black+white deluxe flexi
Seriously schmick hospital and extras.
black+white deluxe flexi
Seriously schmick hospital and extras.
Top cover without pregnancy. Hip replacement, spinal fusion, dialysis, major eye, all included. In fact, it’s so comprehensive we’ve taken out accident cover, because in an emergency you’re already covered.
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.
What’s partially covered
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.
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.
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 deluxe flexi you get a separate limit of $300 to spend just on optical. Limits apply per person, per full financial year. Sub-limits and waiting periods apply.
Know what you’ll get back
Use our claims calculator to estimate 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
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 $1500 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.
No gap dental check-ups
We’ve struck a great deal with a number of dentists to offer you 100% back on dental check-ups.
Just a heads up, claims paid for dental check-ups come off your annual flexi limit which resets every financial year (1 July).Find a participating dentist
What is the final price for me?
Assuming you have nil Lifetime Health Cover Loading, the price you will pay for this cover is ....
We’ve worked hard to keep our pricing easy to find and simple to understand and it’s based on the following:
- black+white deluxe flexi cover in ...
- Paying weekly by Direct Debit
- For a single
- Australian Government Rebate of .... Update now.
- And nil Lifetime Health Cover Loading
About Lifetime Health Cover Loading:
If you’re under 31, Lifetime Health Cover (LHC) loading doesn’t apply to you and ... is your final price.
If you’re over 31, we may have to add LHC to the price.
LHC loading is a Federal Government initiative that encourages people to take out health insurance earlier in life and then maintain it. LHC loading is applied to people who haven’t taken out hospital cover by 1 July following their 31st birthday. This loading is 2% of the base rate of your hospital cover premium multiplied by the number of years since your 30th birthday. For example if you are 35, the loading would be 10%. The loading is removed once you have held hospital cover and paid the loading for 10 continuous years.
If you’re over 31 and think this loading might apply to you, that’s ok. On the next page we’ll update the price, let you know and you are under no obligation to complete the join.
When can I start to claim?
As soon as you have served your waiting periods.
black+white deluxe 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 deluxe flexi?
When you join ahm on black+white deluxe flexi you’ll get a $1100 flexi limit in the first year to spend on included extras, and that flexi limit will increase after the end of your first full financial year, for 5 years.
With ahm’s flexi limit, each member on the policy gets one amount to spend on one, or all of the included extras each financial year. So you might choose to use it all on routine dental, or spread it evenly across all of your services. The choice is yours.
Your extras limit will reset on the 1st July each year for each person on the policy.
Does black+white deluxe flexi have any provider restrictions?
At ahm we pay the same benefits at all recognised providers. This means you don’t have to switch dentists just because you’ve switched health funds. Convenient right!
Use our find a provider tool to see if your regular providers are already recognised by ahm.
What is my hospital excess with black+white deluxe flexi?
$500 per person. And it 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 premium 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).
That’s where GapCover can help.
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 online 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.
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.
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.
I’m switching from another insurer, how does it work?
Switching to ahm is simple. So simple all you need to do is just tell us the name of your current health insurer and that’s it. As soon as you’ve joined, we’ll get in touch with your previous insurer to organise the transfer on your behalf.
Your cover with ahm will be active from the date your cover ended at your previous insurer. This ensures you maintain continuous cover through the switching process.
Finally, any waiting periods you’ve already served are generally carried over for a comparable benefit, so if you’ve already waited those 12 months, you won’t need to do it again.
And if you change your mind, that’s ok, don’t forget we’ve got a 30-day cooling off period.
Can you explain ‘hospital’ and ‘extras’?
What is Hospital Insurance?
Hospital insurance will cover you for what-ifs and procedures that take place when you are admitted to hospital. When assessing your hospital cover the easiest way to do it is this;
If Medicare pays a benefit for it, and it’s not stated as restricted or excluded on your product, your hospital cover pays too. Like ahm, it’s that black and white.
What is Extras Insurance?
Extras Insurance gives you benefits back for only the items listed in your cover and up to the annual limit applicable to your cover. Extras covers you for health services that are non-medical and outside of a hospital, such as going to the dentist, the optometrist or the physiotherapist.
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.
Check your Member Guide for more information on pre-existing conditions.
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 minutes
- Your Medicare card
- Your payment details
Safe and secure payment
MasterCard or Visa cards incur a 0.25% surcharge
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.