Private Health Information Statement - Hospital policy

premium silver plus

ahm health insurance

Monthly Premium

$275.70 #

(before any rebate, loading or discount)

Covers only one person

Available in South Australia

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 benefits for travel or accommodation (outside of hospital) - check with your insurer for details.

This policy does not provide accident cover.

This policy includes cover for

Hospital Cover Legend
Back, neck and spineEye (not cataracts)Miscarriage and termination of pregnancy
BloodGastrointestinal endoscopyPain management
Bone, joint and muscleGynaecologyPain management with device
Brain and nervous systemHeart and vascular systemPalliative care
Breast surgery (medically necessary)Hernia and appendixPlastic and reconstructive surgery (medically necessary)
CataractsHospital psychiatric servicesPodiatric surgery (provided by a registered podiatric surgeon – limited benefits)
Chemotherapy, radiotherapy and immunotherapy for cancerImplantation of hearing devicesRehabilitation
Dental surgeryInsulin pumpsSkin
Diabetes management (excluding insulin pumps)Joint reconstructionsSleep studies
Dialysis for chronic kidney failureKidney and bladderTonsils, adenoids and grommets
Digestive systemLung and chest
Ear, nose and throatMale reproductive system

This policy does not include cover for

Hospital Cover Legend
Assisted reproductive servicesPregnancy and birth
Joint replacementsWeight 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: No excess

Co-payments: Every time you go to hospital you will have to pay:

  • $250 per day for a shared room for overnight admissions - up to $500 per hospital stay
  • $250 per day for a private room for overnight admissions - up to $500 per hospital stay
  • $250 for day surgery (no overnight stay)
  • The maximum co-payment is $500 per year

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

Includes benefits for disease management appliances and doctors health checks. Co-payment max applies per person.

Ambulance cover

In South Australia 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.