Looking for health insurance that promotes flexibility, choice and added value? Discover if ahm is the right fund for you.
With 40 years in the business, ahm Health Insurance is trusted by over 500,000 Australians nationwide to protect their healthcare needs and is backed by Medibank, one of the largest private health funds in the country.
Offering a range of hospital, extras and combined cover, ahm Health Insurance has policies to suit any need or budget.
What policy options are available?
ahm Health Insurance offers hospital, extras and packaged policies. Select from the three categories below to learn more about the different cover options.
- Top Hospital. Made for those who want complete peace of mind, this policy covers all hospital treatments that Medicare pays a benefit for, as well as specialised services including pregnancy, labour ward fees, reproductive services, sterility reversal and weight loss surgery.
- White Deluxe. A good choice if you are looking for a comprehensive policy without pregnancy. It covers all the services included in Top Hospital except for obstetrics, reproductive services and weight loss surgery, which are excluded. A partial benefit also applies to psychiatric services.
- White Classic. An intermediate policy that covers a wide range of hospital services including cancer treatment, heart procedures, brain surgery, joint reconstruction and more. Specialised treatments such as dialysis, spinal fusion, pregnancy and major eye surgery are excluded.
- White Boost. This policy allows you to claim for a number of hospital treatments including surgery to remove wisdom teeth, joint reconstruction, colonoscopies and tonsil removal. Pregnancy, psychology, palliative care and rehabilitation are partially covered.
- White Lite. Designed for the budget-conscious, this policy covers essential hospital services including injury relating to accidents, emergency ambulance transport, tonsil removal and more. Be aware that a large number of treatments are excluded from this policy.
- White Starter. If you are young, healthy and wanting to avoid the Medicare Levy Surcharge, this policy is a solid option. It provides full cover for accident treatment and emergency ambulance as well as partial cover for rehabilitation, palliative care and psychiatric services.
- Super Extras. A premium extras policy that covers you for 28 services including major dental, orthodontics, optical and pharmacy prescriptions. Super Extras also boasts the highest annual benefit limits and no limit is applied to routine dental.
- Family Extras. This policy covers a range of out-of-hospital treatments including pre and postnatal services and birthing courses. While annual benefit limits are not as high as Super Extras, they are still generous and waiting periods are waived for common services your children may need, such as routine dental and optical.
- Lifestyle Extras. Focusing on the wellbeing of the body and the mind, this extras policy covers up to 17 alternative and complementary therapies including acupuncture, naturopathy and herbalism. Other services are not neglected either, as you are also covered for major dental, optical, laser eye surgery and more.
- Black 60. Covering you for a range of essential extras services without breaking the bank, this policy pays up to 60% towards the cost of treatments including major dental, physiotherapy and remedial massage. Optical and emergency ambulance transport costs are fully covered. Annual benefit limits are shared between certain services.
- Black 50 Saver. An inexpensive entry-level policy that covers 50% of the costs relating to routine dental, physiotherapy, chiropractic and osteopathic care. Emergency ambulance transport is also included and fully covered. Annual benefit limits are shared between certain services.
Full list of extras services
|Services||Super Extras||Family Extras||Lifestyle Extras||Black 60||Black 50 Saver|
|Laser eye surgery|
|Diet & nutrition|
|Psychology & hypnotherapy|
|Orthotics & orthopaedic shoes|
|Pre & postnatal services|
|Joint fluid replacement injections|
|Travel & accomodation|
|Outpatient procedure room fees|
|Post-operative & medical aids|
- Deluxe Flexi. Combining all the services included in White Deluxe plus a generous amount of extras, this policy ensures that you are fully covered both inside and outside of hospital. Be aware that psychiatric care has a partial benefit applied, while obstetrics, reproductive services and weight loss surgery are excluded.
- Classic Flexi. A solid option if you are looking for a comprehensive combined policy without the additional cost of insuring for specialised services. The hospital cover is identical to White Classic with the same exclusions and restrictions. All the extras services covered by Deluxe Flexi are also included with the exception of major dental.
- Boost Flexi. The middle ground option between the comprehensive and budget packages, Boost Flexi provides the same level of hospital cover as the White Boost policy while including a large number of extras services such as routine and complex dental, optical, physiotherapy, natural therapies, prescription medications and more.
- Lite Flexi. Affordable without compromising on protection, this policy includes all the hospital services covered by White Lite along with a range of extras. Rehabilitation, palliative care and psychiatric care are partially covered, while major dental, podiatry, orthotics and natural therapies are excluded.
- Starter Flexi. Suitable for those who only require the bare essentials, this policy covers you for vital hospital services and general treatments that are not eligible for a Medicare benefit (such as dental) and it allows the policyholder to avoid the Medicare Levy Surcharge and the Lifetime Health Cover loading.
Full list of extras services
Summary of extras services
|Services||Deluxe Flexi||Classic Flexi||Lite Flexi||Starter Flexi|
Are there any bonus benefits?
- Choose your own provider. ahm Health Insurance does not penalise you if you visit a non-preferred provider for any extras services. You receive full cover no matter where you are treated.
- Excess and co-payment options. Each hospital and combined policy offers multiple excess and co-payment (daily charge) options that can assist in reducing the cost of your premiums.
- Flexible extras limits. If you choose the Deluxe Flexi, Classic Flexi, Lite Flexi or Starter Flexi combined policies, the annual benefit limit is applied as a lump sum for you to spend however you wish. There are no shared limits or sub-limits.
- Loyalty rewards. Annual benefit limits on some extras services increase every year that you maintain your cover. Combined policies cap at five years and standalone extras policies cap at 20 years.
Australian health funds typically exclude some procedures and items from cover, which is why you should always check your policy's rules and exclusions carefully. ahm's general exclusions can be found below:
- Charges above the minimum benefit for surgically implanted prostheses
- The full cost of accommodation or theatre fees if treated at a non-agreement hospital
- Treatment that is currently subject to a waiting period
- Personal items in hospital such as phone calls, TV, faxes, internet and newspapers
- Take-home bandages and dressings
- Costs for services not covered by Medicare
- Any medical, hospital or ambulance services received overseas
- Cosmetic surgery
- The full cost of restricted or excluded services
- Podiatric surgery
Claims for hospital treatments are automatically lodged with ahm Health Insurance, while extras claims can be submitted using the following options:
- Membership card. Most extras service providers have electronic claiming facilities, allowing you to swipe your membership card and claim on the spot.
- Online. You can lodge your claim, along with any receipts, through the members' services portal on the ahm Health Insurance website.
- Post. To claim via post, send a completed claims form along with any receipts to ahm Health Insurance, Locked Bag 1006, Matraville NSW 2036.
Benefit amounts vary per condition, which means it's important to do your research when selecting a policy, especially if you are trying to get insured for a specific treatment or service. The table below outlines the benefit amounts ahm Health Insurance pays for commonly claimed for conditions, along with the Medicare Benefits Schedule (MBS) amounts for comparison.
|Procedure||MBS||ahm Health Insurance|
|Basal cell carcinoma or squamous cell carcinoma removal||$221.35||$303.15|
|Breast, benign lesion surgical biopsy or excision||$260.05||$355.30|
|Carpal tunnel release||$276.80||$404.90|
|Complicated delivery of a baby||$1,629.35||$2,198.50|
|Coronary artery bypass||$2,200.00||$3,265.15|
|Femoral on inguinal hernia||$464.50||$636.05|
|Overnight investigation for sleep apnoea||$588.00||$694.25|
|Tonsils or tonsils and adenoid||$295.70||$472.35|
|Uncomplicated delivery of a baby||$693.95||$1,886.95|
Source: Australian Medical Association's 2016 report card on health insurers
ahm Health Insurance offers Overseas Student Health Cover (OSHC) for international students who are planning to study in Australia. The policy is fully compliant with student visa conditions and includes the following benefits:
- Broad protection. Cover for hospital treatment, visits to the doctor, emergency ambulance transport and medications.
- Fast payment on claims. Benefits are paid to you within two working days and claims can be lodged online or by phone.
- Interpreter. A free interpreter service is available to use.
- 24-hour helpline. Can be called for emergency medical assistance and advice.
- Stress and trauma counselling. All members have free access to counselling if they require it.
Can I add extras cover to a standalone hospital policy?
Can I change my policy?
What is a pre-existing condition?
If I have a pre-existing condition, am I excluded from cover?
How do excesses and co-payments work?
- Excess. A lump sum that must be paid upfront when you are admitted to hospital or day surgery. It is applied to each person on your policy. Child, student and adult dependents may have their excesses waived under some policies.
- Co-payment (daily charge). This is a fee that you agree to pay for each day that you are treated in hospital or day surgery. It applies to each person on your policy and is capped each membership year.