Adventist HealthCare

How many hospitals does Adventist HealthCare run?

Adventist HealthCare runs two facilities – Sydney Adventist Hospital (“the San”) and the San Day Surgery – both located north west of Sydney.

Why has your agreement with Adventist HealthCare ended?

Adventist HealthCare’s new terms could have resulted in increased charges for our members’ hospital admissions, to a level we believe is unacceptable. When we couldn’t agree terms, Adventist HealthCare moved to terminate our contract, effective 7 February 2022.

We know our members expect quality and value from their Hospital cover, and we’re committed to achieving this for you.

We did our utmost to reach an agreement that represents the best value for our members in this case. While we welcome any future opportunities to go back into contract with Adventist HealthCare, we would only do so if it results in the right outcome for our members.

Please note, existing no-gap radiology services with Adventist HealthCare remain available for our members. In addition, medical agreements with doctors were not terminated by Adventist HealthCare, so there are no changes in relation to how doctor fees are paid as a result of the hospital contract termination.

Why were you unable to agree to Adventist HealthCare’s proposed new charges?

We take affordability seriously and the proposed higher charges could have a negative impact on our members' premiums.

As a not-for-profit, member-focused health fund, it would be irresponsible for us to agree to charges we find unfair then pass the cost on to you.

Our commitment to giving back (to members) is reflected in our extensive member support package which includes:

• A premium freeze until 1 October 2022
• Rollover of all 2021 unused Extras annual limits on 1 January 2022
• Extension of telehealth benefits
• Cover for COVID-19 hospital admissions for members with hospital cover.

Is it possible you may come to an agreement with Adventist HealthCare even though the contract has expired?

Our door is always open for discussion. We’ve successfully resolved similar hospital contract issues in the past. Hopefully that’ll be the case this time.

Who has been negotiating with Adventist HealthCare?

The Australian Health Service Alliance (AHSA). It’s a services company that represents small to medium-sized health funds, allowing resources to be pooled together when responding to changes in the private health insurance industry. This includes the AHSA representing us for contract negotiations. We're one of 23 funds that are part of the AHSA.

Is Adventist HealthCare terminating its agreements with any other funds?

Yes – these negotiations have been relevant to all 23 funds that are part of the AHSA.

If non-AHSA funds have agreements with Adventist HealthCare, why can’t you?

While other funds’ agreements are confidential, we know that hospital contracts are a balancing act. Our goal is to help you access quality treatment at a reasonable cost. That means giving you a wide choice of hospitals and keeping premiums as low as possible.

We’re incredibly disappointed an agreement hasn’t been reached with Adventist HealthCare at this point in time. But we remain hopeful that a resolution will be found. 

Which other hospitals does UniHealth have agreements with?

We have agreements with more than 500 hospitals across Australia. Find one now

Should I be worried you may go out of contract with any other hospitals?

There’s no need to worry. The AHSA has been very successful in negotiating terms that meet the needs of the health funds (and their members) and private hospitals for many years. We don't expect this to change.

How will you notify members if you reach an agreement at a later date?

By email or post – depending on your contact preference. If you’ve selected post, your notification may be delayed due to seasonal postal issues and/or COVID-19 restrictions.

To change your contact preference, go to Online Member Services > My membership > Contact details, scroll down to Contact preferences and click Edit.

I’ve pre-booked treatment at an Adventist HealthCare hospital. Will I have to cancel it?

No – you can go ahead. Adventist HealthCare will honour existing bookings for admissions under the old agreement. This change only affects bookings made after 7 February 2022.

I’m booked into an Adventist HealthCare hospital to have my baby. Will I have to switch to another hospital?

No. If you’re already booked in, you’ll be covered under the old agreement for admissions before 7 November 2022.

I’m in the middle of a course of treatment at an Adventist HealthCare hospital. Can I continue?

Yes – up until 7 August 2022 you'll be covered under the old agreement. 

If you want the same specialist to treat you after this date, ask if they can do so at another (agreement) hospital.

My surgery was booked and cancelled due to COVID-19. Where do I stand?

If your surgery was postponed then re-booked for an admission date before 7 February 2022, you'll be covered under the old agreement. 

If your surgery was postponed then re-booked before 7 February for an admission date before 7 August 2022, you’ll be covered under the old agreement.

If your surgery hasn't been re-scheduled yet, it won't be considered 'pre-booked,' so you won’t be covered under the old agreement. Ask your specialist if they have admitting rights into another (agreement) hospital.

Can I still claim if I decide to be treated at an Adventist HealthCare hospital in the future?

Yes, you can still claim for hospital admissions at an Adventist HealthCare hospital as a non-agreement hospital, and lower benefits (what are referred to as second tier default benefits) will be payable. Please be aware that you may have higher out-of-pocket costs than you would at an agreement hospital.

If you decide to go to an Adventist HealthCare hospital, please make sure you’re clear on, and agree to, all the costs involved upfront (in writing) – this is called Informed Financial Consent. No one wants to be faced with unexpected bills while they’re recovering.

Learn more about choosing a hospital and Informed Financial Consent

Existing no-gap radiology services with Adventist HealthCare remain available for our members. In addition, medical agreements with doctors were not terminated by Adventist HealthCare, therefore there are no changes in relation to how doctor fees are paid as a result of the hospital contract termination.

My specialist works out of an Adventist HealthCare hospital. What should I do?

Ask your specialist if they can treat you at another hospital – many specialists have other options. If so, you can use our search tool to check if it’s an agreement hospital. If you need help with this, please get in touch. You can call us on 1300 367 906.

What do I do in an emergency? My local A&E department is at an Adventist HealthCare hospital.

You can access an Adventist HealthCare hospital Accident and Emergency department. If you're admitted for any of the following kinds of emergencies before 7 May 2022, you'll be covered under the old agreement:

• 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.

After 7 May 2022, the hospital won’t be an agreement hospital and you may have significant out-of-pocket costs. 

Given you haven't reached an agreement with Adventist HealthCare, will my premiums go down? 

No. The rising cost of healthcare is a key factor in premium increases. At UniHealth we work hard to keep premiums as low as possible whilst still providing the quality cover members expect. 

If you’ve previously been admitted to an Adventist HealthCare hospital it’s wise to plan future admissions at an agreement hospital to avoid or reduce out-of-pocket costs. 

If you choose an Adventist HealthCare hospital – or another non-agreement hospital – we still pay a benefit towards your hospital bill, but it’s restricted to no less than 85% of the average charge for the same treatment. This means you may have significant out-of-pocket costs.

Learn more about choosing a hospital

There's a number of Adventist HealthCare hospitals in my area. I’m considering switching to a fund that still has an agreement with Adventist HealthCare.

We get it. And we’re genuinely sorry if this causes issues for you. It’s not an outcome that we want for our members.

We’d welcome the opportunity in the future to come to another agreement with Adventist Healthcare, but we’d only do so if this results in the right outcome for our members.

If you do explore other options, please keep the following in mind:

• Check the fund has an active agreement with Adventist HealthCare and this isn’t due to change in the near future
• All health funds offer a minimum 30-day cooling-off period. Provided you haven’t claimed, you can easily switch back to us if an agreement is reached within that time
• If you have Hospital and Extras cover with us, you can always switch your Hospital cover to another fund and keep your Extras with us.

If I switch funds and you reach an agreement with Adventist HealthCare, can I transfer back?

Of course you can! You can come back at any time. All health funds offer a minimum 30-day cooling-off period, so if you haven’t claimed during that time, you can get a full refund and transfer back to us.  

If I switch funds, will my waiting periods be transferred over?

Yes. Any waiting periods already served will be transferred over to the health fund of your choice. If your new cover includes things you weren't covered for previously (or were covered at a lower level) you'll have to serve waiting periods for those services.