ahm Private Health Insurance Review

ahm health insurance was founded in Wollongong over 40 years ago and provides health cover to more than 700,000 members. It also offers travel, life and pet insurance.

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by Gary Andrews

Last update 15 Apr 2021

Overview

ahm is backed by Medibank, one of Australia's largest for-profit health insurers.

The fund has nine hospital plans, with five policies for the budget-conscious, and seven extras plans.

Members also have access to savings on movies, glasses, fitness programs and more, as well as discounted home and car insurance through ahm partner, Real Insurance.

Key Points

Nine different hospital cover plans
Member perks include savings at OPSM and Specsavers
Owned and backed by Medibank

Compare ahm and other insurers on our panel.

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Hospital cover

Nobody chooses to go to hospital.

But when you do, hospital cover will help you get the treatment you need, where and when you want it.

It also helps to pay the bills, as fees for hospital rooms and specialists can add up.

Think about what services you're likely to need, in line with your budget.

If you earn over $90,000 individually or $180,000 as a couple, you could avoid paying the Medicare Levy Surcharge.

ahm offers one of the largest range of hospital plans, with nine in total.

There's five budget level plans, three mid-level plans and one Gold plan.

Starter Basic

An entry level policy if you principally want cover for accidents.

Most useful for anybody who simply wants to avoid the Medicare Levy Surcharge.

Key inclusions:

  • Ambulance cover
  • Avoids the Medicare Levy Surcharge

Essentials Basic Plus

A basic hospital plan with a few common hospital procedures.

Suitable for avoiding the Medicare Levy Surcharge and younger Australians on a tight budget.

Key inclusions:

  • Hernia and appendix
  • Dental surgery
  • Tonsils, adenoids and grommets

Starter Bronze

ahm's budget cover for accidents and a wider range of common hospital procedures.

It's ahm's bestselling hospital cover for singles.

Key inclusions:

  • Gynaecology
  • Earn, nose and throat
  • Digestive system

Lite Bronze Plus

A Bronze plan that's the same as Starter Bronze but with some add-ons with a variety of common hospital procedures.

Key inclusions:

  • Lung and chest
  • Back, neck and spine
  • Chemo, radiotherapy and immunology

Core Bronze Plus

The most comprehensive Bronze plan includes a range of common procedures, plus items such as plastic and reconstructive surgery and hearing aid implants.

Key inclusions:

  • Plastic and reconstructive surgery
  • Blood
  • Implantation of hearing aids

Starter Silver

A medium level of cover with a range of procedures that are common to Australians of all ages and life stages.

With heart and vascular system, this policy may suit older Australians on a budget.

Key inclusions:

  • Heart and vascular system
  • Diabetes Management (excluding insulin pumps)
  • Podiatric surgery

Classic Silver Plus

An enhanced level of cover compared to Start Silver with a longer list of procedures.

Includes hospital services for diabetes and people suffering from sleep disorders.

Key inclusions:

  • Insulin pumps
  • Pain management with device
  • Sleep studies

Deluxe Silver Plus

A premium level of cover with a comprehensive range of procedures.

Similar to ahm's Gold cover but without pregnancy items, making it more suitable for older Australians.

Key inclusions:

  • Cataracts
  • Joint replacements
  • Dialysis for chronic liver failure

Top Hospital Gold

ahm's top level of cover.

Includes pregnancy and birthing, as well assisted reproductive services making it suitable for Australians planning additions to their family.

Key inclusions:

  • Pregnancy and birth
  • Assisted reproductive services
  • Weight loss surgery

Ambulance Cover

Unlimited emergency ambulance cover is included on all extras policies after a one-day waiting period.

Medically necessary ambulance cover is included on all hospital policies after a one-day waiting period.

Extras cover

Extras reset

Extras insurance helps cover the bills for routine treatments such as dental, optical, and chiro, with rebates of up to 100% on some policies.

Simply work out what you need and what you're prepared to pay.

ahm has seven extras plans to choose from, including four tiered Black plans that let you choose how much you want to pay -- and claim back.

Black 50 Saver

ahm's cheapest extras package. Allows you to claim 50% back on the basics, including routine dental, physio, chiro and osteo.

Black 60

Allows you to claim up to 60% back on general and major dental, physio, remedial massage and more, plus 100% back on optical.

Black 70

Allows you to claim up to 70% back on common extras, plus 100% back on optical. Also includes health improvement services such as help quitting smoking and exercise classes.

Lifestyle Extras

Extras package that includes no waiting periods for general dental, optical, physio, chiro and optical. Includes orthodontics, laser eye surgery, psychology, hypnotherapy, and diet and nutrition.

Family Extras

A package designed with families in mind, with a focus on dental. This cover includes 2 no-gap dental check-ups, orthodontics, speech and occupational therapy.

Black 70 Boost

One of ahm's most expensive and comprehensive extras with 70% back on all covered extras, such as dental and psychology, with generous annual limits.

Super Extras

ahm's top extras plan comes with the works, including full dental, laser eye surgery, outpatient procedure room fees, post-operative and medical aids. Comes with more options to choose where you get treated.

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Waiting periods

To stop people signing up, claiming, then cancelling their health insurance, all insurers apply waiting periods.

Generally, the more expensive the treatment, the longer you'll wait. But keep an eye out for special deals with waiting periods reduced or waived.

Starter Basic

  • 2 months -- rehabilitation, psychiatric and palliative care

**Essentials Basic Plus

Starter Bronze Lite Bronze Plus Core Bronze Plus Starter Silver Classic Silver Plus Deluxe Silver Plus**

  • 2 months -- rehabilitation, psychiatric and palliative care
  • 12 months -- pre-existing conditions
  • 2 months -- all other hospital services

Top Hospital Gold

  • 2 months -- rehabilitation, psychiatric and palliative care
  • 12 months -- pre-existing conditions
  • 12 months -- pregnancy and birth
  • 2 months -- all other hospital services

Member benefits

As well as its comprehensive range of hospital and extra covers, ahm offers members perks.

This includes discounts for movies, fitness programs, savings at OPSM and Specsavers, tax returns and discounts on other ahm insurance products.

How to claim

Claim on the spot through the HICAPS payment system at your provider.

You can also claim online, through the mobile app or by email.

Hospital agreements

ahm has agreements with most private hospitals and day clinics across Australia.

When comparing policies, it's worth checking if your local hospitals and clinics are covered.

Our specialists at Compare Club can do this for you.

If you want to check if ahm has agreements with hospitals and clinics near you, you can use their tool to search for a hospital or clinic near you.

Customer service

ahm and Medibank (combined) received 184 complaints from 1 January to 30 March 2020.

That's 21.6% of complaints vs 26.9% market share, indicating customer service is above average.

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FAQs

Is ahm a not-for-profit fund?

No.

Who can apply? Are there any restrictions?

ahm's restrictions are outlined in their fund rules (PDF]

Is it easy to switch to ahm?

Yes, you can sign up right here, right now. We'll take care of the paperwork.

Do I need to re-serve waiting periods?

No, providing you transfer to ahm on an equivalent or lower cover within 30 days of leaving your old fund.

Can I change my level of cover?

Yes, you can choose a lower or higher level of cover. If you move to a higher level of cover, you will usually need to serve waiting periods on the extra services/higher benefits.

Do I get the government rebate?

Most Australians are eligible to receive a rebate from the government. This will depend on your age and income.

To learn what you're entitled to, see this rebate guide.

Do I have to pay the Lifetime Health Cover loading?

If you're 31 or over, you usually need to pay 2% loading for each year you've gone without health cover since the 1st July following your 31st birthday.

You can find out more here.

When do extras reset?

Extras reset on 1 July each year.

What age are children covered up to?

ahm allows all children to stay on family policies up to the age of 21.

If they're studying full time, dependents can be covered as a student under a family policy up to the age of 25.

Selected policies will allow children as adult dependents up until the age of 25. Children must not be married or living in a de facto relationship.

Read our guide to learn more.

Who underwrites the health policies?

ahm, which is part of Medibank.

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This guide is opinion only and should not be taken as medical or financial advice. Check with a financial professional before making any decisions.