ahm health fund

ahm combined hospital and extras cover

Get affordable combined hospital and extras cover in one package with ahm

ahm's flexi insurance policies combine hospital and extras cover into a single package. There is  a range of products so you can select a level that best suits your price range and health needs.

Start comparing ahm's full policy range and receive a quote from a consultant

What combined plans does ahm offer?

There are five levels of cover available, ranging from basic to comprehensive:

  • Starter Flexi: This is entry-level cover for the young and healthy who need only the essentials in an affordable package.
  • Lite Flexi: Also a low-cost cover, but includes additional extras such as optical, and hospital cover for common procedures like tonsil removal.
  • Boost Flexi: At this level hospital cover includes the majority of Medicare treatments. Extras cover is much more expansive, and includes items such as pharmacy, health improvement and dietetics.
  • Classic Flexi: Near-complete hospital cover, with high-limits extras cover for a relatively narrow range of services.
  • Deluxe Flexi: Hospital cover for everything except obstetrics, reproductive services and weight-loss surgery. The extras cover carries high limits, and despite including a wider range of services than Classic Flexi, still covers fewer services than Boost Flexi.

Although combined cover may be a cost-effective way of finding balanced protection, be aware that your specific needs may only qualify under separate plans. For example, no pregnancy cover is available with any of these packages, except for a minimum amount with the Boost plan. Similarly, orthodontics is not covered under any of the combined extras plans, although it is a common inclusion in standalone, high-level extras policies.

Hospital cover under each flexi plan

Starter FlexiLite FlexiBoost FlexiClassic FlexiDeluxe Flexi
Ambulanceyes 1/2 per year for singles/familiesyes 1/2 per year for singles/familiesyes Unlimitedyes Unlimitedyes Unlimited
Accident
  • yes
  • yes
  • yes
  • yes
  • yes
Tonsil and appendix removal
  • no
  • yes
  • yes
  • yes
  • yes
Wisdom teeth
  • no
  • yes
  • yes
  • yes
  • yes
Joint reconstructions and investigations
  • no
  • yes
  • yes
  • yes
  • yes
Minor gynaecology
  • no
  • yes
  • yes
  • yes
  • yes
Ear grommets
  • no
  • yes
  • yes
  • yes
  • yes
Covers all non-excluded Medicare services
  • no
  • no
  • yes
  • yes
  • yes
RehabilitationLimitedLimitedLimited
  •  yes
  • yes
Palliative careLimitedLimitedLimited
  • yes
  • yes
Psychiatric treatmentLimitedLimitedLimitedLimitedLimited

What is not included?

Starter FlexiLite FlexiBoost FlexiClassic FlexiDeluxe Flexi
All non-included Medicare services
  • No cover
  • No cover
  • Covered
  •  Covered
  • Covered
Reproductive services
  • No cover
  • No cover
  • No cover
  • No cover
  • No cover
Obstetrics
  • No cover
  • No cover
Limited cover
  • No cover
  • No cover
Weight-loss surgery
  • No cover
  • No cover
  • No cover
  • No cover
  • No cover
Joint replacements
  • No cover
  • No cover
  • No cover
  • No cover
  • Covered
Dialysis
  • No cover
  • No cover
  • No cover
  • No cover
  • Covered
Major eye surgery
  • No cover
  • No cover
  • No cover
  • No cover
  • Covered
Spinal fusion
  • No cover
  • No cover
  • No cover
  • No cover
  • Covered
Heart procedures
  • No cover
  • No cover
  • No cover
  • Covered
  • Covered
Reconstructive surgery
  • No cover
  • No cover
  • No cover
  • Covered
  • Covered
Vascular and varicose vein surgery
  • No cover
  • No cover
  • No cover
  • Covered
  • Covered
Nerve pain treatment
  • No cover
  • No cover
  • No cover
  • Covered
  • Covered
Hysterectomy
  • No cover
  • No cover
  • No cover
  •  Covered
  • Covered

Extras cover under each policy

All ahm extras cover gives you a “flexi limit” instead of separate limits for different types of service. This is essentially a total limit for your extras cover that can be used as needed, letting you claim more for the same procedure in a single year than you might be able to with other policies.

The exceptions are optical cover, which still has a separate limit, and sub-limits for certain other services.

Starter FlexiLite FlexiBoost FlexiClassic FlexiDeluxe Flexi
Initial limits$550–$750$700–$1,100$800–$1,200$900–$1,300$1,100–$1,500
Limits after 5-year loyalty bonus$750$1,100$1,200$1,300$1,500
Optical
  • no
$200 separate limit$200 separate limit$250 separate limit$300 separate limit
Routine dental
  • yes
  • yes
  • yes
  • yes
  • yes
Complex dental
  • yes
  • yes
  • yes
  • yes
  • yes
Major dental
  • no
  • no
  • no
  • no
  • yes
Physiotherapy
  • yes
  • yes
  • yes
  • yes
  • yes
Chiropractic
  • yes
  • yes
  • yes
  • yes
  • yes
Osteopathy
  • yes
  • yes
  • yes
  • yes
  • yes
Podiatry
  • no
  • no
  • no
  • yes
  • yes
Orthotics
  • no
  • no
  • no
  • yes
  • yes
Remedial massage
  • no
  • yes
  • yes
  • yes
  • yes
Natural therapies
  • no
  • no
  • yes
  • no
  • yes
Pharmacy
  • no
  • no
  • yes
  • no
  • no
Psychology and hypnotherapy
  • no
  • no
  • yes
  • no
  • no
Speech therapy
  • no
  • no
  • yes
  • no
  • no
Health improvement
  • no
  • no
  • yes
  • no
  • no
Diet and nutrition
  • no
  • no
  • yes
  • no
  • no
Prenatal and postnatal
  • no
  • no
  • yes
  • no
  • no

Additional benefits of joining ahm

ahm is backed by Medibank, letting you take advantage of an expansive provider network, while enjoying wide-ranging benefits under your chosen policy. Although the cover for obstetrics and pregnancy services is generally limited, you can still find some benefits with the Boost Flexi package, which was recently added.

The Boost Flexi option has a mid-range price, while delivering some of the more highly demanded additional services. It blends affordability and cover in a more efficient way than the other plans.

If you’re changing to ahm from another health fund, any waiting periods fully served under your previous fund will be recognised after switching.

Waiting periods and other limitations

Although these combined packages offer cover for a wide range of essentials, each specific item may not be covered as comprehensively as it is with a standalone policy.

As with any health insurance policy, waiting periods also apply. For hospital cover these are:

  • 1 day for ambulance and accident services
  • 2 months for most other non-specified hospital services as well as rehabilitation, psychiatric and palliative care, even when these are pre-existing conditions
  • 12 months for pre-existing conditions, health appliances, and pregnancy or obstetrics-related services

Extras waiting periods can vary depending on your chosen cover level, but generally these are:

  • 2 months for most services that aren’t otherwise specified
  • 6 months for optical
  • 12 months for major dental, podiatry, orthotics, and prenatal and postnatal services

How to make a claim

For hospital claims, you can send a claims form to ahm, either through the post or online.

Extras claims can be made on the spot with participating providers by swiping your ahm membership card through an electronic card reader. If this service is not available, you can submit claims forms online or by mail after paying for the service. The fund will then send you a cheque payable to the service provider.

Receive quotes for ahm combined hospital and extras

Andrew Munro

Andrew writes for finder.com.au, comparing products, writing guides, sniffing out deals and looking for new ways to help people get the most out of their money.

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