AAMI Health Insurance Review 2019 - Hospital, Extras, Gap Cover & More

AAMI Health Insurance Review

Overview

AAMI Health Insurance (Australian Associated Motor Insurers Limited) began operating in 2007. The health fund is issued by nib health, and is arranged by Suncorp Insurance.

Eligible members can claim rewards on their Lucky Club program for benefits such as concert tickets and Melbourne Cup tickets.

AAMI Health Insurance key Facts

Founded: 2007

For-Profit or Not-For-Profit?: For-Profit

Private Hospital Agreements Nationwide: 288

Day Hospital Agreements Nationwide: 275

Health Deal Represented?: No

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AAMI Health Insurance Hospital Cover

Hospital policies with AAMI begin with Basic Hospital Plus- so the typical basics like accident and emergency with a few added services such as gynaecology, dental surgery and joint reconstructions. Most policies come with a $500 and $750 Excess option.

AAMI’s Hospital Covers:

Basic Hospital Plus
Bronze Hospital Plus
Silver Everyday Hospital Plus
Silver Advantage Hospital Plus
Gold Hospital

AAMI Health Insurance Extras Cover

AAMI’s extras cover takes care of the everyday healthcare services you may incur during your hospital stay not typically covered under Medicare such as dentist visits, optometric, chiropractor and physio requirements.There are currently four levels of extras cover, beginning with Starter Extras, which covers your general dental, optical, physiotherapy and PBS approved pharmaceutical prescriptions.

Starter
Starter Boost
Everyday Active
Premium Active

AAMI Health Insurance Waiting Periods

AAMI recognises the waiting periods you may have already served with a previous health fund. For first-timers taking out a health fund policy and those upgrading cover, the waiting periods below will have to be served before members can claim on services:

AAMI Hospital Wait Periods

Ambulance services: 1 Day
Accidental Injury: 1 Day
New Conditions: 2 Months
Pregnancy and birth-related services: 12 months
Pre-existing conditions: 12 months
Rehabilitation & Palliative care: 2 months
Weight Loss Surgery: 12 months

How to claim with AAMI Health Insurance

There are two main ways to claim with AAIMI:

You can log into your online account through their website and lodge your claim by uploading a photo of your receipts, or;
You can ring their call centre and a customer service agent will help guide you through the steps.

Benefits can be paid by bank transfer or cheque.

AAMI's Gap cover

A AMMI Health Insurance review, would not be complete without touching on their gap cover, which is called MediGap (the same as nib health insurance).

When you visit the doctor, your medical fees are split between Medicare (75%) and your health fund (25%)

However, if your doctor charges more than the set Medicare Benefits Schedule (MBS), you have to pay the difference. That difference is ‘the gap’.

MediGap focuses on lowering your out-of-pocket expenses or eliminating it altogether. This is achieved by the network that AAMI Health has built with specialists who may agree to receive a higher benefit from AAMI Health in exchange for their agreement not to charge AAMI Health customers at their personal expense.

AAMI Health Insurance Review: Gap cover Ratings By State

You can gauge how efficient a gap scheme is by comparing health funds in the same state or territory and determining which of the fund offers a greater proportion of medical services covered at no gap. While it is more likely that a medical service covered under your fund can be utilised at no personal cost to the customer, it is entirely the choice of the physician whether or not to participate in the gap scheme.

Medical Services with No Gaps: The percentage of claims that were fully refunded.

Medical Services with No or Known Gaps: The percentage of claims that were fully refunded, or where the policy holder knew the cost before the surgery was performed.

The information below outlines the percentages of services covered under no-gap and known-gap.

ACT

AAMI Health Insurance Medical Services with No Gap: 66.2%

Industry Average 79.1%

AAMI Health Insurance Medical Services with No or Known Gap: 66.2%

Industry Average: 90.5%

NSW

AAMI Health Insurance Medical Services with No Gap: 92.6%

Industry Average: 89.5%

AAMI Health Insurance Medical Services with No or Known Gaps: 92.6%

Industry Average: 95.7%

VIC

AAMI Health Insurance medical services with No Gap: 91.4%

Industry Average: 86.7%

AAMI Health Insurance medical services with No or Known Gap: 86.7%

Industry Average: 95.1%

QLD

AAMI Health Insurance medical services with No Gap: 85.9%

Industry Average: 89.2%

AAMI Health Insurance medical services with No or No or Known Gap: 85.9%

Industry Average: 94.5%

AAMI Health Insurance medical services with No Gap: 93.6%

Industry Average: 89.5%

AAMI Health Insurance medical services with No or Known Gap: 93.6%

Industry Average: 96.6%

AAMI Health Insurance medical services with No Gap: 81.8%

Industry Average: 84.4%

AAMI Health Insurance medical services with No or Known Gap: 81.8%

Industry Average: 96.2%

TAS

AAMI Health Insurance Medical Services with No Gap: 85.3%

Industry Average: 90.2%

AAMI Health Insurance Medical services with No or Known Gap: 85.3%

Industry Average: 96.7%

AAMI Health Insurance Medical Services with No Gap: 77.2%

Industry Average: 84.2%

AAMI Health Insurance Medical Services with No or Known gap: 77.2%

Industry Average: 93.8%

AAMI Ambulance Cover

Ambulance Cover is included in all AAMI’s Hospital, Extras and Combined policies.

Do you need Ambulance Cover?