ahm health fund

ahm Hospital Cover Health Insurance Policy Review

Choose from nine 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.

Top 3 features
  1. Good for finding an option that suits you as they offer 9 different types of policies
  2. Good for short waiting periods
  3. Good for health check and travel and accommodation benefits

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What hospital cover is available?

Ahm's 9 hospital cover options include:

  • Starter Basic. This product covers you for accidents, including accident override and limited medically necessary ambulance.
  • Essentials Basic Plus. As well as what's in the Starter Basic pack, this gives you limited medically necessary ambulance and accident override.
  • Starter Bronze. This covers the 18 clinical categories required for a Bronze rating including cancer treatment.
  • Lite Bronze Plus. As well as what's in the Starter Bronze pack, you also get certain hospital services and dental surgery.
  • Core Bronze Plus. The highest Bronze cover, this also includes medically necessary plastic and reconstructive surgery.
  • Starter Silver. Covering the 26 clinical categories required for a Silver rating, Starter Silver includes things like heart and vascular system.
  • Classic Silver Plus. The second best Silver product, you're cover includes palliative care and rehabilitation.
  • Deluxe Silver Plus. This is a comprehensive option for completed families and those not planning on having children.
  • Top Hospital Gold. The Gold policy includes all 38 clinical categories required for a Gold rating including pregnancy and birth services.
BasicBronzeSilverGold
Accident
Ambulance
RehabilitationRestrictedRestricted
Hospital Psychiatric ServicesRestrictedRestrictedRestricted
Palliative CareRestrictedRestricted
Brain & Nervous System
Eye
Ear, nose and throat
Tonsils, adenoids and grommetsIncluded in Essential Basic Plus only
Bone, joint and muscle
Joint reconstructionsIncluded in Essential Basic Plus only
Kidney and bladder
Male reproductive system
Digestive system
Hernia and appendixIncluded in Essential Basic Plus only
Gastrointestinal endoscopy
Gynaecology
Miscarriage and termination of pregnancy
Chemo, radio and immunotherapy cancer
Pain management
Skin
Breast surgery
Diabetes management
Heart and vascular system
Lung and chest
Blood
Back, neck and spine
Included in Lite and Core Bronze
Plastic and reconstructive surgery
Dental surgeryIncluded in Essential Basic Plus onlyIncluded in Lite and Core Bronze
Podiatric surgery
Included in Core Bronze only
Implantation of hearing devices
Included in Core Bronze only
Cataracts
Included in Deluxe Silver Plus only
Joint replacements
Included in Deluxe Silver Plus only
Dialysis for chronic kidney failure
Included in Deluxe Silver Plus only
Pregnancy and birth
Assisted reproductive services
Weight loss surgery
Insulin pumps
Included in Classic and Deluxe Silver Plus
Pain management with device
Included in Classic and Deluxe Silver Plus
Sleep studies
Included in Classic and Deluxe Silver Plus

Other benefits of ahm Hospital Cover

  • 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.

How do the costs work?

ahm will pay benefits towards your hospital charges in an approved private hospital, whether that be a shared or private room. In a public hospital they pay for all of your accommodation and benefits towards a private room. However, it's likely there will be some out-of-pocket expenses depending on the medical gap for your doctors' fees.

Waiting periods and 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?

Want to see what else ahm offers? Check out our review of their extras and combined policies

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