ahm health fund

ahm Health Insurance

Looking for health insurance that promotes flexibility, choice and added value? Then ahm may be 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.

Promotions currently on offer from ahm

Join a combined policy before Nov 30 and get up to $200 off

  • Offer available for new members on new memberships
  • Available via direct debit only
  • Terms and conditions apply

Compare ahm's complete range of policies side-by-side

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.
ServicesSuper ExtrasFamily ExtrasLifestyle ExtrasBlack 60Black 50 Saver
Routine dental
  • Covered
  • Covered
  • Covered
  • Covered
  • Covered
Complex dental
  • Covered
  • Covered
  • Covered
  • Covered
  • Not covered
Major dental
  • Covered
  • Covered
  • Covered
  • Covered
  • Not covered
Orthodontics
  • Covered
  • Covered
  • Covered
  • Not covered
  • Not covered
Optical
  • Covered
  • Covered
  • Covered
  • Covered
  • Not covered
Laser eye surgery
  • Covered
  • Not covered
  • Not covered
  • Not covered
  • Not covered
Physiotherapy
  • Covered
  • Covered
  • Covered
  • Covered
  • Covered
Chiropractic
  • Covered
  • Covered
  • Covered
  • Covered
  • Covered
Osteopathy
  • Covered
  • Covered
  • Covered
  • Covered
  • Covered
Alternative therapies
  • Covered
  • Covered
  • Covered
  • Not covered
  • Not covered
Pharmacy
  • Covered
  • Covered
  • Covered
  • Not covered
  • Not covered
Health improvement
  • Covered
  • Covered
  • Covered
  • Not covered
  • Not covered
Diet & nutrition
  • Covered
  • Covered
  • Covered
  • Not covered
  • Not covered
Psychology & hypnotherapy
  • Covered
  • Covered
  • Covered
  • Not covered
  • Not covered
Speech therapy
  • Covered
  • Covered
  • Not covered
  • Not covered
  • Not covered
Occupational therapy
  • Covered
  • Covered
  • Not covered
  • Not covered
  • Not covered
Eye therapy
  • Covered
  • Covered
  • Not covered
  • Not covered
  • Not covered
Podiatry
  • Covered
  • Covered
  • Not covered
  • Not covered
  • Not covered
Audiology
  • Covered
  • Not covered
  • Not covered
  • Not covered
  • Not covered
Orthotics & orthopaedic shoes
  • Covered
  • Covered
  • Not covered
  • Not covered
  • Not covered
Hearing aids
  • Covered
  • Covered
  • Not covered
  • Not covered
  • Not covered
Pre & postnatal services
  • Covered
  • Covered
  • Not covered
  • Not covered
  • Not covered
Birthing courses
  • Covered
  • Covered
  • Not covered
  • Not covered
  • Not covered
Medical gases
  • Covered
  • Covered
  • Not covered
  • Not covered
  • Not covered
Joint fluid replacement injections
  • Covered
  • Covered
  • Not covered
  • Not covered
  • Not covered
Travel & accomodation
  • Covered
  • Covered
  • Not covered
  • Not covered
  • Not covered
Outpatient procedure room fees
  • Covered
  • Not covered
  • Not covered
  • Not covered
  • Not covered
Post-operative & medical aids
  • Covered
  • Not covered
  • Not covered
  • Not covered
  • Not covered
Emergency ambulance
  • Covered
  • Not covered
  • Not covered
  • Not covered
  • Not covered
  • 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.

Summary of extras services

ServicesDeluxe FlexiClassic FlexiLite FlexiStarter Flexi
Major dental
  • Covered
  • Not covered
  • Not covered
  • Not covered
Complex dental
  • Covered
  • Covered
  • Covered
  • Covered
Routine dental
  • Covered
  • Covered
  • Covered
  • Covered
Physiotherapy
  • Covered
  • Covered
  • Covered
  • Covered
Chiropractic
  • Covered
  • Covered
  • Covered
  • Covered
Osteopathic
  • Covered
  • Covered
  • Covered
  • Covered
Podiatry
  • Covered
  • Covered
  • Not covered
  • Not covered
Orthotics
  • Covered
  • Covered
  • Not covered
  • Not covered
Remedial massage
  • Covered
  • Covered
  • Covered
  • Not covered
Natural therapies
    • Covered
  • Covered
  • Not covered
  • Not covered
Optical
    • Covered
    • Covered
    • Covered
  • Not covered

Are there any bonus benefits?

ahm offer a range of benefits to it's members:

  • Choose your own provider. ahm Health Insurance does not penalise you if you visit a non-preferred provider for any extras services.
  • Excess and co-payment options. You can access a range of excess and co-payment (daily charge) to help reduce 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, without shared 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.

Paying your ahm health insurance premiums

ahm health insurance premiums can be paid:

  • Fortnightly
  • Monthly
  • Annually

Premiums can be paid in the following ways

  • By direct debit from your nominated bank account or credit card
  • By BPAY from your bank account
  • Over the phone using your credit car

How many hospital agreements does ahm have in my state and in total?

The benefit you receive for hospital treatment is influenced not only by the level of cover you have in place, but also by whether or not your health fund has an agreement with the hospital where you are treated. Check out the table below for details of the number of hospital agreements ahm and Medibank Private have in place in your state or territory compared to the maximum of any health fund across the industry:

Private hospital agreementsDay hospital agreements
NSW87 (industry maximum: 101)76 (industry maximum: 96)
ACT5 (industry maximum: 7)4 (industry maximum: 9)
VIC56 (industry maximum: 84)68 (industry maximum: 75)
QLD53 (industry maximum: 57)37 (industry maximum: 51)
SA27 (industry maximum: 29)19 (industry maximum: 27)
WA20 (industry maximum: 23)17 (industry maximum: 26)
TAS5 (industry maximum: 8)3 (industry maximum: 5)
NT1 (industry maximum: 2)1 (industry maximum: 1)

Is there anything I cannot claim for?

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

Did you know ahm also offer travel insurance?

How do I make a claim?

Once you’ve received treatment or purchased an item covered by your policy, you’ll need to make a claim. You can lodge a health insurance claim with ahm in the following ways:

  • On the spot. You can swipe your ahm membership card at almost 20,000 health care providers that support the HICAPS electronic claims system. This allows you to have your claim processed immediately.
  • Via a mobile app. You can lodge a claim using the ahm mobile app by taking a photo of your receipt using your smartphone and then submitting it to ahm.
  • Online. You can log into your online account through the ahm website and lodge your account by providing the details included on your receipt. You’ll also need your bank details handy to arrange an immediate transfer of the benefit into your account.
  • By post. You can fill out a claim form and submit it along with your receipt from the provider to:
    • AHM Health Insurance
    • Locked Bag 1006
    • Matraville, NSW, 2036

Benefits can be paid by bank transfer or cheque.

Coming to Australia on a student visa?

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.

Want to know more about ahm?

Below are some useful info to help you decide whether ahm is the health fund for you:

How many members does ahm service?

ahm provides health insurance cover to more than 500,000 people. Its parent fund, Medibank, boasts a 27.6% market share, making Medibank the largest health fund in Australia.

Complaints about ahm

Medibank Private (the owner of ahm) and ahm account for:

  • 27.6% of the Australian health insurance market
  • 35.4% of all complaints about benefit payments
  • 52.2% of all complaints about service
  • 36.8% of all complaints that require investigation

Source: Private Health Insurance Ombudsman, State of the Health Fund Report 2016

Some final details you might want know about

Yes, you are free to mix and match individual hospital and extras policies. Be aware, though, the lump sum benefit for extras in the combined package policies will not apply and you will be subject to the sub-limits and shared limits of the extras policy you choose.

No.

Yes, but be aware that if you switch to a higher level of cover, waiting periods may apply.

A condition is classified as pre-existing if you have exhibited signs or symptoms of it six months prior to your membership commencing.

While you can still take out cover, a waiting period of 12 months applies to any claims relating to the treatment of your pre-existing condition.

  • 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.

Yes, all extras, hospital and combined policies from ahm provide emergency ambulance cover. However, if you hold a Starter Flexi or Lite Flexi policy, this is restricted to one claim per financial year for a single policy, or two claims per financial year for a couple.

Yes, all ahm extras policies (including combined hospital and extras policies) provide some level of dental cover.

Yes, all ahm extras policies except Black 50 Saver provide optical cover. As for combined hospital and extras policies, all except the Starter Flexi policy provide optical cover.

Yes, all ahm extras policies (including combined hospital and extras policies) provide cover for physio services.

Yes, all ahm extras policies (including combined hospital and extras policies) provide cover for chiropractic services.

Yes, pharmacy cover is included on the following policies:

  • Extras cover: Lifestyle, Family and Super
  • Combined cover: Boost Flexi, Classic Flexi and Deluxe Flexi

Yes, natural therapies cover is included on the following policies:

  • Extras cover: Black 60, Lifestyle, Family and Super
  • Combined cover: Lite Flexi, Boost Flexi, Classic Flexi and Deluxe Flexi

Yes, acupuncture cover is included on the following policies:

  • Extras cover: Lifestyle, Family and Super
  • Combined cover: Boost Flexi, Classic Flexi and Deluxe Flexi

Yes, psychology (including group consultations) is covered by the following ahm policies:

  • Extras cover: Lifestyle, Family and Super
  • Combined cover: Boost Flexi, Classic Flexi and Deluxe Flexi

Yes. ahm’s Health Improvement benefits provide cover for the cost of things like quit smoking courses, disease management association fees, preventative tests and scans, health checks and exercise classes. These benefits are available on the following policies:

  • Extras cover: Lifestyle, Family and Super
  • Combined cover: Boost Flexi, Classic Flexi and Deluxe Flexi

Yes, hearing aids are covered by the ahm’s Family and Super extras cover policies.

Yes, ahm offers Overseas Student Health Cover (OSHC) to suit the insurance needs of international students.

No, ahm does not offer any OVHC policies.



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13 Responses

  1. Default Gravatar
    LeahJanuary 8, 2017

    I was an ahm butbm it lapsed but want to renew it for me and my 3 teen aged kids.

    • Staff
      RichardJanuary 9, 2017Staff

      Hi Leah,

      Thanks for getting in touch. finder.com.au is a comparison service and not ahm. To speak with one of our advisers about getting cover from ahm or to compare your cover options from other funds in our panel, please complete the contact form above.

      All the best,
      Richard

  2. Default Gravatar
    LynNovember 1, 2016

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

    • Staff
      RichardNovember 4, 2016Staff

      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
      RichardNovember 2, 2016Staff

      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

  3. Default Gravatar
    ananthaJune 1, 2016

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

    • Staff
      RichardJune 1, 2016Staff

      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

  4. Default Gravatar
    JasonMarch 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
      RichardMarch 29, 2016Staff

      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
      RichardMarch 29, 2016Staff

      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

  5. Default Gravatar
    ivorMarch 4, 2016

    What will be your increase in april this year

    • Staff
      RichardMarch 4, 2016Staff

      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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