ahm Health Insurance Review

Overview

ahm began over 40 years ago in Wollongong, NSW, as a regional health fund. Today ahm provides cover for over 700,000 members, making them one of the largest providers in the country.

The fund was acquired by Medibank Private in 2009 and has had an influential hand in the formation of the Private Health Insurance Code of Conduct, which exists to protect health fund members from hidden clauses and unclear product information.

ahm have several member perks including:

  • 2 for 1 movie tickets at HOYTS
  • Up to 10% discounts on car insurance
  • 10% off travel insurance
  • And much more!

ahm Health Insurance Key Facts

Founded: 1971

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

Private Hospital Agreements Nationwide: 263

Day Hospital Agreements Nationwide: 222

Head Office: Melbourne, VIC

Health Deal Represented?: Yes

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ahm Health Insurance Hospital Cover

ahm offers a variety of hospital policies suitable for all needs and ages, ranging from Starter Basic Hospital to Top Hospital Gold cover.

All of these policies provide coverage for your stay as a private patient and as a minimum benefit include restrictive cover for rehabilitation, psychiatric, and palliative services. Here is a list of some of the current hospital covers available:

  • Starter Basic Hospital
  • Essentials Basic Plus
  • Starter Bronze
  • Lite Bronze Plus
  • Core Bronze Plus
  • Starter Silver
  • Classic Silver Plus
  • Deluxe Silver Plus
  • Top Hospital Gold

ahm Health Insurance Extras Cover

Extras Cover takes care of the everyday healthcare service expenses that are not covered under Medicare such as dental services, prescription glasses, and physiotherapy. One of ahm’s unique features is that they have some extras cover with no waiting periods on a variety of common services. Here is a list of some of the current extras covers available:

  • Black 50 Saver
  • Black 60
  • Black 70
  • Lifestyle Extras (no waiting periods on a variety of extras)
  • Family Extras (no waiting periods on a variety of extras)
  • Black 70 Boost
  • Super Extras (no waiting periods on a variety of extras)

ahm Health Insurance Combined Cover

Hospital and extras covers can be bought individually or combined to provide members with a more comprehensive health care package.

ahm are famous for their combined covers. They have designed a variety of plans with flexi limits, meaning you can decide how you claim on your extras. For example, The Deluxe Silver Plus plan gives you a $1,200 limit on extras to spend how you want! Want to spend $1,200 solely on physio? Not a problem! Ask a Health Deal agent to find out more. Here is a list of some of the current combined covers available:

  • Starter Basic
  • Essentials Basic Plus
  • Lite Flexi Bronze Plus
  • Classic Sliver Plus
  • Deluxe Silver Plus
  • Black 50 Saver
  • Black 60
  • Black 70
  • Lifestyle Extras (no waiting periods on a variety of extras)
  • Family Extras (no waiting periods on a variety of extras)
  • Black 70 Boost
  • Super Extras (no waiting periods on a variety of extras)

ahm Health Insurance Hospital Waiting Periods

ahm recognises the waiting periods you have already served with a previous health fund if you switch, this is called “portability”. For first-timers taking out a hospital cover, members who may have lapsed in hospital coverage and those upgrading their level of cover, the waiting periods below will have to be served before members can claim on services:

  • 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 month

How Do You Claim Extras with ahm Health Insurance?

Claiming extras with ahm is really easy. There are plenty of convenient ways to claim, such as:

  • On the spot: You can swipe your membership card at any one of the 20,000 health care providers that support the HICAPS electronic claims system to have your claim processed immediately.
  • App: Upload a photo of your receipt to the app to lodge your claim.
  • Online: You can log into your online account through the website info@ahm.com.au.com.au and make your claim by providing the details on your receipt.
  • Email or fax: Claims can be made by scanning and faxing a receipt-attached completed Health Cover Claim form.
  • By post: Claims can be lodged by submitting a completed claim form along with your receipt from your health provider. Mailing details are included on the form.

ahm Health Insurance Gap Cover

ahm’s Health Insurance medical gap cover is called GapCover. If your doctor charges you more than the standard MBS fee, this is known as the ‘gap’ and can leave you with an out-of-pocket expense.  Access Gap can help to minimise or eliminate personal expense but it is the choice of the physician to participate in any given gap scheme.

ahm uses the same gap cover scheme that Medibank Private uses, which means if you are a member of Medibank, you will still be able to go to all the same hospitals.

ahm 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.

ahm Medical Services with No Gap: 80.0%

Industry Average 79.1%

ahm Medical Services with No or Known Gap: 92.4%

Industry Average: 90.5%

ahm Medical Services with No Gap: 88.4%

Industry Average: 89.5%

ahm Medical Services with No or Known Gaps: 96.3%

Industry Average: 95.7% 

ahm medical services with No Gap: 85.1%

Industry Average: 86.7%

ahm medical services with No or Known Gap: 93.8%

Industry Average: 95.1%

ahm medical services with No Gap: 88.6%

Industry Average: 89.2%

ahm medical services with No or No or Known Gap: 94.8%

Industry Average: 94.5%

ahm medical services with No Gap: 89.9%

Industry Average: 89.5%

ahm medical services with No or Known Gap: 99.0%

Industry Average: 96.6%

ahm medical services with No Gap: 72.1%

Industry Average: 84.4%

ahm medical services with No or Known Gap: 87.7%

Industry Average: 96.2%

ahm Medical Services with No Gap: 92.1%

Industry Average: 90.2%

ahm Medical services with No or Known Gap: 98.3%

Industry Average: 96.7%

ahm Medical Services with No Gap: 82.9%

Industry Average: 84.2%

ahm Medical Services with No or Known gap: 94.2%

Industry Average: 93.8%

ahm Health Insurance Ambulance Cover

ahm include ambulance cover as a standard on all their hospital and extras policies, however, the benefits vary for individual policies.

  • Limited cover is provided for Starter Basic Hospital – one claim per financial year for a single policy / two claims per financial year for a couple policy or a family policy.
  • Lite bronze Plus Hospital cover gives you unlimited medically necessary ambulance.

Medicare does not provide ambulance cover and while some states provide a subsidy for emergency transportation, others may require ambulance usage to be an out-of-pocket expense which on average can cost around $900.

Do you need ambulance cover?

You may not need to take out an ambulance cover depending on where you live.

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