Hospital and Extras Packages Starter Basic. It covers you for accidents, including accident override and limited medically necessary ambulance. Essentials Basic Plus. This gives you limited medically necessary ambulance and accident override as well as things like dental surgery and joint reconstructions. Starter Bronze. Bronze cover includes the 18 clinical categories required for a Bronze rating including important services such as chemotherapy, radiotherapy and immunotherapy for cancer.

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When can I start to claim? As soon as you have served your waiting periods. A waiting period is a set amount of time before you can claim any money back for a service included on your cover. Waiting periods apply when you first join or re-join after not having had health insurance for some time or if you change to a higher level of cover that has additional services or higher limits.

For more information on claiming and waiting periods see the Member Guide. Does ahm have any provider restrictions? Convenient right! See if your regular providers are recognised by ahm.

Find a provider What will be my medical out-of-pocket expenses? Your out-of-pocket expenses may vary depending on a range of factors, but significantly if the service is included, partially covered restricted or excluded. For a list of what we pay for each service, view the product guide. Included hospital services When you go to hospital, there might be a gap between what we pay for your medical services, and what your doctor charges you.

This is the referred to as a medical gap and is your out-of-pocket expense. Medical gaps exist because some doctors may charge higher fees than what is set out in the Medicare Benefit Schedule MBS. Doctors can choose to participate in GapCover or not on a per claim, per treatment and per patient basis, so you should always check with them prior to agreeing to each claim as part of your treatment.

You may still have out of pocket costs. You should always check upfront with your doctor before agreeing to each claim forming part of your treatment. If you choose to use a hospital service that is only partially covered, you may be left with additional out-of-pocket expenses related to your stay in hospital. To reduce your out-of-pocket expenses, you may choose to be treated as a private patient in a public hospital, rather than a private hospital.

However, this will not reduce your out-of-pocket expenses entirely. Excluded hospital services If you choose to use a hospital service that is not covered, and you use the private health care system, your out-of-pocket will be the entire cost of the treatment.

Included extras Your out-of-pocket expenses for your extras services will be the difference between what your provider charges and what we pay back on that particular service. How do I switch from another insurer? What exactly is hospital and extras cover? With hospital cover you get the opportunity to choose your own doctor and specialist, and more choice over which hospital you go to.

Things like dental, physio, optometry, massage and many, many more are known as extras. The type of services and amount you can claim will depend on the level of extras cover you take out. A pre-existing condition is any kind of ailment, illness or condition where you had the signs or symptoms in the opinion of one of our Medical Practitioners 6 months before you joined private health insurance or changed your cover.


Extras cover

Might be best suited to people needing more medical care, as this is the only package option that includes: Major dental Hip and knee replacements Dialysis for chronic kidney failure Important: For a complete list of procedures and treatments included in each plan, please request a quote or visit the AHM website. Also, all service providers for Hospital and Extras must be recognised by AHM before they can pay a benefit. What is AHM Flexi limit? The amount of services you can choose will also depend on the policy you have.


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