(before any rebate, loading or discount)
Covers one adult & dependants, including non-student dependants (2 or more people, only one of whom is an adult)
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.
This policy covers children, students up to and including the age of 30 and non-students up to and including the age of 30, as well as persons with a disability who qualify as a child, student or non-student in these age ranges.
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).
| Back, neck and spine | Eye (not cataracts) | Miscarriage and termination of pregnancy |
| Blood | Gastrointestinal endoscopy | Pain management |
| Bone, joint and muscle | Gynaecology | Podiatric surgery (provided by a registered podiatric surgeon – limited benefits) |
| Brain and nervous system | Hernia and appendix | Skin |
| Breast surgery (medically necessary) | Implantation of hearing devices | Sleep studies |
| Chemotherapy, radiotherapy and immunotherapy for cancer | Insulin pumps | Tonsils, adenoids and grommets |
| Dental surgery | Joint reconstructions | Hospital psychiatric services |
| Diabetes management (excluding insulin pumps) | Kidney and bladder | Palliative care |
| Digestive system | Lung and chest | Pregnancy and birth |
| Ear, nose and throat | Male reproductive system | Rehabilitation |
| Assisted reproductive services | Heart and vascular system | Plastic and reconstructive surgery (medically necessary) |
| Cataracts | Joint replacements | Weight loss surgery |
| Dialysis for chronic kidney failure | Pain management with device |
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.
Excess: You will have to pay an excess of $500 per admission. This is limited to a maximum of $500 per person per year.
Excess payments do not apply to hospital admissions for dependants.
Co-payments: No co-payments
Waiting periods:
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.
This cover also includes Accident Override, no excess for Dependants and unlimited medically necessary ambulance.
ahm Health Insurance does not operate a preferred provider scheme. Included Extras benefits apply to any recognised provider. See https://members.ahm.com.au/find-a-provider.
| Treatment | Waiting period (months) | Benefit limits (per 12 months unless otherwise stated) | Examples of maximum benefits |
|---|---|---|---|
| General dental | 2 | $800 per person (combined limit for general dental, endodontic, non pbs pharmaceuticals, physiotherapy, chiropractic, psychology, acupuncture, remedial massage, chinese medicine, dietetics/dietary advice, osteopathy, speech therapy & other services) | Periodic oral examination - $30.00 Scale & clean - $50.00 Fluoride treatment - $18.00 Surgical tooth extraction - $98.00 |
| Endodontic | 12 | Filling of one root canal - $119.55 | |
| Optical | 6 | $200 per person | Single vision lenses & frames - 100% of charge Multi-focal lenses & frames - 100% of charge |
| Non PBS pharmaceuticals | 2 | Combined limit - see General dental | Per eligible prescription - $50.00 |
| Physiotherapy | 2 | Combined limit - see General dental | Initial visit - $37.00 Subsequent visit - $30.00 |
| Chiropractic | 2 | Combined limit - see General dental | Initial visit - $35.00 Subsequent visit - $28.00 |
| Psychology | 0 | Combined limit - see General dental | Initial visit - $71.00 Subsequent visit - $45.00 |
| Acupuncture | 2 | Combined limit - see General dental | Initial visit - $20.00 Subsequent visit - $20.00 |
| Remedial massage | 2 | Combined limit - see General dental | Initial visit - $20.00 Subsequent visit - $20.00 |
| Ante-natal/Post-natal classes | 0 | No annual limit | Initial visit - $25.00 Subsequent visit - $25.00 |
| Chinese medicine | 2 | Combined limit - see General dental | Initial visit - $20.00 Subsequent visit - $20.00 |
| Dietetics/dietary advice | 2 | Combined limit - see General dental | Initial visit - $32.00 Subsequent visit - $25.00 |
| Osteopathy | 2 | Combined limit - see General dental | Initial visit - $37.00 Subsequent visit - $30.00 |
| Speech therapy | 2 | Combined limit - see General dental | Initial visit - $50.00 Subsequent visit - $26.00 |
| With boost flexi basic plus you get one flexi limit to spend across all of your included extras each financial year and a separate optical limit. The longer you're a member with us, the more you can claim with an increasing flexi limit each financial year (capped at year 5). This product also includes Hypnotherapy ($71 for initial consultation and $45 for subsequent consultations, waiting period is 2 months) and a range of Health Improvement Benefits including: Yoga, Pilates, Quit smoking, Disease management association fees, Cancer Council UV products, Stress management courses, Preventative tests, scans and screenings, Health checks, Exercise classes and Swimming lessons (for ages 0-17 years). This product also includes Counselling services. Conditions and annual limits apply. Please refer to your product guide for more details. | |||
| Blood glucose monitors | Major dental | Podiatry |
| Hearing aids | Orthodontic | Other treatments - check with your insurer |
This cover features a flexi limit to use on one or all of your included extras as well as a separate optical limit. The flexi limit increases up to a maximum of $1,200 after 5 continuous financial years of membership.
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.
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.
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.
For information on what is covered under each category, see https://www.privatehealth.gov.au/categories
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.
These categories are not covered by this policy.