About Health Insurance

What is hospital cover?

Hospital cover will insure you towards some of the costs of treatment received in private or public hospitals. Hospital costs span a range of services including doctors' charges, hospital accommodation, operating fees, operating theatre fees and intensive care.

Find out more about private hospital cover.

Why should I take out hospital cover?

With hospital cover you get:

  • the opportunity to choose your own doctor and specialist
  • more choice over the hospital you stay in

Hospital cover will help with:

What is extras cover?

Extras cover, often called ancillary cover or general treatment, will insure you against some of the costs of health and medical services that help you lead a healthier lifestyle.

Why should I take out Extras cover?

When you take out Extras cover you will receive benefits towards services not covered by Medicare, such as dental visits, glasses and physiotherapy. Depending on the cover you take out, you may also get benefits towards a range of alternative and complementary therapies, such as acupuncture and remedial massage.

Find out more about extras cover.

What is combined cover?

Many health insurers offer packaged covers that provide cover for both hospital and extras. Some insurers have pre-packaged cover, while others allow you to mix and match hospital and extras options. For example, you may be able to select a Basic Hospital cover and a comprehensive Extras cover to create your own combined package.

What's the Rebate on Private Health Insurance?

The Australian Government Rebate on private health insurance (AGR) is an amount that the Australian Government may contribute to your health insurance premium (depending on your age and income) to help make it more affordable.

If you are eligible and nominate your rebate tier, we'll reduce the amount you pay for health insurance. Otherwise, if you don't nominate, you'll pay the full premium and your rebate entitlement will be worked out by the ATO when you lodge your income tax return.

Find out more about the rebate, whether you qualify and how to nominate your rebate tier.

What's the Medicare Levy Surcharge (MLS)?

The MLS is a levy that high income earners have to pay if they don't have an appropriate level of private hospital cover.

It's calculated based on 'income for Medicare Levy Surcharge purposes' which includes things like taxable income, exempt foreign employment income, reportable fringe benefits, reportable superannuation contributions and total net investment losses.

If you hold any of the ahm Hospital covers you'll be exempt from paying the MLS.

Visit privatehealth.gov.au for more information on the Medicare Levy Surcharge.

What's the Lifetime Health Cover loading (LHC)?

LHC is an Australian Government initiative designed to encourage people to take out and maintain private hospital cover earlier in life.

If you don't have hospital cover by 1 July following your 31st birthday, you'll pay a 2% loading on your share of the hospital component of the premium for each year you've been without hospital cover. The maximum loading cannot exceed 70%.

The loading may also be applied to your hospital cover if you stop your hospital cover after your 31st birthday for any period of time if those days aren't considered 'permitted days without hospital cover'.

The good news is once you have paid the Lifetime Health Cover loading continuously for 10 years, the loading is removed but you'll need to you retain your hospital cover.

The Australian Government Rebate on private health insurance is not applied to the Lifetime Health Cover (LHC) loading component of your hospital cover premium (if applicable).

Making sure you're covered

What's a Waiting Period?

It's the set amount of time you must wait before being able to claim for benefits on your cover.

Waiting Periods apply when:

  • You first join
  • You re-join after some time without health insurance
  • You change to a higher level of cover or one that has additional services or higher benefits on services where a Waiting Period applies

If you switch to us from another private health insurer, we'll generally recognise any Waiting Periods you've already served for comparable benefits.

If you have ahm Extras or Package cover, you can claim straight away on popular services like Routine dental, Physio and Chiro, however Waiting Periods may apply to some extras.

Check your Quick Guide to see what Waiting Periods you must serve.

Find out more about health insurance waiting periods.

Why do health insurers impose Waiting Periods?

Without Waiting Periods, some people may be more likely to take out health insurance to cover a specific costly treatment – then drop the insurance after the treatment.

If too many people did this, health insurers would have to increase premiums significantly to cover the cost of claims.

What's a partner hospital or day surgery?

If you're treated as a private patient, we have agreements in place with the majority of private hospitals and day surgeries throughout Australia.

These agreements detail agreed theatre and accommodation charges for services included under your cover. This doesn't apply to Restricted or Excluded Services.

If you receive treatment for a Restricted Service in a partner hospital, we'll only pay Limited Benefits and you'll be significantly out-of-pocket. If you receive treatment for an Excluded Service, no Benefits will be paid.

Find an ahm partner hospital or day surgery.

What am I covered for?

You can view what you're covered for in your Quick Guides.

What's not covered

This depends on your ahm cover and whether you're insured for Hospital and/or Extras.

You can check your Quick Guide for more details.

Remember, if you need to go to hospital, it's a good idea to contact us anyway. That way you'll know what you're covered for and how to minimise any out-of-pocket expenses.

If you're still unsure about what is covered, contact us.

How do I change my level of cover?

Changing your cover is easy.

You can browse our health insurance options and if you need help choosing a new cover, call us on 134 246.

To change your cover, call us on 134 246 or fill out the change of cover form and post it to: ahm Health Insurance, Locked Bag 1006, Matraville NSW 2036.

Please note: if you change to a higher level of cover you may have to serve Waiting Periods before you can claim for some services.

There is a 12 month Waiting Period for pre-existing ailments, illnesses or conditions.

Check out your Member Guide for more information.

How do I switch health insurers?

When you join ahm online or over the phone, just tell us that you're switching and we'll contact your current health insurer and take care of the rest for you. That's it.

I had symptoms before I got health insurance. Am I covered?

You may have what's called a pre-existing condition.

This is an ailment, illness or condition where you had the signs or symptoms (in the opinion of one of our Medical Practitioners) 6 months before you joined private health insurance or changed your cover.

It's determined by an ahm approved Medical Practitioner (not your own).

If you have a pre-existing condition, and you're taking out private hospital cover for the first time or changing to a cover that has additional services or higher benefits, you'll have to wait 12 months before you can claim on your hospital cover.

For more information check your Member Guide or contact us.

What's a pre-existing condition?

A pre-existing condition is any kind of ailment, illness or condition where you had the signs or symptoms (in the opinion of one of our Medical Practitioner) 6 months before you joined private health insurance or changed your cover.

Our appointed Medical Practitioner is the only person authorised to decide if an ailment, illness or condition is pre-existing. They must consider any information that was provided by the medical practitioner who treated the ailment, illness or condition.

Check your Member Guide for more information on pre-existing conditions.

What are Fund Rules?

The Fund Rules are a set of rules that govern our fund.

When you join ahm you agree to our Fund Rules.

These are subject to change from time to time with the agreement of the Minister for Health & Ageing. If any changes adversely affect your cover, we will let you know in writing.

Download a copy of our Fund Rules.

How do I make a complaint?

If you want to make a complaint, please contact us straight away.

Where possible we'll aim to resolve your issue on-the-spot.

If we can't fix your problem then and there, we'll refer the issue to our Customer Advocacy Team. They'll conduct a detailed investigation and do their best to find a solution.

If you're unhappy with the result, you can contact the Private Health Insurance Ombudsman (PHIO) for free independent advice via mail:

Suite 2, Level 22
580 George Street,
Sydney NSW 2000

How do I cancel my cover?

Only the Principal Member, or their authorised third party, has the right to cancel a whole membership.

Cancellation can be requested in one of the following ways:

  • contact us (as long as you agree to the call being recorded)
  • mail us a signed letter to: ahm Health Insurance, Locked Bag 1006, Matraville NSW 2036
  • or email a signed, scanned letter to info@ahm.com.au.

We'll cancel your membership from the date that we receive your notice and forward you a refund of any excess premiums.

Cooling off period: If you cancel your cover within 30 days of joining and haven't claimed a benefit during this period, you're entitled to a full refund.

The need-to-know about your membership

I just got married. How do I change my name?

Simply contact us with your change of details and we'll take it from there.

What is Partner Authorisation?

It means that a partner who is listed on a policy can do most of the things that the Principal Member can (unless we're told otherwise). This includes things such as updating membership information, making claims, adding dependants, changing the cover or changing payment details. The partner cannot remove the Principal Member from the membership, or cancel the membership. More info is available in our Member Guide.

Will a partner listed on a policy automatically have partner authority?

Yes, but the Principal Member can opt out of Partner Authorisation by calling us on 134 246. They’ll also be able to manage this via Online Member Services after September 1st.

When does my cover start?

Your health insurance will start from the date you nominate to buy your cover.

You can choose to start your cover at a future date.

Any applicable Waiting Periods will apply, unless you are switching from another private health insurer and have served Waiting Periods for comparable benefits.

Benefits are not payable until you've paid your first premium and you can only claim for services after the date your cover started.

Am I covered for doctor visits or outpatient services?

No. The Australian Government doesn't allow private health insurers to pay benefits for doctor visits or outpatient services.

How do I suspend/resume my cover?

You can suspend your cover for up to two years if:

  • You're overseas for an extended period
  • You become unemployed

You're overseas

If you go overseas for more than 30 days, you can suspend your cover to a maximum of 2 years at any one time.

If your travel plans change, let us know within 30 days and send us confirmation of your new return date to Australia.

Please note: your premiums must be paid up until the date of your departure. We'll then confirm the suspension to you in writing, and contact you on your return to reactivate your cover. Also be aware that you'll still need to serve any Waiting Periods you may have had before leaving the country, and no benefits will be paid for services provided during the suspension period. Suspending your cover may result in you being charged the Medicare Levy Surcharge (please get in touch with your accountant, tax agent or the Australian Tax Office for further advice).

Simply send us an email before you leave, with a copy of your official itinerary or tickets which include the dates of travel.

You're unemployed

If you've been an ahm member for two years and are currently unemployed (or you and your partner, on a couples membership, are both unemployed), you can suspend your cover for up to two years.

Simply provide us with certified proof of your receipt of New Start Allowance, Sickness Allowance or any other allowance relating to unemployment under the Social Security Act.

When you or your partner return to work, you need to let us know within 30 days.

How can I pay my premiums?

Premiums need to be paid at least one payment frequency in advance at all times and can be paid to a maximum of 12 months in advance.

There are many ways you can pay your premiums:

Direct Debit – Simply set up a direct debit with your preferred frequency and date and we'll withdraw the premiums from your nominated bank account or credit card when the premiums fall due.

Online – Online payments can be made using your Visa or MasterCard at anytime. Login to Online Member Services to make a payment. Remember: If you have a direct debit set up, making an additional one-off credit card payment will not change any direct debit arrangements you have with us.

BPAY – Make payments at anytime with BPAY. Use the biller code 57430 and your member number without any spaces as the customer reference number.

Phone – Pay your premiums by Visa or MasterCard over the phone on 134 246.

Mail – Write a cheque to 'ahm Health Insurance' and clearly print your name and member number on the back. Send to: ahm Health Insurance, Locked Bag 1006 Matraville NSW 2036.

I'm planning a family; what do I need to do?

Firstly you need to make sure you're on the right level of cover which includes pregnancy.

You can refer to your Quick Guide to check this, or you can contact us.

If you're not on the right level of cover and you want to be covered for the birth of your baby, you'll need to switch to a cover that includes pregnancy. View some of our cover options.

When you change to a cover which includes obstetrics and pregnancy related services (including the birth of your baby), you will need to serve a 12 month Waiting Period. This means that the baby's due date must fall after your 12 month Waiting Period, so it's best to change your cover 3 or 4 months (minimum) before trying to get pregnant, to ensure you've served your 12 month Waiting Period.

Find out more about pregnancy and private health insurance.

How do I make sure my new baby is covered?

Adding a child to a couple or family membership

If you already have a family cover when your baby is born, all you need to do is add them to the membership from their date of birth by calling us on 134 246. The request must be made within 12 months of the date of birth to ensure your baby is covered straight away and doesn't have to serve any waiting periods that have already been served by the Principal Member.

Where the request is made outside the 12 month period, your child will only be added from the date of notification. Only those waiting periods that apply to the Principal Member will apply to your child.

Adding a child to a single membership

If you're on a single cover, then you'll need to upgrade to a family (or single parent) cover, and add your baby to the membership from their date of birth by calling us on 134 246. The request must be made within 2 months of the date of birth to ensure your baby is covered straight away and doesn't have to serve any waiting periods that have already been served by the Principal Member.

Where the request is made outside two months from the date of birth, the baby will be subject to all applicable waiting periods.

If your current level of cover is not available for families, you will also need to select a new cover. You can view our range of cover options online.

Please note: when you change your existing cover you may have to serve waiting periods before you can claim for some services.

Will my newborn baby have to serve any Waiting Periods?

Waiting periods for a newborn baby are applied according to the Principal Member.

This means that, if at the time your baby is added to your cover, the Principal Member has served all Waiting Periods that apply to your current level of cover, then no additional waiting periods will apply to your baby. Where the Principal Member has not served the waiting periods in full at the time the baby is born, any remaining waiting periods will apply to both you and your baby.

If your baby is added more than 12 months after their date of birth, then they will need to have served all applicable Waiting Periods.

Who is classed as a Dependant?

There are different types of dependants depending on the cover you have.

Partner – a person who lives with the Principal Member in a marital or bona fide domestic relationship

Child Dependant – a child of the Principal Member who doesn't have a partner and is under 21

Student Dependant – a child of the Principal Member who doesn't have a partner and is over 21 and under 25 and studying full-time

Adult Dependant – a child of the Principal Member who doesn't have a partner and is over 21 and under 25, and isn't a Student Dependant. These dependants can only be included on selected covers and for an extra premium

For more information, contact us.

I think my child is a Student Dependant. Can you tell me more?

A Student Dependant is a child of the Principal Member who is:

  • Single
  • Over 21 and under 25
  • Studying full-time at an Australian Education Institution

They can be your or your partner's natural, step or adopted child, or a child you have legal custody of.

My child is 21, are they still covered?

Your child can be covered up to the age of 25 if they are classed as a Student Dependant.

If your child is over 21 and not a Student Dependant, they may be covered as an Adult Dependant.

Adult Dependants can only be included on selected covers and for an extra premium.

For more information, contact us.

What's the difference between single, couple, family and single parent cover?

Single - covers one person only (known as the Principal Member). More about health insurance for singles.

Couple - covers one adult (the Principal Member) and their partner. More about health insurance for couples.

Single Parent - covers one adult (the Principal Member) and any child or student dependants. More about health insurance for single parents.

Family - covers one adult (the Principal Member), their partner and any child or student dependants. More about health insurance for your family.

How do I change my bank account/credit card details?

Download a Payment form and email or mail it free of charge to:

  • ahm Health Insurance, Locked Bag 1006, Matraville NSW 2036

For more information, contact us.

How do I change my address, phone number or email address?

You can update your details online at any time.

If you have moved to a different state, please call us on 134 246 to update your details.

How do I change my income tier for the Australian Government Rebate on Private Health Insurance?

You can contact us and we'll do it for you.

How can I get a new ahm member card?

If your member card is lost or damaged, you can request a new card online.

Your request will be processed and we'll send you a new card within 7 to 10 working days.

Register for Online Member Services.

Please note: once we receive your request, your old member card will be invalid, which means you can't claim on-the-spot until you get your new card. However, you can still make claims using our online services.

If you find your old card, make sure you destroy it.

If your new card doesn't arrive within 10 working days, contact us.

Where can I see all the claims I've made?

You will soon be able to view your claim history in Online Member Services.

In the meantime, if you require information about any of your previous claims, please call us on 134 246.

Going to hospital

I'm going to hospital. What am I covered for and what do I do now?
Where will I be covered?

You can choose where you're treated and whether you're treated in a private hospital or as a private patient in a public hospital, in conjunction with your doctor or specialist.

Partner private hospitals and day surgeries

To help you know your costs and benefits up front, we've contracted with most private hospitals which include an agreement on how much they can charge.

Non agreement hospitals and day surgeries

In some instances, we haven't reached an agreement with a private hospital or day surgery. These are referred to as non agreement hospitals.

If you receive treatment for a service that's included or Restricted on your cover at a non agreement hospital we'll only pay a limited benefit and you'll be significantly out-of-pocket. If you receive treatment for an Excluded Service no Benefits will be paid.

We recommend you call us before being treated to clarify your benefit entitlements.

The hospital and doctors treating you should tell you about their costs before you go to hospital, so it's important to ask.

Public hospitals

If you're treated as a private patient in a public hospital for included services, you'll be covered for same day admissions and overnight accommodation in a shared room.

If you choose a private room in a public hospital, you may have an Out-of-pocket Expense to pay yourself.

This depends on your cover and what you're going to hospital for.

You can refer to your Quick Guide to see at a glance what you're covered for.

We can help out by confirming:

  • Whether any Waiting Periods still apply
  • If you're covered for the procedure
  • If your condition could be considered Pre-existing
  • If you need to pay an Excess or Co-payment
  • If the hospital you will be treated at is an ahm partner hospital

Contact us so we can help to answer this question.

Want to know what questions to ask your doctor before going to hospital?

What's a co-payment and how does it work?

At ahm, a Co-payment is the daily amount you agree to pay towards the cost of treatment if you go to hospital or day surgery.

It applies to each person on the cover and is capped each membership year.

There are 3 levels of Co-payment, the amount depends on your level of cover:

  • $0 Co-payment
  • $500 Co-payment - $250 per night up to a maximum of $500 per person and $1000 per family
  • $800 Co-payment - $400 per night up to a maximum of $800 per person and $1600 per family

Check your cover details in your Quick Guide for more information, or contact us.

Have I already paid my co-payment this year?

This depends on whether you've been to hospital recently, and how long you stayed.

Your Co-payment resets at the beginning of each membership year – that is the date of the anniversary that you commenced or changed your health insurance cover with ahm.

Contact us if you need to go to hospital. We'll confirm if you need to pay a Co-payment when you're admitted.

What's an excess and how does it work?

On an ahm Hospital cover - this is an upfront lump sum payment that you agree to pay towards your hospital stay or day surgery admission.

This applies to each person on your cover and there is a maximum amount for each person per membership year.

The maximum you'll need to pay each membership year depends on your cover, as detailed below:

  • Lite Cover & First Step $500 per person or $1,000 per couple
  • Lite Cover Plus, Standard Cover & Mid Cover $500 per person or $1,000 per family
  • Budget Hospital $500 per person or $1,000 per family

Please note: If the charge for your first admission is less than the excess amount, any remaining excess must be paid if you're admitted again in the same membership year.

Check your cover details in your Quick Guide for more information, or contact us.

What's a restricted service?

If a service is restricted, or partially covered, it means that we'll only pay a Limited Benefit towards your treatment. The benefit won't cover the full cost of your treatment, so if you're treated at a private hospital or as a private patient in a public hospital you may be left with significant out-of-pocket expenses.

For more information on the types of benefit we pay for Restricted Services, refer to your Member Guide. Always check with us if your procedure is included on your cover before agreeing to treatment.

What are excluded services?

If a service is excluded on your cover it means that we won't pay a benefit towards it and you'll be significantly out-of-pocket.

For these services, you won't receive anything from us towards the costs of treatment so you will have to pay all costs yourself.

Check your Quick Guide for a list of services which are excluded.

Get knowledgeable about medical gaps

What is the 'medical gap'?

Medical gaps exist because some doctors may charge higher fees than set out in the Medicare Benefits Schedule (MBS).

Whilst you are in hospital, Medicare pays 75% of the MBS fee and we pay the remaining 25%. Anything higher than the MBS fee is known as the medical gap, which you will need to pay.

What is GapCover?

GapCover can help reduce or remove the medical gap.

If your doctor chooses to participate in GapCover, we'll provide benefits up to an agreed fee and then you'll have to pay the difference. Under GapCover, the maximum gap that you'll have to pay is $500 per claiming provider (i.e. doctor's account). Use our Find a Doctor search to find doctors who've previously registered to participate in GapCover.

You should always check with your doctor before agreeing to treatment.

Is my doctor registered for GapCover?

Doctors can opt in or out of GapCover as they wish.

Use our Find a Doctor search to see which doctors have previously participated in GapCover.

It is best to ask whether they agree to participate in GapCover for your treatment.

If they haven't agreed to GapCover before, they may do so for your treatment.

How do I calculate my out-of-pocket costs for an operation?

This depends on your doctor's fees.

Here are a couple of steps to help you work this out:

Step 1 Ask if they charge above the Medicare Benefits Schedule (MBS)

Yes they do - if they do charge above the MBS fee, ask them if they will participate in GapCover. If they do, the most you'll pay is $500

If they don't participate in GapCover, then you'll have to pay the difference between the MBS fee and the doctor's bill for any services whilst you're in hospital.

Step 2 Ask them to give you an estimate of all the medical fees – including anaesthetist, assistant surgeon and any other costs to allow you to provide Informed Financial Consent

You can always contact us to get a clearer picture of your out-of-pocket costs.

What should I ask my doctor before going to hospital?

It pays to be prepared before you go into hospital.

Here are some good questions to ask:

  • Where you'll be treated? (If it's not a partner hospital we'll only pay a Limited Benefit and you'll be significantly out-of-pocket)
  • How long you will I be in hospital?
  • Who will be treating you and will they participate in GapCover (to keep your costs to a minimum)?
  • What other costs are involved?
  • Will there be any other specialists involved, e.g assistant surgeon or anaesthetist, and will they participate in GapCover?
  • Will you need any prostheses?
  • What are the total costs involved? Your specialist should provide you with an estimate of medicals fees prior to your treatment so that you're fully aware of what you'll have to pay. This will enable you to provide Informed Financial Consent

Ask your doctor for this information if it hasn't already been provided.

I'm a provider/doctor. How do I register for GapCover?

To register for GapCover, simply fill out the GapCover Application form and return by fax to (03) 8456 6250.

Extras claiming at a glance

How does on-the-spot claiming work?

Simply swipe your ahm member card at your health care provider and the claim benefit will be processed electronically on-the-spot. You'll only need to pay the difference between the total amount charged by your provider and the benefit we pay.

How do I make a claim?

You can make your claim in three ways:

  • Claim on-the-spot at your health care provider, just swipe your ahm member card and your benefit will be processed on-the-spot. You'll only need to pay the difference between the total amount charged by your provider and the benefit we pay.
  • You can claim through member services, you'll have to be registered though.
  • Or download a Claim form and post it to: ahm Health Insurance, Locked Bag 1006, Matraville NSW 2036.

Please note: services with a date greater than two years old aren't claimable.

What pharmacy benefits can I claim?

We'll pay benefits for non-PBS (Pharmaceutical Benefits Scheme) pharmacy items that are:

  • Prescription only and prescribed by a medical practitioner, including contraceptives for medical conditions
  • Essential to treat a particular illness injury or condition

For more information, check your Quick Guide.

What's my limit on a particular service?

To find out more about your benefit limits, call us on 134 246.

When do my limits renew?

A limit is the total amount you can claim towards extras included in your cover in a specific period of time.

Most limits are renewed at the start of the financial year (1 July).

Some services covered by Family Extras and Super Extras, such as pre and post natal services, are based on a rolling year. This starts on the date the service is first provided, with the limit renewed 12 months later.

For more information on your limits, refer to your Quick Guide.

What are Health Improvement Benefits?

Health Improvement Benefits are benefits paid for services which may improve your health such as exercise classes, swimming lessons etc.

In Australia, Private Health Insurers can only pay benefits for most Health Improvement Benefits to assist with the management and treatment of already identified health conditions.

This means that in order to claim for Health Improvement Benefits, such as exercise classes, swimming lessons etc., you'll need to provide us with some supporting documentation from your medical or other practitioner.

To enable you to make a claim we will send you a Health Improvement Benefit Approval form, which you can take to your medical practitioner to discuss and complete.

Please note: Health Improvement Benefits aren't available on all ahm Extras covers.

Please check your Quick Guide to see what's included on your cover.

For more information on Health Improvement Benefits contact us.

Can I claim exercise classes? If so, how?

This option is only available for Basic Extras, Lifestyle Extras, Family Extras and Super Extras.

You can claim towards exercises classes provided by a Fitness Australia® accredited gym or personal trainer. You can also claim towards yoga, Pilates and exercise classes with an ahm recognised provider.

Here's what you need to do to make a claim:

Step 1 - See your GP or health practitioner every 12 months

Together with your doctor or health practitioner, you need to complete our Health Improvement Benefit Approval form.

Make sure the date on your Health Improvement Benefit Approval form, or letter from your GP or health practitioner is before your first class or session.

Otherwise, your doctor or health practitioner can provide a letter explaining your condition and how the exercise classes will manage it.

You will need to provide us with a new form or letter every 12 months.

Step 2 - Choose a recognised provider

You need to go to a gym or personal trainer that's a member of Fitness Australia, or a recognised Exercise Physiologist.

Find a recognised provider near you.

Step 3 – Send your Claim form

When you're ready to claim, simply complete a standard ahm Claim form and attach a receipt for exercise classes.

Mail your Claim form, receipt and completed Health Improvement Benefit Approval form to: ahm Health Insurance, Locked Bag 1006, Matraville NSW 2036. Or email us the claim form.

Please note: To find out if you're eligible for Health Management Services, please check out your Quick Guide

For more information contact us.

How can I find a recognised gym, yoga or Pilates instructor?

Simply login to Online Member Services and select Find a Provider from the menu.

What extras am I covered for?

This depends on your level of cover.

Check out your Quick Guide to see what you're covered for.

If you're still unsure about what you're covered for, email or contact us.

How do I make a routine dental claim?

The easiest way to claim is by presenting your member card at the dentist and your claim is processed on-the-spot.

If your dentist doesn't have on-the-spot claiming, or you forget your member card, you can claim online:

Step 1 Enter your details and your provider details. You can claim for most general dental services including Dentists, Endodontists, Oral Surgeons and Peridontists.

Step 2 Select the correct service and item number and enter the amount paid. Remember, you need to enter each item separately with the right charges.

When you have finished your claim you'll be shown a summary of all your services. That's it.

Please note: High cost dental services including orthodontics can't be claimed online, they need to be emailed or mailed to us. You can mail your claim to: ahm Health Insurance, Locked Bag 1006, Matraville NSW 2036

If you're having problems with dental claims or any other health insurance claim, make sure you contact us.

My child needs braces. What do I do now?

You and your child need to have held Lifestyle Extras, Family Extras or Super Extras cover for 12 months to be able to claim Orthodontic benefits.

How to claim:

  • If you've paid the charge in full or are paying it off in instalments;
    You need to attach your receipt(s) to a claim form to receive your benefit for the current financial year or in line with any instalment/payment dates. If you've paid upfront and want to claim over subsequent financial years, please make sure you include written confirmation from your orthodontist or dentist to advise that the treatment is ongoing.

Forward your claims and receipts to info@ahm.com.au including your member number in the subject field or send by post to: ahm Health Insurance, Locked Bag 1006, Matraville NSW 2036.

Please note: Orthodontics cannot be claimed online.

Don't forget you need to retain an appropriate level of Extras cover for the duration of the treatment.

Still need more answers? Please contact us.