AHM health insurance

AHM Health Insurance by Medibank

Looking for health insurance with all the bells and whistles? Find out if ahm is the right fund for you

For the last 40 years Australian Health Management (ahm) has been providing quality health insurance to Australians. ahm is backed by Medibank, one of Australia’s largest health funds. Paying for private health insurance may seem like just another expense, but ahm offer affordable and flexible health insurance packages to suit your needs so that if you fall ill you’re covered for a range of medical services

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What cover does ahm offer?

ahm by Medibank has three different combined cover options: Lite Cover, Lite Cover Plus and Standard Cover.

  • Lite Cover. Lite Cover is the cheapest cover option available and also has the most limited range of cover. It combines ahm’s lowest levels of Hospital and Extras cover. This is a great budget option and is ahm’s most tax effective package.
  • Lite Cover Plus. Lite Cover Plus is the mid-level option provided by ahm and includes both of their Basic levels of Hospital and Extras cover. This option gives you more back on your extras, giving you back 60% of what you paid.
  • Standard Cover. The most expensive combined cover option is Standard Cover and provides the choice of ahm's Classic and Top levels of cover. This policy is aimed towards families as it includes the Family Extras cover option.

ahm offers many different levels of cover so that you can customise your policy to both your budget and health requirements. ahm’s levels of cover are Budget, Basic, Classic, Top No Obstetrics and Top Hospital cover. These levels of hospital cover also come with different levels of Extras cover including Basic, Lifestyle, Family and Super.

Hospital and extras

ahm’s Black & White Flexi packages include four combined hospital and extras options: Starter Flexi, Lite Flexi, Classic Flexi and Deluxe Flexi.

Included

  • Starter Flexi is the entry level hospital cover for emergencies, partial cover for rehab plus extras cover for dental, physio, chiro and osteo, with a flexi limit that increases each year for five years. Ideal for healthy singles and couples wishing to avoid the Medicare Levy Surcharge and Lifetime Health Cover Loading (Only applicable to individuals earning over $90,000 and families earning over $180,000).

Excluded

  • Excludes all other hospital services.
Included

  • Lite Flexi is entry level cover with a little bit more covers. It includes hospital cover for emergencies plus some minor procedures, partial cover for rehab plus extras cover for dental, optical, physio, chiro, osteo and remedial massage. It also includes higher flexi extras limits over five years.

Excluded

  • Excludes all other hospital services.
Included

  • Classic Flexi offers cover for singles, couples and families who aren't content with just the basics. It includes an extensive range of in-hospital services, partial cover for psych, plus extras cover for dental, optical, physio, chiro, osteo, podiatry, orthotics, remedial massage, natural therapies and a bonus limit of $250 to spend on optical.

Excluded

  • Excludes joint replacements, dialysis, major eye surgery, spinal fusion, obstetrics, reproductive services and weight loss surgery.
Inclusions

  • Deluxe Flexi offers comprehensive cover without pregnancy which includes a full range of in-hospital services including hip replacement, spinal fusion, dialysis and major eye procedures. It also includes partial cover for psych plus extras cover for everything included in Classic Flexi with a higher benefit limit and a bonus limit of $300 for optical.

Exclusions

  • Excludes obstetrics, reproductive services and weight loss surgery.

Hospital

ahm’s Just Hospital cover includes Starter, Lite, Classic, Deluxe and Top levels of cover.

Included

  • White Starter is an entry level hospital cover for singles and couples wanting basic cover that lets them avoid the Medicare Levy Surcharge. It includes emergency cover for accident and ambulance, partial cover for rehab and the option to add extras like optical, dental and physio.

Excluded

  • Excludes all other hospital services.
Included

  • White Lite provides accident and ambulance cover plus minor procedures such as tonsils, appendix, wisdom teeth, joint reconstruction and minor gynaecology. It also includes partial cover for rehab, plus the option to add extras and to reduce the cost of your premiums by adding an excess and daily hospital charge.

Excluded

  • Excludes all other hospital services.
Included

  • White Classic covers an extensive range of hospital services including heart-related procedures, partial cover for psych, plus the option to add extras and include an excess and daily hospital charge to reduce the cost of cover.

Excluded

  • Excludes joint replacements, dialysis, major eye surgery, spinal fusion, obstetrics, reproductive services and weight loss surgery.
Included

  • White Deluxe offers comprehensive cover for an extensive range of hospital services including heart procedures and major eye surgery, plus partial cover for psych and the option to add extras and include an excess and daily hospital charge.

Excluded

  • Excludes obstetrics, reproductive services, and weight loss surgery.
Included

  • Top Hospital this is complete hospital cover that includes an exhaustive list of hospital services, with everything included from pregnancy to heart procedures, brain surgery to joint reconstruction. It too includes the option to reduce premium costs by adding an excess and daily hospital charge.

Extras

As the name suggests, Basic Extras covers the basics including routine dental, optical, chiro, physio and osteo, plus pharmacy, health improvement, diet and nutrition and alternative and complementary therapies. As with all ahm’s extras cover, it also includes emergency ambulance.
Lifestyle Extras is ahm’s most popular cover aimed at helping you maintain your healthy lifestyle. It includes everything in Basic cover plus complex and major dental, orthodontics, laser eye surgery and psychology and hypnotherapy.
Family Extras covers families with 24 separate services included. It covers everything from speech therapy, eye therapy and orthotics to braces, hearing aids and pre and post-natal services and birthing courses.
Super Extras is ahm’s top extras cover offering premium benefits for 28 different services. It includes everything covered by Family Extras plus audiology, occupational therapy, outpatient procedure room fees and post-operative and medical aids.

Are there any general exclusions?

Checking the general exclusions of your policy is a very important part of choosing the right health insurance for you. There could be important things left out that will leave you significantly out of pocket when it comes to paying for medical services. Here are some of the procedures, charges and items that aren’t covered by ahm:

  • Charges above the minimum benefit for surgically implanted prostheses
  • The full cost of you accommodation or theatre fees if you go to a non-agreement hospital
  • Treatment subject to a waiting period
  • Personal items such as phone calls, TV, faxes, internet and newspapers
  • Take home bandages and dressings
  • Medical costs for services not covered by Medicare
  • Any medical, hospital or ambulance services received overseas
  • Cosmetic treatment
  • The full costs of private room accommodation, benefits towards operating theatre and intensive care for restricted or excluded services
  • Podiatric surgery.

Do cover amounts for conditions vary?

Yes they differ depending on treatment type claimed for, which means its important to do your research when selecting a policy, especially when you are trying to get insured for a specific medical service. The table below outlines the benefit amounts AHM will pay for a range of commonly claimed for conditions, along with the Medicare (MBS) amounts for comparison:

ProcedureMBSMedibank#
Appendicectomy$445.40$609.95
Basal Cell Carcinoma or Squamous Cell Carcinoma removal from nose, eyelid, lip, ear, digit or genitalia$221.35$303.15
Breast, benign lesion surgical biopsy of excision$260.05$355.30
Carpal Tunnel Release$276.80$404.90
Cataract Surgery$760.55$1,126.25
Cholecystectomy$739.35$1,012.45
Colonoscopy$334.35$442.50
Complicated Delivery (of baby)$1,629.35$2,198.50
Coronary Artery Bypass$2,200.00$3,265.15
Craniotomy$1,586.75$2,322.10
Cytotoxic Chemotherapy$97.95$115.30
Femoral on Inguinal Hernia$464.50$636.05
Haemorrhoidectomy$367.75$503.80
Hip Replacement$1,317.80$2,000.75
Knee Replacement$2,047.60$2,000.75
Overnight investigation for sleep apnoea$588.00$694.25
Tonsils or Tonsils and Adenoid$295.70$472.35
Uncomplicated Delivery (of baby)$693.95$1,886.95
Vaginal Hysterectomy$674.70$986.20
Varicose Veins$109.80$160.70
Vasectomy$229.85$348.95

*NSW, #AHM

I recognise most of these funds except for the AHSA, what is that?

The Australian Health Service Alliance is a management services organisation that represents a number of small to medium sized health insurance funds, allowing them to combine resources to deliver a higher quality of service to their members.

The funds represented by the ASHA are:

  • ACA Health Benefits Fund
  • Australian Unity Health Limited
  • CBHS Health Fund Limited
  • CUA Health Limited
  • Defence Health
  • GMF Health
  • GMHBA
  • Budget Direct Health Insurance
  • Frank Health Insurance
  • GU Health
  • HBF Health Ltd
  • Health Care Insurance Limited
  • health.com.au
  • Health Insurance Fund of Australia Limited
  • Health Partners
  • Navy Health
  • onemedifund
  • Peoplecare Health Insurance
  • Phoenix Health Fund
  • Police Health Limited
  • Queensland Country Health Fund Limited
  • Reserve Bank Health Society Ltd
  • rt health fund
  • Teachers Health Fund > UniHealth Insurance
  • Teachers Union Health
  • The Doctors' Health Fund Pty Ltd
  • Transport Health
  • Westfund

How much does ahm cost?

The cost of ahm Health Insurance is impacted by a number of factors:

  • The level of cover you choose. ahm offers five different levels of cover, the more services covered, the higher your premium. Budget Hospital covers a small number of medical services and is an inexpensive option, while Top Hospital is expensive and covers you for almost anything.
  • Extras. The extras you choose also impact your premium. The more extras, the more you'll pay so only choose the extras you think you'll need.
  • Your relationship status. This refers to how many people you choose to be covered under your policy. Single health insurance is cheap because you are only paying to insure one person. It starts to get more expensive when you start adding a spouse or partner to the policy. The most expensive bracket for insuring with ahm is family insurance bracket.

ahm by Medibank excess

Excess is a predetermined amount that you pay upfront to the hospital towards your stay. ahm Health Insurance policies have a fixed excess of $500 per person and the number of times that you pay excess per year is determined by your policy. ahm provides an added benefit to Top level cover with means that you don’t have to pay excess for a hospitalisation required as a result of an accident or for any child, student dependant or adult dependant on your policy who requires a hospitalisation.

How to save on your ahm policy

There are a range of ways that you can use to save on your ahm health insurance:

  • Medicare Levy. When you earn over $90,000 ($180,000 for couples or families) a year the government imposes an extra 1% to 1.5% tax on your income. You can avoid this tax if you take out any of ahm’s hospital covers.
  • Join now. ahm often run discount offers, such sign up before a certain date and you'll receive a one-off discount, so keep your eyes peeled.
  • Choosing the right cover. Tailor your policy to your needs and you will save on medical services that you would have paid for anyway.
  • Contact your fund. Sometimes just calling up your fund and seeing if they can offer you a better price is a great way to save.

How do I make a claim?

There are a number of ways to make a claim with ahm:

  • ahm membership card. Most of the extras service providers have electronic claiming services, which you can use your ahm membership card to claim on the spot. Just simply swipe your card.
  • Postal. To make a claim via the post you will have to fill out a claims form and mail it to ahm. Any receipts related to medical services you are claiming should be attached.
  • Online. If you are registered online at ahm.com.au then you will be able to make your claims online. Their online service also has an easy way for you to check your limits and make regular payments

Frequently asked questions about ahm

How do I change my level of cover?

You can check out ahm’s health insurance options and then change your cover. Please note that if you change to a higher level of cover you may have to serve waiting periods before you claim.

I had symptoms before I got health insurance. Am I covered?

If you have a pre-existing condition and you are taking out private hospital cover for the first time or changing to a cover that has additional services you will be required to wait 12 months before you can claim on your hospital cover.

What’s a pre-existing condition?

If you had signs or symptoms six months before you joined private health insurance you have what is called a pre-existing condition. This is determined by an ahm-approved medical practitioner.

What’s not covered?

Your cover will depend on whether you’re insured for Hospital and/or Extras and what level of cover you select. You can refer to your policy quick guide provided by ahm to find out what your policy covers.

How do I switch health funds?

All you have to do is let ahm know when you join, either online or by phone, and ahm will contact your current health fund and sort it out for you.

I'm from overseas, can I get cover?

ahm offers Overseas Student Health Cover (OSHC) to any student wanting to study in Australia. Their health cover has a bunch of great benefits:

  • Value. By choosing ahm OSHC you’ll receive great value cover for most of your medical, hospital, ambulance and medication needs.
  • Fast benefit payment. You can claim online or over the phone and get your benefit payment within two working days.
  • Interpreter. You get access to an interpreter service.
  • 24-hour helpline. This helpline can be used for emergency medical assistance.
  • Stress and trauma counselling. ahm provide stress and trauma counselling to their ahm OSHC members.
  • No waiting period on extras. ahm OSHC have recently removed the two and six-month waiting period on all of their extras covers 

Apply for ahm cover today with an adviser

ahm packages take away all of the complexities and hassles that can come with choosing your health cover. They have refined their cover so well that you will find it hard not to find health insurance that will suit you needs and with over 500,000 members already they must be doing something right.

Speak with an adviser about getting cover

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11 Responses to AHM Health Insurance by Medibank

  1. Default Gravatar
    Lyn | November 1, 2016

    Looking to get cover for a new insulin pump…need quote for best cover, waiting periods,any other relevant information. ..

    • Staff
      Richard | November 4, 2016

      Hi Lyn,

      Just letting you know that the diabetes and health insurance article has been updated with waiting periods and other helpful information.

      All the best,
      Richard

    • Staff
      Richard | November 2, 2016

      Hi Lyn,

      Thanks for getting in touch. You may find our diabetes and health insurance article helpful. Unfortunately, the tables don’t contain information about waiting periods at the moment.

      All the best,
      Richard

  2. Default Gravatar
    anantha | June 1, 2016

    I recently joined AHM.If I want to change to top cover
    what should I do?Thanks.

    • Staff
      Richard | June 1, 2016

      Hi Anantha,

      Thanks for your question. finder.com.au is a comparison service. If you enter your details in contact form above, an advisor will be in touch to discuss your options.

      I hope this was helpful,
      Richard

  3. Default Gravatar
    Jason | March 28, 2016

    Wow we are being hit with a 19% premium increase from $906.65 to $1077.9 per quarter by AHM! And from the 31st of May our current Mid-Life cover policy is being closed by AHM and we are being moved to a new black+white policy for the same premium of $1077.9 premium but the new policy covers less items as the old one!

    • Staff
      Richard | March 29, 2016

      Hi Jason,

      Thanks for getting in touch. If you would like to compare the premium increases for other Australian health funds, you may find the following useful:
      Premium increase 2016
      If you would like to compare your options with the help of an advisor, please complete the contact form at the top of the page.

      I hope this was helpful,
      Richard

    • Default Gravatar
      | March 29, 2016

      Richard I am aware of the premium increase page with nowhere does it mention a 19% premium increase;

      https://www.finder.com.au/health-insurance-premium-increase-2016

      I asked a question. Why did our premium increase from $906.65 to $1077.9 per quarter, or 19% by AHM! Also why from the 31st of May will our current Mid-Life cover policy be closed by AHM and we are being moved to a new black+white policy for the same premium of $1077.9 premium but this new policy covers less items as the old one! Why have we been told if we won’t the same policy items as our current Mid-Life policy have we been told we will have to pay even more than the new premium of $1077.99?

    • Staff
      Richard | March 29, 2016

      Hi Jason,

      Thanks for getting in touch. finder.com.au is a comparison service and we are not permitted to provide our users with personalised financial advice. You will need to contact ahm directly about why your premiums are rising and why your cover is changing. If you would like to speak with an advisor to compare your options outside of ahm, you can do so by completing the contact form at the top of the page.

      Cheers,
      Richard

  4. Default Gravatar
    ivor | March 4, 2016

    What will be your increase in april this year

    • Staff
      Richard | March 4, 2016

      Hi Ivor,

      Thanks for your question. finder.com.au is a comparison service and not an insurer. As ahm are a part of the medibank group, their average premium increase is 5.64% for 2016. For more information about 2016 premium increases you may find the following useful.

      I hope this was helpful,
      Richard

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