ahm health fund

ahm hospital cover

Choose from six levels of hospital cover with ahm.

ahm Health Insurance has been around for over 40 years, bringing straightforward and cost-effective plans to Australians as part of Medibank. Offering affordable starter hospital cover as well as a range of top-level hospital cover options, ahm is a popular fixture in Australia’s health insurance market.

Receive quotes for ahm hospital cover

What hospital health insurance policies are available through ahm Health Insurance?

All policies include ambulance cover, hospital accommodation and operating theatre fees. You can choose a range of additional cover with any of the six straightforward plans available.

  • Covered
  • Partially covered
  • Not covered under this plan
StarterLiteBoostClassicDeluxeTop
Accident
  • yes
  • yes
  • yes
  • yes
  • yes
  • yes
Ambulance
  • yes
  • yes
  • yes
  • yes
  • yes
  • yes
Wisdom Teeth
  • no
  • yes
  • yes
  • yes
  • yes
  • yes
Tonsil removal
  • no
  • yes
  • yes
  • yes
  • yes
  • yes
Minor gynaecology
  • no
  • yes
  • yes
  • yes
  • yes
  • yes
Joint investigations and reconstructions
  • no
  • yes
  • yes
  • yes
  • yes
  • yes
Appendix removal
  • no
  • yes
  • yes
  • yes
  • yes
  • yes
Colonoscopies
  • no
  • no
  • yes
  • yes
  • yes
  • yes
Ear grommets
  • no
  • yes
  • yes
  • yes
  • yes
  • yes
Heart procedures
  • no
  • no
  • no
  • yes
  • yes
  • yes
Cancer therapies
  • no
  • no
  • no
  • yes
  • yes
  • yes
All joint replacements
  • no
  • no
  • no
  • no
  • yes
  • yes
Eye surgery
  • no
  • no
  • no
  • no
  • yes
  • yes
Spinal fusion
  • no
  • no
  • no
  • no
  • yes
  • yes
Dialysis
  • no
  • no
  • no
  • no
  • yes
  • yes
Obstetrics
  • no
  • no
  • partial
  • no
  • no
  • yes
Weight-loss surgery
  • no
  • no
  • no
  • no
  • no
  • yes
Psych
  • partial
  • partial
  • partial
  • partial
  • partial
  • yes
Brain surgery
  • no
  • no
  • yes
  • yes
  • yes
  • yes
Palliative care
  • partial
  • partial
  • partial
  • yes
  • yes
  • yes
Bowel surgery
  • no
  • no
  • yes
  • yes
  • no
  • yes
Rehabilitation
  • partial
  • partial
  • partial
  • yes
  • yes
  • yes
Reproductive services
  • no
  • no
  • no
  • no
  • no
  • yes
Labour ward
  • no
  • no
  • no
  • no
  • no
  • yes
Midwife home births
  • no
  • no
  • no
  • no
  • no
  • yes
Sterility reversal
  • no
  • no
  • no
  • no
  • no
  • yes
TENS machine hire or purchase
  • no
  • no
  • yes
  • no
  • no
  • yes
No excess for kids
  • no
  • no
  • yes
  • yes
  • yes
  • yes
All Medicare services
  • no
  • no
  • no
  • yes
  • yes
  • yes

What other benefits can I get with ahm Hospital cover?

Depending on the policy and your chosen options, you can also find the following benefits:

  • Health checks. Everyone on your plan can get up to $50 towards one doctor’s health check or heart check each financial year as long as it’s not covered under Medicare, your employer or somewhere else.
  • Travel and accommodation benefits. You can receive up to $75 per day for a total of $750 per year for accommodation and travel to and from hospitals when it’s more than a 200km round trip. This is also available for partners or next of kin travelling in a life-or-death situation or for parents accompanying dependents under the age of 21.
  • Speech processor and insulin pump replacements. ahm can pay benefits in accordance with the specified minimums on the Federal Government’s Prostheses List.

What are the costs?

The cost of your policy will depend on what level of cover you choose and can go down depending on what level of Australian Government Rebate you are entitled to. There are other ways you can reduce your premium, although this comes at the cost of extra fees. For example, you may be able to add a daily charge to certain plans. The daily charge is an extra hospital admission fee, payable for up to two nights at hospital per year.

The following are other costs you may need to pay:

  • You may need to pay the excess, which is payable when you make a claim.
  • You may need to pay for medical gap expenses, where the cost of a treatment is greater than the amount covered by your policy. By selecting doctors that participate in GapCover, your medical gap expenses will be limited to a maximum of $500 per claiming fund or cut entirely.
  • You may need to pay hospital accommodation expenses or ward fees if your policy does not cover them.

Other than the potential gap expenses, you will still have out-of-pocket expenses when utilising a treatment that is only partially covered by your plan or by getting private hospital treatments under a plan that does not cover all Medicare services.

To avoid unwanted costs, it’s also important to be mindful of the waiting periods and other limitations.


Waiting periods and other limitations

Wait periods apply to the following services:

  • There is a 1-day wait period for ambulance cover, or any hospital treatments as the result of an accident.
  • There is a 12-month wait period for pre-existing conditions, obstetrics, speech processors and insulin pump replacements.
  • There is a 2-month wait period for rehabilitation, psychiatric services, palliative care and other hospital treatments.

Limits also apply to disease management appliances and midwife-assisted home births.

  • Midwife home births. There is a $600 limit for each home birth. This is not available if hospitalisation was required.
  • CPAP machines or BiPAP respirators. There is a limit of $600 per person every 5 continuous financial years and $100 every year for machine rental or masks.
  • Other disease management appliances. Dollar limits apply per item, and you are not able to claim more than a specified number of the same item in a given time period.

How to make a claim

You can make claims by sending a claims form to ahm, either online or in the mail.

To use your hospital cover to reduce costs as much as possible, or eliminate them entirely, you can find out ahead of time how much a procedure will cost, whether a hospital is part of the ahm network and whether your treating doctor will participate in GapCover.

If you’re taken to hospital as the result of an emergency or accident, it’s not possible to do your research ahead of time. In this case, your specialists can let you or your family know about the costs which may apply.

When possible, remember to ask your specialist the following questions:

  • What are the fees?
  • Do you participate in GapCover?
  • Which hospitals do you treat patients at and are any ahm partner hospitals?
  • What are the item numbers for my treatments?

Receive quotes for ahm hospital cover

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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