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Budget Hospital and Super Extras Cover

ahm Health Insurance has been helping more than 350,000 people Australia wide look after their health for over 40 years. Effective July 1 2012

1300 794 535

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Palliative care. Podiatric surgery Other excluded services . Level of cover Waiting period 1 day for treatment that is the result of an accident 2 months (unless pre-existing) 2 months (unless pre-existing) 2 months (unless pre-existing) 2 months 2 months (unless pre-existing) 1300 794 535 iselect. Restrictions: The Default (minimum) benefit only is paid for restricted services in either a private or public hospital. Please call us to check your cover before going to hospital.g.. cataracts and lens related procedures Obstetrics/Pregnancy and birth related services Assisted reproductive e. If you are treated in a non -agreement hospital only the Default (minimum) benefit applies.ahm Budget Hospital Your hospital benefits Benefit Accommodation (public hospital only for restricted services) Theatre costs (public hospital only for restricted services) Intensive care (public hospital only for restricted services) Dialysis Grommets.com. Tonsillectomy or Appendectomy Heart-related services Hip and Knee replacements All other joint replacements Major eye surgery e. yellow reciprocal or no Medicare card. illness or condition that in the opinion of a Medical Practitioner appointed by ahm Health Insurance. partner day surgery or public hospital. some of the benefits outlined may not be available to you. The insurer to which you transfer must give you credit for the waiting periods you have already served for comparable benefits. GIFT Obesity surgery . for the same or a lower level of benefits.au ahm071202 . without serving additional waiting periods. Waiting periods The Government sets the maximum time that health insurers are able to make members wait until they can claim benefits for hospital treatment. rehabilitation and palliative care whether or not there is a pre-existing condition • 2 months in all other circumstances Pre existing conditions A pre-existing condition is an ailment.Male & Female All other in-hospital services where a Medicare benefit is payable Other restricted services . These maximums are: • 12 months for pre-existing conditions • 12 months for obstetric cases • 2 months for psychiatric. the signs or symptoms of that ailment. Transferring between insurers You can transfer from one health insurer to another. Blue interim.including gastric banding Pharmaceuticals – in hospital Prostheses – surgically implanted Psychiatric services – in hospital Rehabilitation services – in hospital Sterility reversal . illness or condition existed at any time in the period of 6 months ending on the day on which the person became insured under the policy or changed their cover. IVF.g.Spinal fusion You are covered when treated at a partner private hospital. Exclusions: No benefit is paid for these services. Yellow Reciprocal or no Medicare card If you have a blue interim.

Queensland or Tasmania.com. $1. However we do cover the costs for any interstate ambulance if not covered by the state scheme. so if you live in NSW.ahm Budget Hospital Ambulance You’re covered for medically necessary ambulance transport and services including air ambulance such as CareFlight. ACT. 1300 794 535 iselect. any remaining excess (up to the maximum limit) must be paid for any subsequent admissions in the same membership year.au ahm071202 . you’re entitled to a lower premium. If you live in Tasmania or Queensland you’re already covered by your state’s scheme. Some state governments however. Your Excess Payment Amount $500 $500 payable per person on the first admission per membership year. to the nearest hospital that’s able to provide the level of care you need.so if you hold a pension or health care card. Pensioners are exempt from this levy . If you live in NSW or ACT your cover includes a levy to the ambulance service. please take note of the following.000 is the maximum you will pay in a membership year for a couple or family policy. $500 is the maximum you will pay in a membership year for a single policy. If the charge for the first hospital admission is less than the excess. Just send us a copy of your card and we’ll reduce your premiums from the date we receive the copy. have their own schemes in place. i NOTE: Excess does not apply to ambulance transportation and we don’t pay benefits towards ambulance subscriptions.

per pontic Bridge . 1 surface Adhesive restoration.80 100% By specialist 70% By GP Financial year limit Waiting period No annual limit None Combined limit 1 to 4 years $1.80 $153.indirect Full crown . home application .each additional canal Orthodontic complete course Maxillary expansion appliance Passive removable appliance .au ahm071201 .75 $189.50 $68 $86 $102 $22.direct Veneer .com.indirect .70 $62.55 $60.10 $276.60 $386.per tooth Occlusal splint Bleaching.per arch Benefit $41 $26 $26 $67 $123.ahm Super Extras Examples of your dental benefits Item Service description no 011 022 121 114 322 323 324 531 532 533 118 965 119 582 583 615 711 712 719 642 643 415 416 417 418 881 843 811 Comprehensive oral examination (2 per person per year) 1 X Ray Fluoride treatment Removal of calculus .400 per person *These limits will increase with increased years of membership 1300 794 535 iselect.75 $105.000 per person* $2.95 $140 $64.100 per person* $2.veneered .750 per family* 12 months Combined limit 1 to 4 years $1.60 $431.500 per family* 1 to 2 years $800 per person* Lifetime limit of $2.direct .indirect Complete maxillary denture Complete mandibular denture Complete maxillary and mandibular denture Bridge .90 $139. external .first visit (3 per year) Surgical removal of a tooth Surgical removal of a tooth (including bone) Surgical removal of a tooth (including bone and tooth division) Adhesive restoration. 2 surfaces Adhesive restoration.per pontic Complete chemo mechanical preparation of root canal one canal Complete chemo mechanical preparation of root canal each additional canal Root canal obturation . 3 surfaces Bleaching.per arch Veneer .one canal Root canal obturation .55 $588 $406 $406 $812 $220.

ahm Super Extras Your optical benefits Service description Frames Single vision lenses Bifocal lenses Progressive lenses Contact lenses Disposable contact lenses Benefits payable for scripted sight correcting products only *These limits will increase with increased years of membership $250 Combined limit 0 to 4 years $250 per person* No annual limit for family Benefit Financial year limit Waiting period None Your therapeutic benefits Service description Chiropractic Osteopathy Physiotherapy Group hydrotherapy. $44 $34 Combined limit 0 to 4 years $300 per person per therapy* $750 per family per therapy* Initial consultation** Subsequent consultation Financial year limit Waiting period $60 $32 $34 $38 $32 $30 $25 $30 $30 $25 1300 794 535 iselect. antenatal exercises and rehabilitation Psychology Hypnotherapy Speech therapy Eye therapy Occupational therapy Podiatry Audiology Naturopathy Homeopathy Exercise physiology Acupuncture Herbalism Remedial massage Reflexology Bowen therapy Chinese medicine Alexander technique *These limits will increase with increased years of membership **1 initial consultation per person per therapy per financial year $28 $28 Combined limit $400 per person $800 per family None $81 $46 Combined limit 0 to 4 years $300 per person per therapy* $750 per family per therapy* None $17 per class Benefits only paid where service is performed by an ahm recognised physiotherapist.com. pilates.au ahm071201 .

per rolling year# Waiting period None Up to $60 each item above the general patient PBS amount $800 per aid $50 per repair $105-$160 $26 per class $125 per course $100 per unit $120 per procedure $320 per injection 12 months None 12 months $1. Hyalagan Benefit Financial year limit 0 to 4 years $500 per person* $1.au ahm071201 .ahm Super Extras Myotherapy Feldenkrais Kinesiology Biochemistry Shiatsu Kinesiology Rolfing Aromatherapy Orthotics Purchased from an ahm recognised podiatrist or orthopaedic supplier only Yoga Chinese massage Iridology Swedish massage Medicine Remedies Not Covered 100% of cost back $200 per person $400 per family 12 months $28 $28 As stated above on previous page None Your other benefits Service description Pharmacy Including general items^. contraceptives for medical reasons and preventive/travel vaccines Hearing Aids Post operative and medical aids Maternity# Pre and post natal consultations Birthing courses (provided by a registered midwife) Medical Gases Per unit (such as oxygen) Outpatient room fees Joint Fluid Replacement Injections e. OsteoArtz. vitamins and herbal medicines # A rolling year begins on the date a service was first provided with the limit applying to that 12 month period * These limits will increase with increased years of membership 1300 794 535 iselect.com.000 per family* $1. per rolling year # 12 months None 12 months ^ Excludes PBS scripts.600 per person (per 3 financial years) No family limit $300 per person $600 per family $300 per person. over the counter or off the shelf medicines.200 per person $360 per person $720 per family $640 per person. hormonal implants.g Synvisc.

30+ sunscreen. Quit Smoking (per course) Quit Smoking (Laser acupuncture therapy) Quit Smoking Nicotine replacement therapy Patches.au ahm071201 . With medical evidence of a BMI of 26 or over for adults and an unhealthy BMI for children. gums.) ahm Health Risk Assessment ahm Health Coaching Program Benefit Initial consultation $45 Subsequent consultation $32 $10 Financial year limit Waiting period Combined limit $400 per person $1. swimwear. Colitis. Arthritis.ahm Super Extras Your health improvement benefits Service description Dietitian and nutritionist Weight Loss (per class) Weight Loss (per course) When delivered by an ahm recognised provider only. inhalers Disease Management association fees Per association .Doctor health checks and Healthy Heart checks limited to 1 per person per financial year Exercise Classes Gym. hats and sunglasses Receipt must identify the item as Cancer Council approved Stress Management (per course) (provided by an ahm recognised psychologist or other ahm recognised provider) Preventative Tests Per test .Asthma. bowel cancer tests and scans. Diabetes. Heart. Coeliac.com. Ostomy and Crohn’s disease Cancer council UV products Per item . lozenges.000 per family None $100 $110 $110 $60 per item $52 $52 Combined limit $250 per person $625 per family None $100 Up to $65 $60 $16 per class $250 per course 1 per 12 months 1 per 6 months 100% 1 day 1300 794 535 iselect.mammograms. pilates and exercise physiology (when part of an ahm or recognised health management program and by an ahm recognised provider. skin cancer screenings. bone mineral density tests Health Checks Per check . yoga.

and • you’re admitted to hospital and choose to be treated as a private patient.You’re treated at a non-agreement private hospital.com.You’re treated in a private hospital for a restricted service. illness or condition. we’ll need 5 working days to make the assessment so you should allow this into your timeline when you agree to a hospital admission date. the signs or symptoms of that ailment.Did you know? Waiting Periods A waiting period means you will need to wait for a specified time before you’re eligible to make a claim after joining as a new member or changing your level of cover. Accidents An accident is defined as an unplanned or unforeseen event resulting in bodily injury that requires immediate medical treatment in a hospital. Newly born infants To be eligible for benefits towards the hospitalisation of your newborn child you must have a family or single parent family policy. . you’ll need to change to a single parent family or family policy at least two months before the baby’s birth.au/Hospital-Network.Your doctor/s do not participate in GapCover and charge above the Medicare Benefits Schedule Fee. Assuming that we receive all the information required from your treating medical practitioner(s). . . 1300 794 535 iselect. Pre-existing ailments or conditions A pre-existing condition is an ailment. The appointed Medical Practitioner is the only person authorised to decide if an ailment is pre-existing. If you’re admitted to hospital for an emergency. you’ll be required to pay any hospital and medical charges not covered by Medicare. illness or condition that in the opinion of a Medical Practitioner appointed by ahm Health Insurance. we may not have time to assess if the pre-existing rule applies. and • your condition is later determined to be pre-existing. illness or condition existed at any time in the period of 6 months ending on the day on which the person became insured under the policy or changed their cover.You choose a prosthesis that costs more than the minimum benefit listed in the Federal Government’s Prostheses List.au ahm071203 . As a result you may have to pay for all or some of the hospital and medical charges if: • you’ve held your current level of hospital cover with us for less than 12 months. If you’re admitted into hospital without confirming your benefit entitlements and your condition is subsequently determined as pre-existing. If you’re switching private health insurers. Out of pocket expenses Out-of-pocket expenses may occur if: .com. If you’re having a baby and you have a single policy. the good news is ahm Health Insurance will recognise waiting periods already served for comparable benefits.ahm. Partner private hospitals For a list of partner private hospitals in your state go to: www. They must consider any information that was provided by the medical practitioner who treated the ailment.

If you choose a prosthesis that costs more than the minimum benefit listed in the Federal Government Prostheses List. you’ll have to pay the difference between the minimum benefit and the prosthesis charge. lives with that person of a bona fide domestic basis and includes a same-sex partner.com. This person is responsible for the payment of premiums under a policy issued by ahm. then your baby will have to serve all waiting periods. Health insurance policy Acceptance of a policy application and continued eligibility for health insurance is conditional on the requirement that no person on the policy also has an active hospital or extras cover with another private health insurer.Did you know? This rule also applies to premature births. Dependant Adults your child is aged 18 and over and under 25 and they’re single and not a full-time student. Single parent policy a policy that includes two or more persons. Some members choose to have a home birth. Call 134 246 for more information and a list of eligible policies. studying full-time and not working full-time. Partner a partner of a person is the person’s husband or wife or a person who. An additional premium applies to keep your child covered as an adult dependant and is not available on all cover types. although not married to the person. Single policy a policy that includes only one person (the principal member). NOTE: The 12 month waiting period for obstetrics and pregnancy related services starts from the date you first join the appropriate cover. This person has the authority to terminate the policy and add or delete persons from the policy. Principal member is the first named member of a policy. Family policy a policy that includes an adult who is the principal member. If you wait until less than 2 months prior to birth or after the birth of your baby to change your cover. ahm Basic Hospital. Adult Child Dependants your child aged 18 and over and under 21 years can be covered on a family or single parent family policy if they’re single and not working full-time. 1300 794 535 iselect.au ahm071203 . Charges above the MBS fee are usually paid by the patient. their partner and any dependants of the principal member or their partner. Health insurers pay the gap up to the MBS fee for inpatient hospital related medical services. Dependants Child Dependants your child can be covered by a family or single parent family policy until the age of 18 years if they’re single. regardless of whether you are pregnant or not when joining. one of whom is the principal member and the other insured persons are dependants of the principal member. Medical gap payments The medical gap is the difference between what Medicare pays. the Medical Benefits Schedule (MBS) fee and the fee your doctor charges. ahm Top Hospital and ahm Family Hospital covers will pay a benefit towards midwife assisted deliveries in the home. ahm Essential Hospital and ahm First Step only pay a default (minimum) benefit for obstetrics. ahm Budget Hospital does not pay benefits for obstetrics. if your doctor(s) participates in the scheme. Student Dependants your child aged 21 and over and under 25 years can be covered on a family or single parent family policy if they’re single. GapCover means you will have out-of-pocket expenses reduced or removed when medical services are charged above the MBS fee. Prostheses ahm Health Insurance cover up to the minimum benefit for surgically implanted prostheses.

Extras Claiming Periods Financial year . Extras Limits Most extras benefits will have a limit which is a maximum amount you can claim in a specified period of time. with premiums being subject to approval by the Minister for Health and Ageing. This means that changes to benefits or premiums may take effect during your payment period. their partner or dependants.ahm. Without adequate travel insurance.au) NOTE: Limits not used in a claiming period don’t roll over to the next claiming period.1 July to 30 June. even if you change your cover. Benefits won’t be paid for services performed or goods supplied by unrecognised practitioners or by a provider on themselves. If you’re travelling overseas.au ahm071203 . ahm Health Insurance reserves the right to vary its premiums and benefits during the year. All information is subject to the fund rules for ahm products. Family limit Benefits are payable up to the family limit indicated in the benefits table for the claiming period. and premiums and claims will be accepted and paid in accordance with these rules. Extras Limit Types Per person limits Where applicable. Members who pay premiums in advance won't be exempt from such changes. prior to the date that your policy is financial. each person on a policy can claim up to the ‘per person’ limit for the claiming period except where the family limit has already been used by other members on the policy. Your benefit entitlements are renewed at the beginning of each financial year. business partners or business partners’ partner or dependants. call ahm Health Insurance on 134 246 so that we can help you arrange travel insurance at discounted rates. including online purchases from overseas companies.Did you know? Overseas benefits Your ahm Hospital policy doesn’t cover you for any medical. You can check your benefit limits online at any time (www. This brochure should be read in conjunction with the relevant ahm Policy document. Disclaimer The information contained in this document was accurate at the time of publication.com. you can no longer claim that benefit in any future year of membership. Recognised Providers All service providers must be recognised with ahm Health Insurance before benefits are payable. hospital or ambulance services received overseas or goods purchased outside of Australia. Per person limits also apply. Lifetime limit A benefit with a lifetime limit means that once you reach the limit.com. Limits are outlined in the benefits table of this policy and are per financial year unless otherwise stated. you could find yourself paying a lot of money if you’re hospitalised overseas. Recognising a provider means that we get specific details and credentials from them to make sure they meet ahm Health Insurance and legislative criteria for benefit payment. 1300 794 535 iselect.

you can either call the consultant you dealt with or contact the Compliance Manager by telephone on 1300 735 255. If you are not satisfied with iSelect’s response you may contact the Private Health Insurance Ombudsman on 1800 640 695. ahm Health Insurance is a business of Medibank Private Ltd ABN 47 080 890 259. Resolution of problems If you have any queries or feedback about any aspect of a health insurance product or iSelect’s service.com.com.TM ahm Health Insurance proudly supports and complies with the Private Health Insurance Code of Conduct.com. ‘ahm Health Insurance’ or ‘ahm’ are references to Medibank Private Ltd trading as ahm Health Insurance. Privacy For further information about iSelect’s privacy policy please visit iSelect’s web site: iSelect.au .au 1300 794 535 iselect.au. and by email on compliance@iselect.