AHM Health Insurance

Hospital cover

Hospital cover can pay towards services you receive when you’re admitted to hospital and treated as a private patient.

Here are the hospital services that are Included or Excluded under your cover.

You may still incur out-of-pocket expenses above the amount we pay. Before booking your treatment, call us to find out the benefits you can expect to receive, and any out-of-pocket expenses you might incur.

Services that are Included or Excluded

Rehabilitation ✔

Hospital psychiatric services ✔

Palliative care ✔

Brain and nervous system ✔

Eye (not cataracts) ✔

Ear, nose and throat ✔

Tonsils, adenoids and grommets ✔

Bone, joint and muscle ✔

Joint reconstructions ✔

Kidney and bladder ✔

Male reproductive system ✔

Digestive system ✔

Hernia and appendix ✔

Gastrointestinal endoscopy ✔

Gynaecology ✔

Miscarriage and termination of pregnancy ✔

Chemotherapy, radiotherapy and immunotherapy for cancer* ✔

Pain management ✔

Skin ✔

Breast surgery (medically necessary) ✔

Diabetes management (excluding insulin pumps) ✔

Heart and vascular system ✔

Lung and chest ✔

Blood ✔

Back, neck and spine ✔

Plastic and reconstructive surgery (medically necessary) ✔

Dental surgery^ ✔

Podiatric surgery (provided by a registered podiatric surgeon)+ ✔

Implantation of hearing devices ✔

Cataracts ✔

Joint replacements ✔

Dialysis for chronic kidney failure ✔

Pregnancy and birth ✔

Assisted reproductive services ✘

Weight loss surgery ✔

Insulin pumps ✔

Pain management with device ✔

Sleep studies ✔

* We will only pay towards cancer-related surgery related to an Included service under your cover.

What does it mean?

Included service ✔

An Included service is a service where we pay benefits towards overnight and same-day hospital accommodation, intensive care, and medical services where a valid Medicare Benefits Schedule (MBS) item is billed.

Excluded service ✘

An Excluded service is a service that we won’t pay any benefits towards, including any hospital accommodation or medical services.

Common and Support services

There are a number of Medicare Benefits Schedule (MBS) items that will also be included to support the services under this cover where a benefit is payable. These may include items like in-hospital consultations and some scans, tests and anaesthetics that are associated with your hospital admission.

Ambulance transport

Unlimited emergency ambulance transport Australia- wide. For ambulance transportation to a hospital where immediate professional attention is required and your medical condition is such that you couldn’t be transported any other way.

Accident and emergency departments

If you need to attend an accident and emergency department, we’ll pay 100% of any ‘facility fee’ charged by the hospital for attending their accident and emergency department.

The fee may not include all medical services provided and out-of-pocket expenses may apply such as for x-rays, blood tests and any charges raised by the doctor above the benefit we pay.

We do not pay towards cosmetic treatment or services without an MBS item. Under your cover, we pay limited benefits towards pharmaceuticals. You may have large out-of-pocket expenses if you require high-cost drugs, such as those used in oncology (cancer treatment).