Private Health Information Statement - Hospital policy

essentials basic plus

ahm health insurance

Monthly Premium

$119.55 #

(before any rebate, loading or discount)

Covers only one person

Available in Victoria

Closed to new members

# You may be entitled to an Australian Government rebate on the above premium. Your premium may also include a Lifetime Health Cover loading, an age-based discount or an insurer discount. Check with your insurer for details.

Hospital cover

This policy exempts you from the Medicare Levy Surcharge.

This policy provides accident cover - check with your insurer for details.

This policy does not provide benefits for travel or accommodation (outside of hospital).

This policy includes cover for

Hospital Cover Legend
Dental surgeryMiscarriage and termination of pregnancyPalliative care
Hernia and appendixTonsils, adenoids and grommetsRehabilitation
Joint reconstructionsHospital psychiatric services

This policy does not include cover for

Hospital Cover Legend
Assisted reproductive servicesDigestive systemLung and chest
Back, neck and spineEar, nose and throatMale reproductive system
BloodEye (not cataracts)Pain management
Bone, joint and muscleGastrointestinal endoscopyPain management with device
Brain and nervous systemGynaecologyPlastic and reconstructive surgery (medically necessary)
Breast surgery (medically necessary)Heart and vascular systemPodiatric surgery (provided by a registered podiatric surgeon – limited benefits)
CataractsImplantation of hearing devicesPregnancy and birth
Chemotherapy, radiotherapy and immunotherapy for cancerInsulin pumpsSkin
Diabetes management (excluding insulin pumps)Joint replacementsSleep studies
Dialysis for chronic kidney failureKidney and bladderWeight loss surgery

The benefits paid for hospital treatment will depend on the type of cover you purchase and whether your fund has an agreement in place with the hospital in which you are treated. See ‘Agreement Hospitals’ on privatehealth.gov.au for which hospitals have arrangements with your insurer – https://privatehealth.gov.au/dynamic/agreementhospitals.

Under this policy, you may have to pay out-of-pocket costs above what you get from Medicare or your private health insurer. Before you go to hospital, you should ask your doctors, hospital and health insurer about any out-of-pocket costs that may apply to you.

The following payments may also apply for hospital admissions

Excess: You will have to pay an excess on admission. This is limited to a maximum of $750 per person and $750 per policy per year.

Co-payments: No co-payments

The following waiting periods for hospital admissions apply to new or upgrading members

Waiting periods:

  • 2 months for palliative care, rehabilitation and hospital psychiatric treatments, even if pre-existing
  • 12 months for other pre-existing conditions
  • 2 months for all other treatments

Gap Cover

This provider offers 'known gap' or 'no gap' cover for medical bills for this product.

The Medical Costs Finder lets you find out more about the cost of specialist medical services.

Other features of this hospital cover

This cover also includes Accident Override.

Ambulance cover

In Victoria this policy provides:

Emergency: Unlimited with a waiting period of 1 day.

Call-out fees:  will be paid for each attendance, including emergency treatment without transport to hospital.

Other features of this ambulance cover

Unlimited benefits for medically necessary ambulance trips to the nearest hospital that is able to provide the level of care you require. TAS and QLD have State schemes to cover ambulance services for residents of those States.

Disclaimer

The information contained in this Private Health Information Statement was provided by the insurer and is intended as general information. It may not take into account your particular circumstances. For information please contact the insurer.

Covered

For information on what is covered under each category, see https://www.privatehealth.gov.au/categories

Restricted

Restricted categories partially cover your hospital costs as a private patient in a public hospital. You may incur significant expenses in a private room or private hospital.

Not Covered

These categories are not covered by this policy.