Basic

ambulance & accident hospital (basic)

You can’t plan for an accident, but you can plan for getting hospital cover where we have your back for Accidents. And, you won’t have to pay an excess for these Accidents# - double the win!

Features

Accident Override means we will pay benefits towards services that are listed as excluded or restricted on your cover if it was as a result of an accident#
No excess for Accidents under Accident Override^^
No excess for dependants
Unlimited Medically Necessary Ambulance means that we’ll help with the ambulance fees for medically necessary ambulance transport to the nearest hospital^.

Basic

ambulance & accident hospital (basic)

You can’t plan for an accident, but you can plan for getting hospital cover where we have your back for Accidents. And, you won’t have to pay an excess for these Accidents# - double the win!

Features

Accident Override means we will pay benefits towards services that are listed as excluded or restricted on your cover if it was as a result of an accident#
No excess for Accidents under Accident Override^^
No excess for dependants
Unlimited Medically Necessary Ambulance means that we’ll help with the ambulance fees for medically necessary ambulance transport to the nearest hospital^.

ambulance & accident hospital (basic)

$-/weekly

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*Price is for single cover in NSW paying weekly by direct debit. Price reduced by an Australian Government Rebate of 24.288% (based on an age of under 65 years old, single income of $97,000 or less per year). Hospital price includes an excess of $750, excludes any Youth Discount and excludes Lifetime Health Cover loading.

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Hospital

This product includes the minimum standard clinical categories required for a ‘basic’ rating.

What’s restricted

On this product, we pay restricted benefits towards the services below.

We’ll pay all accommodation charges for a shared room in a public hospital. We’ll only pay limited benefits towards your stay at a private hospital or in a private room in a public hospital. You will incur significant out of pocket expenses if you are treated at a private hospital or stay in a private room at a public hospital.

What’s excluded

On this product, we don’t pay benefits towards the services below.

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 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 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 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 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 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 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 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 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 gynaecomastia.

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 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 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).

$500$750

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.

Product guide (pdf)(opens in a new tab)

Member guide (pdf)(opens in a new tab)

Lifetime Health Cover loading and Medicare Levy Surcharge, still confused? Find out more

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 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.

For more information on claiming and waiting periods see the Member Guide.

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 $97,000 as a single or $194,000 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.

Ready to join? You’ll need …

Medicare card

We’ll need this to pay your service refunds.

Payment details

We accept Visa, Mastercard and bank account details as payment.

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Details you should know

#We will pay benefits towards the initial and ongoing hospital treatment that resulted from an Accident for all services that are listed as excluded and restricted on your cover. An Accident refers to an unplanned or unforeseen event resulting in bodily injury that requires immediate medical treatment in a hospital.

^^If you are admitted to hospital for an Accident, where possible we’ll waive the excess upfront. However, due to the way we receive claims for hospitalisations relating to Accidents, the hospital may require you to pay the excess on the day of the admission. We’ll then reimburse this amount, subject to eligibility of the waiver. The excess will only be waived for the first admission each membership year in relation to a non-compensatable Accident.

^Transport to the nearest hospital provided by an ahm approved road, sea or air Ambulance provider that’s able to provide the level of care you medically need. Some ahm products limit the number of Ambulance services we’ll pay benefits towards per financial year. Check your product information to see if any limits apply. Your Daily Charge and/or Excess doesn’t apply to Ambulance claims.

$-/weekly

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