AHM Health Fund Guide

  • AHM is backed by Medibank, one of the country’s largest health insurance providers.
  • A range of hospital, extras, and combination policies are available through AHM.
  • AHM members can receive several promotional deals on movie tickets, gym memberships, glasses, and much more.

AHM is part of Australia’s largest health insurer: Medibank. It’s a name you probably recognise, as their reputation often precedes them.

AHM takes the phrase ‘black and white’ quite literally. Their policies are designed around transparency, and they name many of their plans either ‘black’ or ‘white.’ Their entire website is black and white as well, showing their dedication to the on-the-nose metaphor.

The insurance provider has over 700,000 members, and their range of insurance products means there’s something to fit the needs of most individuals and families. Take a look at what they’re offering in our section below.

Hospital & Extras

AHM has several hospital and extras packages for their customers. All of the policies are straightforward with their coverage, and allow you to spend up to your extras limit each year.

As a reward for your loyalty, AHM raises your extras limit each year you stay for the first five years.

Each policy – save for Starters Flexi – can be for individuals, families, or couples. AHM designed some of these policies to be more attractive to young Aussies, and others to attract adults and aging residents.

Plan Hospital Coverage Partial Coverage Extras Coverage Extras Limit
Starter Flexi Accident
Ambulance
Rehabilitation
Palliative Care
Psych
Routine Dental
Complex Dental
Physio
Chiro
Osteo
$550
Raises by $50
per year to a
max of $750
Lite Flexi Accident
Ambulance
Tonsil and Adenoid Removal
Appendix Removal
Wisdom Teeth Removal
Joint Investigation & Reconstructions
Minor Gynaecological Procedures
Grommets in Ears
Rehabilitation
Palliative Care
Psych
Routine Dental
Complex Dental
Physio
Chiro
Osteo
Natural Therapies
Optical
$700
Raises by $100
per year to a
max of $1,100
Separate $200
optical limit
Classic Flexi All previously mentioned procedures (no TENS machine)
Rehabilitation
Heart
Plastic and Reconstructive Surgery
Vascular and Varicose Vein Surgery
Nerve Pain Treatment
Contraceptive Procedures and Vasectomy
Hysterectomy
Psych Routine Dental
Complex Dental
Physio
Chiro
Osteo
Natural Therapies
Optical
Podiatry
Orthotics
$900
Raises by $100 per year to a max of $1,300
$250 separate optical limit
Deluxe Flexi All previously mentioned procedures (no TENS machine)
Dialysis
Major Eye Surgery
Spinal Fusion
Psych Routine Dental
Complex Dental
Major Dental
Physio
Chiro
Osteo
Natural Therapies
Optical
Podiatry
Orthotics
$1.100
Raises by $100 per year to a max of $1,500
$300 separate optical limit

Almost all of the AHM hospital only policies cover the same procedures and medical needs as their bundle counterparts. By bundling hospital and extras cover, you’ll be choosing one of the following hospital-only plans and adding extras on top of it.

Take a look at the above table to see the included coverage of the following hospital-only policies:

  • Starter
  • Lite
  • Boost
  • Classic
  • Deluxe

The hospital-only policy that isn’t included in the bundles is called ‘Top Hospital.’ This is the highest level of coverage and doesn’t list any exclusions.

Some of the procedures covered by Top Hospital (on top of the already listed procedures) are as follows:

  • Weight loss surgery
  • Psych
  • Reproductive services
  • Labour ward
  • Midwife-assisted home births
  • Sterility reversal
  • Nerve pain treatment
Extras Only

Extras only policies give you a percentage of your money back on the included extras of the plan. The more expensive the plan, the more you get back and the higher your annual limit. The higher-end plans also include more procedures in their coverage.

Below is a breakdown of the different extras-only policies that AHM provides.

Extras Plan Features Coverage
Black 50 50% back on included extras
Choose your extras provider
No gap dental check-ups at Pacific Smiles
Emergency ambulance included
Routine Dental
Physiotherapy
Chiropractic
Osteopathy
Black 60 60% back on included extras
100% back on optical
No gap dental check-ups at Pacific Smiles
Emergency ambulance included
All above mentioned procedures
Complex Dental
Major Dental
Natural Therapies
Optical
Black 70 70% back on included extras
100% back on optical
No gap dental check-ups at Pacific Smiles
Emergency ambulance included
All above mentioned procedures
Health Improvement
Black 70 Plus 70% back on included extras
100% back on optical
No gap dental check-ups at Pacific Smiles
Emergency ambulance included
All above mentioned procedures
Pharmacy
Diet and nutrition
Psychology
Hypnotherapy
Podiatry
Orthotics and orthopaedic shoes
Black 70 Plus 70% back on included extras
100% back on optical
No gap dental check-ups at Pacific Smiles
Emergency ambulance included
All above mentioned procedures
Pharmacy
Diet and nutrition
Psychology
Hypnotherapy
Podiatry
Orthotics and orthopaedic shoes
Lifestyle 17 Different natural therapies
No 2 or 6 month waiting period
No gap dental checkups
Emergency ambulance included
Routine Dental
Complex Dental
Major Dental
Orthodontics (lifetime limit applies)
Laser eye surgery (lifetime limit applies)
Physio
Chiro
Osteo
Natural Therapies
Pharmacy
Health Improvement
Psychology
Hypnotherapy
Optical
Diet and Nutrition
Family Dental for the whole family
No 2 or 6 month waiting period
No gap dental checkups
Emergency ambulance included
All above mentioned procedures except laser eye surgery
Podiatry
Speech therapy
Occupational therapy
Eye therapy
Orthotics and orthopaedic shoes
Hearing aids
Pre and post natal
Medical gases
Joint fluid replacement injections
Travel and accommodations
Super Unlimited routine dental
No 2 or 6 month waiting period
No gap dental checkups
Emergency ambulance included
All above mentioned procedures
Audiology
Laser eye surgery

We took a look at how the Private Health Insurance Ombudsman – a regulatory group – rated AHM in each of the following categories. Since AHM is a subsidiary of Medibank, the two are included together in the review.

Hospital Related Charges Covered

AHM is slightly below the industry average in most states

Medicare Services with No Gaps

AHM is slightly below the industry average in most states

Medicare Services No or Known Gap

AHM is slightly above the industry average in most states

General Treatment Covered

AHM is close to/slightly above the industry average in most states

AHM Industry Average
Benefits as % Contributions 83.5% 86%
Management Expenses (% Fund Cont.) 8.7% 8.8%
Management Expenses (Average Policy) $299 $310
Surplus (-Loss) from Health Insurance 7.7% 5.2%
Member Retention (hospital) 80% 83%
Medibank/AHM market share: 26.9%
Benefit Complaints 34.4%
Service Complaints 71.4%
All Complaints 46.3%
Investigations 26.3%
Source: http://www.ombudsman.gov.au/__data/assets/pdf_file/0021/29145/Medibank.pdf

ou can initiate a hospital, extras, or ambulance claim by visiting the AHM website and logging in with your account information.

Certain bills and payment methods require different forms, and AHM has them all available for download on the claims page of their website.

You can also initiate an extras claim by using the AHM app and navigating to the claims section.

AHM sells several different kinds of insurance policies, and not all of their member benefits apply to every policy. Still, most of their benefits and rewards are available to health insurance customers.

There are a few periodic benefits you can check on the offers page, but their current promotions include:

  • Buy one get one free movie tickets at HOYTS (Thursdays after 5 PM)
  • 10% life insurance premiums for health members
  • 2 months free AHM pet insurance
  • Up to 25% off home and contents insurance
  • 20% off Michelle Bridges 12WBT
  • Up to 15% off car insurance
  • 15% off new Active Life memberships at Goodlife Health Clubs
  • 25% off single pair of glasses at Specsavers
  • 25% off a range of Fitbit trackers

AHM has partnered with dozens of fitness, parenting, nutrition, entertainment, travel, and other companies through their Bupa Plus program to help bring value to a health fund membership.

You’ll be able to receive discounts and exclusive services through these providers. Members can log in or register with my AHM to find out how to get the most out of your AHM health fund membership.

Phone: 134 246Outside Australia: +61 3 9487 6400Hours:Mon – Fri 8am – 8pm
Mail:AHMGPO Box 9809Brisbane, QLD 4001Australia
Website:ahm.com.au
Find a Retail Store::ahm.com.au/find-a-centre

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