advanced hospital goldHospital cover
*Price is for single cover in NSW paying weekly by direct debit. Price reduced by an Australian Government Rebate of 24.608% (based on an age of under 65 years old, single income of $93,000 or less per year).
We are customer satisfaction award winners!
advanced hospital goldHospital cover
All the gold category services. All solid gold. Get the widest range of treatments, including:
- Back, neck and spine
- Cataracts
- Heart and vascular system
- Joint replacements
It’s the gold standard for your ongoing peace of mind. Planning on having kids too? Get the reassurance of having access to pregnancy and birth services.
You also get midwife assisted home birth*, disease management appliances and unlimited medically necessary ambulance^ and no excess for dependants to help you stay gold.
*where a Medicare rebate is not payable.^TAS/QLD State schemes cover ambulance services for residents of those States.
We are customer satisfaction award winners!
Price is for single cover in NSW paying weekly by direct debit. Price reduced by an Australian Government Rebate of 24.608% (based on an age of under 65 years old, single income of $93,000 or less per year).
Hospital
This product includes the minimum standard clinical categories required for a ‘gold’ rating.
What’s included
On this product, we pay benefits towards the services below.
We’ll pay benefits towards all agreed hospital charges in a partner private hospital in a shared or private room. In a public hospital we’ll pay all accommodation charges for a shared room and benefits towards a private room. You may still incur out-of-pocket costs as a result of a medical gap for your doctors’ fees.
Hospital treatment for physical rehabilitation for a patient related to surgery or illness.
For example: inpatient and admitted day patient rehabilitation, stroke recovery, cardiac rehabilitation.
Hospital treatment for the treatment and care of patients with psychiatric, mental, addiction or behavioural disorders.
For example: psychoses such as schizophrenia, mood disorders such as depression, eating disorders and addiction therapy.
Mental Health Waiver
To access included benefits for Hospital psychiatric services in the first 2 months of joining this product, you may be eligible for the Mental Health Waiver.
Find out howHospital treatment for care where the intent is primarily providing quality of life for a patient with a terminal illness, including treatment to alleviate and manage pain.
Hospital treatment for the investigation and treatment of the brain, brain-related conditions, spinal cord and peripheral nervous system.
For example: stroke, brain or spinal cord tumours, head injuries, epilepsy and Parkinson’s disease.
Related hospital treatments and where to find them
Treatment of spinal column (back bone) conditions is listed separately under Back, neck and spine.
Chemotherapy and radiotherapy for cancer is listed separately under Chemotherapy, radiotherapy and immunotherapy for cancer.
Hospital treatment for the investigation and treatment of the eye and the contents of the eye socket.
For example: retinal detachment, tear duct conditions, eye infections and medically managed trauma to the eye.
Related hospital treatments and where to find them
Cataract procedures are listed separately under Cataracts.
Eyelid procedures are listed separately under Plastic and reconstructive surgery.
Chemotherapy and radiotherapy for cancer is listed separately under Chemotherapy, radiotherapy and immunotherapy for cancer.
Hospital treatment for the investigation and treatment of the ear, nose, throat, middle ear, thyroid, parathyroid, larynx, lymph nodes and related areas of the head and neck.
For example: damaged ear drum, sinus surgery, removal of foreign bodies, stapedectomy and throat cancer.
Related hospital treatments and where to find them
Tonsils, adenoids and grommets are listed separately under Tonsils, adenoids and grommets.
The implantation of a hearing device is listed separately under Implantation of hearing devices.
Orthopaedic neck conditions are listed separately under Back, neck and spine.
Sleep studies are listed separately under Sleep studies.
Chemotherapy and radiotherapy for cancer is listed separately under Chemotherapy, radiotherapy and immunotherapy for cancer.
Hospital treatment of the tonsils, adenoids and insertion or removal of grommets.
Hospital treatment for the investigation and treatment of diseases, disorders and injuries of the musculoskeletal system.
For example: carpal tunnel, fractures, hand surgery, joint fusion, bone spurs, osteomyelitis and bone cancer.
Related hospital treatments and where to find them
Chest surgery is listed separately under Lung and chest.
Spinal cord conditions are listed separately under Brain and nervous system.
Spinal column conditions are listed separately under Back, neck and spine.
Joint reconstructions are listed separately under Joint reconstructions.
Joint replacements are listed separately under Joint replacements.
Podiatric surgery performed by a registered podiatric surgeon is listed separately under Podiatric surgery (provided by a registered podiatric surgeon).
Management of back pain is listed separately under Pain management. Pain management that requires a device is listed separately under Pain management with device.
Chemotherapy and radiotherapy for cancer is listed separately under Chemotherapy, radiotherapy and immunotherapy for cancer.
Hospital treatment for surgery for joint reconstructions.
For example: torn tendons, rotator cuff tears and damaged ligaments.
Related hospital treatments and where to find them
Joint replacements are listed separately under Joint replacements.
Bone fractures are listed separately under Bone, joint and muscle.
Procedures to the spinal column are listed separately under Back, neck and spine.
Podiatric surgery performed by a registered podiatric surgeon is listed separately under Podiatric surgery (provided by a registered podiatric surgeon).
Hospital treatment for the investigation and treatment of the kidney, adrenal gland and bladder.
For example: kidney stones, adrenal gland tumour and incontinence.
Related hospital treatments and where to find them
Dialysis is listed separately under Dialysis for chronic kidney failure.
Chemotherapy and radiotherapy for cancer is listed separately under Chemotherapy, radiotherapy and immunotherapy for cancer.
Hospital treatment for the investigation and treatment of the male reproductive system including the prostate.
For example: male sterilisation, circumcision and prostate cancer.
Related hospital treatments and where to find them
Chemotherapy and radiotherapy for cancer is listed separately under Chemotherapy, radiotherapy and immunotherapy for cancer.
Hospital treatment for the investigation and treatment of the digestive system, including the oesophagus, stomach, gall bladder, pancreas, spleen, liver and bowel.
For example: oesophageal cancer, irritable bowel syndrome, gall stones and haemorrhoids.
Related hospital treatments and where to find them
Endoscopy is listed separately under Gastrointestinal endoscopy.
Hernia and appendicectomy procedures are listed separately under Hernia and appendix.
Bariatric surgery is listed separately under Weight loss surgery.
Chemotherapy and radiotherapy for cancer is listed separately under Chemotherapy, radiotherapy and immunotherapy for cancer.
Hospital treatment for the investigation and treatment of a hernia or appendicitis.
Related hospital treatments and where to find them
Digestive conditions are listed separately under Digestive system.
Hospital treatment for the diagnosis, investigation and treatment of the internal parts of the gastrointestinal system using an endoscope.
For example: colonoscopy, gastroscopy, endoscopic retrograde cholangiopancreatography (ERCP).
Related hospital treatments and where to find them
Non-endoscopic procedures for the digestive system are listed separately under Digestive system.
Hospital treatment for the investigation and treatment of the female reproductive system.
For example: endometriosis, polycystic ovaries, female sterilisation and cervical cancer.
Related hospital treatments and where to find them
Fertility treatments are listed separately under Assisted reproductive services.
Pregnancy and birth-related conditions are listed separately under Pregnancy and birth.
Miscarriage or termination of pregnancy is listed separately under Miscarriage and termination of pregnancy.
Chemotherapy and radiotherapy for cancer is listed separately under Chemotherapy, radiotherapy and immunotherapy for cancer.
Hospital treatment for the investigation and treatment of a miscarriage or for termination of pregnancy.
Hospital treatment for chemotherapy, radiotherapy and immunotherapy for the treatment of cancer or benign tumours.
Your hospital cover does not include non-PBS drugs. We will only pay towards cancer-related surgery where that surgery is an Included or Restricted Service under your cover.
Related hospital treatments and where to find them
Surgical treatment of cancer is listed separately under each body system.
Hospital treatment for pain management that does not require the insertion or surgical management of a device.
For example: treatment of nerve pain and chest pain due to cancer by injection of a nerve block.
Related hospital treatments and where to find them
Pain management using a device (for example an infusion pump or neurostimulator) is listed separately under Pain management with device.
Hospital treatment for the investigation and treatment of skin, skin-related conditions and nails. The removal of foreign bodies is also included. Plastic surgery that is medically necessary and relating to the treatment of a skin-related condition is also included.
For example: melanoma, minor wound repair and abscesses.
Related hospital treatments and where to find them
Removal of excess skin due to weight loss is listed separately under Weight loss surgery.
Chemotherapy and radiotherapy for cancer is listed separately under Chemotherapy, radiotherapy and immunotherapy for cancer.
Hospital treatment for the investigation and treatment of breast disorders and associated lymph nodes, and reconstruction and/or reduction following breast surgery or a preventative mastectomy.
For example: breast lesions, breast tumours, asymmetry due to breast cancer surgery, and gynecomastia.
Related hospital treatments and where to find them
This clinical category does not require benefits to be paid for cosmetic breast surgery that is not medically necessary.
Chemotherapy and radiotherapy for cancer is listed separately under Chemotherapy, radiotherapy and immunotherapy for cancer.
Hospital treatment for the investigation and management of diabetes.
For example: stabilisation of hypo- or hyper- glycaemia, contour problems due to insulin injections.
Related hospital treatments and where to find them
Treatment for diabetes-related conditions is listed separately under each body system affected. For example, treatment for diabetes-related eye conditions is listed separately under Eye.
Treatment for ulcers is listed separately under Skin.
Provision and replacement of insulin pumps is listed separately under Insulin pumps.
Hospital treatment for the investigation and treatment of the heart, heart-related conditions and vascular system.
For example: heart failure and heart attack, monitoring of heart conditions, varicose veins and removal of plaque from arterial walls.
Related hospital treatments and where to find them
Chemotherapy and radiotherapy for cancer is listed separately under Chemotherapy, radiotherapy and immunotherapy for cancer.
Hospital treatment for the investigation and treatment of the lungs, lung-related conditions, mediastinum and chest.
For example: lung cancer, respiratory disorders such as asthma, pneumonia, and treatment of trauma to the chest.
Related hospital treatments and where to find them
Chemotherapy and radiotherapy for cancer is listed separately under Chemotherapy, radiotherapy and immunotherapy for cancer.
Hospital treatment for the investigation and treatment of blood and blood-related conditions.
For example: blood clotting disorders and bone marrow transplants.
Related hospital treatments and where to find them
Treatment for cancers of the blood is listed separately under Chemotherapy, radiotherapy and immunotherapy for cancer.
Hospital treatment for the investigation and treatment of the back, neck and spinal column, including spinal fusion.
For example: sciatica, prolapsed or herniated disc, spinal disc replacement and spine curvature disorders such as scoliosis, kyphosis and lordosis.
Related hospital treatments and where to find them
Joint replacements are listed separately under Joint replacements.
Joint fusions are listed separately under Bone, joint and muscle.
Spinal cord conditions are listed separately under Brain and nervous system.
Management of back pain is listed separately under Pain management. Pain management that requires a device is listed separately under Pain management with device.
Chemotherapy and radiotherapy for cancer is listed separately under Chemotherapy, radiotherapy and immunotherapy for cancer.
Hospital treatment which is medically necessary for the investigation and treatment of any physical deformity, whether acquired as a result of illness or accident, or congenital.
For example: burns requiring a graft, cleft palate, club foot and angioma.
Related hospital treatments and where to find them
Plastic surgery that is medically necessary relating to the treatment of a skin-related condition is listed separately under Skin.
Chemotherapy and radiotherapy for cancer is listed separately under Chemotherapy, radiotherapy and immunotherapy for cancer.
Hospital treatment for surgery to the teeth and gums.
For example: surgery to remove wisdom teeth, and dental implant surgery.
For Dental surgery performed by a dentist rather than a medical practitioner we only pay benefits towards hospital charges. If the surgery is performed by a medical practitioner and Medicare benefits are payable, we will pay benefits towards the hospital and medical charges.
Hospital treatment for the investigation and treatment of conditions affecting the foot and/or ankle, provided by a registered podiatric surgeon, but limited to benefits towards:
- accommodation; and
- the cost of a prosthesis as listed in the prostheses list set out in the Private Health Insurance (Prostheses) Rules, as in force from time to time.
For Podiatric surgery we only pay benefits towards hospital charges. There are no Medicare benefits payable for podiatric surgery. This means we also don’t pay any benefits towards the podiatric surgeon’s fees under hospital cover and you could incur significant out-of-pocket expenses.
Related hospital treatments and where to find them
Insurers are not required to pay for any other benefits for hospital treatment for this clinical category but may choose to do so.
Hospital treatment to correct hearing loss, including implantation of a prosthetic hearing device.
Related hospital treatments and where to find them
Stapedectomy is listed separately under Ear, nose and throat.
Hospital treatment for surgery to remove a cataract and replace with an artificial lens.
Hospital treatment for surgery for joint replacements, including revisions, resurfacing, partial replacements and removal of prostheses.
For example: replacement of shoulder, wrist, finger, hip, knee, ankle, or toe joint.
Related hospital treatments and where to find them
Joint fusions are listed separately under Bone, joint and muscle.
Spinal fusions are listed separately under Back, neck and spine.
Joint reconstructions are listed separately under Joint reconstructions.
Podiatric surgery performed by a registered podiatric surgeon is listed separately under Podiatric surgery (provided by a registered podiatric surgeon).
Hospital treatment for dialysis treatment for chronic kidney failure.
For example: peritoneal dialysis and haemodialysis.
Hospital treatment for investigation and treatment of conditions associated with pregnancy and child birth.
Treatment for the baby is included under the clinical category relevant to their condition.
Related hospital treatments and where to find them
Female reproductive conditions are listed separately under Gynaecology.
Fertility treatments are listed separately under Assisted reproductive services.
Miscarriage and termination of pregnancy is listed separately under Miscarriage and termination of pregnancy.
Hospital treatment for fertility treatments or procedures.
For example: retrieval of eggs or sperm, In vitro Fertilisation (IVF), and Gamete Intra-fallopian Transfer (GIFT).
Related hospital treatments and where to find them
Treatment of the female reproductive system is listed separately under Gynaecology.
Pregnancy and birth-related services are listed separately under Pregnancy and birth.
Hospital treatment for surgery that is designed to reduce a person’s weight, remove excess skin due to weight loss and reversal of a bariatric procedure.
For example: gastric banding, gastric bypass, sleeve gastrectomy.
Hospital treatment for the provision and replacement of insulin pumps for treatment of diabetes.
Hospital treatment for the implantation, replacement or other surgical management of a device required for the treatment of pain.
For example: treatment of nerve pain, back pain, and pain caused by coronary heart disease with a device (for example an infusion pump or neurostimulator).
Related hospital treatments and where to find them
Treatment of pain that does not require a device is listed separately under Pain management.
Hospital treatment for the investigation of sleep patterns and anomalies.
For example: sleep apnoea and snoring.
Hospital Excess
An excess is an upfront lump sum payment that you agree to pay towards the cost of your hospital stay or day surgery. You can reduce your health insurance premium by opting for a $750 hospital excess per person (up to a maximum of $1500 per couple/family per membership year).
Supporting documents
Before buying any of our health insurance, it’s important that you read and understand the product information for the cover you have chosen.
Common questions
As soon as you have served your waiting periods.
If you’re switching from another private health insurer, we’ll generally recognise any waiting periods you’ve already served for comparable services.
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, reduced excess, or higher limits.
If a member with hospital cover has an Accident after joining or upgrading their cover with ahm and the treatment required is an Included service, they can apply to have the Waiting Period reduced to 1 day where the treatment is required during the initial two month Waiting Period for hospital treatment.
An Accident is defined by ahm as ‘an unplanned or unforeseen event resulting in bodily injuries that requires immediate medical treatment in a hospital.’ Note: this includes both public and private hospitals.
For more information on claiming and waiting periods see the Member Guide.
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.
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(opens in a new tab).
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 services 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.
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 might not need to wait to claim.
During the switch you’ll still be insured with us. That’s because your cover with ahm starts from the date your cover ends with your current insurer.
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
- with medical fees not covered by Medicare
- with reducing fees above the Medicare Benefits Schedule (MBS) through GapCover
- avoid the Medicare Levy Surcharge (MLS) if you earn over $90,000 as a single or $180,000 as a couple/family
- avoid the government’s Lifetime Health Cover loading by taking out hospital cover before 1 July following your 31st birthday
Put plainly, extras insurance helps with the cost 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.
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 Practitioners) 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(opens in a new tab).
This is a set amount of time you must wait before you can claim any money back for a service included in your cover.
A waiting period applies when you:
- first join, or re-join after some time without health insurance.
- change to a higher level of cover with increased benefits.
- change to a cover with additional services or increase your limits.
- add an additional bundle to your cover.
If you switch to us from another private health insurer, we’ll generally recognise any waiting periods you’ve already served for comparable extras.
Why ahm?
Straightforward private health insurance
We take a fresh approach to health insurance and cut out the complexity. Everything we do is about making things simpler, so you can make the most of what matters to you.
30 day cooling off period
Just let us know within 30 days of joining and as long as you haven’t made any claims we’ll refund your premiums. Simple.
Join in a matter of minutes
It takes less than 3 minutes to join ahm, but who’s counting? Have these goodies handy and you’re set to go:
- Your Medicare card
- Visa, Mastercard or bank account details
Safe and secure payment
Pay by Direct Debit, Mastercard or Visa
Mastercard or Visa cards incur a 0.21% surcharge
Switching private health insurance?
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
(opens in a new tab)