to choose your own provider. | More info |
![]() | Yes | The HBF Member Plus network includes medical, dental and optical providers. | More info |
![]() | No | You are free to choose your own extras provider. | More info |
![]() | Yes | Health Partners' preferred providers include dental, optical, physio and pharmacy services. | More info |
![]() | No | You are free to choose your own extras provider. | More info |
![]() | Yes | Latrobe Health's preferred providers. | More info |
![]() | Yes | The Super Dental scheme allows members to access gap-free preventative dental services. | More info |
![]() | Yes | Navy Health members can access a range of preferred optical providers. | More info |
![]() | Yes | The Member Wellbeing Network allows you to access discounts on optical services. | More info |
![]() | Yes | Members can access a range of optical discounts at selected providers around the country. | More info |
![]() | Yes | 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. | More info |
![]() | Yes | As part of Australian Health Service Alliance (AHSA), Phoenix has agreements with a range of hospitals. | More info |
![]() | No | You are free to choose your own extras provider. | More info |
Queensland Country Health Fund | No | Premier provider optical network and dental premier provider network. | More info |
![]() | No | You are free to choose your own extras provider. | More info |
![]() | Yes | Members can enjoy discounted optical and dental services at preferred providers. | More info |
![]() | Yes | The fund has agreements with a number of optical providers to help members access discounted eyewear. | More info |
![]() | Yes | Members can access optical, dental, physio, chiro and remedial massage services at preferred providers. | More info |
![]() | Yes | Transport Health has preferred provider relationships with dentists, optometrists, physiotherapists, chiropractors, osteopaths, remedial therapists, pathology centres and more. | More info |
![]() | Yes | TUH provides access to a broad network of preferred dental and optical providers. You are also free to choose your own extras provider. | More info |
![]() | Yes | Unihealth's Member Wellbeing Network provides access to preferred providers of optical, dental, physiotherapy, chiropractic and remedial massage services around Australia. | More info |
![]() | Yes | Dental provider of choice network and physiotherapy provider of choice network. | More info |
Data last confirmed as correct 5 May 2020.
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.
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.
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