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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.

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.

What are preferred providers?

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:

  • Dentists
  • Optometrists
  • Physiotherapists
  • Chiropractors
  • Massage therapists
  • Osteopaths
  • Podiatrists

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.

Which funds have preferred providers?

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 fundDoes it have a preferred provider program?Details
ACA HealthNoYou are free to choose your own extras provider.
ahmNoYou are free to choose your own extras provider.
Apia NoYou are free to choose your own extras provider.
Australian UnityYesAustralian Unity is affiliated with dentists in its national dental network and has an optical services company, EyeCare Advantage.
Budget Direct NoYou are free to choose your own extras provider.
BupaYesBupa has relationships with dental, physio, chiropractic, optical and podiatry providers through its Members First network.
CBHSYesThe CBHS Choice Network offers access to preferred providers who waive the gap on selected dental and optical procedures.
Cessnock District Health FundNoYou are free to choose your own extras provider.
CUA Health LimitedNoYou are free to choose your own extras provider.
Defence Health LimitedYesDefence Health members can get discounted treatment at selected dental and optical providers. However, you are also free to choose your own extras provider.
Doctors Health FundNoYou are free to choose your own extras provider.
Emergency Services HealthNoYou are free to choose your own extras provider.
FrankNoYou are free to choose your own extras provider.
GMHBAYesPreferred service provider arrangements are in place with dentists, optometrists and chiropractors, but you are also free to choose your own provider.
HBFYesThe HBF Member Plus network includes medical, dental and optical providers.
HCFYesHCF’s network of preferred providers includes dental, optical, physio, podiatry, chiro and osteo services.
Health Care InsuranceNoYou are free to choose your own extras provider.
Health PartnersYesHealth Partners’ preferred providers include dental, optical, physio and pharmacy services.
health.com.auNoYou are free to choose your own extras provider.
HIFNoYou are free to choose your own extras provider.
Latrobe HealthNoYou are free to choose your own extras provider.
MedibankYesMedibank Members’ Choice network includes dental, optical, physio, chiro, podiatry, acupuncture, naturopathy, remedial massage and hearing aid services.
Mildura Health FundYesThe Super Dental scheme allows members to access gap-free preventative dental services.
Navy HealthYesNavy Health members can access a range of preferred optical providers.
nibYesThe nib First Choice Network includes dentists, GPs and a range of medical specialists around Australia.
Nurses & Midwives HealthYesThe Member Wellbeing Network allows you to access discounts on optical services.
onemedifundYesMembers can access a range of optical discounts at selected providers around the country.
PeoplecareYesPeoplecare 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.
Phoenix Health FundYesAs part of Australian Health Service Alliance (AHSA), Phoenix has agreements with a range of hospitals.
Police HealthNoYou are free to choose your own extras provider.
Qantas AssureNoYou are free to choose your own extras provider.
Queensland Country Health FundNoYou are free to choose your own extras provider.
Reserve Bank Health SocietyNoYou are free to choose your own extras provider.
RT HealthYesMembers can enjoy discounted optical and dental services at preferred providers.
St.LukesHealthYesThe fund has agreements with a number of optical providers to help members access discounted eyewear.
Teachers HealthYesMembers can access optical, dental, physio, chiro and remedial massage services at preferred providers.
Transport HealthYesTransport Health has preferred provider relationships with dentists, optometrists, physiotherapists, chiropractors, osteopaths, remedial therapists, pathology centres and more.
TUHYesTUH provides access to a broad network of preferred dental and optical providers.
Unihealth InsuranceYesUnihealth’s Member Wellbeing Network provides access to preferred providers of optical, dental, physiotherapy, chiropractic and remedial massage services around Australia.
WestfundYesWestfund has two dental practices and several eye care practices around Australia.

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.

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.

Compare your health insurance options today

Picture: Shutterstock

Don Gribble

Don is a creative writer with extensive experience writing scripts, blogs, web content and ebooks. He enjoys writing because it allows him to know a little bit about a lot of subjects and to continue learning new things every day.

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