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Private health funds

Who is ARHG?

ARHG is a boutique service provider whose purpose is to enhance the competitive success of our member funds. We do this through collaboration, centralisation, innovation and scale.

ARHG’s primary role is to negotiate and manage competitive hospital contracts reflective of the customer promise made by our member funds.

Underpinning negotiations is rigorous data analysis, industry experience and insight, and the development of productive relationships.

Importantly, our funds operate in different competitive markets, ensuring that each fund can steer the strategic direction for their area.

Where it is a suitable fit for our member fund’s strategies, we also identify and deliver additional services that add value through collaboration and specialisation.¬†

ARHG represents and advocates for our funds at all levels of industry, leading the discussion on regional issues. We are part of the Members Health Fund Alliance; an alliance of health insurance funds that share the principle of putting members health before profits.

How we are different

Governance framework

Membership of ARHG entitles the CEO of each member fund to sit on the ARHG Board of Directors. The structure allows each fund to directly influence the strategic objectives and direction of the company.

Member engagement model

Collaboration and consultation occur at every level through our member engagement model. The model identifies the different cohorts of interest between ARHG and its member funds, and outlines a formal calendar of engagement.

Lead fund approach

Each hospital contract is allocated a 'lead fund' based on which fund is impacted most by the contract. Key decisions are always made in consultation with the lead fund during the contract negotiation process.

Our key services

Contract relationship management

Our 'lead fund' approach to hospital contracting gives funds control over the contracts that impact them the most. It also creates a clear and effective escalation process if challenges occur during the negotiation. Our contracts are Eclipse-friendly and seamless for hospitals and funds to implement.

Claims analytics and fraud detection

ARHG has sophisticated Business Intelligence technology and highly skilled data analysts with extensive experience across the Australian health care system. Member funds have access to business critical, current and targeted information, and work with ARHG on data interrogation and fraud detection intitiatives.

Industry participation and advocacy

ARHG represents our member funds at industry forums and on specialist task forces. Our role is to advocate for a better future for regional members. We have a regional advocacy strategy with the objective of achieving improved access to affordable health services in regional areas.

Alternative therapy database

The ARHG alternative therapy database lists alternative therapy providers that meet a set of agreed provider accreditation standards, ensuring funds pay benefits to providers in line with private health benefit rules. ARHG also conducts audits of general treatment providers to identify and prevent fraudulent activity.

QualiPHI e-learning platform

ARHG operates an online learning platform called QualiPHI, providing funds with a suite of training modules on fundamental private health insurance topics. ARHG member funds also have access to use the MATRIX LMS system for their own L&D e-learning programs.

Dental reasonability rules

ARHG maintains a schedule of dental reasonability rules, reviewed regularly by a qualified dental consultant. The file supports funds in the management of dental claims, and reduces the risk of fraud and inappropriate claiming behaviours through electronic claiming platforms.

What our member funds say

ARHG gives funds a voice. Their approach is personable and takes into consideration issues that impact at a grass-roots level.

We really value the collegiate relationships between ARHG member funds. We leverage off each other's knowledge to maximise our outcomes.

ARHG is member-centric, solution-focused, and encourages collaboration for the greater good of all involved.

The voice of the fund is heard and considered at every step of every project, discussion and change.

    ©Australian Regional Health Group 2022

    ABN 44 067 435 714