About Health Insurance

What is private health insurance?

There are two types of private health insurance cover available: hospital cover and extras cover. Hospital insurance covers all or some of the costs of hospital treatment as a private patient including doctor's charges and hospital accommodation. This applies when you are a private patient in a public or private hospital or day hospital facility. Extras cover helps with the cost of services such as physiotherapy, dental and optical treatment. Find out more about Private Health Insurance

Why do I need private health insurance?

Private health insurance gives you control of your health care. It allows you and your family to access the right health services at the right time; to choose the doctor, hospital and timing of your treatment. With health insurance you have access to an extensive range of private hospitals and can rest assured that you are in good hands.

Private health insurance also provides extras cover for services not covered by Medicare such as physiotherapy, dental, optometry and podiatry services. More about ahm Extras

The Federal Government's Rebate on private health insurance has made premiums even more affordable. And, with the introduction of Lifetime Health Cover, there is further incentive to take out health insurance earlier in life and benefit from base rate premiums. Find out more

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I'm from overseas and studying in Australia. What do I need to do?

As an international student, it is a requirement of your student visa that you have private health insurance for the duration of your stay in Australia. Medicare, Australia’s national health program, does not cover you. Australian Health Management can provide you with health insurance through our Overseas Student Health Cover (ahm OSHC) products.

If this is your first year and your educational institution in Australia has an OSHC Student Health agreement with ahm, you can simply nominate us when you apply for your visa. Your educational institution will collect the premium and forward it to us on your behalf.You will then receive a membership card and more information about your cover. You can start claiming as soon as we receive your first payment. If you are already a student at an Australian University and wish to change to ahm OSHC, you can do so online or by downloading an application form

More information about ahm Overseas Student Health Cover.

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I recently moved to Australia to live here permanently. What do I need to do?

To avoid or minimise the Lifetime Health Cover loading, you should take out private health insurance (at least a hospital cover) as soon as possible. For more information on how the Lifetime Health Cover loading will affect you, visit the Department of Health & Ageing web site.

The Medicare Levy Surcharge may apply to you if your income falls within the specified levels. For more information see Medicare Levy Surcharge.

Call us on 134 246 if you have any questions and we can help you.

For more information on Private Health Insurance in Australia, go to the PHIAC web site.

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What if I hold a yellow Medicare card or no Medicare card?

If you have a yellow Medicare card, you will have restricted access to the Commonwealth Medicare Benefits Scheme (Medicare) and if you don’t have a Medicare card at all, then you won’t have any access to Medicare. This means that, even if you hold an ahm hospital cover, you may incur significant out of pocket expenses if you are admitted as a private patient in any hospital.

You will only receive the default benefit from us should you be admitted to a hospital as a private patient. The default benefit covers the cost of:

  • Shared accommodation at a public hospital or
  • Reduced level of accommodation benefits and no theatre fee benefits in a private hospital.

Your ahm hospital cover will only provide a very limited benefit in relation to your costs. You will, however, be protected against the Medicare Levy Surcharge and Lifetime Health Cover loadings.

If you have limited or no access to Medicare, we strongly recommend that you only purchase ahm hospital cover in conjunction with an Overseas Visitors Health Cover policy, which is more suitable to your needs.

We recommend you visit:

  • www.aushealth.com
  • Freecall 1800 22 11 33 or
  • Phone +61 8437 2888 if you are calling from outside Australia

Please Note: Overseas Visitors Health Cover does not provide protection against the Medicare Levy Surcharge or Lifetime Health Cover loadings.

For more information call us on 134 246.

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What if I hold a blue interim Medicare card?

You do have unrestricted access to Medicare, but only until the expiry date of your Medicare card. Should the card expire during the course of a hospital admission, you would incur significant out of pocket expenses as you would no longer have access to Medicare. Even if you hold an ahm hospital cover, you may incur significant out of pocket expenses if you are admitted as a private patient in any hospital and your Medicare card expires.

For more information call us on 134 246.

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I am an Overseas Visitor living and working in Australia (Inpat)

ahm strongly recommends that you take out Overseas Visitors Health Cover (OVHC) for comprehensive health cover whilst you are here. This may also have been a condition of your visa depending on your circumstances. We recommend you look at IMAN/Australian Health Insurance‘s cover. There are 4 levels of cover to choose from and you can find further information at http://www.aushealth.com/.

Even if you take out OVHC, this cover WILL NOT exempt you from the Medicare Levy Surcharge. You can join a basic level of hospital cover with ahm which will do this. Because of your limited, or no access to Medicare, the benefits paid on this cover are not as described in the policy document - they are much less - so you should direct all your claims through the OVHC in the first instance as it pays much more comprehensive benefits.

The ahm hospital cover will need to be held for 365 days of the financial year to exempt you from the Medicare Levy Surcharge. If you suspend your cover for any reason or you fall into arrears, you will not be exempt.

For further information, see Overseas Visitors Cover.

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If you are an Australian travelling overseas to live and work for an extended period (Expat)

If you will still have a sizeable taxable income in Australia while you are working overseas, you will still be liable for the Medicare Levy Surcharge. Any insurance you hold with a general insurer, such as travel insurance or expatriate insurance WILL NOT exempt you from the surcharge.

You need to hold an appropriate hospital cover with a Private Health Insurer. You can join a basic level of hospital cover with ahm which will exempt you from the surcharge, but you must hold the cover for 365 days of the financial year. If you suspend your cover for any reason or you fall into arrears, you will not be exempt.

For further information, see Hospital Cover.

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What does private health insurance cover me for?

If you purchase hospital cover you will be covered for some or all of the costs of being a private patient in either a public or private hospital. Alternatively, you can still be treated as a public patient in a public hospital at no charge to you under Medicare.

The exact amount of hospital treatment you are covered for depends on the level of hospital cover that you purchase, as well as the hospital and doctor you choose and whether they have an agreement with your health fund.

You can also purchase extras cover that may offer you cover for services out of hospital that are generally not provided under Medicare, such as:

  • Dental treatment
  • Glasses and contact lenses
  • Ambulance
  • Chiropractic treatment
  • Home nursing
  • Podiatry
  • Physiotherapy
  • Occupational therapy
  • Speech therapy
  • Alternative therapies and medicines.

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What is not covered?

Private health insurance does not cover medical services that are provided out of hospital. These services include GP visits and consultations with specialists.

Private health insurance may not cover the total cost of the doctors' services provided to you in hospital, which in turn may leave you with an out-of-pocket expense. This out-of-pocket expense is referred to as the medical gap.

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How do I change health funds?

Changing from another fund has never been easier. By simply answering a few questions we can find the right cover for you! You can get a Quick Quote, join Australian Health Management securely online and start your cover today!

On your application form just select the fund you are transferring from, and we will advise them that you are switching to Australian Health Management.

Please note, we will send you a clearance certificate request to sign and return. You must organise to stop payments to your previous fund yourself. We will recognise any waiting periods served under your previous cover.

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What is the 'gap'?

The 'medical gap' is the difference between the doctor's fee for services provided in hospital and the combined Medicare benefit and health insurance benefit. The patient must pay this amount in cases where a gap exists.

You may also need to make a payment from your own pocket for non-medical hospital services, consultations in a specialist's rooms, or extras services.

More information about Access Gap Cover

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Gap cover and Australian Health Management

Access Gap Cover is designed to minimise or eliminate out-of-pocket expenses for medical services in hospital and works as follows:
  • Enables health funds to cover the medical gap without the need for a contract with doctors.
  • Facilitates payment of the medical gap above the schedule fee in a simple manner that benefits both members and Doctors.
  • Is open to all doctors nationwide, on a patient by patient basis.

More information about Access Gap Cover

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What is Lifetime Health Cover?

Lifetime Health Cover is a Federal Government initiative that allows health funds to charge different contributions depending on a person's age and when a person takes out private health cover. Anyone who doesn't have hospital cover by their 31st birthday will pay an additional 2% loading on their premiums. This 2% applies every year a person delays joining after age 30.
  • Funds set a different premium depending on your age when you join.

  • If you stay in the fund, you pay less than someone who joins later in life.

  • Under the legislation, people who join after age 30 pay 2% more for each year they delay joining.

  • The loading is capped at 70%.

The Federal Government's Lifetime Health Cover initiative aims to encourage more people to join private cover at a younger age and maintain their membership over their lifetime. Lifetime Health Cover was implemented on 1 July 2000. More information on Lifetime Health Cover.

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Why do the health funds impose waiting periods on new members?

When you join a health fund or increase your level of cover you may have to wait some time before you are able to claim benefits. This waiting period protects you and others in your health fund by making sure that people do not join a health fund solely for the purpose of making a claim, and then dropping their cover.

More about Waiting Periods

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I had symptoms before I took out health insurance, what am I covered for?

When you decide to take out or upgrade private health insurance, you may already be ill. You may have what is referred to as a pre-existing ailment. A pre-existing ailment means an illness or condition, the signs or symptoms of which existed anytime in the 6 months before the day on which you joined or upgraded to a higher level of cover. You may have a pre-existing condition or ailment without being aware of it. In these cases, you will have to wait 12 months before you are entitled to claim benefits for treatment

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Am I eligible for the Government's rebate on health insurance?

The Federal Government introduced a Rebate on private health insurance to help Australians with private health cover to meet the costs. All Australians who are eligible for Medicare benefits, and who are members of private health funds, are eligible for the rebate. The rebate is as follows:
  • 30% if you are under 65
  • 35% if your membership includes a person aged between 65 and 69
  • 40% if your membership includes a person aged 70 or over.

More about the rebate.

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What is a partner hospital?

The fund has a specialised network of Partner Private Hospitals in Australia. At these hospitals members are guaranteed 100% cover for agreed theatre and accommodation charges after any co-payment has been paid.

View the current list of partner hospitals by state.

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What is a Co-payment?

To keep premiums lower, some health covers have a range of co-payment options.
The co-payment is the amount you pay towards the total cost of each day spent in hospital and applies each membership year, to each person covered by your policy.

If you are hospitalised and have a cover with a co-payment, it will apply each day you (or someone covered by your policy) are in hospital. The co-payment will apply for the first two days of any hospitalisation, each membership year. Your co-payment applies if you are admitted for day surgery, or any stay in a public or private hospital. More about how the co-payment works.

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Glossary of Health Insurance Terms

Find out more about the terms of your hospital and extras cover, and the rules of the fund. Glossary & Rules

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Fund Rules

You can download a copy of the rules of the fund.

 

How do I register as a provider with your fund?

To register as a provider with Australian Health Management, just complete our online registration form.

Alternatively, call 134 246 with your professional and contact details or email info@ahm.com.au.

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Who is classed as a dependant?

Dependants can include your wife, husband or partner, and children under 21 years of age not working full-time and living at home. Children who are single and full time students, can remain covered under the parent’s family policy until they are aged 25 and are not required to live at home.

For more information, please see How do I add a spouse/dependant to my cover?.

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How do I make a complaint?

Most issues can be addressed at the first point of contact. If it takes longer, we have a Customer Advocacy Team available to help you. You can contact us in the following ways:

  • By phone: Call our friendly staff on 134 ahm (134 246)
  • By email: Send details to feedback@ahm.com.au
  • By mail: Write to ahm member feedback, Locked Bag 1006, Matraville, NSW, 2036
  • By fax: Our fax number is 1300 fax ahm (1300 329 246)

More information on our feedback and complaints procedure.

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What is the Medicare Levy Surcharge?

The Medicare Levy Surcharge was introduced on 1 July 1997 as a way of encouraging high income earners to take out private hospital cover, use the private hospital system and thereby reduce demand on the public system.

The surcharge is an additional 1% surcharge of taxable income imposed on high income earners who do not have an appropriate hospital cover with a Private Health Insurer. The Medicare Levy Surcharge is in addition to the normal 1.5% Medicare Levy.

To find out more about the Medicare Levy Surcharge, go to What you should know - Medicare Levy Surcharge

Find out how much you can save by having ahm health insurance using the Medicare Levy Surcharge Calculator.

Last updated 30 June 2008