Extras
Contents
Welcome to ahm Health Insurance ...3
We’ve got the right cover for you ...4
Waiting periods ...7
Basic Extras ...9
Lifestyle Extras ...10
Family Extras ...12
Super Extras ...14
Claiming your Extras benefits ...16
a healthy me ...19
Health improvement benefits ...23
Online member services ...25
You could save on premiums ...26
Your membership ...27
How to pay ...29
Important information and definitions you need to know ...30
Feedback ...34
ahm Privacy Statement ...35
Private Health Insurance
Code of Conduct
We adhere to the Private Health Insurance Code of Conduct. This is a self-regulatory code that promotes informed relationships between private health insurers, consumers, agents and brokers.
Our documents display the PHI Code of Conduct logo. This shows that we comply with the Code and have been authorised by the Code Compliance Committee to use the logo. If you’d like more information about the Code – or if you’d like your own copy of the Code – call one of our friendly staff on 134 246 or go to ahm.com.au
Important note
The information contained in this document is current at the time of issue October 2012 and supersedes previously published material. Please ensure you read this document thoroughly and retain a copy for your reference. Membership of ahm Health Insurance is subject to our Fund Rules and policies which are summarised in this document. Premiums, benefits, Fund Rules and policies change from time to time. The information in this document only applies to ahm Health Insurance branded products. Policies of insurance issued under, or on the terms of, any products described in this publication are referable to the Medibank Private Limited (ABN 47 080 890 259) health benefits fund.
At ahm Health Insurance we understand that health insurance can sometimes be confusing, with so many different options, benefits and rules. By choosing ahm Health Insurance you can be assured that our Cover Specialists will help you choose a level of cover that matches your needs and help you understand what you’re covered for.
More value from your cover
At no extra cost, you can access an integrated suite of health management programs, to help improve and maintain your heath and wellbeing. You can receive personalised advice, support and motivation online, by phone or email and save time managing your health with a trusted team of qualified consultants and experts.
You don’t have to wait
No waiting periods apply on some of our most popular extras services like Physiotherapy, Optical, or Routine Dental. So you can join today and claim today.*
You can count on us to help you use your extras
We want to make sure you’re getting the most of your Extras cover, so from time to time we contact our members if we notice they’re not claiming.You can come to us for easy, friendly and helpful advice
The ahm Health Insurance team have been looking after the health of Australians for more than 40 years and each of our recognised health providers are accredited in their field. Our friendly staff are just a phone call away to help you understand, make the most of your insurance and make sure your level of cover is right for you.You can manage your health insurance 24/7
Our online member services allow you to claim for most paid ahm Extras, pay your premiums, check your benefit limits and more.
You’re rewarded the longer you stay with us
Some of our Extras covers include loyalty limits which means the longer you’re with us, the more you can claim.
*Other waiting periods apply. Extras are subject to benefit limits. You can only claim once you have paid your first premium.
Welcome to
ahm Health Insurance
Already covered?
No worries!
If you’re switching private health insurers, we will recognise any waiting periods served for comparable benefits. Plus there are no two or six month waiting periods on any ahm Extras covers!Note: Other waiting periods may apply, please see page 7 for details.
ahm Health Insurance (formally Australian Health Management) was named Best Health Insurer in the Australian Financial Review’s Smart Investor SMILES Survey 2011/2012.
2011 / 2012 Voted best health insurer
We’ve got the right cover for you
Basic Extras – pays benefits on our most popular extras services such as routine dental, optical, physiotherapy and remedial massage plus a range of health improvement benefits.
Lifestyle Extras – our most popular Extras cover includes all the benefits you get on Basic Extras plus also covers you for complex and major dental, psychology and 17 different complementary and alternative therapies.
Family Extras – perfect if you have a growing family, this cover has all our most popular benefits with higher limits so that the whole family can claim more on the services they use.
Super Extras – our highest level of cover is perfect for those that want to receive the most back. It includes benefits for all services covered on our other covers with the best benefits and highest limits.
At ahm Health Insurance, we offer a range of different Extras covers to meet your individual needs. Whether you just want the basics covered on our most popular extras services or higher benefits on a larger range of services, we can keep you and your family covered in a way that suits you.
Our Extras covers have set benefits for services so that you know exactly how much you’ll get back each time you visit a service provider.
Generally, the higher your level of cover the more you’ll be able to get back.
Our Extras covers
Choose a cover that suits you best
Your ahm Extras policy covers you for things like dentist visits, prescription glasses or physiotherapy. However if you want peace of mind knowing that you’re covered if you need to go to hospital or if you’re looking to avoid paying the Medicare Levy Surcharge or Lifetime Health Cover loading, you’ll need hospital cover.
Like our Extras covers, we offer a range of Hospital covers that are designed to suit different needs.
You can combine any of our Hospital covers with any Extras cover so that you choose a cover that’s just right for you.
The right cover for you
For more information on ahm Hospital covers, please call us on 134 246. One of Budget Hospital Basic Hospital Family Hospital Essential Hospital Top Hospital
Hospital cover
One of Basic Extras Lifestyle Extras Family Extras Super ExtrasExtras cover
The services available for each of our cover types
The following table provides a summary of what each Extras cover includes, for more detail including the benefits and annual limits that apply to each service, please refer to the enclosed ahm Extras Benefit Chart.
Basic Lifestyle Family Super Routine dental
Physiotherapy, chiropractic and osteopathy Complementary and alternative therapies (naturopathy, homeopathy, acupuncture, herbalism and remedial massage) Optical (frames, lenses and repairs) Diet and nutrition (dietitian and nutritionist, weight loss1)
Health improvement benefits
(quit smoking, Cancer Council UV products, disease management association fees, health checks) Stress management courses, preventive tests, exercise classes2
Pharmacy
Major and complex dental 3
Orthodontics Psychology and hypnotherapy
Laser eye surgery (sight correcting) Complementary and alternative therapies (reflexology, feldenkrais, rolfing, bowen therapy, alexander technique, kinesiology, biochemistry, traditional Chinese medicine, shiatsu, myotherapy and aromatherapy)
Speech therapy, occupational therapy and eye therapy Podiatry and orthotics
Swimming lessons and training 0-17 years4
Hearing aids
Pre and post natal services and birthing courses Medical gases and joint fluid replacement injections
Audiology
Outpatient procedure room fees, post operative and medical aids
1 ahm recognised providers only. Medical evidence of a BMI of 26 or over required for adult claims and an unhealthy BMI for children’s claims.
2 Where part of an ahm or recognised health management program and provided by an ahm recognised provider. 3 Doesn’t include dentures.
4 By an Austswim® or Swim Australia accredited swim school with evidence of asthma, diabetes, an unhealthy BMI or a doctor’s recommendation to undertake this activity due to their condition.
Waiting Periods
When you take out Extras cover or change your level of cover, you may have to wait a set period of time before you can claim for services and benefits you weren’t previously covered for.
The good news is that there are no two or six month waiting periods on any ahm Extras covers so you’ll be able to start claiming straight away on many benefits including routine dental, optical, physiotherapy, chiropractic and osteopathy and complementary and alternative therapies including naturopathy and remedial massage.
If you change your cover and your new level of cover has additional or higher benefits on services where waiting periods of 12 months or more apply, you will still have to serve these waiting periods.
The following table outlines the waiting periods that apply to our Extras policies. Please note, some services may not be available on all covers, please refer to pages 9-15 to confirm whether a benefit is paid on your level of cover.
1 day > Emergency ambulance
> ahm Health Management Programs
12 months
> Complex dental benefits >Major dental benefits >Orthodontics >Podiatric surgery
>Orthotics and orthopaedic shoes >Hearing aids
>Pre and post natal services >Medical gases
>Joint fluid replacement injections 2 years
>Refractive sight correcting laser eye surgery
(You need to have held Lifestyle Extras or Super Extras for 2 years before you’re entitled to this benefit)
Extras covers
Basic Extras ... 9
Lifestyle Extras ... 10
Family Extras ... 12
Basic Extras
Basic Extras is a great choice if you want cover that pays benefits towards some of the most popular services such as routine dental, optical and physiotherapy.
What you’re covered for
To find out what benefits and limits you receive for each of the services below please refer to the ahm Extras Benefit Chart included with this policy document.
> Routine dental > Optical
Frames, lenses and repairs > Physiotherapy
> Chiropractic > Osteopathy
> Complementary and alternative therapies Remedial massage Naturopathy Homeopathy Acupuncture Herbalism Exercise physiology > Diet and nutrition*
Dietitian and nutritionist consultations Weight loss classes
> Health improvement benefits* Quit smoking benefits
Cancer Council UV products Preventive tests
Health checks
Stress management courses
Disease management association fees Exercise classes
> Pharmacy
> Emergency ambulance
Lifestyle Extras
Looking for a cover that gives you great value and lets you claim for 17 different complementary and alternative therapies? Then our popular Lifestyle Extras is for you. It includes all our most popular extras services with higher benefits than Basic, plus you can also claim for complex and major dental (excluding dentures), psychology and sight correcting laser eye surgery. A number of the services also include loyalty limits which means that the longer you stay with us, the more you can claim.
What you’re covered for
To find out what benefits and limits you receive for each of the services below please refer to the ahm Extras Benefit Chart included with this policy document.
> Routine dental
> Complex and Major dental (excluding dentures)
> Orthodontics > Optical
Frames, lenses and repairs Refractive sight correcting laser eye surgery
> Physiotherapy > Chiropractic > Osteopathy
> Complementary and alternative therapies Remedial massage Naturopathy Homeopathy Acupuncture Herbalism Exercise physiology Reflexology Feldenkrais Rolfing Bowen therapy Alexander technique Kinesiology Biochemistry
Traditional Chinese medicine Shiatsu
Myotherapy Aromatherapy
> Psychology and hypnotherapy > Diet and nutrition*
Dietitian and nutritionist consultations
Weight loss classes > Health improvement benefits*
Quit smoking benefits Cancer Council UV products Preventive tests
Health checks
Stress management courses Disease management association fees
Exercise classes > Pharmacy
> Emergency ambulance
Get more the longer you stay with us
Lifestyle Extras include loyalty limits which are based on the number of financial years you’ve been a member of ahm Health Insurance. This means your annual claiming limit for some of our most popular extras benefits will increase after you’ve been with us for over 5, 10 and 20 years.
To find out more about how loyalty limits work, see page 18. For details on the limits see below.
< 5 years 5+ years 10+ years 20+ years
Complex Dental
Per person limit combined $600 $700 $800 $900
Family limit $1,200 $1,400 $1,600 $1,800
Major Dental
Per person limit combined $750 $900 $1,100 $1,300
Family limit $1,500 $1,800 $2,200 $2,600
Physiotherapy, Osteopathy and Chiropractic
Per person limit per therapy $300 $350 $400 $450 Family limit per therapy $750 $875 $1,000 $1,125 Psychology and hypnotherapy
Per person limit $250 $275 $300 $325
Family limit $500 $550 $600 $650
Pharmacy – general items, hormonal implants, contraceptives and preventative/travel vaccines
Per person limit combined $350 $400 $450 $500
Family limit $700 $800 $900 $1,000
Orthodontics
Orthodontic benefits increase after you’ve been with us after 3 and 5 years
< 3 years 3-4 years 5+ years
Family Extras
If the kids need braces or speech therapy or you need to attend pre or post natal classes then Family Extras is for you. It also gives you access to a wide range of services such as routine and major dental, optical, physiotherapy, other therapies and plus a range of health improvement benefits.
What you’re covered for
To find out what benefits and limits you receive for each of the services below please refer to the ahm Extras Benefit Chart included with this policy document.
> Routine dental > Complex and Major
dental > Orthodontics > Optical
Frames, lenses and repairs > Physiotherapy > Chiropractic > Osteopathy > Complementary and alternative therapies Remedial massage Naturopathy Homeopathy Acupuncture Herbalism Exercise physiology > Psychology and hypnotherapy > Speech therapy > Occupational therapy > Eye therapy (Orthoptics) > Podiatry
> Orthotics and orthopaedic shoes
> Hearing aids > Maternity options
Pre and post natal consultations and classes
Birthing courses (provided by a registered midwife) > Diet and nutrition*
Dietitian and nutritionist consultations Weight loss classes
> Health improvement benefits*
Quit smoking benefits Cancer Council UV products Preventive tests Health checks Stress management courses Swimming lessons Disease management association fees Exercise classes > Travel and accommodation > Medical gases > Joint replacement injections > Pharmacy > Emergency ambulance
Get more the longer you stay with us
Family Extras include loyalty limits which are based on the number of financial years you’ve been a member of ahm Health Insurance. This means your annual claiming limit for some of our most popular extras benefits will increase after you’ve been with us for over 5, 10 and 20 years. To find out more about how loyalty limits work, see page 18. For details on the limits see below.
< 5 years 5+ years 10+ years 20+ years Routine Dental
Per person limit combined $500 $550 $600 $650
Family Limit $1,250 $1,375 $1,500 $1,625
Complex Dental
Per person limit combined $600 $700 $800 $900
Family Limit $1,500 $1,750 $2,000 $2,250
Major Dental
Per person limit combined $750 $900 $1,100 $1,200
Family Limit $1,750 $2,250 $2,750 $3,000
Physiotherapy, Osteopathy and Chiropractic
Per person limit per therapy $250 $275 $300 $325
Family limit per therapy $625 $675 $750 $850
Psychology and hypnotherapy, speech therapy, occupational therapy, eye therapy & podiatry
Per person limit per therapy $250 $275 $300 $325
Family limit per therapy $625 $675 $750 $850
Pharmacy – general items, hormonal implants, contraceptives and preventative/travel vaccines
Per person limit combined $350 $400 $450 $500
Family limit $700 $800 $900 $1,000
Orthodontics
Orthodontic benefits increase after you’ve been with us after 3 and 5 years
< 3 years 3-4 years 5+ years
Super Extras
If you’re after a top level of cover offering high limits and benefits then Super Extras is for you. It offers everything included on all our other Extras covers and more, with higher limits and the best benefits.
What you’re covered for
To find out what benefits and limits you receive for each of the services below please refer to the ahm Extras Benefit Chart included with this policy document.
> Routine dental > Complex and Major
dental > Orthodontics > Optical
Frames, lenses and repairs
Refractive sight correcting laser eye surgery > Physiotherapy > Chiropractic > Osteopathy > Complementary and alternative therapies Remedial massage Naturopathy Homeopathy Acupuncture Herbalism Exercise physiology Reflexology Feldenkrais Rolfing Bowen therapy Alexander technique Kinesiology Biochemistry Traditional Chinese medicine Shiatsu Myotherapy Aromatherapy > Psychology and hypnotherapy > Speech therapy > Occupational therapy > Eye therapy (Orthoptics) > Podiatry
> Audiology
> Orthotics and orthopaedic shoes
> Hearing aids > Post operative and
medical aids > Outpatient procedure
room fees > Maternity options
Pre and post natal consultations and classes
Birthing courses (provided by a registered midwife) > Diet and nutrition*
Dietitian and nutritionist consultations Weight loss classes
> Health improvement benefits*
Quit smoking benefits Cancer Council UV products Preventive tests Health checks Stress management courses Swimming lessons Disease management association fees Exercise classes > Travel and accommodation > Medical gases > Joint replacement injections > Pharmacy > Emergency ambulance
Get more the longer you stay with us
Super Extras include loyalty limits which are based on the number of financial years you’ve been a member of ahm Health Insurance. This means your annual claiming limit for some of our most popular Extras benefits will increase after you’ve been with us for over 5, 10 and 20 years. To find out more about how loyalty limits work, see page 18. For details on the limits see below.
< 5 years 5+ years 10+ years 20+ years Complex Dental
Per person limit combined $1,000 $1,100 $1,200 $1,300
Family limit $2,500 $2,750 $3,000 $3,250
Major Dental
Per person limit combined $1,100 $1,300 $1,500 $1,700
Family limit $2,750 $3,250 $3,750 $4,250
Physiotherapy, Osteopathy and Chiropractic
Per person limit per therapy $300 $350 $400 $450 Family limit per therapy $750 $875 $1,000 $1,125 Psychology and hypnotherapy, speech therapy, occupational therapy, eye therapy, podiatry and audiology
Per person limit per therapy $300 $350 $400 $450 Family limit per therapy $750 $875 $1,000 $1,125 Optical – frames, single lens, bi-focal, multi-focal, contact lenses, repair to frames or lenses
Per person limit combined $250 $275 $300 $325
Family limit No limit No limit No limit No limit
Pharmacy – general items, hormonal implants, contraceptives and preventative/travel vaccines
Per person limit combined $500 $550 $600 $650
Family limit $1,000 $1,100 $1,200 $1,300
Orthodontics
Orthodontic benefits increase after you’ve been with us after 3 and 5 years
< 3 years 3-4 years 5+ years
Claiming your Extras benefits
We’ve made claiming easy by providing a range of options so that you can choose the claiming method that suits you.
There are some rules though, so we’ve provided you with details of these and how to claim on the following pages.
We can only pay a claim if:
> the service is performed by an ahm recognised provider > the service date on the receipt is less than two years old > an original receipt or invoice is submitted to and kept by ahm
> your claim is not payable or subsidised by a third party such as workers compensation unless an authority has been completed
> your policy is financial on the date of service.
How to claim
Most extras service providers offer the convenience of HICAPS (Health Insurance Claiming and Processing System) using your member card. You just pay any remaining balance directly to the provider so there’s no need to submit anything to us. If your service provider doesn’t offer HICAPS you can use one of the following services we provide:
ONLINE
You can make a claim any time you want if you’ve already paid for the service by visiting the online members’ section at ahm.com.au. Claiming for most extras benefits is easy and can be completed in three easy steps.
1. Log in to the members’ section at ahm.com.au and enter your claim details 2. We’ll deposit your benefit into your nominated account within two working days
3. We’ll send you a letter to confirm your claim, so make sure your contact details are up to date. You need to attach your original receipt/s to this letter and send it back to us. If you’ve lost your receipts, you can contact your service provider for duplicates.
OvER THE PHONE
If you’d prefer to speak to someone, the ahm team can process most extras benefits over the phone as long as you’ve already paid for the service.
1. Call us on 134 246 to provide your claim details
2. We’ll deposit your benefit into your nominated account within two working days
3. We’ll send you a letter to confirm your claim, so make sure your contact details are up to date. You need to attach your original receipt/s to this letter and send it back to us. If you’ve lost your receipts, you can contact your service provider for duplicates.
NOTE: There’s a $500 limit for claims made online or over the phone. If you reach this limit, you can’t make any more claims online or over the phone until we have received your receipts. Once we’ve received your receipts and verified your claims, you can start claiming again.
POSTAL – PAID CLAIMS 1. Fill in a Claim form
2. Make sure you attach your original receipts (these won’t be returned to you) 3. Mail to: ahm Health Insurance, Locked Bag 1006, Matraville NSW 2036.
We can either deposit the benefit in your bank account or send you a cheque. If you’ve lost your original receipts, contact your service provider for duplicates before you claim.
POSTAL – UNPAID CLAIMS
1. If you haven’t paid the bill – fill in a claim form, attach the bill and mail it to us 2. We’ll send you a cheque that’s payable to your service provider
3. When you receive the cheque, you must send it to the provider and include any additional amount that you may be required to pay.
Claim forms can be downloaded from ahm.com.au or call us on 134 246 to have them posted to you.
Annual limits
This is the maximum amount we’ll pay for items or services in a 12 month period. Unless stated otherwise, annual limits on our ahm Extras are for the financial year period (1 July – 30 June) and all benefit entitlements are renewed at the beginning of each financial year (unless you’ve already reached your lifetime limit (where applicable)).
We’ve outlined the limits that apply to all our Extras covers in the ahm Extras Benefit Chart (included with this document) and you can check benefit limits online at any time.
Claiming periods
Financial year – 1 July to 30 June. Your benefit entitlements are renewed at the beginning of each financial year.
Rolling year – Very few of our benefits have a rolling year however, a rolling year begins on the date a service was first provided with the limit applying to that 12 month period following the date of service.
Limit types
Per person limits – Where applicable, 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.
Family limit – Benefits are payable up to the family limit indicated in the benefits table for the claiming period (as subject to per person limits).
Lifetime limit – A benefit with a lifetime limit means that once you reach the limit, you can no longer claim that benefit in any future year of membership, even if you change your cover.
Loyalty limits
Our Lifestyle, Family and Super Extras covers include loyalty limits as a way of rewarding members for their ongoing membership.
Loyalty limits are based on maintaining an ahm policy for a continuous period of time and apply to some of our most popular benefits. This means your benefit limit is dependent on how long the principal member has held an ahm policy. To confirm your loyalty limit entitlement, you need to know the number of years you have continuously held an ahm policy then refer to the benefits table. You can check your loyalty years online in our ‘members’ section or by calling us.
How loyalty limits work
The loyalty date for the policy is determined by the principal member (see definition page 27). If your partner or dependant (see definition page 27) leaves the policy for any reason, they’ll carry their own joining date as their loyalty date.
We’ve provided some examples below to help explain:
1. Betty (principal member) started an ahm family policy in 1980 and John was added to the policy in 1991 when he was born. John recently turned 21 and left the family policy to start his own single ahm policy. Because he’s been covered under an ahm policy since 1991 he’ll start a single policy with 21 years of loyalty (as at 2012).
2. Tom has held an ahm policy since 2002, he married Betty and he joined her policy in 2004. The policy stays in Betty’s name so their loyalty date remains at 1980 and they’re entitled to the highest limits.
If the policy had transferred into Tom’s name (he became the principal member) their loyalty date would be 2002 instead of 1980 and their loyalty years would be less. Note: If you have to make a change to your policy, it’s important that you consider who will be the principal member as this may determine the loyalty limits that will apply.
Moving into a higher limit category
As loyalty limits apply to a financial year, the number of years the principal member has held an ahm policy as at 1 July each year determines which category of loyalty limit they’re entitled to.
For example, if a member has held an ahm policy continuously for 5 years in December 2011 (having joined in December 2006), they won’t be entitled to their 5 years loyalty limits until 1 July 2012.
a healthy me
LEARN MORE > TAkE ACTION > LIvE WELL
a healthy me is an integrated suite of health management programs, tools and resources available exclusively to our members to help improve and maintain their health and wellbeing. It’s based on a continuous cycle of learning, taking action and living well. It will inspire you to make changes to your lifestyle and support you in managing your health issues, no matter how simple or complex.
With a healthy me you can:
>Empower yourself with our suite of integrated health tools, programs and online resources.
>Receive personalised advice, support and motivation online, by phone or email.
>Save time managing your health from a central, reliable source of information and support. Some additional a healthy me services are also available if you have an ahm Hospital cover. Please refer to the Hospital policy document for details.
ahm Health Hub
Achieving and maintaining good health takes planning and action.
Now you can conveniently organise a healthy lifestyle from one secure online resource – the ahm Health Hub.
If you’re an eligible member and you register for ahm Health Hub, you gain full and immediate access to an extensive range of motivational and interactive health information tools. The ahm Health Hub is available at no extra cost to all ahm Extras members who are at least 18 years of age.
WELLBEING ASSESSMENT
This comprehensive questionnaire provides you with an overview of your current health and lifestyle, including your real health age compared to your actual age.
It outlines the risks to your health and recommends activity plans to improve your wellbeing. To help you stay informed, a fortnightly email newsletter will be sent to you containing informative and timely articles. You can also revisit your assessment as often as you like to track and check your progress.
HEALTH ACTION PROGRAMS
Once you have undertaken the Wellbeing Assessment you can sign up for Health Action Programs that have been designed to address your individual health needs.
These educational courses, developed by experts in their field, are delivered to you via email. A range of programs are available from sport and general fitness, diabetes management, heart and lung health, as well as weight loss and mental health management.
MEAL & ACTIvITY PLANNERS
The ahm Health Hub can help you design a daily meal plan tailored to your body shape and lifestyle. You can also create an unlimited number of customised workout plans to suit your goals, activity preferences and the time and equipment you have available.
ahm Health Coaching
When it comes to your health, sometimes you just need someone to talk to, especially if you have a specific medical condition or multiple health issues to address.
If you prefer one-on-one support, you can speak directly and confidentially over the phone to an experienced, qualified Health Consultant with ahm Health Coaching.
Through the ahm Health Coaching program you’ll receive the motivation, tools and techniques you need to sustain a healthy lifestyle.
You will also receive support through regular phone calls from your Health Consultant over a six month period so that you can talk about your progress. Some of the health goals ahm Health Coaching can support include:
> weight loss/management > exercise > blood pressure/stress > quit smoking > alcohol intake > cholesterol reduction > Arthritis management > Diabetes management > auto-immune conditions
Depending on your health goals, your Health Consultant will be a qualified health professional, such as a Nurse, Dietitian, Psychologist, Occupational Therapist, Exercise Physiologist, Health Educator or Nutritionist.
ahm Health Coaching is available to all members on an ahm Extras policy who are at least 18 years old. Each member on the policy can enrol once every six months. To apply call 134 246 or visit ahm.com.au/health-coaching
News & info
The first step to improving and managing your health is through education. You need to stay informed about potential risks to your health and learn how to lead a healthy lifestyle. We provide our members with reliable and current health information that has been clinically verified, including nutritional advice for everyday eating, tips from exercise experts and mouth watering recipes. Plus we keep you up to date with how to get the most from your health cover.
A HEALTHY ME MAGAzINE
a healthy me is a printed magazine that is posted to all members. To find out more and view previous editions visit ahm.com.au/ahealthyme/magazine
A HEALTHY ME ENEWSLETTER
The eNewsletter can be delivered straight to your inbox every two months. To subscribe you need to sign up for online member services on the ahm Health Insurance website. Visit ahm.com.au/Members to register, then follow the links to the ‘a healthy me’ eNewsletter. ahm HEALTH LIBRARY
A comprehensive range of articles is available on the ahm website, covering topics such as nutrition, exercise, lifestyle and mental health. Visit the ahm Health Library at ahm.com.au/articlelibrary
Health improvement benefits
To help you better manage your health, all ahm Extras policies include benefits for a range of health improvement benefits.
It’s important to note that in some cases we’re only able to pay benefits if proof is provided that the service is to assist in helping a medical condition, so please read through all the information carefully and call us before you send in a claim if you’re unsure whether you’ll be covered or not.
Cancer Council Uv products
We’ll pay benefits for approved Cancer Council UV sun protection from the sunscreen, hats, swimwear, and sunglasses range.
Items from the cosmetics, clothing, shade or accessories range aren’t covered.
Special conditions - Your receipt must identify the item as Cancer Council approved.
Disease management association fees
We’ll pay a benefit for association fees paid to the Arthritis Foundation, the Asthma Foundation, the Coeliac Society, Diabetes Australia, the Heart Foundation, the Crohn’s and Colitis Association and Ostomy Associations to help manage and receive support for these diagnosed chronic diseases.
Doctor’s health checks and Healthy Heart checks
We’ll pay a benefit for health checks to assist with early diagnosis and/or prevent an illness or condition.
Special conditions - The benefit isn’t payable when your health check is claimable through Medicare, is related to employment (such as pre-employment health checks) or when you can claim it through a third party insurer.
Exercise classes
We’ll pay a benefit for exercise classes including gym, yoga, pilates and exercise physiology sessions to assist in the management of a condition.
Special conditions - An Exercise Approval form or letter completed by your health provider, or evidence of participation in ahm Health Coaching, must be provided specifying the condition being managed and dated prior to the date of service of any claim. Gym classes must be provided by a Fitness Australia accredited gym or personal trainer. You can download a copy of the Exercise Approval form at ahm.com.au/downloads
Preventive tests, scans and screenings
We’ll pay a benefit to assist with early diagnosis and/or to prevent an illness or condition.
Special conditions - We can’t pay a benefit if the test is claimable through Medicare.
Quit smoking
We pay benefits for laser therapy, hypnotherapy and nicotine replacement therapy (patches, gum, lozenges and inhalers) where not claimable under the Pharmaceutical Benefits Scheme (PBS) to assist in quitting or reducing smoking with the aim to help improve or prevent an associated health condition.
Stress management courses
To manage and prevent health conditions associated with high levels of prolonged anxiety.
Special conditions - Course must be provided by a recognised psychologist or as part of an ahm Health Coaching program.
Weight loss classes and courses
We pay a benefit if the class or course is provided by ahm recognised providers Weight Watchers®, Jenny Craig® or Fernwood®.
Special conditions - Medical evidence of a Body Mass Index (BMI) (see definition on page 31) of 26 or over must be provided. This can be in the form of a doctor’s certificate, an ahm health profile (provided after completion of an online ahm Wellness Assessment) or a certificate from an ahm recognised weight loss provider. If the claim is for a child, evidence of an unhealthy BMI must be provided in the form of a doctor’s certificate/letter prior to claiming benefits.
Swimming lessons (Family and Super Extras only)
A benefit is payable for children 0 – 17 years of age if provided by an Austswim® or Swim Australia accredited swim school if they have asthma, diabetes or an unhealthy BMI (see definition page 31).
Special conditions - Medical evidence of one of these conditions must be provided or a doctor’s recommendation to undertake this activity due to their condition.
Online member services
Online member services allows you to manage your cover online when it suits you best. You can log on, any time of day to review your cover details and confirm they’re correct or to make a claim. You can also access a range of information relating to healthy living including hundreds of healthy recipes.
As soon as you’ve registered you’ll be able to: > view your claims history
> change your level of cover
> request a replacement member card > search for recognised providers
> view and update your personal information > make a payment
> access information on healthy living and dental and eyecare health > claim for most Extras benefits
> check your benefits limits > and more
You could save on premiums
The Australian Government Rebate on Private Health Insurance is the amount that the Australian Government contributes to your health insurance premium to help make it more affordable. If you’re eligible, you can reduce your premium by up to 30% and as you get older it can reduce even further.
The rebate is income tested which means that the amount the Australian Government contributes towards your private health insurance premium will be determined by your income tier.
Income tiers are based on ‘income for Medicare Levy Surcharge purposes’ which includes things like taxable income, exempt foreign employment income, reportable fringe benefits, reportable superannuation contributions and total net investment losses.
Once you’ve advised us of your chosen income tier, the amount that you have to pay towards your premiums will be adjusted based on what the Government will contribute. You’ll need to tell us what income tier you think you should be on, so if you’re not sure, speak to your accountant or financial advisor.
Visit ahm.com.au/rebate for more information including a table with current income levels for each tier.
Your membership
Who’s on your cover
At ahm Health Insurance our policies are designed to suit the different lifestyle needs of our members. All covers listed in this document can be purchased in any of the membership categories listed below.
Single – a policy that covers one person only (the principal member)
Single parent – a policy that covers one adult (the principal member) and any child or student dependants
Family – a policy that covers one adult (the principal member), their partner and any dependants
Members on your cover
Principal member – this 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 – means a person who lives with the principal member in a marital or bona fide domestic relationship
Child dependant – means a child of the principal member who doesn’t have a partner and is under the age of 21
Student dependant – means a child of the principal member who doesn’t have a partner, has reached the age of 21 but is under the age of 25, and is undertaking full-time education Adult dependant – means a child of the principal member who doesn’t have a partner; has reached the age of 21 but is under the age of 25; isn’t a student dependant; and is a member of an eligible cover or combination of eligible covers.
Changing your cover
As your life changes, so do your health insurance needs. It’s important to know when changing your level of cover it may impact the benefits you’re entitled to receive, and you may have to serve waiting periods for any additional services or higher benefits that were not on your previous level of cover. The good news is that we don’t have any two or six month waiting periods on any extras covers so for many services you’ll be able to claim the higher benefit straight away.
Changing your cover may affect your eligibility or participation in ahm Health Coaching and Health Hub programs.
Switching private health insurers
If you’ve switched private health insurers, we’ll recognise the waiting periods you’ve already served for comparable benefits. In accepting a transfer from a private health insurer, we reserve the right to treat any benefits paid by the previous insurer in the current financial year as already being used under the limits of your new cover.
Suspending your policy
We recognise that we all need to get away sometimes, so if you’re travelling overseas for more than 30 days, you can suspend your policy (to a maximum of two years at any one time) without it affecting your loyalty. The period of suspension will still count towards the years of continuous cover.
To suspend your policy just send us a written or email request before your holiday with a copy of your official itinerary or e-ticket which includes the dates of travel. We’ll contact you on your return to confirm reinstatement of your policy and advise you of the need to reactivate your premium payments.
Note: You’ll still need to serve any waiting periods you may have had before leaving the country and no benefits will be paid for services provided during the suspension period. If you also have an ahm Hospital cover, suspending your policy may result in you being charged the Medicare Levy Surcharge. We suggest you speak to your accountant, tax agent or the Australian Taxation Office for further advice.
How to pay
We offer a number of convenient payment options to make sure you’re covered when you most need it. All you need to do is pick the one that’s right for you.
Direct debit
The easiest way to pay and our most popular payment method. There’s no need to think about when your premium is due because we’ll just withdraw the premiums from your nominated bank account or credit card at a frequency chosen by you. Simply call us on 134 246 to set this up or download a Payment form from ahm.com.au
BPAY
You can pay any time of day, over the phone or online if you’re registered for phone or internet banking with your financial institution. Simply use the biller code 57430 and your member number as the customer reference number.
Online
One off payments can be made using your Visa or MasterCard credit card. Just log in to the members’ section and select ‘Make a payment’.
Phone
You can pay your premiums by Visa or MasterCard credit card over the phone on 134 246. Mail
Make cheques payable to ahm Health Insurance. Please ensure you clearly print your name and member number on the back of the cheque and send it to: ahm Health Insurance, Locked Bag 1006, Matraville NSW 2036
Over the counter
We accept Visa and MasterCard credit cards, EFTPOS, cheques and cash over the counter at 77 Market St, Wollongong NSW.
Our fund rules for ahm products require that all members who pay their premiums by direct debit, cheque, cash or by BPAY must pay their premium so that it remains at least one premium frequency in advance at all times.
If you pay by group payroll deductions, you must be paid up to the same date as your group.
Payments in advance
ahm Recognised Providers
It is important that we recognise service providers so that you receive quality health care from the providers you choose. Recognising a provider means we get specific details and credentials from them to make sure they meet both legislative and our criteria for benefit payment. All service providers must be recognised by ahm Health Insurance before we can pay benefits. Recognition of a provider means that we may check with the provider on the goods or services supplied to any person on a policy to ensure that appropriate claims and benefits are being paid.
Benefits won’t 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 us call 134 246 or use the online provider search tool at ahm.com.au If your preferred provider isn’t recognised by ahm Health Insurance, they can find out more information on the requirements by visiting ahm.com.au/provider
Disclaimer: ahm Health Insurance encourages its Recognised Providers to offer high-quality products and services at competitive prices to its members. Where ahm Health Insurance recognises a provider, to the fullest extent allowed by the law, such advertising or reference should not be construed as:
> an endorsement by ahm Health Insurance
> an acknowledgement or representation by ahm Health Insurance as to fitness for purpose; or
> a recommendation or warranty by ahm Health Insurance;
of, for, or in relation to, the product and/ or service of the recognised provider. Accordingly, to the fullest extent allowed by law, ahm Health Insurance neither takes nor assumes any responsibility for the product and or services provided.
Members should make and rely on their own enquiries and seek any assurance or warranties directly from the recognised provider of the services or product.
Important information
Ambulance transportation
If you have ahm Extras cover on its own, your policy only covers you for emergency transportation.
This means a sudden or unexpected need for hospitalisation where the only practical way of getting to a hospital is by ambulance.
Note: We don’t pay benefits for ambulance subscriptions and we don’t cover you for non-essential transportation such as:
> transfer between a public and private hospital
> changing hospitals to be closer to home
> travelling from home to hospital for tests.
If you have ahm Hospital cover, you’re covered for all medically necessary ambulance transportation, please refer to the ahm Hospital policy document for more detail.
Body Mass Index (BMI)
The BMI is used to estimate your total amount of body fat. It’s an approximate measure of the best weight for health. To calculate your BMI, divide your weight in kilograms by your height in metres squared. For example, if you weigh 70kg and you’re 1.7 metres tall, your BMI would be 24.2. 70 ÷ (1.7 x 1.7) = 24.2
A BMI between 18.5 and 25 is within the normal range. A BMI less than 18.5 means you may be underweight and a BMI of 26 and over means you may be considered overweight. A BMI above 30, is considered obese.
A child’s BMI can only be determined by a medical practitioner as the child’s age and sex is also taken into account.
Broken appointments
Your ahm Extras cover doesn’t pay benefits towards broken appointments, so if you’ve been charged for not attending or cancelling an appointment, you won’t be able to claim for it.
Consultations
You’re able to claim for one face to face consultation with a provider on a given day. This means that if you have two or more consultations with the same provider on the same day, even if they’re for different types of services, you’ll only be able to claim for one. Telephone or video consultations aren’t eligible for benefits except where preapproved by ahm.
Dental
Dental benefits are paid by the type of service and according to the category as detailed below. Different benefits are not paid for the type of provider except orthodontics. Routine – Includes x-rays, examinations or consultations, preventive procedures such as clean and polish, oral surgery for tooth extractions and minor restorative services. Complex – Includes periodontics (root planing, oral surgery for prostheses, jaw injuries or non-tooth related surgery) and endodontics (root canal therapy).
Major – Includes indirect restorations, all crowns, bridgework and implants and dentures (dentures not available on ahm Lifestyle Extras).
Orthodontics – We’ll pay benefits for orthodontic services by a General Practitioner (GP) or specialist dentist provided claims are accompanied by a detailed treatment plan.
Note: Benefits paid for services provided by a General Practitioner are lower than benefits paid for services performed by a specialist.
Orthotics and orthopaedic footwear
We’ll pay benefits for orthotics and orthopaedic footwear only if custom made and supplied by an ahm recognised podiatrist or orthopaedic footwear supplier. Make sure you include a referral from an ahm Recognised Provider with your claim. We accept referrals from ahm recognised physiotherapists and chiropractors for orthotic devices.Outpatient procedure room fees
Benefits will be paid towards the charge incurred for the use of a facility or procedure room for an outpatient medical service. The cost of the doctor’s fee for the medical service isn’t claimable.Overseas claims
Your Extras policy doesn’t cover you for any services received or goods purchased outside of Australia, including online purchases from overseas companies.
If you’re travelling overseas, call us on 134 246 so that the ahm team can help you arrange travel insurance at discounted rates.
Note: If you’re planning to be out of the country for more than 30 days, you can suspend your policy for the time you’re away up to a maximum of two years at any one time (see Suspending your policy page 28).
Pharmaceutical Benefits Scheme (PBS)
The PBS is the national pharmaceutical benefits scheme funded by the Australian Government where patients pay a set amount towards the cost of a subsidised drug. The PBS is only available to persons with Medicare eligibility.Pharmacy
We’ll pay benefits for non-PBS pharmacy items that are:
> prescription only and prescribed by a medical practitioner, including contraceptives for medical conditions, and > essential to treat a particular illness, injury
or condition.
We’ll pay a benefit for each eligible pharmacy item after you pay the set PBS general patient amount as a co-payment. Items available without a prescription including over the counter, off the shelf, herbal medicines and vitamins can’t be claimed.
Policy in arrears (unfinancial)
Benefits are not payable for services provided during the period in which a policy is in arrears until the premium is fully paid and accepted by us. Our fund rules for ahm products require members to be at least one premium payment frequency in advance. We have the right to refuse to accept premiums if more than two months have elapsed since the financial date of the policy.
Note: If a member is more than two months in arrears then the policy will be terminated by notice in writing to the principal member, effective from the last financial date of the policy.
Policy termination
It’s only ahm Health Insurance and the principal member who have the right to terminate a policy. The policy can be terminated from the date we receive notice. You’re entitled to a refund of any premiums paid in advance of the date of termination. Any member or dependant over the age of 16 covered by a policy can terminate their own individual cover by giving notice to ahm Health Insurance but can’t terminate the policy.
Cooling off period – If the principal member terminates their policy within 30 days of joining and hasn’t claimed a benefit during this period, they’re entitled to a full refund.
Standard Information Statements
A Standard Information Statement (SIS) is an overview of key benefits and product features of your policy. We send you a copy of your SIS at least once every 12 months and sometimes at other times as we are required to. You should review the SIS in conjunction with your cover’s policy document to provide a full overview of the benefits available to you.If you’d like a copy of your SIS, you can download a copy from privatehealth.gov.au or call us on 134 246.
Travel and accommodation
Travel and accommodation benefits are available if you need to travel more than 200km return for a specialist medical appointment or an outpatient procedure and there’s no ahm recognised practitioner near where you live.
This doesn’t include travel and accommodation related to hospitalisations, dental or extras services and IVF treatment. Accommodation benefits are only payable for the patient – or a parent if the patient is a dependant child under the age of 18 – for a maximum of one night before, the night of and one night after the appointment. Travel benefits are payable for the patient only. To claim these benefits you need to supply an invoice for your accommodation including the date, plus one of the following:
> statement of attendance from a doctor > copy of the doctor’s account
> IPTAS (Isolated Patients Travel and Assistance Scheme) forms > Medicare statement or bulk billing
At ahm Health Insurance, we work hard to make sure you always get the best service when you need it and we welcome your feedback.
Whether you’re making a suggestion, paying a compliment or making a complaint, your feedback is important to us.
If you have a suggestion about how we can improve our products or service, please let us know. If you’re ever unhappy about something we’ve done – or perhaps not done – please give us the opportunity to put things right.
We use your de-identified feedback for training and coaching purposes so that we can improve our products and services.
Online
Use the ‘contact us’ form – choosing the most relevant subject at the top of the form Phone
Call us on 134 246 Email
[email protected] Mail
ahm Health Insurance feedback Locked Bag 1006
Matraville NSW 2036 Fax
1300 329 246
Complaints
If you have a complaint related to your policy, please let us know straight away so that we can work to resolve matters as soon as possible.
Where possible, we’ll resolve your issue on the spot. However, if we’re unable to resolve your issue immediately, we’ll refer it to our Customer Advocacy Team who’ll undertake a detailed investigation.
Customer Advocacy Team
Our Customer Advocacy Team will aim to find a solution for you by investigating your complaint and then letting you know the result. They will:
> investigate the issue
> keep you informed
> aim to resolve the issue within 10 working days.
To assist in this process, please provide as much information as possible about the nature of your complaint. Please include your name, and member number (if applicable), on all correspondence.
What if I’m not satisfied?
If you’re not satisfied with the steps taken by ahm to resolve your complaint or with the result of the investigation, you can request a review of your complaint by the Private Health Insurance Ombudsman.
Private Health Insurance Ombudsman
We will do our best to resolve the issue to your satisfaction. If you’re unhappy with the result, you can contact the Private Health Insurance Ombudsman (PHIO) for free independent advice. Phone 1800 640 695 Email [email protected] Address Suite 2, Level 22 580 George Street Sydney NSW 2000 Website phio.org.auFeedback
Australian Health Management Group Pty Ltd (we, us or our) collects and uses your personal (including sensitive) information (Information) to provide you with products and services, including insurance, health related services, information on other products and services offered by us, by another company in the Medibank group of companies (Our Group Companies) or a third party, and to facilitate and assess the provision of health related services to you by us, Our Group Companies and third parties. We may not be able to perform these functions if you do not provide us with your Information. We may collect your Information from you, another person on your membership, a person authorised to provide us this Information on your behalf, one of Our Group Companies or a third party. We may disclose your Information to third parties (including overseas) such as the parties named above, our service providers, health service providers, government agencies, financial institutions, your employer (if you have a corporate product) and your educational institution, migration agent or broker (if you have OSHC or a visitors cover).
These third parties may also collect your Information directly from you. You are permitted by law to access and correct Information we hold about you. From time to time, we may also use your Information to contact you (including by phone, text message or email) about other products or services we think may be of interest to you. This may include our branded products and services, the products or services of one of Our Group Companies or of third parties.
We may also collect and disclose your Information from or to Our Group Companies, and they may also share your Information with each other, to have an integrated view of our members and provide you with a personalised service (including health service). Our Group Companies may use your Information to contact you (including by phone, text message or email) about their services. You may withdraw your consent to these specific uses and disclosures by calling us on 134 246 or +61 2 4221 8888 Monday to Friday: 8:00am - 6:00pm or emailing us at [email protected]
As an ahm customer or member, you consent to the collection, use and disclosure of your Information in accordance with the ahm Privacy Policy. If you are the person responsible for the management of your membership you must ensure any spouse/partner and dependant children are aware of and consent to how their Information is handled. For more information about how we handle your Information, to request access to personal information we hold about you or to obtain the latest copy of the ahm Privacy Policy (effective 1 July 2012) go to ahm.com.au, email [email protected], call us on 134 246 or write to:
Privacy Officer ahm Health Insurance Locked Bag 1006 Matraville NSW 2036
ahm Privacy Statement
All enquiries: 134 246
Customer service centre hours:
Monday to Friday
8.00am – 6.00pm
(Eastern Standard Time)
Fax:
1300 329 246
Web:
ahm.com.au
Email:
[email protected]
Postal Address:
ahm Health Insurance,
Locked Bag 1006,
Matraville NSW 2036
Find us on Facebook
facebook.com/ahm.health.insurance March 2013
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.
This document is printed on Publishers Offset stock produced in Australia. The stock is made from fibres sourced from sustainably managed forests and is AFS/PEFC certified product. The paper manufacturing process is subject to strict environmental controls including ECF (Elemental Chlorine Free) process. The inks used to print this document contain a vegetable oil base. The vegetable oils used are derived from renewable and sustainable resources.
ahm Health Insurance is committed to reducing our impact on the environment by promoting good environmental practice and sustainability.
