I am an AHSA health fund member. What does this mean for me?
We welcome all patients in Healthscope hospitals, whether we have a contract with their health fund or not. When the existing AHSA contract has terminated on Tuesday 4 March 2025, we enter a transitional period where the terms of the current contract will continue to apply to some patients. If Healthscope continues to remain out of contract with the AHSA beyond the transitional period, or the transitional period does not apply, you can still be treated in our hospitals, but you may face additional out of pocket costs. We remain ready to work with the AHSA to reach an agreement that sustainably funds our hospitals.
Your health fund is required to let you know about the impacts of this situation and you can discuss the specific details of your expected costs by contacting your AHSA fund (visit https://ahsa.au/our-funds/ for details).
Maternity scenarios where an AHSA fund member patient WILL NOT need to pay out of pocket fees
The patient books before or on the 3 March 2025 for AHSA funds for maternity care and:
- is admitted before their due date for observation or complications such as dehydration, high blood pressure, etc.
- their due date is in within nine months of those dates.
- their baby/babies require admission to a special care nursery or neonatal intensive care unit after birth.
Mental health scenarios where an AHSA fund member patient WILL NOT need to pay out of pocket fees
Patients booking before or on 3 March 2025 for AHSA funds for inpatient treatment:
- General admission within six months of those dates (for example in May or June).
- Multiple general admissions, or EMDR admissions within six months of those dates.
Patients booking before or on 3 March 2025 for AHSA for outpatient treatment:
- Transcranial magnetic stimulation (TMS) treatment within six months of those dates. This only applies to previously contracted treatments, noting that TMS is not always a contracted service.
- Day program groups (open or closed) within six months of those dates. This must be for a currently contracted program or service.
Emergency scenarios where an AHSA fund member patient WILL NOT need to pay out of pocket fees
- A patient presents at emergency before or on 3 March 2025 for AHSA funds or within three months of those dates and is:
- At risk of serious morbidity or mortality and requiring urgent assessment and resuscitation.
- Suffering from suspected acute organ or system failure.
- Suffering from an illness or injury where the viability of function of a body part or organ is acutely threatened.
- Suffering from a drug overdose, toxic substance, or toxin effect.
- Experiencing severe psychiatric disturbance whereby the health of the patient or other people is at immediate risk.
- Suffering from severe pain where the viability or function of a body part or organ is suspected to be acutely threatened.
- Suffering acute significant haemorrhaging and requiring urgent assessment and treatment.
Other scenarios where an AHSA fund member patient WILL NOT need to pay out of pocket fees
- A patient is admitted for a procedure that has been booked before or on 3 March 2025 for AHSA funds, has the procedure and is readmitted within 7 days of discharge due to a related condition.
- A patient books before or on 3 March 2025 for AHSA funds for a procedure and the operation is cancelled, but then the operation is rescheduled within six months of those dates.
- A patient has been referred from their GP to a colorectal surgeon. The surgeon has booked the patient in for an endoscope before or on 3 March 2025 for AHSA funds. The patient has the endoscopy then requires bowel surgery which is performed one month after those dates.
- A patient has seen their ophthalmologist and requires cataract surgery on both eyes. The first procedure was booked in before or on 3 March 2025 for AHSA funds. The second procedure was booked in after those dates.
- A chemotherapy patient whose treatment ends but requires further treatment within six months of 3 March 2025 for AHSA funds.
Transitional arrangements apply on and from Tuesday 4 March 2025 for AHSA fund members
1 Emergency admissions: the current contract arrangements and payment schedules continue to apply for a continuous period of three months. Emergency admission (in absence of any agreement) will include any of the following:
- At risk of serious morbidity or mortality and requiring urgent assessment and resuscitation.
- Suffering from suspected acute organ or system failure.
- Suffering from an illness or injury where the viability of function of a body part or organ is acutely threatened.
- Suffering from a drug overdose, toxic substance, or toxin effect.
- Experiencing severe psychiatric disturbance whereby the health of the patient or other people is at immediate risk.
- Suffering from severe pain where the viability or function of a body part or organ is suspected to be acutely threatened.
- Suffering acute significant haemorrhaging and requiring urgent assessment and treatment.
- Patient requires immediate admission to avoid imminent morbidity or mortality and where a transfer to another facility is impractical.
2 Course of treatment: all patients undertaking a course of treatment (e.g., chemotherapy, dialysis, psychiatric, rehabilitation) for a continuous period of up to six months. Course of treatment is not limited to the examples listed here.
3 Maternity pre-bookings: if a booking has been received by the hospital prior to the contract termination date, including bookings notified by the doctor. If a pre-booked mother has a baby or multiple babies requiring admission to a special care nursery, this would be covered at the current contract rates. There may be exceptions where the baby requires ongoing treatment after being discharged from hospital. This would be deemed a separate admission and the rates payable would need to be confirmed with the AHSA.
4 Non-maternity pre-bookings: if a booking is received by the hospital prior to the contract expiration date, including bookings notified by the doctor or where the patient has completed the necessary forms. Admission must occur within six months of the contract expiration date.
If you are a patient who is an AHSA health fund member and you:
- meet the criteria in the table above, you will not be required to pay additional out of pocket fees;
- do not meet the criteria in the table above, it is likely that you will be required to pay additional out of pocket fees.
