essentials silver plus & family extras
- weekly
- fortnightly
- monthly
- yearly
$100 cash back!
Join & commence by Sep 30.
Silver Hospital cover, with a side order of added benefits:
- Sleep studies
Palliative care and rehab are also included. You also get unlimited medically necessary ambulance^, accident override and no excess for dependants.
From braces to orthotics, and even pre and post natal services - this one‘s for the whole family.
^TAS/QLD State schemes cover ambulance services for residents of those States.essentials silver plus & family extras
Silver Hospital cover, with a side order of added benefits:
- Sleep studies
Palliative care and rehab are also included. You also get unlimited medically necessary ambulance^, accident override and no excess for dependants.
From braces to orthotics, and even pre and post natal services - this one‘s for the whole family.
^TAS/QLD State schemes cover ambulance services for residents of those States.- weekly
- fortnightly
- monthly
- yearly
$100 cash back!
Join & commence by Sep 30.
essentials silver plus & family extras
$-/weekly
*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 $97,000 or less per year). Hospital price includes an excess of $750, excludes any Youth Discount and excludes Lifetime Health Cover loading.
We are customer satisfaction award winners!
Want $100 cash back?
As part of our claims saving promise, we’re giving $100 cash back to our members. If you join and stay with AHM on your hospital and/or extras policy on 30 September 2024, the cash will be paid into your account by the end of October 2024. Very nice!
Extras
Holy molars?
Heaps of dental for the whole family.
No 2 or 6 month waiting periods
on included extras.
No gap dental check-ups
Available at select dentists.
What’s included
On this product, we pay benefits towards routine dental up to your annual limit.
Dental treatments include:
- x-rays
- examinations and consultations
- clean and polish procedures
- tooth extractions
- minor restorative services such as fillings.
That’s 2 dental check-ups with no out of pocket cost every financial year (up to your annual limit). No gap dental check-ups include comprehensive and periodic examinations, clean and polish or scale and clean, and fluoride treatments only. Excludes x-rays, tooth extractions and fillings. Waiting periods may apply.
Find a participating dentist
^Excludes specialists
On this product, we pay benefits towards complex dental up to your annual limit.
Dental procedures including root canal therapy (endodontics), and root planing, jaw injuries or non-tooth related surgery (periodontics).
On this product, we pay benefits towards major dental up to your annual limit.
Major dental covers procedures such as crowns, bridgework, veneers, implants and dentures.
Major dental does NOT include orthodontic treatments.
Lifetime limit
On this product, we pay benefits towards orthodontics up to your annual and lifetime limits.
We define this as specialist dentistry treatment to align teeth and jaws. Orthodontic treatments include braces, plates and retainers.
More about orthodontics.On this product, we pay benefits towards optical up to your annual limit.
With this cover you get 100% back on optical up to annual limits to spend on included services, such as the cost of glasses, frames, lenses, repairs, and contact lenses.
On this product, we pay benefits towards physiotherapy up to your annual limit.
Physiotherapy benefits include one-on-one consultations, as well as group or class sessions for hydrotherapy, clinical pilates (by a recognised physiotherapist), antenatal exercise and rehabilitation.
On this product, we pay benefits towards chiropractic up to your annual limit.
Chiropractic treatment involves the manipulation or adjustment of the spine and the diagnosis and management of spinal health related problems.
Benefits are paid towards consultations with a Chiropractor.
On this product, we pay benefits towards osteopathy up to your annual limit.
Osteopathy involves stretching and the manipulation of bones and muscles.
Benefits are paid towards consultations with an Osteopath.
Remedial massage
On this product, we pay benefits towards remedial massage up to your annual limit.
Acupuncture
On this product, we pay benefits towards acupuncture up to your annual limit.
Exercise physiology
On this product, we pay benefits towards exercise physiology up to your annual limit.
On this product, we pay benefits towards pharmacy up to your annual limit.
Benefits are paid towards non-PBS pharmacy items that are prescription-only and prescribed by a medical practitioner. This includes oral contraceptives and cosmetic pharmaceuticals for medical conditions, travel and other vaccinations, and hormonal implants that are essential to treat a particular illness, injury or condition.
We’ll pay a benefit for each eligible pharmacy item after you pay the set PBS general patient amount as a co-payment up to your limit.
Items available without a prescription including over the counter, off the shelf, herbal medicines and vitamins can’t be claimed.
On this product, we pay benefits towards health improvement up to your annual limit.
Depending on your level of extras health cover, we'll contribute to the costs of some treatments designed to keep you healthy.
Some included treatments are:
- quit smoking benefits
- Cancer Council UV products
- preventive tests
- health checks
- stress management courses
- disease management association fees
- exercise classes
Some restrictions apply and you may need medical evidence that you qualify for some benefits.
Dietetics
On this product, we pay benefits towards dietetics up to your annual limit.
Benefits are paid towards dietetics consultations with a recognised Dietitian.
Nutrition
On this product, we pay benefits towards nutrition up to your annual limit.
Benefits are paid towards nutrition consultations with a recognised Nutritionist.
Weight loss
On this product, we pay benefits towards weight loss up to your annual limit.
Benefits are paid towards weight loss classes and courses, provided you meet certain eligibility criteria.
Psychology
On this product, we pay benefits towards psychology up to your annual limit.
Benefits are paid towards psychology consultations with a recognised Psychologist.
Counselling
On this product, we pay benefits towards counselling up to your annual limit.
Benefits are paid towards counselling consultations with a recognised Counsellor.
On this product, we pay benefits towards hypnotherapy up to your annual limit.
Benefits are paid towards hypnotherapy consultations with a recognised Psychologist.
On this product, we pay benefits towards speech therapy up to your annual limit.
Benefits are paid towards consultations with a Speech Therapist.
On this product, we pay benefits towards occupational therapy up to your annual limit.
Benefits are paid towards consultations with an Occupational Therapist.
On this product, we pay benefits towards eye therapy up to your annual limit.
Benefits are paid towards consultations with an Orthoptist.
On this product, we pay benefits towards podiatry up to your annual limit.
Benefits towards consultations, biomechanical assessments, castings and podiatric surgery.
*There is a 12 month waiting period for Podiatric Surgery benefits.
On this product, we pay benefits towards orthotics & orthopaedic shoes up to your annual limit.
Benefits are payable towards custom-made orthotics, and repairs to custom-made orthotics. We accept referrals from ahm-recognised physiotherapists and chiropractors for orthotic devices.
Benefits don’t cover pre-moulded, pre-fabricated or off-the-shelf orthotics such as sporthotics or formthotics.
Limit
On this product, we pay benefits towards hearing aids up to your annual limit.
Benefits are paid towards the cost of hearing aids and hearing aid repairs. Limits are applied every 3 financial years.
Limit
On this product, we pay benefits towards pre & post natal services & birthing courses up to your rolling year limit. The rolling year starts on the date the service is first provided, with the limit renewed 12 months later.
Includes benefits towards birthing classes and courses, lactation consultant services and pre or postnatal visits from a registered midwife.
Also includes benefits towards pregnancy compression garments, which are clothes designed to provide support and to relieve pain associated with pregnancy and post-birth. You can claim up to 2 garments per rolling year. You will need to provide a supporting letter from a Medical Practitioner that you require pregnancy compression garments and they must be approved by the Therapeutic Goods Administration (TGA).
On this product, we pay benefits towards medical gases up to your annual limit.
Benefits towards the costs related to the use of oxygen gases and oxygen concentrators (excluding repairs).
Limit
On this product, we pay benefits towards joint fluid replacement injections up to your rolling year limit. The rolling year starts on the date the service is first provided, with the limit renewed 12 months later.
Benefits are paid towards the costs of fluid injections to joints including the knee, hip and shoulder, such as visco-supplemental treatments to alleviate the pain of osteoarthritis.
Benefits are paid per rolling year, which begins on the date the service was first provided.
On this product, we pay benefits towards travel & accommodation up to your annual limit.
Travel and accommodation benefits are available if you need to travel more than 200km return for a specialist medical appointment or for an outpatient procedure. This doesn’t include travel and accommodation related to hospitalisations, dental or extras services and IVF treatment.
We define this as emergency transport to hospital due to a sudden or unexpected event where the only practical way of getting to a hospital is by ambulance.
We also pay towards attendance fees where an ambulance is called but transportation isn’t required.
We don’t pay benefits for ambulance subscriptions and we don’t pay benefits for other ambulance services such as:
- transfers between hospitals
- travelling from home to hospital for tests
- any transport on discharge from hospital (e.g.hospital to home)
Tasmania and Queensland have State schemes that cover ambulance services for residents of those States.
1 day waiting period applies.
You choose extras providers — not us
First, what exactly are extras providers? That’s just what we call the dentists, optometrists, chiros, physios and other professionals who provide health services. Unlike some health insurers, we’ll pay the same benefits at most extras providers, as long as they are legally qualified to practise in Australia and have been recognised by ahm. So you choose your provider, not us.
Know what you’ll get back
Use our benefit calculator to find out upfront what you’ll get back on your extras services. To see what we pay for each service view the product guide.
No gap dental check-ups
We’ve struck a great deal at select dentists^ to offer you up to 2 dental check-ups per financial year with no out of pocket costs (up to your annual limit).
No gap dental check-ups include:
- Periodic and comprehensive examination
- Clean and polish or scale and clean
- Fluoride treatment
^Excludes specialists
Hospital
Silver Hospital cover, with a side order of added benefits:
- Sleep studies
Palliative care and rehab are also included. You also get unlimited medically necessary ambulance^, accident override and no excess for dependants.
^TAS/QLD State schemes cover ambulance services for residents of those States.This product includes the minimum standard clinical categories required for a ‘silver’ rating, ‘plus’ hospital services for sleep studies.
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 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 the investigation of sleep patterns and anomalies.
For example: sleep apnoea and snoring.
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.
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, you may be eligible for the Mental Health Waiver if you upgrade to our top hospital gold cover.
Find out howWhat’s excluded
On this product, we don’t pay benefits towards the services below.
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 to remove a cataract and replace with an artificial lens.
Hospital treatment for dialysis treatment for chronic kidney failure.
For example: peritoneal dialysis and haemodialysis.
Hospital treatment for the provision and replacement of insulin pumps for treatment of diabetes.
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 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 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 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 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 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.
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 $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
Medicare card
We’ll need this to pay your service refunds.
Payment details
Payment details
We accept Visa, Mastercard and bank account details as payment.
5 minutes
5 minutes
We've made it as simple as can be.