AHM FAQs
AHM's Frequently Asked Questions page is a central hub where its customers can always go to with their most common questions. These are the 194 most popular questions AHM receives.
Frequently Asked Questions About AHM
Use our find a provider searchbelow to ensure you are listed as a recognised provider with ahm. Simply select your speciality and postcodeor search by provider number or your name.
If your record is listed
You won't need to do anything as inclusion in this database means that your recognition with ahm is current.
If your record isn't listed or is incorrect
Contact the relevant board/association directly to discuss requirements for membership with them.
Providers with multiple specialities e.g.acupuncture and naturopathy will need to be a member of an association(s) which covers all these modalities.
Search for your listing
Need to update your details?
If need your provider listing details updated orremoved from our website, or if you have any questions, please contact us.
View ArticleFirst, read our No gap dental page. You could get up to 2 dental checkups per financial year with no out-of-pocket expenses with eligible products at selected dentists below, subject to annual limits.
No gap dental check-ups include:
Periodic and comprehensive examination (012 & 011)
Clean and polish OR Scale and clean (111 & 114)
Flouride Treatment (121)
They DON'T include:
X-rays
Tooth extractions
Fillings
But we still pay for these services under Routine dental (subject to annual limits).
Products that includeno gapdental check-ups
At any select dentist in Australia
Hospital and extras packages
boost flexi basic plus
boost package basic plus
classicflexi silver plus
classic package silver plus
deluxeflexi silver plus
deluxe package silver plus
first step bronze plus
top hospital package gold
lite package bronze plus
lite flexi bronze plus
Extras only
classic extras
black 70 extras
lifestyle extras
family extras
black 70 boost extras
super extras
At Pacific Smiles Dental Centres in VIC, NSW, QLD and ACT only
black 50
black 50 saver
black 60
Find a participating no gapdentist
ACT
Book appointment
Pacific Smiles Dental Belconnen
Shop 75/75a Westfield
18 Benjamin Way
BELCONNEN 2617 ACT
Get directions
02 6251 5100
Book appointment
Pacific Smiles Dental Gungahlin
Marketplace Gungahlin
30-33 Hibberson Street
GUNGAHLIN 2912 ACT
Get directions
02 6250 5400
Book appointment
Pacific Smiles Dental Manuka
Cnr Flinders Way & Franklin St
MANUKA 2603 ACT
Get directions
02 6260 6400
Book appointment
Pacific Smiles Dental Tuggeranong
Cnr Reed & Anketell St
TUGGERANONG 2901 ACT
Get directions
02 6293 2700
Book appointment
Pacific Smiles Dental Woden
28 Brewer St
WODEN 2606 ACT
Get directions
02 6282 8100
Book appointment
NSW
Pacific Smiles DentalBalgowlah
Shop 21 197-215 Condamine St
BALGOWLAH 2093 NSW
Get directions
Book appointment
Pacific Smiles DentalBateau Bay
12 Bay Village Rd
BATEAU BAY 2261 NSW
Get directions
Book appointment
Pacific Smiles DentalBaulkham Hills
Stockland Baulkham Hills
375 Windsor Rd
BAULKHAM HILLS NSW 2153
Get directions
Book appointment
Pacific Smiles Dental Belmont
12 Thomas St
BELMONT 2280 NSW
Get directions
Book appointment
Pacific Smiles Dental Belrose
56-58 Glen St
BELROSE 2085 NSW
Get directions
Book appointment
Pacific Smiles Dental Blacktown
116 Main St
BLACKTOWN 2148 NSW
Get directions
Book appointment
Pacific Smiles Dental Brookvale
Westfield Warringah Mall
Cnr Condamine & Old Pittwater Rd
BROOKVALE 2100 NSW
Get directions
Book appointment
Pacific Smiles Dental Campbelltown
Macarthur Square
200 Gilchrist Dr
CAMPBELLTOWN 2560 NSW
Get directions
Book appointment
Pacific Smiles DentalCharlestown
Cnr Smart & Pearson St
CHARLESTOWN 2290 NSW
Get directions
Book appointment
Pacific Smiles DentalErina
Erina Fair
620-658 Terrigal Dr
ERINA 2250 NSW
Get directions
Book appointment
Pacific Smiles Dental Forster
22 South St
FORSTER 2428 NSW
Get directions
Book appointment
Pacific Smiles Dental Gladesville
225 Victoria Rd
GLADESVILLE 2111 NSW
Get directions
Book appointment
Pacific Smiles Dental Greenhills
8 Molly Morgan Dr
GREENHILLS 2323 NSW
Get directions
Book appointment
Pacific Smiles DentalJesmond
28 Bluegum Rd
JESMOND 2299 NSW
Get directions
Book appointment
Pacific Smiles DentalKotara
6/88 Park Ave
KOTARA 2289 NSW
Get directions
Book appointment
Pacific Smiles DentalLake Haven
Lake Haven Dr
LAKE HAVEN 2263 NSW
Get directions
Book appointment
Pacific Smiles DentalMarrickville
34 Victoria St
MARRICKVILLE 2204 NSW
Get directions
Book appointment
Pacific Smiles DentalMorisset
49 Yambo St
MORISSET 2264 NSW
Get directions
Book appointment
Pacific Smiles DentalMount Hutton
Lake Macquarie Square
46 Wilsons Rd
MOUNT HUTTON 2290 NSW
Get directions
Book appointment
Pacific Smiles DentalNarellan
326 Camden Valley Way
NARELLAN 2567 NSW
Get directions
Book appointment
Pacific Smiles DentalNowra
64 JUNCTION St
NOWRA 2541 NSW
Get directions
Book appointment
Pacific Smiles DentalParramatta
80 George St
PARRAMATTA 2150 NSW
Get directions
Book appointment
Pacific Smiles DentalPenrith
59-61 Station St
PENRITH 2750 NSW
Get directions
Book appointment
Pacific Smiles DentalQueanbeyan
131 Monaro St
QUEANBEYAN 2620 NSW
Get directions
Book appointment
Pacific Smiles DentalRutherford
Rutherford Shopping Centre
3 West Mall
RUTHERFORD 2320 NSW
Get directions
Book appointment
Pacific Smiles DentalSalamander Bay
Salamander Bay Square
2 Town Centre Cct
SALAMANDER BAY 2317 NSW
Get directions
Book appointment
Pacific Smiles Dental Shellharbour
Shop 1096 Stockland Shellharbour
211 Lake Entrance Road
SHELLHARBOUR 2529 NSW
Get directions
Book appointment
Pacific Smiles DentalSingleton
1 Gowrie St
SINGLETON 2330 NSW
Get directions
Book appointment
Pacific Smiles DentalSydney CBD
Level 1 The Galeries Shopping Centre
500 George St
SYDNEY 2000 NSW
Get directions
Book appointment
Pacific Smiles DentalToronto
43 The Blvd
TORONTO 2283 NSW
Get directions
Book appointment
Pacific Smiles DentalTuggerah
50 Wyong Rd
TUGGERAH 2259 NSW
Get directions
Book appointment
Pacific Smiles DentalTweed Heads
Tweed City Shopping Centre
54 Minjungbal Drive
TWEED HEADS SOUTH 2486 NSW
Get directions
Book appointment
Pacific Smiles DentalWagga Wagga
37 Trail St
WAGGA WAGGA 2650 NSW
Get directions
Book appointment
QLD
Pacific Smiles DentalAspley
Shop 4 Aspley Hypermarket
59 Albany Creek Rd
Aspley QLD 4034
Get directions
Book appointment
Pacific Smiles DentalBirtinya
Stockland Birtinya
8 The Avenue
Birtinya QLD 4575
Get directions
Book appointment
Pacific Smiles DentalBribie Island
Bribie Island Shopping Centre
1/ 241 Goodwin Dr
BRIBIE ISLAND 4507 QLD
Get directions
Book appointment
Pacific Smiles DentalBurleigh Heads
149 West Burleigh Rd
BURLEIGH HEADS 4220 QLD
Get directions
Book appointment
Pacific Smiles DentalCapalaba
Capalaba Central Shopping Centre
38-62 Moreton Bay Rd
CAPALABA 4157 QLD
Get directions
Book appointment
Pacific Smiles DentalDeception Bay
Market Square Deception Bay
Bay Ave
Deception Bay 4508QLD
Get directions
Book appointment
Pacific Smiles DentalHelensvale
Westfield Helensvale
1 - 29 Millaroo Dr
HELENSVALE 4212 QLD
Get directions
Book appointment
Pacific Smiles Dental Mitchelton
Brookside Shopping Centre
159 Osbourne Rd
Mitchelton 4053QLD
Get directions
Book appointment
Pacific Smiles Dental Morayfield
Morayfield Shopping Centre
171 Morayfield Rd
Morayfield 4506QLD
Get directions
Book appointment
Pacific Smiles DentalMount Ommaney
171 Dandenong Rd
MOUNT OMMANEY 4074 QLD
Get directions
Book appointment
Pacific Smiles DentalNorth Lakes
Westfield North Lakes
North Lakes Dr
NORTH LAKES 4509 QLD
Get directions
Book appointment
Pacific Smiles DentalMount Gravatt
Cnr Logan & Kessels Rd
UPPER MOUNT GRAVATT 4122 QLD
Get directions
Book appointment
Pacific Smiles Dental Redbank Plains
Town Square Redbank Plains
Redbank Plains Rd
REDBANK PLAINS 4301QLD
Get directions
Book appointment
Pacific Smiles Dental Robina
Robina Town Centre
19-33 Robina Town Centre
ROBINA 4230 QLD
Get directions
Book appointment
Pacific Smiles Dental Runaway Bay
GF024 Runaway Bay Centre
10-12 Lae Drive
RUNAWAY BAY 4216 QLD
Get directions
Book appointment
Pacific Smiles Dental Strathpine
Strathpine Centre
Gympie Rd
Strathpine 4500QLD
Get directions
Book appointment
SA
National DentalCare Findon
Findon Shopping Centre
303 GrangeRd
FINDON 5023 SA
Get directions
Book appointment
National DentalCareKadina
70 Graves St
KADINA 5554 SA
Get directions
Book appointment
National DentalCareMawson Lakes
The Promenade Shopping Centre Shop 10
121-131 Mawson Lakes Blvd
MAWSON LAKES 5095 SA
Get directions
Book appointment
National DentalCareNailsworth
83 Main NorthRd
NAILSWORTH 5083 SA
Get directions
Book appointment
National DentalCareNorth Adelaide
104 Ward St
NORTH ADELAIDE 5006 SA
Get directions
Book appointment
National DentalCare Salisbury
12 John St
SALISBURY 5108 SA
Get directions
Book appointment
National DentalCare South Terrace
303 South Tce
ADELAIDE 5000 SA
Get directions
Book appointment
National DentalCare West Lakes
151 Brebner Dr
WEST LAKES 5021 SA
Get directions
Book appointment
TAS
Crotty Dental
174 Macquarie St
Hobart 7000 TAS
Get directions
03 6224 7666
Book appointment
City Dental
119 Collins St
Hobart 7000 TAS
Get directions
03 6234 1303
Book appointment
City Dental
15 ReginaSt
Glenorchy 7010 TAS
Get directions
03 6272 8253
Book appointment
City Dental
130 New Town Rd
New Town 7008 TAS
Get directions
03 6228 1185
Book appointment
Dr Daniel Tan & Associates
3 High St
LAUNCESTON 7250
Get directions
03 6331 2804
Book appointment
Eastern Shore Dental
127 Clarence St
BELLERIVE TAS 7018
Get directions
03 6245 0955
Book appointment
VIC
Pacific Smiles DentalBairnsdale
287 Main Street
BAIRNSDALE 3875 VIC
Get directions
Book appointment
Pacific Smiles DentalBendigo
84 Mollison St
BENDIGO 3550 VIC
Get directions
Book appointment
Pacific Smiles DentalCaroline Springs
CS Square
29 Lake St
CAROLINE SPRINGS 3023 VIC
Get directions
Book appointment
Pacific Smiles DentalChirnside Park
Chirnside Park Shopping Centre
Shop L01 601, 239-241 Maroondah Hwy
CHIRNSIDE PARK 3116 VIC
Get directions
Book appointment
Pacific Smiles DentalCranbourne
Cranbourne Park Shopping Centre
85 High St
CRANBOURNE 3977 VIC
Get directions
Book appointment
Pacific Smiles DentalDrysdale
41 High St
DRYSDALE 3222 VIC
Get directions
Book appointment
Pacific Smiles DentalEpping
Pacific Epping
571 High St
EPPING 3076 VIC
Get directions
Book appointment
Pacific Smiles Dental Glen Iris
Stockland Tooronga
Shop 2, Corner Tooronga and Toorak Rds
GLEN IRIS 3146 VIC
Get directions
Book appointment
Pacific Smiles DentalGlen Waverley
The Glen Shopping Centre
235 Springvale Road
GLEN WAVERLEY 3150 VIC
Get directions
Book appointment
Pacific Smiles DentalGreensborough
Greensborough Plaza
Shop 108A 25 Main Street
GREENSBOROUGH 3088VIC
Get directions
Book appointment
Pacific Smiles Dental Keysborough
Parkmore Shopping Centre
Shop L01 A06, 317 Cheltenham Road
KEYSBOROUGH 3173 VIC
Get directions
Book appointment
Pacific Smiles DentalLeopold
Gateway Plaza
641 Bellarine Highway
LEOPOLD 3224VIC
Get directions
Book appointment
Pacific Smiles DentalMelbourne
Level 1, 360 Bourke St
MELBOURNE 3000 VIC
Get directions
Book appointment
Pacific Smiles DentalMelton
Woodgrove Shopping Centre
533-555 High St
MELTON WEST 3337 VIC
Get directions
Book appointment
Pacific Smiles DentalMill Park
Westfield Plenty Valley
415 McDonalds Rd
MILL PARK 3082 VIC
Get directions
Book appointment
Pacific Smiles DentalMulgrave
Waverley Gardens
271 Police Rd
MULGRAVE 3170 VIC
Get directions
Book appointment
Pacific Smiles DentalOcean Grove
Kingston Village
122-160 Grubb Rd
OCEAN GROVE 3226 VIC
Get directions
Book appointment
Pacific Smiles DentalPoint Cook
Stockland Point Cook Shopping Centre
Corner Main Street and Murnong St
POINT COOK 3030 VIC
Get directions
Book appointment
Pacific Smiles DentalPreston
Northland Shopping Centre
2-50 Murray Road
PRESTON 3072 VIC
Get directions
Book appointment
Pacific Smiles DentalRingwood
171-175 Maroondah Hwy
RINGWOOD 3134 VIC
Get directions
Book appointment
Pacific Smiles DentalSale
56 Cunningham St
SALE 3850 VIC
Get directions
Book appointment
Pacific Smiles DentalTorquay
110 GEELONG Rd
TORQUAY 3228 VIC
Get directions
Book appointment
Pacific Smiles DentalTaralgon
20 Hotham St
TRARALGON 3844 VIC
Get directions
Book appointment
Pacific Smiles DentalWarragul
130 Albert Rd
WARRAGUL 3820 VIC
Get directions
Book appointment
Pacific Smiles DentalWaurn Ponds
160 Colac Rd
WAURN PONDS 3216 VIC
Get directions
Book appointment
Pacific Smiles DentalWerribee
Pacific Werribee
Cnr Derrimut Road & Heaths Rd
WERRIBEE 3030 VIC
Get directions
Book appointment
WA
DB Dental Applecross (Cnr Sleat Rd)
884 Canning Hwy
APPLECROSS 6153 WA
Get directions
1300 4 83384
Book appointment
DB DentalApplecross (Riseley St)
764 CanningHwy
APPLECROSS 6153 WA
Get directions
1300 4 83384
Book appointment
DB Dental Baldivis
Shop 21 Stockland Baldivis Shopping Centre
26 Safety Bay Rd
BALDIVIS 6171 WA
Get directions
1300 4 83384
Book appointment
DB Dental Brighton
5/2359 Marmion Ave
JINDALEE 6036 WA
Get directions
1300 4 83384
Book appointment
DB Dental Claremont
Unit 1/240 Stirling Hwy
Claremont 6010 WA
Get directions
1300 4 83384
Book appointment
DB Dental Cottesloe
Level 1 525 Stirling Hwy
COTTESLOE 6011 WA
Get directions
1300 4 83384
Book appointment
DB Dental Craigie
92 EddystoneAve
CRAIGIE 6025 WA
Get directions
1300 4 83384
Book appointment
DB Dental Currambine
Unit 2/1 Hobsons Gate
CURRAMBINE 6028 WA
Get directions
1300 4 83384
Book appointment
DB Dental Ellenbrook
Unit 3 1549 Gnangara Rd
AVELEY 6069 WA
Get directions
1300 4 83384
Book appointment
DB Dental Innaloo
Shop 3 Innaloo Shoppers Village
388 Scarborough Beach Rd
Innaloo 6018 WA
Get directions
1300 4 83384
Book appointment
DB Dental Joondalup
420 Joondalup Dr
JOONDALUP 6027 WA
Get directions
1300 4 83384
Book appointment
DB Dental Mandurah
Shop 3/319 Pinjarra Rd
Mandurah 6210 WA
Get directions
1300 4 83384
Book appointment
DB Dental Melville
Point Walter Medical Centre
322 Canning Hwy
Bicton 6157 WA
Get directions
1300 4 83384
Book appointment
DB Dental North Fremantle
2 Pensioner Guard Rd
North Fremantle 6159 WA
Get directions
1300 4 83384
Book appointment
DB Dental Perth City Kings Square
570 Wellington St
PERTH 6000
Get directions
1300 4 83384
Book appointment
DB Dental Rockingham
Woodbridge Shopping Centre
2-4 Elanora Dr
ROCKINGHAM 6168 WA
Get directions
1300 4 83384
Book appointment
DB Dental South Lake
Unit 1-5 Berrigan Dr
SOUTH LAKE 6164 WA
Get directions
1300 4 83384
Book appointment
DB Dental Spearwood
6 Barrington St
SPEARWOOD 6163 WA
Get directions
1300 4 83384
Book appointment
NT
National DentalCare Darwin
26 Mitchell St
DARWIN 0800 NT
Get directions
Book appointment
National DentalCare Palmerston
3 Gurd St
Palmerston 0830 NT
View ArticleThe ahm app is available for both iPhone and Android.
With the ahm app you can:
Check your policy info
Make most extras claims
See your extras limits and your claims history
As the Principal member on your ahm policy, you can log in with your member number and password. Make sure you keep your ahm mobile app updated because we are always making it better.
Get the app now
.
View ArticleWe will communicate premium change information
to all members before 1 April 2020.
Each year all health insurers review their premiums. These changes are reviewed and approved by the Federal Government and Minister for Health and come into effect on 1 April each year.
View ArticleChanging your cover is easy, simply contact us and we’ll sort it out for you.
Important stuff to know about changing your cover:
You may have to serve waiting periods for any additional services or items not previously included or that have an increased benefit (e.g. changing cover to reduce your daily charge or hospital excess).
You may have different daily charges and/or hospital excesses to your previous cover.
Even if you change to a higher level of cover, in some instances certain services may become unavailable make sure you check you’re still covered for the things you need.
Keep in mind that if limits apply to your cover, any benefits previously paid under your old cover will be taken into account.
See your member guide for more information.
View ArticleThe Mental Health Waiver allows a person with hospital cover to access in-hospital psychiatric services without serving the usual 2 month waiting period.
To access the MentalHealth Waiver, you need to have:
Private hospital cover, and
served your 2 month Waiting Period onPartially covered (restricted) in-hospital Psychiatric services, and
upgraded to a hospital cover that has Included in-hospital Psychiatric services.
If you’re a new ahm member, you’ll need to have had a gap of less than 30 days since you last held private hospital cover.
The Mental Health Waiver can be used once per person in a lifetime.
To access the Mental Health Waiver, live chat with us or call 134 246 weekdays, 8am 7pm (AEST/AEDT)
View ArticleTo cancel your cover simply contact us on 134 246.
Keep in mind that only the Principal Member, or their authorised third party, has the right to cancel a whole membership. We’ll cancel your policy from the date that we receive your notice and forward you a refund of any excess premiums.
30 day cooling-off period
It’s OK if you change your mind. Just let us know within 30 days of joining and as long as you’ve made no claims we’ll refund your premiums.
View ArticleOur thoughts are with all those fighting and affected by the Australian bushfires, and we’re here to support our members that are impacted.
Eligible members with hospital, or combined hospital and extras cover, have the option to waive their premiums for up to three months or suspend their policy for up to two years. Members who have held hospital cover for at least three months and are in a bushfire-impacted area may be eligible for this assistance.
Contact 134 246 for more information.
The Australian Medical Association has said the mental health burden of this disaster on our communities will be considerable. If you or someone you know needs urgent psychological support please call Lifeline on 13 11 14 or see your GP or psychologist.
View ArticleFirst off, if you’re a Tas or Qld resident. Your Ambulance services are covered by your state schemes for everybody else, ahm have made Ambulance cover simple:
ahm Unlimited Emergency Ambulance cover is Australia-wide and
is Included on all ahm extras products after a 1 day waiting period.
Emergency Ambulance means:
We’ll pay a benefit when there is a sudden or unexpected need for hospitalisation where the only practical way of getting to hospital is by an approved road, sea or air Ambulance.We also pay towards attendance fees where transportation is not required.
Note: We don’t pay benefits for Ambulance subscriptions or for other Ambulance services such as:
Transfers between hospitals.
Travelling from home to hospital for tests.
Transport on discharge from hospital (e.g. hospital to home).
ahm Medically Necessary Ambulance cover is Australia-wide and
is Included on all ahm hospital and package products after a 1 day waiting period.
Medically Necessary Ambulance means:
Transport to the nearest hospital provided by an ahm approved road, sea or air Ambulance provider that’s able to provide the level of care you need. Some ahm products limit the number of Ambulance services we’ll pay benefits towards per financial year. Check your product information to see if any limits apply. Your Daily Charge and/or Excess doesn't apply to Ambulance claims.
Note: We don't pay benefits for Ambulance Subscriptions or for other Ambulance services that are not Medically Necessary such as:
Ambulance transportation where the member is treated at the scene but then not formally admitted to the hospital for further treatment (e.g. transport to/from hospital for tests).
Ambulance costs that are fully covered by a state or third party arrangement such as for residents of Tas or Qld, WorkCover or the TransportAccident Commission.
Any air Ambulance services that are fully subsidised.
NSW and ACT Ambulance-only cover
This is for Medically Necessary Ambulance transportation. To apply, please complete an Ambulance cover application form and return it to [email protected]
To make an Ambulance claim
Log in to your account and upload your invoice.
View ArticleTo make your claim as smooth as possible, we need the answers to these questions from your doctor or hospital.
1. What are all the specific MBS item numbers for my procedure?
2. Will my doctor/surgeon be participating in GapCover for each claim forming part of my treatment?
3. Will other specialists involved in my treatment, eg assistant surgeon or anaesthetist, participate in GapCover for each claim forming part of my treatment?
Tip: Your surgeon can provide their contact details so you can check directly with them.
4. Which hospital will I be treated in? Is the hospital public or private?
If you have chosen a non-partner private hospital we’ll only pay a limited benefit and you may be significantly out-of-pocket. Call us to discuss this on 134 246 weekdays, 8am 7pm (AEST/AEDT)
5. Can I get a full written breakdown of fees for my treatment from eachtreating doctor or specialist?
This is called yourInformed Financial Consent. It's your right to know how much your in-hospital treatment will cost BEFORE you get admitted. For more information, read our Informed Financial Consent guide.
6. If I need prosthesis, what out-of-pocket expenses could there be?
7. If I need radiology or pathology, what out-of-pocket expenses could there be?
Print this page off below to take to your next appointment.
When you've got these answers ready to go, get back in touch with us to prepare your claim.
For more information, it's best to read our Going to hospital guide.
If you need help with any of this, live chat with us or call 134 246 weekdays, 8am - 7pm (AEST/AEDT)
View ArticleAdding a child to a family membership
If you already have a family cover when your baby is born, all you need to do is add them to the membership from their date of birth by calling us on 134 246. The request must be made within 12 months of the date of birth to ensure your baby is covered straight away and doesn’t have to serve any waiting periods that have already been served by the Principal Member.
Where the request is made outside the 12 month period, your child will only be added from the date of notification. Only those waiting periods that apply to the Principal Member will apply to your child.
Adding a child to a single or couple membership
If you’re on a single or couples cover, then you’ll need to upgrade to a family (or single parent) cover, and add your baby to the membership from their date of birth by calling us on 134 246. The request must be made within 2 months of the date of birth to ensure your baby is covered straight away and doesn’t have to serve any waiting periods that have already been served by the Principal Member.
Where the request is made outside two months from the date of birth, the baby will be subject to all applicable waiting periods.
If your current level of cover is not available for families, you will also need to select a new cover. See our pregnancy cover options.
Please note: when you change your existing cover you may have to serve waiting periods before you can claim for some services.
View ArticleGoing to hospital can be daunting. To help make it simple, here’s our guide to the stuff you need to consider before, during and after you leave.
Before you book
If you haven’t already, live chat with us or call 134 246 weekdays, 8am 7pm (AEST/AEDT) to let us know you’re going to hospital we’ll check:
Your cover includes the treatments you’re looking to have and you’ve served your waiting periods.
Your premium payments are up to date.
Any excess or co-payment you’ll need to pay on admission.
To make your claim as smooth as possible, we need some information from your doctor or hospital.
For the answers you need, print the off the questions below to take to your next hospital appointment at ahm.com.au/7questions
7 Questions for your specialist before going to hospital
1. What are all the specific MBS item numbers for my procedure?
2. Will my doctor/surgeon be participating in GapCover for each claim forming part of my treatment?
3. Will other specialists involved in my treatment, eg assistant surgeon or anaesthetist, participate in GapCover for each claim forming part of my treatment?
Tip: Your surgeon can provide their contact details so you can check directly with them.
4. Which hospital will I be treated in? Is the hospital public or private?
If you have chosen a non-partner private hospital we’ll only pay a limited benefit and you may be significantly out-of-pocket. Call us to discuss this on 134 246 weekdays, 8am 7pm (AEST/AEDT)
5. Can I get a full written breakdown of fees for my treatment from each treating doctor or specialist?
This is called yourInformed Financial Consent.It's your right to know how much your in-hospital treatment will cost BEFORE you get admitted. For more information, read our Informed Financial Consent guide.
6. If I need prosthesis, what out-of-pocket expenses could there be?
7. If I need radiology or pathology, what out-of-pocket expenses could there be?
While you're at hospital
Find out how to pay your out-of-pocket expenses.
Medicare or ahm don’t pay towards out-of-pocket expenses.
Your doctor may ask for some of these to be paid before you get admitted and then bill you any other costs later or you may be asked to pay 100\% of your out-of-pocket expenses upfront.
Either way, they will issue invoices for you to claim on after you leave hospital.
After you leave hospital
Claiming - what happens next?
Once you’ve left hospital, any costs you agreed to in your Informed Financial Consent will be billed and you will be issued with invoices for your out-of-pocket expenses. (See above.)
If you’ve received a bill from your doctor(s) or recognised provider(s) for any inpatient hospital treatment, you’ll need to fill in both a Medicare Claim Form and a Two-way Claim Form to submit your claim to Medicare.
Medicare will process your form and pass on the required information to us. If you have not paid for the services, you will receive a cheque from Medicare followed by a cheque from ahm. You will need to forward these to the doctor together with any gap amount.
Doctors participating in GapCover will bill ahm directly. ahm will claim from Medicare on your behalf.
Hospitals will bill ahm directly for the cost of your admission to the hospital. They will bill you separately for your excess/co-payment, discharge pharmacy and any other stuff ahm doesn't pay towards like TV, telephone, newspapers or meals etc.
Other important stuff
Make sure you get any information you may need to refer to afterwards from your specialists.
Don’t forget to get any medical certificates you may need for work.
For help and more information on any part of this process, live chat with us or call 134 246 weekdays, 8am 7pm (AEST/AEDT).
View Article31 January 2020 27 February 2020
The offer is:
Up to $100 off for families, couples and single parents and up to $50 off for singles
General:
Offer available for new joins who have not held ahm hospital and/or extras cover in the last 30 days.
Must join and commence a hospital and extras package or combination policy on direct debit on or before 27 February 2020
If you join online you must enter the promo code $OFFAHM at the time of joining to be eligible to receive the offer. If you don’t enter the promo code you will not receive the offer.
Only available on direct debit.
Only available via direct web, phone and live chat joins.
Offer is not available in conjunction with any other ahm or third party offers.
Not available on aggregators.
Not available for hospital only, extras only, ambulance only or overseas student health cover.
Cannot be redeemed for cash.
Please note we reserve the right to amend the offer terms and conditions from time to time.
Annual limits and waiting periods apply. If switching funds, limits used from your precious fund may be deducted.
Up to $100 off for families, couples and single parents and up to $50 off for singles:
Single parent, couple and family joins receive $100 off on all hospital and extras package or combination products.
Single joins receive $50 off on all hospital and extras package or combination products.
Must maintain eligible hospital and extras cover continuously for 60 days from the cover start date to be eligible to receive the offer. If you change to an ineligible product during this period, the offer will not be issued.
View ArticleIf your specialist decides to charge more than the Medicare Benefit Schedule fee (the set government fee), you will be left with an out of pocket expense, commonly referred to as the ‘gap’. GapCover is a scheme designed to help eliminate or reduce your out-of-pocket expenses for in-hospital specialists’ charges.
Find a GapCover doctor
How it works
Specialists can choose whether or not to participate in GapCover for part or all of your treatment. If you are being treated by more than one doctor (e.g. surgeon and anaesthetist), participation is at each individual doctor’s discretion. So it’s important to ask your doctor(s) if they’ll do so before each claim forming part of your treatment.
GapCover doesn’t apply to diagnostic services such as blood tests, x-rays and ultrasounds, out-of-hospital medical services and services not included on your policy. GapCover also doesn’t apply to things like excess payments and co-payments. You may still have out-of-pocket expenses.
If your specialist chooses to participate in GapCover, the maximum out-of-pocket medical expense you’ll pay is $500 per doctor’s account for each hospital stay.
GapCover is available on most Hospital covers in relation to eligible services. However, it does not apply to Public Hospital covers. Out of pocket costs may still apply.
If your specialist chooses not to participate in GapCover then you will need to pay the balance after we have paid the ahm benefit for the doctor’s account.
What should you do?
Before you consent to any treatment, ask your specialist/s if they’ll participate in GapCover for all claims as part of your treatment to help reduce your out-of-pocket expenses. To find a doctor that participates in GapCover, use our find a doctor search tool.
Prior to going to hospital ask each of your specialists and your hospital for a breakdown of all the costs in writing. This is known as Informed Financial Consent. It should list the fees for each specialist involved in your treatment your surgeon, assistant surgeon, and anaesthetist and any other related costs.
For more information about GapCover, check the Member Guide.
View ArticleThe following standard clinical definition applies to Gold, Silver, Bronze and Basic hospital covers:
Hospital treatment of the tonsils, adenoids and insertion or removal of grommets.
View ArticleFirst, let's start with what exactly is aprovider. That’s just what we call the dentists, optometrists, chiropractors, physiotherapists, doctors and many other professionals who provide health services.
A recognised provider isa medical practitioner that islegally qualified to practise in Australia.
Need to find a provider, hospital or doctor? Check out our simple search tool.
Find a provider
View ArticleThe following standard clinical definition applies to Gold, Silver, Bronze and Basic hospital covers:
Hospital treatment for surgery to the teeth and gums.
For example: surgery to remove wisdom teeth, and dental implant surgery.
View ArticleOut-of-pocket expenses are any expense for a hospital, medical or extras service for which you will not be reimbursed by either us or Medicare.
This is an amount you have to pay. To help understand these amounts, always contact us BEFORE your treatment.
For hospital cover, your out-of-pocket costs depend on your doctor’s fees.
To help understand these:
Read our Going to Hospital guide
Print off our 7 Questions for your specialists before going to hospital and hand this to your doctor or specialist to get the answers you need to minimise your out-of-pocket expenses.
Read about your Informed Financial Consent. This is your right to see agree to a breakdown of all the costs of your treatment BEFORE you go to hospital.
Ask if they charge above the Medicare Benefits Schedule (MBS) fee for the service or treatment.
If they charge above the MBS feeask them if they will participate in GapCover.
If they do, the most you’ll pay is $500.
If they don’t participate in GapCoverthen you’ll have to pay the difference between the
MBS fee and the doctor’s bill for any services whilst you’re in hospital.
Always contact us BEFORE your treatment to discuss your out-of-pocket expenses.
View ArticleYour right to know how much your treatment costs BEFORE you go tohospital is called your Informed Financial Consent. By working with ahm to understand what costs you're up for, you may be able to reduce them.
Your hospital should provide you with a written estimate of medical fees.
If they don't, it's your right to ask for one.
Your written estimate should include the following:
Details of your hospital treatment, including a description and costs for each MBS item in
your upcoming procedure
Individual costs from any other specialists in your team, your anaesthetist, assistant surgeon, pathology and x-rays (radiology) or any other prostheses you may need
Costs for hospital accommodation and any other services the hospital may charge you
It also outlines any out-of-pocket costs you may need to pay after you leave hospital
A declaration for you to sign. (Don't sign it until you have read this guide)
What are out-of-pocket costs?
Your ahm hospital cover can help towards most hospital fees, but any extra expenses you may need to pay are known as out-of-pocket costs. Some common out-of-pocket costs include:
Your hospital excess
Costs for pharmaceuticals or services not covered (either partially or in full) by our agreement with your hospital
Costs for treatments that aren’t recognised by Medicare
Any difference in costs between your specialist fees and the benefits you might be paid toward them from Medicare and ahm. This is known as 'the gap'
Gapcover helps reduce the gap
For any inpatient specialist bills, Medicare pays 75\% of a pre-determined ‘standard fee’ known as the Medicare Benefits Schedule (MBS) fee and ahm pays the remaining 25\%.
When specialists charge more than the MBS fee, this extra amount is called ‘the gap’. By choosing a specialist who participates in GapCover for your claim forming part of your treatment, your out-of-pocket costs from that specialist are capped at $500.
Specialists can choose to participate in GapCover on a per claim, per treatment and per patient basis. If you’re being treated by more than one specialist (e.g. surgeon and anaesthetist) their participation is at each individual specialist’s discretion.
If a specialist does not participate in GapCover for your treatment, you have the option of finding one that does. For more help on this, please contactus
How to limit your out-of-pocket expenses
1. Choose an ahm partner hospital or provider
We have agreements in place with ahm partner hospitals, this limits the costs you will need to pay for
hospital treatment. If your specialist works at a few hospitals, check if they’ll treat you at an ahm partner hospital. Find your nearest ahm partner hospital or provider at ahm.com.au/find-a-provider
2. Ask our '7 Questions for your specialists before you go to hospital'
To make your claim simple, we've put the important information we need from your hospital on one page.
Print it off to take to your next appointment at ahm.com.au/7questions
3. Contact us when you have these answers
When you have these answers ready to go, live chat with us or call 134 246 weekdays, 8am 7pm (AEST/AEDT).We’ll check your admission date and the following:
Your cover includes the treatments you need and you’ve served your waiting periods
Your premium payments are up to date
Any excess or co-payment you’ll need to pay on admission
If you need to pay any other out-of-pocket costs
In an emergency
In an emergency, your specialists should tell you everything you need to know as soon as possible. If they can’t get this information to you personally, they’ll need to tell your relatives or someone who can act on your behalf.
If you're treated in an Emergency department and you're not admitted to hospital, you'll be an outpatient and we won't pay any benefits towards the treatment you receive. However, a rebate may be claimable from Medicare for outpatient services.
How do I deal with unexpected fees?
If your bill is higher than expected, first go back over your written estimates. If your bill is different to your estimate, contact your specialist to talk about any changes. If you get stuck, give us a call on 134 246.
Know your rights
As a private patient you’re entitled to:
Know the full cost of your in-hospital treatment
Know about any out-of-pocket costs you could be up for
Ask for this information in writing from your specialist, hospital or us
Ask your specialist if they’ll participate in GapCover
Choose your specialists and hospital
Make a complaint if you’re rights aren’t upheld.
Need help?
If you need help understanding your rights, your medical bills or your hospital cover, please get in touch with us. You can live chatwith us or call 134 246 weekdays, 8am 7pm (AEST/AEDT)
If you're still worried about your bill or treatment, you can call the Private Health Insurance Ombudsman
on 1800 640 695.
The Private Health Insurance code of conduct logo is a trademark of and is used under authorisationfrom Private Healthcare Australia.
View ArticleIf you’re treated as a private patient, we have agreements in place with the majority of private hospitals and day surgeries throughout Australia.
These agreements detail agreed theatre and accommodation charges for services included under your cover. This doesn’t apply to Restricted or Excluded services.
If you receive treatment for a Restricted service in a partner hospital, we’ll only pay limited benefits and you’ll be significantly out-of-pocket. If you receive treatment for an Excluded service, no Benefits will be paid.
Find an ahm partner hospital or day surgery.
View ArticleBefore you claim
For most services, you can claim on-the-spot at your provider with your member card, by logging in to your online account or via the ahm app. You’ll need to have paid for the service before you can claim online or via the ahm app.
The below services are claimable online but not in the ahm app:
Major dental
Hearing aids
Orthodontic treatment
Laser eye treatment
Ambulance claims
Post-operative and medical aids
Travel and accommodation
Joint fluid replacement injections
Medical gases
Exercise classes, swimming lessons and weight management services.
For exercise classes, swimming lessons, and weight management services you may need your medical practitioner to complete a Health Improvement Benefit Approval Form to claim for these services.
Claim your way
At your recognised provider
Simply present your ahm member card after your appointment and the claim benefit will be processed electronically on-the-spot if your recognised provider has a HICAPS machine. You’ll only need to pay the difference between the total amount charged by your recognised provider and any benefit we pay.
The amount you'll have to pay will depend on your level of cover, limits and waiting periods. If you’ve reached the limit for that service, you’ll have to pay the full amount.
Online
Log in to your account and go to ‘Make a claim’. Make sure you have your receipt with you.
Select the service you want to claim for from the list and select 'Start claim'
Enter the provider name or number, who went, the date of the service, item number and the amount paid.
For some services you may need to upload a copy of your receipt with your claim.
For a step-by-step guide see How to make an extras claim online
Please note:
You need to enter each item separately with the corresponding cost.
You’ll be shown what benefit you’ll get for each item.
Any benefits will be paid into your nominated bank account in 2 to 5 business days.
You'll need to keep original receipts for 3 years for audit purposes.
App
Log in to the ahm mobile app and go to the ‘Claims’ tab. Make sure you have your receipt with you.
Select ‘Start claim’. If you haven’t used the ahm mobile app for over 10 minutes, you may need to re-authenticate with either your password or Touch ID/Face ID.
If there is more than one person on your policy, you’ll need to select who received the service.
Enter the service, provider name or number and claim details including the date of the service, item number and amount paid.
Please note:
You'll be shown what benefit you'll get for each item.
Not all extras services are claimable via the ahm mobile app.
You can only claim for one item at a time. If you want to claim multiple items, we recommend you log in to your account.
For successful claims, any benefits will be paid into your nominated bank account in 2 to 5 business days.
You’ll need to keep original receipts for 3 years for audit purposes.
Email
Download and complete a claim form, and email your completed form and receipt/s to [email protected] with your name and member number in the subject line.
Please note: You can't claim for services that were received more than two years ago.
View ArticleEverything you need is now at the top of the page.
To make things easier to find, the menu that used to appear in the side navigation has been updated and moved to the header (at the top of the page).
Image 1: New header navigation
Image 2: The old side navigation has been removed
What else has changed at members.ahm.com.au?
Payments can now be found in settings
Click on the arrow next to your name to open the newSettings dropdown and click onPaymentsto update your bank details and make one-off payments. See below.
Image 3: New settings dropdown menu
Replace a lost card in my account
While you're in theSettings dropdown, Find theNew card request feature inMy account. See below.
Image 4: In the people on my cover section you can find the link to request a new card
Simpler and easier navigation on your mobile
On your mobile, theI want to section has been replaced by the new mobile menu.
Click on the three lines (which look like a hamburger) under your name to trigger the newmobile menu.
Image 5: Hamburger menu link
Image 6: New mobile menu
Image 7: The I want to navigation menu has been removed
Clicking the arrow next to your name will open thesettings dropdown.
Image 8: Settings dropdown on mobile
View ArticleThe following standard clinical definition applies to Gold, Silver, Bronze and Basic hospital covers:
Hospital treatment for the provision and replacement of insulin pumps for treatment of diabetes.
View ArticleYou can suspend your cover for up to 2years if:
You’re travelling overseas (for more than 30 days), or,
You or your Partner become unemployed.
If you're going overseas
If you go overseas for more than 30 days, you can suspend your cover to a maximum of 2 years at any one time.
If your travel plans change, let us know within 30 days and send us confirmation of your new return date to Australia.
Please note: Your premiums must be paid up until the date of your departure. We’ll then confirm the suspension to you in writing, and contact you on your return to reactivate your cover. Also be aware that you’ll still need to serve any waiting periods you may have had before leaving the country, and no benefits will be paid for services provided during the suspension period. Suspending your cover may result in you being charged the Medicare Levy Surcharge (please get in touch with your accountant, tax agent or the Australian Tax Office for further advice).
Simply send us an email before you leave, with a copy of your official itinerary or tickets which include the dates of travel.
If you or your partner are unemployed
If you’ve been an ahm member for 2years and are currently unemployed (or, on a couples policy, if you or your partner are unemployed), you can suspend your cover for up to two years.
Simply provide us with certified proof of you, or your partner’s, receipt of New Start Allowance, Sickness Allowance or any other allowance relating to unemployment under the Social Security Act.
When you or your partner return to work, please contact us within 30 days.
View ArticleHit the tab at the bottom of your screen to live chat with an ahm agent between8am 7pm Monday to Friday (AEDT/AEST).
What does 'Busy' mean?
log in
Busy means all our chat agents are currently helping someone out. We'll do our best to connect you with someone as quickly as possible to assist with your enquiry.
You can also make claims on most extras, order a new card and change your payment details when youto your account.
Trying to get in touch from overseas? Call us on(+61) 2 4221 8888.
View ArticleSimply use the below link to log in and request a new member card.
Request a new card
Please note:
If your new card doesn’t arrive within 10 working days, contact us.
Your old card will be deactivated 14 days after you request a new one.
View ArticleAged 18-29? You could be eligible for a discount
ahm is stoked to be making hospital insurance more affordable for young Australians by offering a 'Youth Discount' on all hospital covers.
To be eligible to receive a Youth Discount, you have to be the Principal member or Partner on a hospital cover and aged between 18-29.
See ‘how big’ a Youth Discount you could get:
Age at discount assessment date
\% discount
18 - 25 years old
10\%
26years old
8\%
27years old
6\%
28 years old
4\%
29years old
2\%
30years old
0\%
How is the Youth Discount calculated?
The Youth Discount is calculated on your base premium before the application of any Australian Government Rebate, Lifetime Health Cover loading and/or any other eligible discount.
The Youth Discount only applies to hospital cover or the hospital component of a package it doesn’t apply to extras.
The Youth Discount doesn’t apply to persons aged under 18, regardless of whether or not they’re the Principal member or Partner on a hospital cover.
If you’re on a couple or family hospital cover, the Youth Discount is calculated by taking an average of the Youth Discount applied to the adults on the hospital cover. So, if the Principal member has a 10\% Youth Discount and their partner has no discount, or 0\%, the discount applied overall to the hospital cover is 5\% (10\% 2).
When does the Youth Discount apply?
This is also known as the ‘discount assessment date’.
If you were already a member and eligible for a Youth Discount, it was automatically applied to your hospital cover based on your age on 1 April 2019; there's nothing you needed to do.
If you didn't have hospital cover before 1 April 2019, don’t worry! If you take out hospital cover on or after 1 April 2019 and you’re eligible for a Youth Discount, ahm will apply the youth discount based on your age when you take out hospital cover on or after 1 April 2019.
Plus, if you’re transferring from another fund on or after 1 April 2019 and they gave you a Youth Discount, ahm will recognise it. We’ll just need your transfer certificate to confirm it. This is also sometimes referred to as a ‘retained age-based discount’.
Stick with us and your discount will be ongoing
If you maintain continuous hospital cover, the Youth Discount you received on 1 April 2019 or at the age you take out an eligible hospital product will continue to apply until you turn 41. From 41, if you maintain continuous hospital cover, your discount will reduce by 2\% per year until it reaches zero.
Basically, the sooner you join ahm before you turn the big 3-0 the more you could save on hospital cover.
View Article17JANUARY 2020 GAPCOVER SCHEDULE OF BENEFITS
The GapCover Schedule of Benefits for 17 January 2020 is now available. To view and download the GapCover Schedule of Benefits 17 January 2020, please see the ‘Current GapCover Schedule of Benefits’section below.
Current GapCover Schedule of Benefits
The GapCover Schedule of Benefits is indexed in line with the Medicare Benefits Schedule (MBS).
Please refer to the Department of Human Services website for further information on the MBS - www.mbsonline.gov.au
GapCover Schedule of Benefits 17 January 2020 (xls)
PreviousGapCover Schedule of Benefits
GapCover Schedule of Benefits 1 November 2019 (xls)
GapCover Schedule of Benefits 1 July 2019 (xls)
GapCover Schedule of Benefits 1 May 2019 (xls).
GapCover Schedule of Benefits 1 April 2019 (xls)
GapCover Schedule of Benefits 8 March 2019 (xls)
GapCover Schedule of Benefits 1 March 2019 (xls)
GapCover Schedule of Benefits 1 Jan 2019 (xls)
GapCover Schedule of Benefits 1 Nov 2018 (xls)
GapCover Schedule of Benefits 1 Oct 2018 (xls)
GapCover Schedule of Benefits 1 July 2018 (xls)
GapCover Schedule of Benefits 1 May 2018 (xls)
GapCover Schedule of Benefits 1 April 2018 (xls)
GapCover Schedule of Benefits 1 December 2017 (xls)
GapCover Schedule of Benefits 1 November 2017 (xls)
GapCover Schedule of Benefits 1 May 2017 (xls)
View ArticleFirst visit our ahm Travel Insurance page
Why do I need travel insurance?
Because stuff happens, even when you’re on holiday!
ahm travel insurance includes unlimited^ overseas medical and hospital expenses cover, just in case you get sick or injured while you’re travelling outside of Australia.
Depending on the type of cover you choose, ahm travel insurance can also cover your luggage, valuables, cancellations and much more.*
Get a quote
What type of cover does ahm provide?
We’ve kept things simple so it’s easy to choose cover.
You want
Available extras
Consider
Basic cover just in case, when all you want is unlimited^ medical and hospital expenses cover
Snow sports cover
Cruise cover
Medical Only Single Trip
More extensive cover that also pays benefits for things like cancellations, lost luggage and stolen or damaged valuables*
Snow sports cover
Increased cancellation cover
Motorcycle & moped riding cover
Increased rental car excess
Increased luggage cover
Cruise cover
Comprehensive Single Trip
Cover for more than one overseas trip in the next 12-month
Snow sports cover
Increased cancellation cover
Motorcycle & moped riding cover
Increased rental car excess
Increased luggage cover
Cruise cover
Comprehensive Annual Multi-Trip
Get a quote
How do I know what I’m covered for?
The Combined Product Disclosure Statement/Financial Services Guide (PDS/FSG) whichincludes details of everything your cover includes and excludes. Make sure you read it so you know exactly what you’ve paid for. No one like’s being caught out in the rain!
How do I make a claim?
You can make a claim online or download and complete a claim form and return it by post with any supporting documents.
Find out more about making a claim.
How can I get help while I’m travelling?
With ahm travel insurance, you get access to our emergency assistance team of doctors, nurses, travel agents and case managers who are available 24 hours a day, 365 days a year.
If something happens, give us a call using one of the numbers below:
Your location
Number to call
New Zealand
0800 931 760
UK
0808 234 2686
USA
1844 210 9967
Canada
1844 210 9967
Any other country
+61 (0) 2 8907 5662
Am I covered if my phone or laptop gets lost, stolen or damaged?
Never fear, cover is provided for your valuables up to a certain amount depending on the level of cover you choose. You can also get higher items cover with an additional premium for your valuables (e.g. cameras, laptops, smartphones).* You’ll be back online and taking selfies in no time.
My luggage is lost, am I covered?
Lost luggage is the worst! To get cover for lost luggage, choose either Comprehensive Single Trip cover or Comprehensive Annual Multi-Trip cover.* If you’re travelling with valuables, see “Am I covered if my phone or laptop gets lost, stolen or damaged?”.
What if my trip gets cancelled?
To get cover for trip cancellation, choose either the International Comprehensive Single Trip cover or International Comprehensive Annual Multi-Trip cover. You can add an extra cancellation amount to make sure your trip is covered if things go pear-shaped.
$3,000 cancellation cover is automatically included on the International Comprehensive Single Trip and Annual Multi-Trip plans.
$10,000 cancellation cover is automatically included on the Domestic Single Trip and Annual Multi-Trip plans.To make a claim for trip cancellations, you’ll need to meet certain criteria, which you can find in the Combined PDS/FSG.
Find out more about making a claim.
What if I get sick or injured while on my trip?
Anything can happen when you’re on holidays, which is why having overseas medical and hospital expenses cover is important.
If you’re travelling overseas, ahm travel insurance offer you unlimited^ overseas medical and hospital expenses cover (subject to the conditions outlined in the Combined PDS/FSG ).
If you’re sick overseas and need assistance to find the nearest medical clinic, give us a call at anytime
Your location
Number to call
New Zealand
0800 931 760
UK
0808 234 2686
USA
1844 210 9967
Canada
1844 210 9967
Any other country
+61 (0) 2 8907 5662
Can I ride a motorcycle or moped while I’m away?
Riding a motorcycle or moped is not one of the activities included in your ahm travel insurance.
To get cover for motorcycle & moped riding, choose either Comprehensive Single Trip cover or Comprehensive Annual Multi-Trip cover and add it as an extra.
Conditions apply to this cover. Read the Combined PDS/FSG for more details.
Still got questions?
Give us a call on 1300 617 409.
* Comprehensive plans only. Item and aggregate limits apply.
^ Medical cover will not exceed 12 months from the onset of the illness or injury. Only applies to international policies. Reduced limits may apply for customers 70 years or over.
View ArticleBenefits are paid towards the cost of hearing aids and hearing aid repairs. Limits are applied every 3 years.
View ArticleLooking for more control over the cost of your premiums?
A new higher excess level became available from 1 April on some of our hospital covers. This gives you more options to reduce your hospital premiums and more flexibility in what you pay for your hospital insurance.
Most people already choose to pay an excess when they go to hospital. Choosing a hospital cover with the new higher $750 excess can reduce your health insurance premiums while still meeting the requirement to avoid the Medicare Levy Surcharge ( find out more )
How does an excess affect my premium?
Your choice of excess impacts the cost of your premiums.
You only ever pay an excess if you're admitted to hospital. If your hospital cover has an excess, this is a fixed amount you agree to pay towards your hospital admission (same day or overnight) before ahm pays you any benefits.
Everyone is different, so it's important to think about the relationship between your excess and your premium, how frequently you’re admitted to hospital, and the excess you’ll be happy to pay if you’re admitted.
Fit and healthy?A higher excess could give you more flexibility in what you pay for your hospital cover
- but be aware of the following:
Changing your excess resets your membership year. This means, if you choose a higher $750 excess and you are admitted to hospital, you’ll have to pay your new $750 excess even if you have already paid $500 for a hospital admission in the last 12 months.
You can change back to a $500 excess within 30 days of changing; meaning we will revert back to the date of your previous membership year and acknowledge any previous excess payments paid under the $500 excess.
View ArticleWe recently discovered an issue in identifying and paying claims for joint investigations and reconstruction procedures for some members on our Boost and Lite products. The issue has been fixed and we’ve put measures in place to prevent this kind of thing from happening again.
Members who may have been impacted are those who held a:
Lite health insurance policy between February 2013 and July 2018, and/or
Boost health insurance policy between February 2017 and July 2018.
We’ve conducted a thorough review to make sure this issue doesn’t exist across any of our other products. So if you hold another ahm product with us, rest assured you are not impacted by this issue.
We’re getting in touch with all Lite and Boost members to let them know what’s happened and to give them the opportunity to claim compensation if they’ve been affected by this issue.
To find out more about eligibility or to lodge a claim, go to the online Claim Form.
View ArticleThe following standard clinical definition applies to Gold, Silver, Bronze and Basic hospital covers:
Hospital treatment for the investigation and treatment of skin, skin-related conditions and nails. The removal of foreign bodies is also included. Plastic surgery that is medically necessary and relating to the treatment of a skin-related condition is also included.
For example: melanoma, minor wound repair and abscesses.
Related hospital treatments and where to find them
Removal of excess skin due to weight loss is listed separately under Weight loss surgery.
Chemotherapy and radiotherapy for cancer is listed separately under Chemotherapy, radiotherapy and immunotherapy for cancer
View ArticleThe following standard clinical definition applies to Gold, Silver, Bronze and Basic hospital covers:
Hospital treatment for the investigation and treatment of diseases, disorders and injuries of the musculoskeletal system.
For example: carpal tunnel, fractures, hand surgery, joint fusion, bone spurs, osteomyelitis and bone cancer.
Related hospital treatments and where to find them
Chest surgery is listed separately under Lung and chest.
Spinal cord conditions are listed separately under Brain and nervous system.
Spinal column conditions are listed separately under Back, neck and spine.
Joint reconstructions are listed separately under Joint reconstructions.
View ArticleApart from claiming on the spot at your provider's HICAPS machine. You can claim online for most extras like dental, optical and physio.
Before you start: Make sure you have your receipt from your extras provider handy. You don’t need to upload the receipt, but please hold onto receipts for 3 years just in case we need it for auditing purposes.
To make your claim
Log in to your account at ahm.com.au and go to Claims.
My claim submitted as ‘Assessing’
Under Make an extras claim,choose the service you are claiming from the dropdown list
and pushStart claim.
Enter the provider’s name or provider number and check the state is correct.
Hint:If your searching by name, try only using their initial of their first name eg D Howser instead of Douglas Houser. More searching tips If other people listed on your cover, selectthe member who went from the list.
Select the date of service.
Select the item from the list.
Make a dentalclaim
Find the 3-digit item numbers for the services you paid for. These are on your receipt nextto the description/name of the service, eg 114 is for 'Scale and clean'.
You need to enter each 3-digit item code separately for each service you're claiming for with the amount you paid.You can claim for most general dental services including Dentists, Endodontists, Oral Surgeons and Periodontists.
Enter the item cost then tab or click out of the field. You’ll then be shown the benefit back you’ll get for your item. Got more than one service listed on your receipt? Hit Add another itemto claim another service.
Confirm the bank account details we are paying into.
To amend your details before you submit, select Change.
Tick the declaration and hit Submit claim. All done!
Got a different message to the above? See claims submitted as ‘Assessing’
Handy claiming tips and info
Provider searching tips
Not finding the provider you saw for your claim? Try these tips.
Find the provider number: Every health provider has a unique number to identify them as a register medical health practitioner in Australia. This is usually on the receipt from the provider next to their name and contact or clinic details. If this isn’t on your receipt then contact your provider.
Search by name using an initial for their first name and entering their full surname e.g. ‘Dr J Smith’. Sometimes provider records don’t have the full first name included which is why it won’t show up in the search list.
Still can’t see your provider in the list? This may be because they have asked us to be removed or are not an ahm recognised provider. Please contact us so we can assist.
The main reason this has occurred is because we are waiting for your transfer certificate from your previous health insurer. This include information on waiting periods you have already served with your old fund for services you have on your ahm cover simply put so you don’t have to wait again.
Transfer certificates usually take around 14 - 20 days from the date you joined us. Once we’ve received and processed your transfer certificate your claims will be automatically paid and you’ll get an SMS letting you know.
View ArticleFrom 1 April 2019, as part of the government reforms, all health insurers no longer pay benefits towards the following natural therapies:
Alexander technique
aromatherapy
Bowen therapy
Buteyko
Feldenkrais
herbalism
homeopathy
iridology
kinesiology
naturopathy
Pilates
reflexology
Rolfing
shiatsu
tai chi
yoga
Because of these changes, ahm will also no longer pay benefits towards Biochemistry.
You’ll still be able to claim towards treatments for the therapies listed above, as long as the date of service is before 1 April 2019.
If you’re on an eligible product, the following treatments will continue to be included:
Remedial Massage/Myotherapy
Acupuncture
Chinese medicine
Exercise physiology
We’ll also continue to pay benefits for pilates exercises or techniques if they form part of your physio treatment by an ahm recognised physiotherapist.
Waiting periods and annual limits apply.
FAQs
Will I still be able to get benefits towards clinical Pilates treatment from my Physio?
Yes, if you’re on an eligible product we’ll continue to pay benefits for pilates exercises or techniques if it forms part of your physio treatment by an ahm recognised physiotherapist. Waiting periods and annual limits apply.
Can I claim Natural Therapies after 1 April 2019?
If your product currently includes these Natural Therapies being removed, and you receive treatment for a Natural Therapy being removed before 1 April 2019, you will be able to claim for any services received before 1 April 2019 for up to 2 years after the date of service. Any services provided on or after 1 April 2019 will not be payable. Annual limits and waiting periods apply.
Which Natural Therapies will I be able to use after 1 April 2019?
If you are on an eligible ahm product, you can still claim benefits towards Remedial Massage, Myotherapy, Acupuncture, Chinese Medicine, Exercise Physiology, as well as other included services like Dental, Physio, Chiro and more.
Your normal waiting periods and annual limits apply. We won’t be making any reductions to your limits as a result of this change.
Why are you making this change?
Removing benefits for some Natural Therapies is a requirement ofthe Australian Government reforms to private health insurance.
Why is the Australian Government making health insurers make this change?
The Australia Government’s decision to remove some natural therapies was based on a review chaired by the Commonwealth Chief Medical Officer, which found no clear evidence to demonstrate the effectiveness of these services.
View ArticleThe following standard clinical definition applies to Gold, Silver, Bronze and Basic hospital covers:
Hospital treatment for surgery that is designed to reduce a person’s weight, remove excess skin due to weight loss and reversal of a bariatric procedure.
For example: gastric banding, gastric bypass, sleeve gastrectomy.
View ArticleIf you joined ahm after 16 September 2016 and make a premium payment by Mastercard or Visa, you’ll need to pay a 0.21\% credit card surcharge. This is an extra amount on top of your premium.
The credit surcharge also applies if you joined ahm before 16 September 2016 but make a change to your product and pay using your credit card.
Find out more about paying your premium.
View ArticlePrivate health insurance reforms made simple.
On 1 April 2019, the government started to introduce reforms across all private health insurance providers to make it easier to choose and compare hospital products. The reforms also impacted some extras services.
At ahm, we’re big fans of anything that makes health insurance simple. That’s why we welcome these changes and will be rolling them out as smoothly as possible for all new and existing ahm members.
Removal of some natural therapies on some extras
Due to government reforms, we’ve stopped paying for some natural therapies.
See which ones.
New product categories
New product categories make hospital products easier to compare.
New standard clinical categories make all hospital treatments within standard clinical categories consistent.
Learn more.
Age 18-29? You might be eligible for a discount
You could get a youth discount on your hospital cover premiums.
Learn more.
New $750 excess option
Switching to a $750 excess hospital cover could save you money on your premiums.
Learn more.
Other reforms
Learn more about the government reforms that are already in place.
To learn more about why the government private health insurance reforms are happening, visit the Department of Health website.
View ArticleThe following standard clinical definition applies to Gold, Silver, Bronze and Basic hospital covers:
Hospital treatment for fertility treatments or procedures.
For example: retrieval of eggs or sperm, In vitro Fertilisation (IVF), and Gamete Intra-fallopian Transfer (GIFT).
Related hospital treatments and where to find them
Treatment of the female reproductive system is listed separately under Gynaecology.
Pregnancy and birth-related services are listed separately under Pregnancy and birth.
View ArticleSwitching to ahm is easy - just tell us the name of your current health insurer when you join, and we’ll organise it for you.
If you switch to ahm within 30 days of leaving your current health insurer, any waiting periods you’ve already served are generally carried over for comparable services.So this means you may not need to wait to claim andyou'll havecover with ahm from the date your cover starts, even if you're switching.
View ArticleWe always aim to do the right thing by our customers. If you feel something isn't right or if we’re not meeting your expectations, we’d like the opportunity to resolve it.
If you have feedback or want to make a complaint please email us at [email protected] or contact us 8am 7pm Monday to Friday (AEDT). Where possible we’ll aim to resolve your issue on-the-spot.
If we can’t fix your problem then and there, we’ll refer the issue to our Customer Advocacy Team. They’ll conduct a detailed investigation and do their best to find a solution. If you’re unhappy with the result, you can contact the Private Health Insurance Ombudsman (PHIO) for free independent advice.
When lodging a complaint, it helps to provide us with as much relevant information as possible, including:
a clear description of your concern, and what you believe caused it
whether your concern relates to a specific claim or interaction
your desired outcome
any special arrangements you’d like us to follow, such as a preferred contact method or support needs.
To protect the security of your personal information, please don’t include details such as your credit card number or password.
Our guiding principles
People focused We acknowledge that you have a right to complain, and we will work with you in a mutually respectful way to resolve complaints within a reasonable timeframe.
Visible and transparent We’ll make sure that information about how to make complaints (to us, or about us) is made widely available.
Accessible We’ll make sure our complaint handling system is accessible to everyone, support customers to make a complaint where needed and enable them to have another person assist or represent them in making a complaint.
Responsive We acknowledge customer complaints promptly and will advise if we are unable to deal with all or part of a complaint. We’ll deal with complaints efficiently to the urgency of the issues raised.
Fair and objective We’ll deal with complaints in an objective and unbiased manner, and provide for ‘unsatisfactory’ outcomes to be reviewed by an independent person.
Accountable and preventative We’ll ensure clear accountability for the operation of our complaint handling system and resolving the root causes of recurrent complaint issues.
Informative We’ll draw from complaint data to continuously improve our products and services.
These principals align with our responsibilities under the Private Health Insurance Code of Conduct, and guidelines set out in the Australian/New Zealand Standard 10002:2014 Guidelines for Complaint Management in Organisations.
Process and timeframes
We’ll aim to resolve your complaint when you first contact us.
In more complex cases, where immediate resolution is not possible, we’ll escalate your complaint to our Customer Advocacy Team. This is a specialist team who will investigate your concerns. The Customer Advocacy Team case manager assigned to handle the matter will attempt to contact you withintwo working daysto:
assign a case manager
contact you to inform you about your escalation
conduct an independent review of the matter.
We seek to resolve all complaints within 10 working days. Where it appears this timeframe won’t be met, we’ll contact you to:
let you know about the expected delay
explain the reasons for the delay
provide an alternative timeframe.
We will prioritise any urgent cases such as those involving a threat to life, an upcoming hospital admission or any situation involving financial hardship.
When settling your complaint with you, we’ll explain the reasons for our proposed resolution. If you’re not satisfied with the outcome, we’ll let you know about your right to seek an external review of the matter, see ‘External review’ below.
If we haven’t met the process or timeframes mentioned above, we would like to address this. Please email your complaint details to [email protected]
Remedies
When deciding how to resolve your complaint, we’ll consider what would be fair and reasonable in the circumstances. Where we have done the wrong thing, we’ll always aim to return you to the circumstances you were in before the problem arose.
Remedies we may apply include:
apologye.g. a verbal or written apology given in recognition of harm or impact you experienced
information e.g. verbal or written advice to clarify one of our fund rules or policies
refunds e.g.returning a premium payment, where appropriate in the circumstances
financial compensation e.g. by providing you with a benefit payment or reimbursement in recognition of a genuine grievance, where appropriate in the circumstances
referral e.g. to make sure you’re aware of your right to seek an external review of the matter if you wish (see ‘External review’ below)
othere.g. any other remedy we consider appropriate in the circumstances.
Please note: We do not charge any fees for handling complaints and we’ll take all reasonable steps to make sure you’re not adversely affected because of a complaint made by you or on your behalf.
External review
If you’re not satisfied with the outcome of your complaint, you can pursue the matter through the independent dispute resolution service offered by the Private Health Insurance Ombudsman (PHIO):
Website: ombudsman.gov.au
Email: [email protected]
Phone: 1300 362 072 (option 4 for private health insurance)
Mail: GPO Box 442, Canberra ACT 2601
Privacy
We’re committed to protecting our customers’ personal information in accordance with our obligations under the Privacy Act 1988 (Cth) and other relevant state and territory laws. In keeping with this commitment, all personal information we collect in relation to your complaint will be handled in accordance with the ahm Privacy Policy.
View ArticleThe following standard clinical definition applies to Gold, Silver, Bronze and Basic hospital covers:
Hospital treatment for the investigation of sleep patterns and anomalies.
For example: sleep apnoea and snoring.
View Article1 September 2019 26 September 2019
Offer available for new joins only who have not held ahm hospital and extras cover in the last 30 days.
Must join and commence an eligible hospital and extras policy on direct debit on or before 26 September 2019.
Waiver of 2 & 6 month waiting periods only applies to the extras part of ahm (a) packages, and (b) black extras (black 50, black 60, black 70 & black 70 boost) when combined with any hospital cover. The extras part of other packages and combinations do not have 2 & 6 month waiting periods. Please note other waiting periods may still apply to your product.
If you join online you must enter the promo code WAIVEWAITS at the time of joining to be eligible to receive the offer. If you don’t enter the promo code you will not receive the offer.
Annual limits on extras apply. If switching funds, limits used from your previous fund may be deducted.
Only available via direct debit.
Only available via ahm direct web, phone and live chat joins.
Offer is not available in conjunction with any other ahm or third party offers.
Not available on aggregators.
Not available for hospital only, extras only, ambulance only or overseas student health cover.
Cannot be redeemed for cash.
Please note we reserve the right to amend the offer terms and conditions from time to time.
View ArticleProduct Disclosure Statements
The Product Disclosure Statement provides detail on the key features, benefits, exclusions, terms and conditions of the relevant product.
ahm life insurance product disclosure statement
ahm life insurance express product disclosure statement
Key Fact Sheets
ahm life insurance key fact sheet
ahm life insurance express key fact sheet
Financial Services Guide
The Financial Services Guide contains information about who is providing you with the financial services. It explains the financial service offered, the fees charged and how we will deal with complaints.
ahm life insurance financial services guide
Forms
ahm nomination of beneficiaries form
Contact us
Call us on 1300 052 593
8am 8pm Monday to Friday (AEDT)
Important Update for ahm Life Insurance Policy Holders
Effective 16 April 2019, the cancellation process for ahm Life Insurance products has been updated for customers who wish to cancel their policy with us. Previously you could only cancel your policy in writing, however from 16 April 2019 onwards, you can cancel your policy either in writing or over the phone with us.
For an over the phone cancellation, make sure you have your policy information handy to complete the request.
Things you should know
Any advice provided is general only and does not consider your objectives, financial situation or needs.
You should carefully read the relevant Product Disclosure Statement to ensure the product is right for you. It contains the terms and conditions, exclusions and other important information to help you make an informed decision.
ahm life insurance products are issued by the insurer, Swiss Re Life & Health Australia Limited ABN 74 000 218 306, Australian Financial Services Licence No. (AFSL) 324908, Level 36, Tower Two, International Towers Sydney, 200 Barangaroo Avenue, Sydney NSW 2000.
ahm life insurance products are distributed by Greenstone Financial Services Pty Ltd (GFS) ABN 53 128 692 884, AFSL 343079, 58 Norwest Boulevard, Bella Vista NSW 2153 and promoted by ahm health insurance, a business of Medibank Private Limited ABN 47 080 890 259 Authorised Representative No. 286089, 720 Bourke Street, Docklands VIC 3008.
Medibank Private Limited is an authorised representative of GFS. The Financial Services Guide tells you more about the services provided for ahm life insurance products.
Your personal information will be handled in accordance with our Privacy Collection Notice.
View ArticleIf your extras cover includes pharmacy, we’ll pay benefits for non-PBS (Pharmaceutical Benefits Scheme) pharmacy items that are:
Prescription only and prescribed by a medical practitioner, including contraceptives for medical conditions, travel and other vaccinations, and hormonal implants.
Essential to treat a particular illness injury or condition.
Please note, you cannot claim pharmacy items that are:
Available without a prescription including over the counter, off the shelf, herbal medicines and vitamins.
Already subsidised by the PBS.
For more information, check your product guide.
View ArticleRegister now with your member number to manage your cover online.
Log in to sort all the following:
My cover
Check your policy details
Check who’s covered
Check your extras limits
Request a new member card
Search for recognised doctors, hospitals and specialists
Claims
Make an extras claim
View extras claims history
Change the account we pay your claims into
Check your extras benefits before you make a claim
Payments
Change your preferred payment frequency/date
Change your payment method
Make a once off credit card payment
Documents
Get your tax statement
Download your product guide
My account
Update contact details/address
Change your communication preferences
Change password
Set up/remove partner authorisation
Log in
Quick things you can do without logging in
Make a once off credit card payment
Find a provider
View ArticleThe Australian Government Rebate (AGR) on private health insurance is an amount the government may contribute towards your premium to make it more affordable.
If you’re eligible, you can choose to get the rebate by paying reduced premiums. You should nominate the income tier you fall under to ensure that we claim the right rebate amount for you. Alternatively, your rebate may be claimed through your annual tax return with ATO.If you choose to claim any rebate through your tax return or if your income tier changes throughout the financial year, you may get a debit in your tax return under the heading ‘Excess private health reduction or refund (rebate reduced)’.
Am I eligible for the rebate?
All the people listed on the policy must be eligible to claim Medicare for you to receive the rebate.
How much is the rebate?
The rebate amount you are entitled to is based on the age of the oldest person covered by the policy and your income tier.
Base tier
Tier 1
Tier 2
Tier 3
Income thresholds from 1 April 2015 to 30 June 2021
Singles
$90,000 or less
$90,001 - $105,000
$105,001 - $140,000
$140,001
or more
Families
$180,000
or less
$180,001 - $210,000
$210,001 - $280,000
$280,001
or more
2019 rebate entitlement - based on age and income
Age under 65
25.059\%
16.706\%
8.352\%
0\%
Age 65 - 69
29.236\%
20.883\%
12.529\%
0\%
Age 70+
33.413\%
25.059\%
16.706\%
0\%
Single parents and couples are considered families. For families with children, the thresholds are increased by $1,500 for each child after the first.
More information
For more information about the Australian Government Rebate visit humanservices.gov.au/privatehealth
View ArticleLooking for health cover options as an overseas visitor or student?
For students
See our Overseas Student Health Cover options on the ahm OSHC website.
For visitors
We offer Overseas Visitors Cover through Medibank. For more information, visit medibank.com.au.
Not sure?
If you're not sure what type of overseas cover you're eligible for then its best to check the colour of your Medicare Card which indicates your eligibility for Medicare.
If you hold a Yellow (Reciprocal) Medicare Card, pictured below, or if you don't have a Medicare Card at all, this can affect the benefits we can pay under the cover you’ve chosen. In some instances, the benefits set out in your coverwon’t be able to be paid, and you may end up with very large out-of-pocket expenses to pay.
contact us
Pleaseso we can findthe most appropriate cover for your circumstances.
View ArticleIf you need to post something to us like receipts
for a claimor a form, you can post it to:
Locked Bag 4
Wetherill Park NSW 2164
But ... You can also scan, or take a photo, of your completed formsand email it to [email protected]
Make sure to put your member number in the subject line.
View Article
