ahm lite cover

8/9/2019 Ahm Lite Cover

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Restricted benefits Waiting periodPsychiatric services - in hospital

2 monthsRehabilitation services - in hospital

Podiatric sugery by an accredited podiatric surgeon 2 months (unless pre-existing)

Private hospital benefits

Private hospital benefits Waiting periodHospital treatment as a result of an accident 1 day

Accommodation (except for excluded services)

2 months (unless pre-existing)

Theatre costs (except for excluded services)

Intensive care (except for excluded services)

Removal of appendix, tonsils and adenoids

Joint investigations and reconstructions

Minor Gynaecological Procedures

Surgical removal of wisdom teeth in hospital

Pharmaceuticals – in hospitalProstheses – surgically implanted (minimum benefit only)

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

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

ExclusionsDialysis

Heart related treatment and procedures

Hip and knee replacements

All other joint replacements

Major eye surgery (e.g. cataracts and lens related products)Obstetrics/Pregnancy and birth related services

Assisted reproductive e.g. IVF, GIFT

Obesity surgery - including gastric banding and bypass

Sterility reversals

Spinal fusion

All cosmetic surgery

All other in-hospital services where a Medicare benefit is payable

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

Any item that has an MBS (Medicare Benefits Schedule) item number and is not stated as included or restricted is NOT coveredin this policy.

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Ambulance Transportation

i NOTE: The excess does not apply to ambulance transportation. ahm Health Insurance doesn’tpay benefits towards ambulance subscriptions.

Your Hospital ExcessPayment Amount

$500$500 is payable per person on the first admission permembership year.

$500 is the maximum you will pay in a membership year fora single’s policy.

$1000 is the maximum you will pay in a membership year fora couple’s policy.

If the charge for your first admission is less than the excess amount, any remaining excess must be paid ifyou are admitted to hospital again in the same membership year.

You’re covered for medically necessary ambulance transport and services includingair ambulance such as CareFlight, to the nearest hospital that’s able to provide thelevel of care you need. Some state governments however, have their own schemesin place, so if you live in NSW, ACT, Queensland or Tasmania, please take note ofthe 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,you’re entitled to a lower premium. Just send ahm Health Insurance a copy of yourcard and they’ll reduce your premiums from the date they receive the copy. If youlive in Tasmania or Queensland you’re already covered by your state’s scheme.However, ahm Health Insurance do cover the costs for any interstate ambulancetransport if not covered by the state scheme.



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Examples of your dental benefits

Itemno

Service description Benefit Financial year limit Waitingperiod

011 Comprehensive oral examination

50% of cost backCombined limit for all Extras

services included on this cover$750 per person

None

022 1 X Ray

121 Fluoride Treatment

114 Removal of calculus - first visit

322 Surgical removal of a tooth



531 Adhesive restoration, 1 surface532 Adhesive restoration, 2 surfaces

533 Adhesive restoration, 3 surfaces

118 Bleaching, external - per tooth

119 Bleaching, home application - per arch

965 Occlusal splint

415 Root canal obturation - each additional canal

12 months

416 Complete chemo mechanical preparation ofroot canal - one canal

417 Complete chemo mechanical preparation ofroot canal - each additional canal

418 Root canal obturation - one canal

582 Veneer - direct

Not covered

583 Veneer - indirect

615 Full crown - veneered - indirect

711 Complete maxillary denture

712 Complete mandibular denture

719 Complete maxillary and mandibular denture

843 Maxillary expansion appliance

811 Passive removable appliance - per arch

642 Bridge - direct - per pontic

643 Bridge - indirect - per pontic

881 Orthodontic complete course



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Your therapeutic benefits

Your optical benefits

Service description Benefit Financial year limit Waiting

periodSpectacle frames

Not covered

Single visions lenses

Bifocal lenses

Progressive lenses

Contact lenses - pair

Disposable contact lenses

Service description Benefit Financial year limit Waitingperiod

Chiropractic

50% of cost backCombined limit for all Extras services

included on this cover$750 per person

NoneOsteopathy

Physiotherapy

Exercise physiology

Not covered

Hydrotherapy

Psychology

Hypnotherapy

Speech therapy

Eye therapy

Occupational therapy

Podiatry

Orthotics

Audiology

Naturopathy

HomeopathyAcupuncture

Herbalism

Remedial massage

Reflexology

Bowen therapy

Chinese medicine

Alexander technique

Myotherapy

Dietetics

Aromatherapy



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Shiatsu

Not covered

Nutrition

YogaPilates

Chinese massage

Kinesiology

Iridology

Swedish massage

Rolfing

Medicine

Remedies

Your other benefits

Your health improvement benefits

Service description Benefit Financial year limit Waiting period

Weight Management programs

Not covered

Quit Smoking programs

Health Management programs

First Aid courses

Health Tests

Service description Benefit Financial year limit Waiting period

Pharmaceutical Prescriptions(Benefits only payable for non PBS

items. Benefits do not apply toprescriptions dispensed to hospitalin-patients.)

Not covered

Hearing aids

Medical Appliances



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Did you know? (Read & Retain)

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Pre-existing ailments or conditionsIf you’re taking out private hospital cover for the first time, or changing to a cover (either within ahm or fromanother insurer) that has additional services or higher benefits and you have a pre-existing condition, you’ll haveto wait 12 months before you can claim on your hospital cover.

A pre-existing condition is an ailment, illness or condition, the signs or symptoms of which - in the opinion of amedical practitioner appointed by ahm Health Insurance - existed at any time in the 6 month period before youeither took a new policy or changed your cover.

The appointed medical practitioner is the only person authorised to decide if an ailment is pre-existing. Theymust consider any information that was provided by the medical practitioner who treated the ailment, illness or

condition.

Assuming that ahm Health Insurance receive all the information required from your treating medical practitioner(s),they’ll need five working days to make the assessment so you should consider this when you agree to a hospitaladmission date.

If you’re admitted into hospital without confirming your benefit entitlements and your condition is subsequentlydetermined as pre-existing, you’ll be required to pay any hospital and medical charges not covered by Medicare.

If you’re admitted to hospital for an emergency, ahm Health Insurance may not have time to asses 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:• you’ve held your current level of hospital cover with ahm Health Insurance for less than 12 months,

• you’re admitted to hospital and choose to be treated as a private patient, and• your condition is later determined to be pre-existing.

Accidents

An accident is defined as an unplanned or unforseen event resulting in bodily injury that requires immediatemedical treatment in a hospital.

ahm Health Insurance will pay a benefit towards the costs of hospital treatment that is required as a result of anaccident, provided that the medical services is one Medicare pays a benefit for. This applies even if the hospitaltreatment is included in the list of excluded treatments.

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. You can transfer from one health insurer to another, forthe same or a lower level of benefits, without serving additional waiting periods. If you’re switching private healthinsurers, the good news is ahm Health Insurance will recognise waiting periods already served for comparablebenefits.

The Government sets the maximum time that health insurers are able to make members wait until they can claimbenefits for hospital treatment. These maximums are:

• 12 months for pre-existing conditions• 2 months for psychiatric, rehabilitation and palliative care whether or not there is a pre-existing condition.• 2 months in all other circumstances



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Medical gap payments

The benefit ahm Health Insurance pays towards in-hospital medical services is based on the Medicare Benefits

Schedule (MBS). This is a list of fees that has been issued by the Australian Government to set out the minimumamounts that Medicare and Private health funds should pay towards each medical service listed.

If a service is listed on the MBS and included in your cover, Medicare will pay 75% of the MBS fee and ahm willpay the remaining 25%.

A doctor may choose to charge more than the MBS fee which may leave you with an out-of-pocket expense thatyou’ll have to pay. This is known as the medical gap and is the difference between the fees you’re charged by themedical providers and the MBS (i.e. The amount you receive from Medicare and ahm) for the services they providein hospital.

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: - You’re treated at a non-agreement private hospital; - You’re treated in a private hospital for a restricted or excluded service - You request a private room in a public hospital - Your doctor/s do not participate in GapCover and charge above the Medicare Benefits

Schedule Fee; - You choose a prosthesis that costs more than the minimum benefit listed in the Federal Government’s

Prostheses List.

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 availableto you. It is recommended that you call ahm Health Insurance, to check your cover prior to joining to ensure thecover is suitable for you.

GapCover

GapCover is designed to help remove or reduce the medical gap so that you pay less for your hospital treatmentor nothing at all.

If your doctor chooses to participate in GapCover ahm Health Insurance provides benefits up to an agreed feeand then you’ll have to pay the difference. Under GapCover, the maximum gap that you’ll have to pay is $500 perclaiming provider (i.e. doctor’s account).

A doctor can choose to participate in GapCover on a case by case basis, so you should always check with them priorto agreeing to treatment and ask them to provide you with an estimate of medical fees.

If your doctor chooses not to participate in GapCover, ahm health insurance will only pay up to the MBS fee andyou’ll have to pay the difference between the MBS fee and what your doctor charges you.

Note: ahm Health Insurance don’t pay any GapCover benefits for excluded services.



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Health insurance policySingle policy a policy that includes only one person (the principal member).Couple policy - a policy that includes two people, both of whom are insured adults and one is the principal memberand the other is their partner

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

have full authority to make any changes to the membershipPartner This is the person who lives with the principal member in a marital or bona fide domestic relationship

Overseas benefits

Your ahm Health Insurance policy doesn’t cover you for any medical, hospital or ambulance services receivedoverseas or goods purchased outside of Australia, including online purchases from overseas companies. If you’retravelling overseas, call ahm Health Insurance on 134 246 so that they can help you arrange travel insurance atdiscounted rates. Without adequate travel insurance, you could find yourself paying a lot of money if you’re sickor hospitalised overseas.

Prosthesesahm Health Insurance pays up to the minimum benefit for surgically implanted prostheses. There may be morethan one clinically appropriate prosthesis available for your procedure. If you choose a prosthesis that costs morethan the minimum benefit listed in the Federal Government Prostheses List, you’ll have to pay the differencebetween the minimum benefit and the prosthesis charge.

Search for a doctorYou can access a doctor search facility at ahm.com.au/find-a-doctor to find a list of doctors who have previously

registered to participate in GapCover.

Recognised ProvidersAll service providers must be recognised with ahm Health Insurance before benefits are payable. Recognising aprovider means that they get specific details and credentials from providers to make sure they meet both ahmHealth Insurance and legislative criteria for benefit payment. Benefits won’t be paid for services performed orgoods supplied by unrecognised practitioners or by a provider on themselves, their partner or dependants, businesspartners or business partners’ partner or dependants. To find out if your service provider is recognised by ahmHealth Insurance use the online provider search tool at ahm.com.au/find-a-provider



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Privacy PolicyTo obtain a copy of the ahm Health Insurance Privacy Policy go to ahm.com.au, email [email protected] or callahm Health Insurance on 134 246.

DisclaimerThe information contained in this document was accurate at the time of publication. Membership of ahm HealthInsurance is subject to ahm Health Insurance’s Fund Rules and policies. Premiums, benefits, Fund Rules and poli-cies change from time to time. The information in this document only applies to ahm Health Insurance brandedproducts.

Cooling off periodIf you terminate your policy within 30 days of joining and haven’t claimed a benefit during this period, you’reentitled to a full refund.

Resolution of problemsIf you have any queries or feedback related to your ahm Health Insurance cover, please contact ahm HealthInsurance on 134 246 or email [email protected] you are not satisfied with ahm Health Insurance’s response you may contact the Private Health Insurance Om-

budsman on 1800 640 695.

Other Important Information

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

Extras Limit TypesPer person limits

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

Extras LimitsMost 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 cancheck your benefit limits online at any time at ahm.com.au

NOTE: Limits not used in a claiming period don’t roll over to the next claiming period.


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TM ahm Health Insurance proudly supports and complies with the Private Health InsuranceCode 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 Ltdtrading as ahm Health Insurance.

Resolution of problems

If you have any queries or feedback about any aspect of a health insurance product or iSelect’s service,you can either call the consultant you dealt with or contact the Compliance Manager by telephone on1300 735 255, and by email on [email protected].

If you are not satisfied with iSelect’s response you may contact the Private Health Insurance Ombudsmanon 1800 640 695.

Privacy

For further information about iSelect’s privacy policy please visit iSelect’s web site: iSelect.com.au

http://www.iselect.com.au/

http://www.iselect.com.au/



MEMBERSHIP NUMBER ISSUED BY FUND OFFICE USE ONLY iSelect Client No.

New Membership Transfer Membership from another Fund(Complete Transfer Authority on follow ing page)

AGENT CODE: U60101

DECLARATION (PLEASE SIGN THIS SECTION WHERE INDICATED) You are applying for an ahm Health Insurance private health insurance policy with Medibank Private Limited ABN 47 080 890 259 under its HealthBenefits Fund and agree to be bound by the Rules of the Fund. You declare that all of the statements made in this application are true and completeand understand we may refuse payment of benefits, and that Lifetime Health Cover loading may be affected, if any statements are false in anyrespect. We reserve the right to vary our premiums, our private health insurance products or benefits payable, subject to the

and Rules. If you have paid premiums in advance, you will not be exempt from such changes. You consent to the collection, use anddisclosure of personal information in accordance with the ahm Privacy Policy You warrant that each named beneficiary has also given that consent.This includes consent to collect any personal information about a named beneficiary from you, any other named beneficiary, medical practitioner orhealth insurer. You completely indemnify us, related parties, our officers, employees and agents for any losses, damages or expenses that arise fromany allegation by any named beneficiary that their conduct, in acting in accordance with the ahm Privacy Policy, is without consent or otherwiseamounts to an interference with privacy.

By signing this I have read, and agree to, the above declaration.

Signature x Date:

Cover commences on ______________________ (nominated date no more than 10 days prior)

Base Premium Quoted: $ ____________ Lifetime Health Cover Loading (if applicable): $ ____________

Total Premium: $ ______________

Conditional on receipt of payment within 14 days.

OTHER PERSONS TO BE COVERED

Email address:

Address:

State:

Date of Birth:Mr/Mrs/Ms/Miss/Other: __________ Given name/s: _______________________

(DD/MM/CCYY)

Student Dependant Declaration 1

Surname: ______________________________

Postcode:Town/Suburb:

Phone: Home: ( ) Work: ( ) Mobile:

Occupation:

SurnameGiven name & Initial Date of birth Sex Relationship to Member Pre-existing conditions

Name:

Educational Institution:

Student Id Number:

Date Study Commenced:

Name:

Educational Institution:

Student Id Number:

Date Study Commenced:

Full-time Student Part-time Student Full-time Student Part-time Student

Student Dependant Declaration 2

SELECTED PRODUCT/S

Type of Cover

iSelect Health Pty Ltd ABN 87 088 749 955

Please fax or send pages 1 & 2 onl y Fax: 1300 735 322 or call 1300735255 Mail: Reply Paid 2021, MOORABBIN, VIC 31891

APPLICATION FORM

Please fax or mail pages 1 & 2 only. Fax: 1300 735 322 Mail: Reply Paid 2021, Moorabbin , Vic 3189

Co-payment Amount

P rices are subject to change

Gender M / F (circle one)

ahmHealthInsuranceisabusinessofMedibankPrivateLtdABN47080890259.'ahmHealthInsurance'or'ahm'arereferencestoMedibankPrivateLtdtradingasahmHealthInsurance.

WB

60.25 p/month inc 30.0% rebate

500.0

VIC

Single Female

Lite Cover

13696676

0.00

60.25

24-Jul-1987



Signature x

Date:

Financial

Institution

Address of

financialinstitution

-

ote: A statement of benefits is not issued, so you will need toheck your own account statements.

gnature x _________________________ Date: ________

me on a/c

ame of Bank, Credit Union or Building Society

BSB No.

ccount No.

-

Expiry Date

Visa MasterCard

Card No.

CREDIT CARD DETAILS

Name ofaccount

holder(s)

CHOICE OF PAYMENT FREQUENCY

Disclaimer for payment by credit card or direct debit

I/we authorise ahm Health Insurance, a business of Medibank PrivateLimited, to charge my health insurance premiums to my bank account/credit card. In the event of changes to premiums, levels of cover orarrears of payments to my policy, I/we authorise ahm Health Insuranceto alter the amount from the appropriate date in accordance with suchchanges. A copy of our Direct Debit Request Service Agreement will besent to you upon receipt of these details. The first debit will cover yourstandard premium plus any adjustments necessary to bring your policy inline with your required debit date. For existing members any change todebit dates may result in the next debit varying from the standarddeduction.Signed in accordance with account/credit card authority.

ate joined insurer: ___________________

RANSFER AUTHORITY:

ame of existing insurer ______________________________

embership no _____________________________________

ame of insured person_________________________________

ate paid to with insurer______________________

hereby authorise ahm Health Insurance to terminate my policy with yourganisation and obtain full details about my policy. I also authorise ahmealth Insurance on my behalf to obtain information, if appropriate from you inspect of policy details including benefit payment.

gnature x Date:

Australian Government Rebate on Private Health Insurance

IMPORTANT INFORMATION

APPLICATION FORM

You will be sent an application form for the AustralianGovernment Rebate on Private Health Insurance. If you haveselected to receive the rebate as a reduction on yourpremium, please ensure you complete and return the form toahm Health Insurance

Choose from 1-28th of month

MEDICARE ELIGIBILITY

Green – Unrestricted Medicare card Blue – Interim Medicare card

Yellow – Reciprocal Medicare card NO MEDICARE CARD

Valid to

My card number

I / we request that payments due to ahm Health Insurance, a businessof Medibank Private Limited (user id 010758) covered by this document,be drawn under the Bulk Electronics Clearing System from my / ouraccount.

Please fax or send pages 1 & 2 only Fax: 1300 735 322 or call 1300735255 Mail: Reply Paid 2021, MOORABBIN, VIC 31892

ame as it appears

n Medicare card

DIRECT DEBIT REQUEST

Choice of - Fortnightly, Monthly or Yearly

If you've chosen fortnightly, please choose a day of the week you'dlike ahm Health Insurance to draw your premiumsMon _ Tues _ Wed _ Thurs _ Fri _

If you've chosen monthly or yearly, please choose a date from the1st to the 28th on which you'd like ahm Health Insurance to drawyour premium each time it's due

IRECT CREDIT OF CLAIMSyou'd like your claims paid directly into your account, please complete the

etails below. Once you do this, you can use phone and internet claimingrvices. Note: benefits cannot be paid into a credit card account.

Account No

BSB No

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

ease complete if you are switching health insurers

Fortnightly

Monthly

Yearly Choose from 1-28th

of month

Choose from Mon, Tue, Wed ,Thur, Fri

Signature x

If this is a joint account, both signatures are required

Date:

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

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