- What's happening with Healthscope?
Healthscope has given notice to terminate their contract with Defence Health. The termination effective date is midnight 3 March 2025.
There is a transitional period that will apply in certain circumstances for up to six months from the termination date or nine months for pre-booked maternity services. The details are below.
What does this mean for me?
There are no immediate changes for Defence Health members, and you are covered until midnight 3 March 2025 with transition arrangements after this date.
If you are treated in a Healthscope hospital after 3 March 2025, you may face significant out-of-pocket expenses (we will continue to pay benefits towards Healthscope after the termination but at lower rates until another agreement is in place).
However, the contract arrangements will continue to apply for some members’ treatment at Healthscope hospitals beyond 3 March 2025 for a transitional period.
The transitional period applies in the following circumstances:
Treatment has already commenced: If you are admitted and undergoing treatment before 3 March 2025 the transitional period will end on your discharge.
- Pre-bookings: If you have booked (by 3 March 2025) a procedure (other than maternity procedures) and are admitted before 3 September 2025, the transitional period will end on your discharge.
- Maternity bookings: If you have booked your admission by 3 March 2025, the transitional period will end on 3 December 2025.
- Course of treatment: If you have ongoing treatment that commenced prior to 3 March 2025, the transitional period will cover that course of treatment until completed or 3 September 2025 (whichever occurs first).
- Emergency admissions: Until 3 June 2025. (Note: as with all private Emergency Departments there are out-of-pocket costs associated with your treatment)
- To take advantage of the transitional periods you will need to book treatment before 3 March 2025. Let us know in advance if you have concerns.
Members are advised to speak to their doctor about alternative hospitals where we have an agreement. - More examples of what is covered during the transition period
Will I be covered for an emergency hospital admission?
Yes, emergency admissions are covered during the transition period for at least three months. An emergency admission includes situations like:
- Life-threatening conditions requiring urgent care.
- Acute organ or system failure.
- Serious injuries or illnesses that could lead to permanent damage.
- Drug overdose or poisoning.
- Severe psychiatric disturbances putting the patient or others at immediate risk
- Intense pain with suspected serious harm to an organ or body part.
- Significant hemorrhaging requiring urgent treatment.
- Any condition needing immediate hospital care to prevent serious harm or death, especially when transferring to another facility isn’t possible.
- Will I be covered for my course of treatment? If you are pre-booked for treatment or currently undergoing a course of treatment, your ongoing care for that treatment, along with any related services, will continue. This includes courses of treatment like renal dialysis, chemotherapy, psychiatric care, or rehabilitation. Your care will continue for six months to 3 September 2025.
- Will I be covered for maternity? And what if my baby needs treatment? During the transition period, if you’re pre-booked for maternity and you’re admitted before delivery due to complications you will be covered. And if you’re pre-booked for maternity and your baby needs admission to a special care nursery or neonatal intensive care unit, your baby's admission will be covered.
- What happens if I’m admitted for a pre-booked procedure, discharged but readmitted within seven days with a related condition? You are covered if you are admitted for a pre-booked procedure, discharged after the procedure, and then discharged but you are readmitted within seven days due to a related condition.
- What if my prebooked surgery is cancelled and performed at a later date? You are covered if you are pre-booked and the operation is cancelled, but it’s performed at a later date within the six month period (so long as you are admitted before 3 September 2025).
- Am I covered if I need follow-up surgery after a procedure booked before the 4 March 2025? If your GP refers you to a colorectal surgeon who books you in for a colonoscopy before the termination date, and you then require bowel surgery one month after 4 March 2025, this would be considered an ongoing course of treatment. In this case, you would be covered for both the colonoscopy and the bowel surgery.
- Am I covered for follow-up cataract surgery if one procedure was booked before the contract termination date and the other after? If you’ve seen your ophthalmologist and require cataract surgery on both eyes, you will be covered for both procedures. This applies even if the first procedure was booked before 4 March 2025 and the second procedure was booked after midnight 3 March 2025, as this is considered an ongoing course of treatment.
- When wouldn’t I be covered? For example if you have a chronic cardiac condition, like heart failure or a chronic arrhythmia. You’re prebooked for treatment to address an acute episode related to your condition, and the treatment resolves the episode, bringing the condition back to a stable state, that course of treatment is considered complete. However, if you experience a new acute episode four months after 3 March 2025, it would be treated as a new course of treatment and would not be covered under the transitional arrangements.
- How will Defence Health know to pay my hospital benefits, if I’m booked in before the hospital contract termination date? The hospital will provide us with a list of all members who are booked for treatment at the Healthscope hospital before the contract termination, so claims can be processed.
- The Defence Health website still lists Healthscope as agreement hospitals The search engine for agreement hospitals is provided for use on our website by the Australian Health Services Alliance (AHSA). Healthscope hospitals will be removed from the list from the termination effective date 3 March 2025.
- I’m not happy about this and want to continue my treatment at a Healthscope hospital. We understand that you may prefer to be treated at Healthscope, however, we must make it very clear that if you undergo treatment on or after 3 March 2025, that is outside the transitional arrangements described above, you may face significant out-of-pocket expenses as a Defence Health member.
- Is it likely this situation will change? We hope that Healthscope will reverse its decision and that a mutually acceptable path forward can be reached before the termination date. We will keep you updated on any changes to the situation.
- Why has Defence Health gone out of contract with Healthscope? We’ve been unable to agree on the terms and conditions of a new contract. The foreign-owned Healthscope hospital group, not Defence Health that has made the decision to terminate the agreement. Healthscope had asked for a variation to the agreement to increase rates paid, or to allow an additional hospital facility fee to be paid. Defence Health did not consider this reasonable or in the interests of our members, and Healthscope has elected to terminate the agreement. The hospital is demanding a greater increase in charges to our health fund than the increases we’ve recently agreed to with other private hospitals. It’s important that we try to manage these charges because they place pressure on the premiums for all members.
- This is unsatisfactory. Why should I keep my private health insurance if I can’t access my private hospital of choice? We’re here to support you and represent your interests in discussions with industry and health care providers. We’re also focused on helping you navigate your health care options during this time. We aim to provide you with the best possible choice of private hospitals, while keeping premiums as low as possible. But it would not be in the best interests of our members for us to accept the terms currently on offer from Healthscope.
- Why do other health funds still have agreements with Healthscope? We are not privy to the agreements between other funds and hospitals and so we are unaware of what charges they have agreed to.
- As Healthscope has made the decision to terminate the agreement, what is Defence Health going to do to ensure that I don’t have enormous out of pocket hospital expenses in the future? Unfortunately, the hospital group has decided to terminate the contract, not Defence Health. We would like to continue negotiations in good faith and agree to a new contract in the future, if we can do so on commercially reasonable terms that are in the interests of our members.
- Will Defence Health go out of contract with any other hospitals? It is unusual for us to go out of contract with a hospital; however, this situation can occur from time to time. We currently have agreements with over 500 hospitals across Australia and we expect that these will continue. With the exception of the Northern Territory, we do maintain agreements with a number of hospitals in each region.
- What other hospitals can I go to? Defence Health has alternative agreement hospitals. You should speak with your doctor about other hospitals where they can admit you for your specific health care needs. Our website includes a search tool for alternative agreement hospitals.
- There are no other Private Hospitals in my area that provide this service. What should I do? If you are currently undergoing a course of treatment, you will remain covered for that course of treatment for six months or nine months for prebooked maternity. If you are admitted on or after 3 March 2025 for the first time, you may face significant out-of-pocket expense. The hospital should provide you with informed financial consent outlining costs prior to your admission. We recommend that you contact them to confirm what your out-of-pocket expense will be.
- Will my medical benefits be affected by this dispute? No. No longer having an agreement in place with Healthscope only affects the hospital benefits we can pay. The medical benefits paid towards your doctor’s charges are not affected you can continue to use Access Gap to reduce medical out of pocket expenses.
- List of Healthscope hospitals:
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