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black​+​white lite flexi

Hospital and extras package

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black​+​white lite flexi

Hospital and extras package

Are you the sporty type? Want more than just the basics? Do you wear glasses or contacts? Or simply want a little more $$ in your flexi extras limit? Introducing black+white lite flexi with more of all.
Join and save $50 (after your first 60 days).

Offer ends 31 August 2018. More info

Join and save $50 (after your first 60 days).

Offer ends 31 August 2018. More info

Australian Government Rebate 25.415%
Lifetime Health Cover loading 0%
Join and save $50 (after your first 60 days).

Offer ends 31 August 2018. More info

Join and save $50 (after your first 60 days).

Offer ends 31 August 2018. More info


What’s included

Removal of tonsils & adenoids
Removal of appendix
Wisdom teeth
Joint investigations & reconstructions
Minor gynaecological procedures
Grommets in ears

Although these services are included, there still may be some out-of-pocket expenses as some doctors and medical practitioners charge more than what is set out in the Medicare Benefits Schedule (MBS).

A note on ambulance: Tasmania and Queensland have state schemes that cover ambulance services for residents of those states. Annual limits apply per person, per financial year.

What’s partially covered

Palliative care

We’ll cover some of the costs of the above items but not all, so you will end up with out of pocket expenses if you go to a private hospital or are in a private room in a public hospital.

What’s excluded

For these excluded services the cost of treatment won’t be covered at all. This won’t stop you from going to a public hospital as a public patient for treatment.

All services covered by Medicare
Lifetime Health Cover loading and Medicare Levy Surcharge, still confused? Find out more


What’s included

Routine dental
Complex dental
Natural therapies
Want extra extras?See black+white classic flexi 

Make the most of your extras

You’ll get one amount to use on one, some or all of your included extras each financial year. Plus, with black​+​white lite flexi you get a separate limit of $200 to spend just on optical. Limits apply per person, per full financial year. Sub-limits and waiting periods apply.

Flexi Diagram

Know what you’ll get back

Use our Benefit calculator to find out upfront what you’ll get back. To see what we pay for each service view the product guide.

Stick with us and you’ll be rewarded

When you join
Year 1
Year 2
Year 3
Year 4
Year 5

Your annual flexi limit for included extras will start increasing after you’ve been with us for one full financial year. This means you get a $100 more to spend on your included extras each full consecutive financial year you stay with us, capped at $1100 in year 5. The flexi limit is calculated by using the number of full continuous financial years the Principal Member has held cover with us.

Common questions

What’s the price for me?

The price for this cover is ..., based on:

  • black+white lite flexi cover in ...
  • Paying weekly by Direct Debit
  • For a single
  • Australian Government Rebate of ....
  • No Lifetime Health Cover loading

If you’re over 31 and haven’t had hospital cover before, we may have to add Lifetime Health Cover (LHC) loading to the price. Payment by Mastercard or Visa incurs a 0.25% surcharge. The final price will be calculated before you join.

What is Lifetime Health Cover (LHC) loading?

This is a Government initiative to encourage people to take out hospital insurance earlier in life and then maintain it. LHC loading is an amount added to premiums of people who haven’t taken out hospital cover by 1 July following their 31st birthday.

How is the loading calculated

This loading is 2% of the hospital part of your premium multiplied by the number of years since your 30th birthday. For example, if you are 35 the loading would be 10% (2% times 5). The loading is removed once you have held hospital cover and paid the loading for 10 continuous years.

When can I start to claim?

As soon as you have served your waiting periods.

black+white lite flexi has the following waiting periods:

    If you’re switching from another private health insurer, we’ll generally recognise any waiting periods you’ve already served for comparable benefits.

    A waiting period is a set amount of time before you can claim any money back for a service included on your cover. Waiting periods apply when you first join (or re-join after not having had health insurance for some time) or if you change to a higher level of cover that has additional services or higher limits.

    How much can I claim with black+white lite flexi?

    Claiming extras

    You’ll get a $700 flexi limit to spend per person on included extras in the first financial year.

    Each member on the policy gets an amount to spend on one, some or all of the included extras each financial year. For example, you could spend this just on routine dental or spread it across all your extras. Your extras flexi limit resets on 1 July each year for each person on the policy.

    Your annual flexi limit increase will begin after you’ve been with us for one full financial year.

    Claiming hospital

    For information about claiming hospital expenses, see our going to hospital section.

    Does black+white lite flexi have any provider restrictions?

    At ahm we pay the same benefits at all recognised providers other than our no gap dental offering at select dentists. This means you don’t have to switch your physio or chiro just because you’ve switched health funds. Convenient right!

    See if your regular providers are recognised by ahm.

    Find a provider

    How much is the hospital excess with black+white lite flexi?

    $500 per person

    This resets each year on the anniversary of when you took out your cover. We add the excess to your cover to keep the cost of your premiums down.

    What will be my medical out-of-pocket expenses?

    Your out-of-pocket expenses may vary depending on a range of factors, but significantly if the service is included, partially covered (restricted) or excluded.

    For a list of what we pay for each service, view the product guide.

    Included hospital services

    When you go to hospital, there might be a gap between what we pay for your medical services, and what your doctor charges you. This is the referred to as a medical gap and is your out-of-pocket expense.

    Medical gaps exist because some doctors may charge higher fees than what is set out in the Medicare Benefit Schedule (MBS).

    Doctors can choose to participate in GapCover or not on a per claim, per treatment and per patient basis, so you should always check with them prior to agreeing to each claim as part of your treatment. If your doctor chooses to participate in GapCover for the claim forming part of your treatment, then we’ll provide benefits up to an agreed fee and the maximum gap that you’ll have to pay is $500 per claim per provider (i.e. per each doctor’s account).

    GapCover doesn’t apply to diagnostic services such as blood tests, x-rays and ultrasounds, out-of-hospital medical services and sevices not included on your policy. GapCover doesn’t apply to things such as excess payments and co-payments. You may still have out of pocket costs.

    You can search for doctors who’ve previously registered to participate in GapCover with our find a provider tool. This doesn’t mean they’ll do so for your claim forming part of your treatment. You should always check upfront with your doctor before agreeing to each claim forming part of your treatment.

    For more information on GapCover refer to What is GapCover? or Member Guide.

    Partially covered hospital services

    In addition to any out-of-pocket costs as a result of a medical gap, partially covered services only pay limited benefits towards your accommodation and won’t cover the full cost of treatment.

    If you choose to use a hospital service that is only partially covered, you may be left with additional out-of-pocket expenses related to your stay in hospital.

    To reduce your out-of-pocket expenses, you may choose to be treated as a private patient in a public hospital, rather than a private hospital. However, this will not reduce your out-of-pocket expenses entirely.

    Should you need to use a partially covered hospital service, give us a call on 134 246 before you go into hospital for your treatment and we can confirm what you’re covered for.

    Excluded hospital services

    If you choose to use a hospital service that is not covered, and you use the private health care system, your out-of-pocket will be the entire cost of the treatment. ahm will pay no benefits towards the cost of your treatment.

    Included extras

    Your out-of-pocket expenses for your extras services will be the difference between what your provider charges and what we pay back on that particular service.

    How do I switch from another insurer?

    Switching to ahm is easy - just tell us the name of your current health insurer when you join, and we’ll organise it for you. Also, any waiting periods you’ve already served are generally carried over for comparable services, so you probably won’t need to wait to claim.

    And during the switch you’ll still be covered. That’s because your cover with ahm starts from the date your cover ends with your current insurer.

    What exactly is hospital and extras cover?

    Hospital cover

    With hospital cover you get the opportunity to choose your own doctor and specialist, and more choice over which hospital you go to.

    Hospital cover will help:

    • avoid or reduce waiting times on non- emergency treatments in a hospital
    • cover medical fees not covered by Medicare
    • with fees above the Medicare Benefits Schedule (MBS) through GapCover
    • avoid or reduce waiting times on non-emergency treatments in a hospital.
    • avoid the Medicare Levy Surcharge (MLS) if you’re a high income earner
    • avoid the Federal Government’s Lifetime Health Cover loading by taking out an ahm hospital cover before you turn 31.

    If you have hospital insurance, you can choose to be treated as a private patient in any hospital (public or private), and Medicare will cover you for 75% of the Medicare Benefits Schedule (MBS) fee for associated medical costs. The remaining hospital and medical costs will be charged to you - and depending on your policy some or all of these costs may be covered on your private health insurance.

    Extras cover

    Put plainly, extras insurance helps cover some of the costs of health services and therapies that aren’t covered by Medicare. Things like dental, physio, optometry, massage (and many, many more) are known as extras. The type of services and amount you can claim will depend on the level of extras cover you take out.

    What’s a pre-existing condition?

    A pre-existing condition is any kind of ailment, illness or condition where you had the signs or symptoms (in the opinion of one of our Medical Practitioner) 6 months before you joined private health insurance or changed your cover.

    Our appointed Medical Practitioner is the only person authorised to decide if an ailment, illness or condition is pre-existing. They must consider any information that was provided by the medical practitioner who treated the ailment, illness or condition.

    For more information on pre-existing conditions see the Member Guide.

    How to join

    On average it takes 5 minutes to join ahm. But who’s counting? Just have these goodies handy and you’re set to go:

    • 5 minutes5 minutes
    • Your Medicare cardYour Medicare card
    • Your payment detailsYour payment details
    Safe and secure payment

    MasterCard or Visa cards incur a 0.25% surcharge

    Switching today?

    Just tell us the name of your current health insurer and we’ll take care of the rest. Don’t worry, we’ll let them down gently.
    More about how switching works

    30 day cooling off period

    It’s OK if you change your mind. Just let us know within 30 days of joining and as long as you’ve made no claims we’ll refund your premiums.

    Before buying any of our health insurance, it’s important that you read and understand the product information for the cover you have chosen. We recommend you keep a copy of the product guide for future reference.

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