Lite Cover

Australians have relied on ahm for their health insurance for more than 40 years and theyre
backed by Medibank, Australias largest health insurer. Ahms number one focus is helping
over 370,000 members make the most of their cover, by taking a no-nonsense approach to
health insurance, cutting out unnecessary costs and offering more choice.

Effective February 2013

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Consultants available to help

Lite Cover
Private hospital benefits
You are covered in participating hospitals and day surgeries for the benefits listed below ONLY. This may be a private or shared
room, depending on availability. You may incur out of pocket expenses if you are treated in non-agreement hospitals or day surgeries.

Private hospital benefits

Waiting period

Hospital treatment as a result of an accident

1 day

Accommodation (except for excluded services)

Theatre costs (except for excluded services)
Intensive care (except for excluded services)
Removal of appendix, tonsils and adenoids
Joint investigations and reconstructions

2 months (unless pre-existing)

Minor Gynaecological Procedures

Surgical removal of wisdom teeth in hospital
Pharmaceuticals in hospital
Prostheses surgically implanted (minimum benefit only)

Restricted benefits
The minimum (default) benefit only is paid for restricted services in either a private or public hospital.

Restricted benefits
Psychiatric services - in hospital
Rehabilitation services - in hospital
Podiatric sugery by an accredited podiatric surgeon

Waiting period
2 months
2 months (unless pre-existing)

Exclusions
There is no benefit payable for excluded services listed below.

Exclusions
Dialysis
Heart related treatment and procedures
Hip and knee replacements
All other joint replacements
Major eye surgery (e.g. cataracts and lens related products)
Obstetrics/Pregnancy and birth related services
Assisted reproductive e.g. IVF, GIFT
Obesity surgery - including gastric banding and bypass
Sterility reversals
Spinal fusion
All cosmetic surgery
All other in-hospital services where a Medicare benefit is payable
Any item that has an MBS (Medicare Benefits Schedule) item number and is not stated as included or restricted is NOT covered
in this policy.

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Lite Cover
Ambulance Transportation
Youre covered for medically necessary ambulance transport and services including
air ambulance such as CareFlight, to the nearest hospital thats able to provide the
level of care you need. Some state governments however, have their own schemes
in place, so if you live in NSW, ACT, Queensland or Tasmania, please take note of
the following.
If you live in NSW or ACT your cover includes a levy to the ambulance service.
Pensioners are exempt from this levy - so if you hold a pension or health care card,
youre entitled to a lower premium. Just send ahm Health Insurance a copy of your
card and theyll reduce your premiums from the date they receive the copy. If you
live in Tasmania or Queensland youre already covered by your states scheme.
However, ahm Health Insurance do cover the costs for any interstate ambulance
transport if not covered by the state scheme.

NOTE: The excess does not apply to ambulance transportation. ahm Health Insurance doesnt
pay benefits towards ambulance subscriptions.

Your Hospital Excess

Payment Amount

$500

$500 is payable per person on the first admission per

membership year.
$500 is the maximum you will pay in a membership year for
a singles policy.
$1000 is the maximum you will pay in a membership year for
a couples policy.
If the charge for your first admission is less than the excess amount, any remaining excess must be paid if
you are admitted to hospital again in the same membership year.

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Lite Cover
Examples of your dental benefits
Item Service description
no
011

Comprehensive oral examination

022

1 X Ray

121

Fluoride Treatment

114

Removal of calculus - first visit

322

Surgical removal of a tooth

323

Surgical removal of a tooth

324

Surgical removal of a tooth

531

Adhesive restoration, 1 surface

532

Adhesive restoration, 2 surfaces

533

Adhesive restoration, 3 surfaces

118

Bleaching, external - per tooth

119

Bleaching, home application - per arch

965

Occlusal splint

415

Root canal obturation - each additional canal

416

Complete chemo mechanical preparation of

root canal - one canal

417

Complete chemo mechanical preparation of

root canal - each additional canal

418

Root canal obturation - one canal

582

Veneer - direct

583

Veneer - indirect

615

Full crown - veneered - indirect

711

Complete maxillary denture

712

Complete mandibular denture

719

Complete maxillary and mandibular denture

843

Maxillary expansion appliance

811

Passive removable appliance - per arch

642

Bridge - direct - per pontic

643

Bridge - indirect - per pontic

881

Orthodontic complete course

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Benefit

Financial year limit

Waiting
period

None

50% of cost back

Combined limit for all Extras

services included on this cover
$750 per person

12 months

Not covered

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Lite Cover
Your optical benefits
Service description

Benefit

Financial year limit

Waiting
period

Spectacle frames
Single visions lenses
Bifocal lenses

Not covered

Progressive lenses
Contact lenses - pair
Disposable contact lenses

Your therapeutic benefits

Service description

Benefit

Financial year limit

50% of cost back

Combined limit for all Extras services

included on this cover
$750 per person

Chiropractic
Osteopathy
Physiotherapy

Waiting
period
None

Exercise physiology
Hydrotherapy
Psychology
Hypnotherapy
Speech therapy
Eye therapy
Occupational therapy
Podiatry
Orthotics
Audiology
Naturopathy
Homeopathy

Not covered

Acupuncture
Herbalism
Remedial massage
Reflexology
Bowen therapy
Chinese medicine
Alexander technique
Myotherapy
Dietetics
Aromatherapy

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Lite Cover
Shiatsu
Nutrition
Yoga
Pilates
Chinese massage
Kinesiology

Not covered

Iridology
Swedish massage
Rolfing
Medicine
Remedies

Your health improvement benefits

Service description

Benefit

Financial year limit

Waiting period

Weight Management programs

Quit Smoking programs
Health Management programs

Not covered

First Aid courses

Health Tests

Your other benefits

Service description
Pharmaceutical Prescriptions
(Benefits only payable for non PBS
items. Benefits do not apply to
prescriptions dispensed to hospital
in-patients.)

Benefit

Financial year limit

Waiting period

Not covered

Hearing aids
Medical Appliances

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Did you know? (Read & Retain)

Waiting Periods
A waiting period means you will need to wait for a specified time before youre eligible to make a claim after
joining as a new member or changing your level of cover. You can transfer from one health insurer to another, for
the same or a lower level of benefits, without serving additional waiting periods. If youre switching private health
insurers, the good news is ahm Health Insurance will recognise waiting periods already served for comparable
benefits.
The Government sets the maximum time that health insurers are able to make members wait until they can claim
benefits for hospital treatment. These maximums are:
12 months for pre-existing conditions
2 months for psychiatric, rehabilitation and palliative care whether or not there is a pre-existing condition.
2 months in all other circumstances

Accidents
An accident is defined as an unplanned or unforseen event resulting in bodily injury that requires immediate
medical treatment in a hospital.
ahm Health Insurance will pay a benefit towards the costs of hospital treatment that is required as a result of an
accident, provided that the medical services is one Medicare pays a benefit for. This applies even if the hospital
treatment is included in the list of excluded treatments.

Pre-existing ailments or conditions

If youre taking out private hospital cover for the first time, or changing to a cover (either within ahm or from
another insurer) that has additional services or higher benefits and you have a pre-existing condition, youll have
to wait 12 months before you can claim on your hospital cover.
A pre-existing condition is an ailment, illness or condition, the signs or symptoms of which - in the opinion of a
medical practitioner appointed by ahm Health Insurance - existed at any time in the 6 month period before you
either took a new policy or changed your cover.
The appointed medical practitioner is the only person authorised to decide if an ailment is pre-existing. They
must consider any information that was provided by the medical practitioner who treated the ailment, illness or
condition.
Assuming that ahm Health Insurance receive all the information required from your treating medical practitioner(s),
theyll need five working days to make the assessment so you should consider this when you agree to a hospital
admission date.
If youre admitted into hospital without confirming your benefit entitlements and your condition is subsequently
determined as pre-existing, youll be required to pay any hospital and medical charges not covered by Medicare.
If youre admitted to hospital for an emergency, ahm Health Insurance may not have time to asses if the preexisting rule applies. As a result, you may have to pay for all or some of the hospital and medical charges if:
youve held your current level of hospital cover with ahm Health Insurance for less than 12 months,
youre admitted to hospital and choose to be treated as a private patient, and
your condition is later determined to be pre-existing.

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Did you know? (Read & Retain)

Blue Interim, Yellow Reciprocal or No Medicare card
If you have a blue interim, yellow reciprocal or no Medicare card, some of the benefits outlined may not be available
to you. It is recommended that you call ahm Health Insurance, to check your cover prior to joining to ensure the
cover is suitable for you.

Partner private hospitals

For a list of partner private hospitals in your state go to: www.ahm.com.au/Hospital-Network.

Out of pocket expenses

Out-of-pocket expenses may occur if:

- Youre treated at a non-agreement private hospital;

- Youre treated in a private hospital for a restricted or excluded service
- You request a private room in a public hospital

- Your doctor/s do not participate in GapCover and charge above the Medicare Benefits
Schedule Fee;

- You choose a prosthesis that costs more than the minimum benefit listed in the Federal Governments
Prostheses List.

Medical gap payments

The benefit ahm Health Insurance pays towards in-hospital medical services is based on the Medicare Benefits
Schedule (MBS). This is a list of fees that has been issued by the Australian Government to set out the minimum
amounts that Medicare and Private health funds should pay towards each medical service listed.
If a service is listed on the MBS and included in your cover, Medicare will pay 75% of the MBS fee and ahm will
pay the remaining 25%.
A doctor may choose to charge more than the MBS fee which may leave you with an out-of-pocket expense that
youll have to pay. This is known as the medical gap and is the difference between the fees youre charged by the
medical providers and the MBS (i.e. The amount you receive from Medicare and ahm) for the services they provide
in hospital.

GapCover
GapCover is designed to help remove or reduce the medical gap so that you pay less for your hospital treatment
or nothing at all.
If your doctor chooses to participate in GapCover ahm Health Insurance provides benefits up to an agreed fee
and then youll have to pay the difference. Under GapCover, the maximum gap that youll have to pay is $500 per
claiming provider (i.e. doctors account).
A doctor can choose to participate in GapCover on a case by case basis, so you should always check with them prior
to agreeing to treatment and ask them to provide you with an estimate of medical fees.
If your doctor chooses not to participate in GapCover, ahm health insurance will only pay up to the MBS fee and
youll have to pay the difference between the MBS fee and what your doctor charges you.
Note: ahm Health Insurance dont pay any GapCover benefits for excluded services.

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Did you know? (Read & Retain)

Search for a doctor
You can access a doctor search facility at ahm.com.au/find-a-doctor to find a list of doctors who have previously
registered to participate in GapCover.

Prostheses
ahm Health Insurance pays up to the minimum benefit for surgically implanted prostheses. There may be more
than one clinically appropriate prosthesis available for your procedure. If you choose a prosthesis that costs more
than the minimum benefit listed in the Federal Government Prostheses List, youll have to pay the difference
between the minimum benefit and the prosthesis charge.

Health insurance policy

Single policy

a policy that includes only one person (the principal member).
Couple policy

- a policy that includes two people, both of whom are insured adults and one is the principal member
and
the other is their partner
Principal member

is the first person listed on the membership. They are responsible for the payment of premiums and

have full authority to make any changes to the membership
Partner

This is the person who lives with the principal member in a marital or bona fide domestic relationship

Overseas benefits
Your ahm Health Insurance policy doesnt cover you for any medical, hospital or ambulance services received
overseas or goods purchased outside of Australia, including online purchases from overseas companies. If youre
travelling overseas, call ahm Health Insurance on 134 246 so that they can help you arrange travel insurance at
discounted rates. Without adequate travel insurance, you could find yourself paying a lot of money if youre sick
or hospitalised overseas.

Recognised Providers
All service providers must be recognised with ahm Health Insurance before benefits are payable. Recognising a
provider means that they get specific details and credentials from providers to make sure they meet both ahm
Health Insurance and legislative criteria for benefit payment. Benefits wont be paid for services performed or
goods supplied by unrecognised practitioners or by a provider on themselves, their partner or dependants, business
partners or business partners partner or dependants. To find out if your service provider is recognised by ahm
Health Insurance use the online provider search tool at ahm.com.au/find-a-provider

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Did you know? (Read & Retain)

Extras Limits

Most extras benefits will have a limit which is a maximum amount you can claim in a specified period of time.
Limits are outlined in the benefits table of this policy and are per financial year unless otherwise stated. You can
check your benefit limits online at any time at ahm.com.au
NOTE: Limits not used in a claiming period dont roll over to the next claiming period.

Extras Limit Types

Per person limits

Where applicable, each person on a policy can claim up to the per person limit for the claiming period.

Extras Claiming Periods

Financial year - 1 July to 30 June. Your benefit entitlements are renewed at the beginning of each financial year.

Other Important Information

Cooling off period
If you terminate your policy within 30 days of joining and havent claimed a benefit during this period, youre
entitled to a full refund.
Resolution of problems
If you have any queries or feedback related to your ahm Health Insurance cover, please contact ahm Health
Insurance on 134 246 or email feedback@ahm.com.au
If you are not satisfied with ahm Health Insurances response you may contact the Private Health Insurance Ombudsman on 1800 640 695.
Privacy Policy
To obtain a copy of the ahm Health Insurance Privacy Policy go to ahm.com.au, email info@ahm.com.au or call
ahm Health Insurance on 134 246.
Disclaimer
The information contained in this document was accurate at the time of publication. Membership of ahm Health
Insurance is subject to ahm Health Insurances Fund Rules and policies. Premiums, benefits, Fund Rules and policies change from time to time. The information in this document only applies to ahm Health Insurance branded
products.

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TM

ahm Health Insurance proudly supports and complies with the Private Health Insurance
Code of Conduct. ahm Health Insurance is a business of Medibank Private Ltd ABN 47
080 890 259. ahm Health Insurance or ahm are references to Medibank Private Ltd
trading as ahm Health Insurance.

Resolution of problems
If you have any queries or feedback about any aspect of a health insurance product or iSelects service,
you can either call the consultant you dealt with or contact the Compliance Manager by telephone on
1300 735 255, and by email on compliance@iselect.com.au.
If you are not satisfied with iSelects response you may contact the Private Health Insurance Ombudsman
on 1800 640 695.

Privacy
For further information about iSelects privacy policy please visit iSelects web site: iSelect.com.au

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APPLICATION FORM
Please fax or mail pages 1 & 2 only. Fax: 1300 735 322 Mail: Reply Paid 2021, Moorabbin , Vic 3189
iSelect Health Pty Ltd ABN 87 088 749 955

WB

OFFICE USE ONLY

MEMBERSHIP NUMBER ISSUED BY FUND

New Membership

AGENT CODE: U60101

13696676

iSelect Client No.

Transfer Membership from another Fund

(Complete Transfer Authority on following page)

Mr/Mrs/Ms/Miss/Other: __________ Surname: ______________________________ Given name/s: _______________________

Date of Birth: 24-Jul-1987

(DD/MM/CCYY) Occupation:

Gender M / F

(circle one)

Address:
State: VIC

Town/Suburb:
Phone: Home: (

Work: (

Postcode:

Mobile:

Email address:

OTHER PERSONS TO BE COVERED

Given name & Initial

Date of birth

Surname

Sex

Relationship to Member

Student Dependant Declaration 1

Student Dependant Declaration 2

Name:

Name:

Educational Institution:

Educational Institution:

Student Id Number:
Full-time Student

Pre-existing conditions

Student Id Number:
Full-time Student

Part-time Student

Date Study Commenced:

Part-time Student

Date Study Commenced:

SELECTED PRODUCT/S
Type of Cover

Lite Cover

Co-payment Amount

Single Female

500.0
Cover commences on ______________________

(nominated date no more than 10 days prior)

Conditional on receipt of payment within 14 days.

60.25
Base Premium Quoted: $ ____________
0.00
Lifetime Health Cover Loading (if applicable): $ ____________
60.25 p/month inc 30.0% rebate
Total Premium: $ ______________
Prices are subject to change

DECLARATION (PLEASE SIGN THIS SECTION WHERE INDICATED)

You are applying for an ahm Health Insurance private health insurance policy with Medibank Private Limited ABN 47 080 890 259 under its Health
Benefits Fund and agree to be bound by the Rules of the Fund. You declare that all of the statements made in this application are true and complete
and understand we may refuse payment of benefits, and that Lifetime Health Cover loading may be affected, if any statements are false in any
respect. We reserve the right to vary our premiums, our private health insurance products or benefits payable, subject to the
and Rules. If you have paid premiums in advance, you will not be exempt from such changes. You consent to the collection, use and
disclosure of personal information in accordance with the ahm Privacy Policy You warrant that each named beneficiary has also given that consent.
This includes consent to collect any personal information about a named beneficiary from you, any other named beneficiary, medical practitioner or
health insurer. You completely indemnify us, related parties, our officers, employees and agents for any losses, damages or expenses that arise from
any allegation by any named beneficiary that their conduct, in acting in accordance with the ahm Privacy Policy, is without consent or otherwise
amounts to an interference with privacy.
By signing this I have read, and agree to, the above declaration.

Signature x

Date:

ahm Health Insurance is a business of Medibank Private Ltd ABN 47 080 890 259. 'ahm Health Insurance' or 'ahm' are references to Medibank Private Ltd trading as ahm Health Insurance.

Please fax or send pages 1 & 2 only

Fax: 1300 735 322

or call 1300735255
1

Mail: Reply Paid 2021, MOORABBIN, VIC 3189

APPLICATION FORM
MEDICARE ELIGIBILITY

DIRECT DEBIT REQUEST

Green Unrestricted Medicare card

Blue Interim Medicare card

Yellow Reciprocal Medicare card

NO MEDICARE CARD

Financial
Institution

Name as it appears
on Medicare card

Address of
financial
institution

My card number

Name of
account
holder(s)

Valid to

Australian Government Rebate on Private Health Insurance

I / we request that payments due to ahm Health Insurance, a business

of Medibank Private Limited (user id 010758) covered by this document,
be drawn under the Bulk Electronics Clearing System from my / our
account.

IMPORTANT INFORMATION
You will be sent an application form for the Australian
Government Rebate on Private Health Insurance. If you have
selected to receive the rebate as a reduction on your
premium, please ensure you complete and return the form to
ahm Health Insurance

BSB No

Account No

CREDIT CARD DETAILS

Visa

MasterCard

DIRECT CREDIT OF CLAIMS

If you'd like your claims paid directly into your account, please complete the
details below. Once you do this, you can use phone and internet claiming
services. Note: benefits cannot be paid into a credit card account.

Card No.
Expiry Date

:Name of Bank, Credit Union or Building Society

CHOICE OF PAYMENT FREQUENCY

Choice of - Fortnightly, Monthly or Yearly

Note: A statement of benefits is not issued, so you will need to

check your own account statements.

If you've chosen fortnightly, please choose a day of the week you'd

like ahm Health Insurance to draw your premiums
Mon _ Tues _ Wed _ Thurs _ Fri _

Name on a/c
BSB No.

Account No.

Signature x _________________________ Date: ________

TRANSFER AUTHORITY:
Please complete if you are switching health insurers

Fortnightly

Choose from Mon, Tue, Wed ,Thur, Fri

Monthly

Choose from 1-28th of month

Yearly

Choose from 1-28th of month

Disclaimer for payment by credit card or direct debit

Name of existing insurer ______________________________

Membership no _____________________________________
Date joined insurer: ___________________
Date paid to with insurer______________________
Name of insured person_________________________________
I hereby authorise ahm Health Insurance to terminate my policy with your
organisation and obtain full details about my policy. I also authorise ahm
Health Insurance on my behalf to obtain information, if appropriate from you in
respect of policy details including benefit payment.

Signature x

If you've chosen monthly or yearly, please choose a date from the

1st to the 28th on which you'd like ahm Health Insurance to draw
your premium each time it's due

I/we authorise ahm Health Insurance, a business of Medibank Private

Limited, to charge my health insurance premiums to my bank account/
credit card. In the event of changes to premiums, levels of cover or
arrears of payments to my policy, I/we authorise ahm Health Insurance
to alter the amount from the appropriate date in accordance with such
changes. A copy of our Direct Debit Request Service Agreement will be
sent to you upon receipt of these details. The first debit will cover your
standard premium plus any adjustments necessary to bring your policy in
line with your required debit date. For existing members any change to
debit dates may result in the next debit varying from the standard
deduction.
Signed in accordance with account/credit card authority.
If this is a joint account, both signatures are required

Signature x

Date:

Signature x

Date:

Date:

NOTE: Please remember to cancel your payments to your existing insurer

ahm Health Insurance is a business of Medibank Private Ltd ABN 47 080 890 259. 'ahm Health Insurance' or 'ahm' are references to Medibank Private Ltd trading as ahm Health Insurance.

Please fax or send pages 1 & 2 only

Fax: 1300 735 322

or call 1300735255
2

Mail: Reply Paid 2021, MOORABBIN, VIC 3189