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
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.
Customise your cover
If you like extra toppings on your ice cream or hamburgers (or those way healthier options!), then you’ll love extras on your white lite cover.
What’s the price for me?
The price for this cover is ..., based on:
- white lite 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.
white lite 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 is the hospital excess?
$500 per person
This resets every year on the anniversary of when you took out your cover. So that’s one anniversary you can set and forget. And, to keep the cost of your cover down, we add the excess.
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.
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.
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 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.
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 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.