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

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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, Tonsillectomy or Appendectomy Heart-related services Hip and Knee replacements All other joint replacements Major eye surgery e.g. cataracts and lens related procedures Obstetrics/Pregnancy and birth related services Assisted reproductive e.g. IVF, GIFT Obesity surgery - including gastric banding Pharmaceuticals in hospital Prostheses surgically implanted Psychiatric services in hospital Rehabilitation services in hospital Sterility reversal - Male & Female All other in-hospital services where a Medicare benefit is payable Other restricted services - Palliative care, Podiatric surgery Other excluded services - Spinal fusion
You are covered when treated at a partner private hospital, partner day surgery or public hospital. If you are treated in a non -agreement hospital only the Default (minimum) benefit applies.. Restrictions: The Default (minimum) benefit only is paid for restricted services in either a private or public hospital. Exclusions: No benefit is paid for these services.
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. Please call us to check your cover before going to hospital. 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. These maximums are: 12 months for pre-existing conditions 12 months for obstetric cases 2 months for psychiatric, 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, illness or condition that in the opinion of a Medical Practitioner appointed by ahm Health Insurance, the signs or symptoms of that ailment, 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. Transferring between insurers You can transfer from one health insurer to another, for the same or a lower level of benefits, without serving additional waiting periods. The insurer to which you transfer must give you credit for the waiting periods you have already served for comparable benefits.

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)

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ahm Budget Hospital

Ambulance
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 us a copy of your card and well reduce your premiums from the date we receive the copy. If you live in Tasmania or Queensland youre already covered by your states scheme. However we do cover the costs for any interstate ambulance if not covered by the state scheme.

NOTE: Excess does not apply to ambulance transportation and we dont pay benefits towards ambulance subscriptions.

Your Excess
Payment Amount

$500

$500 payable per person on the first admission per membership year. $500 is the maximum you will pay in a membership year for a single policy. $1,000 is the maximum you will pay in a membership year for a couple or family policy.

If the charge for the first hospital admission is less than the excess, any remaining excess (up to the maximum limit) must be paid for any subsequent admissions in the same membership year.

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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 - 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, 1 surface Adhesive restoration, 2 surfaces Adhesive restoration, 3 surfaces Bleaching, external - per tooth Occlusal splint Bleaching, home application - per arch Veneer - direct Veneer - indirect Full crown - veneered - indirect Complete maxillary denture Complete mandibular denture Complete maxillary and mandibular denture Bridge - direct - per pontic Bridge - indirect - per pontic Complete chemo mechanical preparation of root canal one canal Complete chemo mechanical preparation of root canal each additional canal Root canal obturation - one canal Root canal obturation - each additional canal Orthodontic complete course Maxillary expansion appliance Passive removable appliance - per arch

Benefit
$41 $26 $26 $67 $123.80 $153.75 $189.50 $68 $86 $102 $22.10 $276.55 $60.75 $105.60 $386.55 $588 $406 $406 $812 $220.60 $431.95 $140 $64.90 $139.70 $62.80 100% By specialist 70% By GP

Financial year limit

Waiting period

No annual limit

None

Combined limit 1 to 4 years $1,100 per person* $2,750 per family*

12 months Combined limit 1 to 4 years $1,000 per person* $2,500 per family*

1 to 2 years $800 per person* Lifetime limit of $2,400 per person

*These limits will increase with increased years of membership

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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, pilates, 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. $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

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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^, hormonal implants, 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.g Synvisc, OsteoArtz, Hyalagan

Benefit

Financial year limit

0 to 4 years $500 per person* $1,000 per family* $1,600 per person (per 3 financial years) No family limit $300 per person $600 per family $300 per person, 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

$1,200 per person $360 per person $720 per family $640 per person, per rolling year #

12 months None 12 months

^ Excludes PBS scripts, over the counter or off the shelf medicines, 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

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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. With medical evidence of a BMI of 26 or over for adults and an unhealthy BMI for children. Quit Smoking (per course) Quit Smoking (Laser acupuncture therapy) Quit Smoking Nicotine replacement therapy Patches, gums, lozenges, inhalers Disease Management association fees Per association - Asthma, Diabetes, Heart, Arthritis, Colitis, Coeliac, Ostomy and Crohns disease Cancer council UV products Per item - 30+ sunscreen, swimwear, 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 - mammograms, skin cancer screenings, bowel cancer tests and scans, bone mineral density tests Health Checks Per check - Doctor health checks and Healthy Heart checks limited to 1 per person per financial year Exercise Classes Gym, yoga, pilates and exercise physiology (when part of an ahm or recognised health management program and by an ahm recognised provider.) 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 $1,000 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

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Did you know?

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. If youre switching private health insurers, the good news is ahm Health Insurance will recognise waiting periods already served for comparable benefits.

Accidents
An accident is defined as an unplanned or unforeseen event resulting in bodily injury that requires immediate medical treatment in a hospital.

Pre-existing ailments or conditions

A pre-existing condition is an ailment, illness or condition that in the opinion of a Medical Practitioner appointed by ahm Health Insurance, the signs or symptoms of that ailment, 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. 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 we receive all the information required from your treating medical practitioner(s), well need 5 working days to make the assessment so you should allow this into your timeline 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, we may not have time to assess if the pre-existing 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 us for less than 12 months, and youre admitted to hospital and choose to be treated as a private patient, and your condition is later determined to be pre-existing.

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 service; - 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.

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. If youre having a baby and you have a single policy, youll need to change to a single parent family or family policy at least two months before the babys birth.

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Did you know?

This rule also applies to premature births. If you wait until less than 2 months prior to birth or after the birth of your baby to change your cover, then your baby will have to serve all waiting periods. NOTE: The 12 month waiting period for obstetrics and pregnancy related services starts from the date you first join the appropriate cover, regardless of whether you are pregnant or not when joining. ahm Budget Hospital does not pay benefits for obstetrics. ahm Basic Hospital, ahm Essential Hospital and ahm First Step only pay a default (minimum) benefit for obstetrics. Some members choose to have a home birth. ahm Top Hospital and ahm Family Hospital covers will pay a benefit towards midwife assisted deliveries in the home.

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. Health insurers pay the gap up to the MBS fee for inpatient hospital related medical services. Charges above the MBS fee are usually paid by the patient. GapCover means you will have out-of-pocket expenses reduced or removed when medical services are charged above the MBS fee, if your doctor(s) participates in the scheme.

Prostheses
ahm Health Insurance cover up to the minimum benefit for surgically implanted prostheses. 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

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. Single policy a policy that includes only one person (the principal member). Single parent policy a policy that includes two or more persons, one of whom is the principal member and the other insured persons are dependants of the principal member. Family policy a policy that includes an adult who is the principal member, their partner and any dependants of the principal member or their partner. Dependants Child Dependants your child can be covered by a family or single parent family policy until the age of 18 years if theyre single. 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 theyre single and not working full-time. Student Dependants your child aged 21 and over and under 25 years can be covered on a family or single parent family policy if theyre single, studying full-time and not working full-time. Dependant Adults your child is aged 18 and over and under 25 and theyre single and not a full-time student. An additional premium applies to keep your child covered as an adult dependant and is not available on all cover types. Call 134 246 for more information and a list of eligible policies. Principal member is the first named member of a policy. This person is responsible for the payment of premiums under a policy issued by ahm. This person has the authority to terminate the policy and add or delete persons from the policy. Partner a partner of a person is the persons husband or wife or a person who, although not married to the person, lives with that person of a bona fide domestic basis and includes a same-sex partner.

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Overseas benefits
Your ahm Hospital 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 we can help you arrange travel insurance at discounted rates. Without adequate travel insurance, you could find yourself paying a lot of money if youre hospitalised overseas.

Recognised Providers
All service providers must be recognised with ahm Health Insurance before benefits are payable. 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. 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.

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 (www.ahm.com.au) NOTE: Limits not used in a claiming period dont roll over to the next claiming period.

Extras Claiming Periods

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

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 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. Per person limits also apply. 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. Disclaimer The information contained in this document was accurate at the time of publication. All information is subject to the fund rules for ahm products, and premiums and claims will be accepted and paid in accordance with these rules. ahm Health Insurance reserves the right to vary its premiums and benefits during the year, with premiums being subject to approval by the Minister for Health and Ageing. Members who pay premiums in advance won't be exempt from such changes. This means that changes to benefits or premiums may take effect during your payment period, prior to the date that your policy is financial. This brochure should be read in conjunction with the relevant ahm Policy document.

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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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