Super Extras This Quick Guide shows you what you can claim, how much you ll get back, your annual limits and when you can start claiming. This information will help you make the most of your cover. After all, the more you know, the better off you ll be. This is just a summary of your cover. For more information about how your health insurance works, you should read our Member Guide. You can download a copy at ahm.com.au/pages/downloads The information contained in this document is current at the time of issue (January 2015). What s covered, how much and when Service Routine Dental (most common shown) Diagnostic Item No 1 Benefit Comprehensive examination 1 011 $41.80 ic examination 1 0 $39.75 Emergency examination 2 013 $33.65 X-ray (one film) 022 $26.50 Preventive Clean and polish 3 111 $36.70 Scale and clean 3 114 $78.50 Topical fluoride application 2 1 $26.50 Mouthguard - custom made 2 151 $92.80 Extractions Non-surgical extraction 311 $71.40 Surgical extraction 324 $193.80 Direct Restorations Metallic restoration 1 surface/3 surfaces 511 / 513 $63.20/$86.70 Adhesive filling 1 surface/3 surfaces (front) 521 / 523 $64.25/$89.75 Adhesive filling 1 surface/3 surfaces (back) 531 / 533 $69.35/$104.00 Complex Dental ontics Non-surgical periodontic treatment 281 $182.55 Endodontics (Root canal therapy) Preparation of one root canal 415 $142.80 1. Maximum two services per year 2. Maximum two services per year 3. Maximum three services per year Annual Limits No limit < 5 years $1,000 5+ years $1,100 10+ years $1,200 20+ years $1,300
Service Major Dental Indirect restorations Item No Benefit Tooth coloured filling 1 surface 551 $251.90 Crowns/bridges/implants Fully veneered crown 615 $599.75 Dentures (one complete set per person each 3 years) Full upper 711 $414.10 Full lower 7 $414.10 Orthodontics Up to your yearly limit for GP and specialist services 100% Optical Annual Limits < 5 years $1,100 5+ years $1,300 10+ years $1,500 20+ years $1,700 < 3 years $900 3-4 years $1,100 5+ years $1,300 Lifetime limit $2,900 per person Frames, single lenses (pair), bi-focal (pair), multi-focal (pair), contact lenses, repair of frames or lenses (for scripted sight correcting products only) Refractive sight correcting laser eye surgery Therapies Physiotherapy < 5 years $250 5+ years $275 $250 2 10+ years $300 20+ years $325 $900 per eye Initial consultation / subsequent consultation 1 $44 / $34 Per class (group hydrotherapy, Pilates, antenatal exercises, rehabilitation - all classes must be provided by an ahm recognised Physiotherapist) Chiropractic & Osteopathy Initial consultation / subsequent consultation 1 $44 / $34 $17 Lifetime limit $1,800 per person per therapy < 5 years $600 5+ years $650 10+ years $700 20+ years $750 < 5 years $400 5+ years $450 10+ years $500 20+ years $550 2 years 1. Benefits are payable for one initial consultation per therapy per person each financial year 2. Benefits and limits are based on your loyalty years 2
Complementary & Alternative Therapies Remedial Massage $33 Acupuncture, Alexander Technique, Aromatherapy, Biochemistry, Bowen Therapy, Exercise Physiology, Feldenkrais, Herbalism, Homeopathy, Kinesiology, Myotherapy, Naturopathy, Reflexology, Rolfing, Shiatsu, Chinese Medicine (consultations only) Pharmacy General items (excludes PBS scripts, over-thecounter medicines, vitamin & herbal medicines), Hormonal implants, Contraceptives for medical reasons, Preventive/travel vaccines Diet & Nutrition Dietitian & Nutritionist $28 Up to $60 each item above the general patient PBS amount Initial consultation / subsequent consultation 1 $45 / $32 Weight loss - Some conditions apply, see your Member Guide for more information Per class/course $10 / $100 Orthotics & Orthopaedic Shoes Purchases must be from an ahm recognised Podiatrist or orthopaedic supplier (excludes sporthotics and formthotics) Hearing Aids account must be paid in full before benefit is paid Per hearing aid $800 Repair $50 Pre/post Natal Services & Birthing Courses Consultations & classes (including lactation consultants) Birthing courses (must be provided by a registered Midwife) $400 < 5 years $500 5+ years $550 10+ years $600 20+ years $650 $400 $200 $200 $26 $5 1. Benefits are payable for one initial consultation per therapy per person each financial year (every 3 years) $1,600 (per rolling year) $300 3
Health Improvement Benefits Some conditions apply, see your Member Guide for more information Quit smoking Per course $110 Per item (nicotine replacement therapy ie. patches, gum, lozenges, inhalers) Disease management association fees Per association (Asthma, Diabetes, Heart, Arthritis, Colitis, Coeliac, Ostomy, Crohn's Disease) $60 $52 Cancer Council UV products Per item (sunscreen, swimwear, hats, sunglasses) $52 Stress management courses Per course $100 Preventive tests, scans & screenings Per test (mammograms, skin cancer screenings, bowel cancer tests and scans, bone mineral density Up to $65 tests) Health checks Per check (doctor s health checks, Healthy Heart checks) Exercise classes Per class/course. Exercise classes Types of exercises classes include gym classes or courses (membership), personal trainer, yoga, pilates and exercise physiology $60 $16 / $250 Swimming lessons and training (0-17 years) Per lesson/course $10 / $250 $250 4
Other Therapies Psychology & Hypnotherapy (service must be provided by an ahm recognised Psychologist) Assessment or initial consultation / subsequent consultation 1 $81 / $46 Group consultation $25 Speech Therapy Initial consultation / subsequent consultation 1 $60 / $30 Occupational Therapy Initial consultation / subsequent consultation 1 $34 / $30 Eye Therapy (Orthoptics) Initial consultation / subsequent consultation 1 $32 / $25 Audiology Initial consultation / subsequent consultation 1 $32 / $25 Podiatry Initial consultation / subsequent consultation 1 $38 / $30 Casting $30 Podiatric surgery (not in hospital) $210 Medical Gases Per unit (eg. oxygen) $100 Oxygen concentrator $1,200 Joint Fluid Replacement Injections per therapy < 5 years $300 5+ years $350 10+ years $400 20+ years $450 $1,200 (per rolling year) Per injection (eg. Synvisc, OsteoArtz, Hyalgan) $320 $640 Post Operative & Medical Aids (evidence of hospitalisation or medical need is required) Post operation aid (eg. surgical stockings) $105 Braces and supports (eg. crutches) $105 Medical aids (including Irlen lens) $160 Non-surgical prosthesis (including wigs) $160 Outpatient Procedure Room Fees $300 Per procedure $0 $360 1. Benefits are payable for one initial consultation per therapy per person each financial year 5
Travel & Accommodation (conditions apply see our Member Guide) Travel over 200kms return trip Accommodation per night (for specialist medical appointments and outpatient procedures only) Ambulance Emergency ambulance (excludes ambulance subscriptions and non-emergency transport eg. transfers between hospitals) periods $0.15 / km A set amount of time you must wait before you can claim any money back for a service included on your cover. All health insurers have waiting periods, which apply when you first join (or rejoin after some time without health insurance) or when you change to a higher level of cover or one with additional services. Benefits The amount you get back from us to help with the cost of your treatment. $300 Limits Benefits are subject to annual limits. An annual limit is the maximum amount of benefits payable towards services, items or groups of services and/or items within a financial year (1 July to 30 June). However some benefits for Super Extras are based on a rolling year, which begins on the date a service was first provided with the limit applying to that month period following the date of the first service. Benefits that have been paid under your previous cover will be taken into account in determining the benefits payable under your ahm cover. Your annual claiming limit for some services will increase after you ve been with us for over 5, 10 and 20 continuous financial years. Some services also have a lifetime limit. Once you ve reached this limit you can no longer claim that benefit in any future year of membership, even if you change your cover. $30 100% No limit 1 day Get in touch 134 246 Monday to Friday info@ahm.com.au ahm.com.au Find us on Facebook facebook.com/ahm.health.insurance ahm by Medibank is a business of Medibank Private Ltd ABN 47 080 890 259. ahm by Medibank, ahm Health Insurance and ahm are references to Medibank Private Ltd trading as ahm by Medibank. January 2015 6 MAHM00090115