Essential Hospital Level 5

Essential Hospital is great value for people not planning to have kids. It's a step up from Basic Hospital, covering additional things like heart related surgery and major eye surgery. Some benefits like hip & knee replacements, pregnancy and gastric banding are restricted at this level.

To keep the premium lower, Essential Hospital comes with a co-payment. Find out more about how the co-payment works.

And you can also access ahm’s Health Management Programs to help you achieve and maintain good health. 

For a full run down, download a policy document.

 


Looking for a package?

Combine any of our Hospital covers with any of our Extras covers to create a package to suit you. Use our Quick Quote tool to find the combination that best suits your needs and budget.

What you're covered for?

There are more services we pay for than we can include here, so make sure you call us before you go to hospital or have any treatments to confirm the benefits you’ll receive.

Hospital cover options
Most common hospital services		 Essential Hospital Level 5
Co-payments
(per person per membership year)		 $500
Ambulance transport
where medically necessary		 tick
Major eye surgery tick
Dialysis tick
Psychiatric services tick
Rehabilitation tick
Palliative care tick
Cardio-thoracic procedures
including open heart and bypass surgery and other invasive cardiac procedures such as angiograms and stents		 tick
Surgically implanted prostheses
We’ll cover the cost of any No Gap prostheses, and the minimum benefit for Gap Permitted Prosthesis		 tick
Travel & accommodation
for a hospitalisation		 tick
Disease management appliances tick
Health management programs tick
Health checks tick
Obstetrics and labour ward asterisk
Fertility treatments – IVF and GIFT
(inpatient services only)		 asterisk
Midwife assisted home births asterisk
Male and female sterility reversals asterisk
Hip & knee joint replacements asterisk
Gastric banding surgery asterisk

tick Covered for all agreed charges

asterisk This service isn't fully covered on this level and you'll only get a default (minimum) benefit.

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Where you're covered

We’ll cover you when treated at a:

  • Partner private hospital (including Partner day surgery)
  • Public hospital
  • Non agreement hospital*

* Default (minimum) benefit only

Restricted services

We pay the default (minimum) benefit only for restricted services and services not covered by Medicare in either a private or public hospital. Restricted services include:

  • Hip and knee joint replacements (full or partial)
  • Pregnancy related service / obstetrics
  • Assisted reproductive services (eg. IVF and GIFT)
  • Male and female sterility reversals
  • Any gastric banding and associated surgery
  • Podiatric surgery
  • Cosmetic surgery where not considered medically necessary
  • Services not covered by Medicare unless otherwise specified
  • Services where Medicare doesn’t pay a benefit (e.g. where patient is not Medicare eligible).

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Health improvement benefits

Health managament programs
Pregnancy programs Benefit
ahm’s Pregnancy Support Program ahm pays 100% of the cost
Disease prevention programs Benefit
ahm’s Health Risk Assessment ahm pays 100% of the cost
ahm’s Health Coaching ahm pays 100% of the cost
Chronic disease management programs Benefit
ahm’s Chronic and Complex Care ahm pays 100% of the cost
Health checks Financial year limit Benefit
Doctor health checks and Healthy Heart checks (where not claimable through Medicare, an employer or another party) 1 per person $50
Disease management appliances Financial year limit Benefit
Blood pressure monitor 1 per policy every 3
continuous financial years		 $80
CPAP machine or BiPAP respirator 1 per policy every 5
continuous financial years		 $500
CPAP machine or BiPAP respirator mask and/or rental Combined per policy
per financial year		 $80
Blood glucose testing machine 1 per policy every 3
continuous financial years		 $80
Instant injector or insulin pen 1 per policy every 3
continuous financial years		 $80
Nebuliser 1 per policy every 2
continuous financial years		 $80
Peak Flow Meter 1 per policy every 2
continuous financial years		 $40
Spacer 1 per policy every 2
continuous financial years		 $40
TENS machine 1 per policy every 3
continuous financial years		 $60
Lymphoedema Garments 3 items per person,
per financial year		 $40 per item
Consultations 4 consultations per person,
per financial year		 $30 per consult
More health benefits Benefit
Insulin pump and speech processor replacements ahm pays 100% up to the listed minimum price on the Government’s Prosthesis List
Travel and accommodation $75 per day combined up to $750 per person every Membership year

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Waiting periods

When you take out private hospital cover or change your level of cover, you’ll have to wait a set time before you can claim for services and benefits you weren’t previously covered for.

Where benefits are greater on your new level of cover, we’ll pay the benefit at the amount on your previous level of cover until the waiting period is served.

1 day
  • Hospital treatment as a result of an accident
  • Ambulance
  • Disease prevention programs
  • Chronic disease management programs
  • Travel and accommodation
2 months
  • Hospital treatment (where there’s no pre-existing conditions)
  • Rehabilitation, psychiatric and palliative care (regardless of whether pre-existing)
  • Doctor health checks and Healthy Heart checks
  • Hospital substitute services (except obstetric related or if a pre-existing condition)
12 months
  • Pre-existing conditions
  • Obstetrics, pregnancy and birth related conditions in a public or private hospital
  • Disease management appliances
  • Hospital substitute services that are obstetric related or if a pre-existing condition
  • Disease management appliances
  • Speech processor and insulin pump replacements


Important information

For more information on how your policy works, please read our Important Information for hospital cover.

Please Note: This is important information about your policy. Please read this in conjunction with your policy document which you can download and save for future reference.

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