Health Insurance FAQs

Hospital Cover is the payment of benefits toward the cost of treatment in an Agreement Private Hospital, non-agreement Private Hospital or any public hospital. The level of hospital cover you choose determines the types of procedures you're covered for. The higher the level of cover, the more procedures you will be covered for.

If you've received a bill for a hospital procedure and that procedure is included in your level of cover, and you've served the waiting period(s), there are several ways you can claim. You can claim online, through the mobile app, or by contacting AAMI Health Insurance directly. If you're unsure why you have been billed please give us a call on 13 22 44 (8am-6pm Mon-Fri AEST/AEDT, Closed Weekends and Public Holidays).

When you suspend your Hospital Cover you put it on hold. You aren't charged premiums while it's suspended, but you can't claim during this period. You can suspend your cover if you're experiencing financial hardship or if you're travelling overseas for longer than 2 months. You must be with AAMI Health Insurance for 12 continuous months before being able to apply for a suspension. Please refer to your policy booklet for further information.

You can add your newborn to your cover by contacting AAMI Health Insurance as soon as possible. Your newborn child will receive immediate cover, as long as you notify AAMI Health Insurance of the birth and request the newborn become an insured person under the Policy:

i. within 2 months after the newborn’s birth, where the parent/guardian upgrades from an existing Single or Couples policy; or

ii. within 24 months after the newborn’s birth, if the newborn is to be added to a Family Policy or a Single Parent Policy that was active at the newborn’s date of birth.

A pre-existing condition is any ailment, illness, or condition that you had signs or symptoms of during the 6 months prior to you first joining hospital cover or upgrading to a higher level of hospital cover. A health condition can still be considered pre-existing even if the illness had not been formally diagnosed prior to you purchasing or upgrading your level of hospital cover.

If your condition or illness is determined to have met the pre-existing condition definition, a 12 month waiting period applies from the date of joining or upgrading your level of hospital cover. You may not receive hospital benefits for treatment for the condition during this waiting period.

Minimum Benefits Payable (MBP) is the minimum amount of benefits that AAMI is required to pay under the Private Health Insurance Act, to or on behalf of a customer for hospital treatment under Hospital Cover. It means there will be significant out-of-pocket costs for treatment if you're attending a private hospital. If a treatment is limited to MBP and is important to you, we recommend you consider a higher level of cover.

A Benefit Limitation Period (BLP) means that unless you’re transferring from a Complying Health Insurance Product (see Policy Booklet), there will be significant out-of-pocket costs if you go to hospital for this treatment in the first 12 months of your policy. After serving the 2 month Waiting Period, your benefit will be limited to “Minimum Benefits Payable” for the following 10 months. After this period of time you are entitled to the full benefit claimable for the treatment.

An out-of-pocket expense is the difference between what we'll cover and the total cost of your stay in hospital – it's similar to the Medicare gap. If your stay in hospital costs more than what you're covered for, you'll need to pay an out-of-pocket expense.

The total cost of your stay in hospital depends on the hospital, your doctors and your specific procedure. Before going to hospital, we can explain how to keep costs down and even avoid out-of-pocket expenses altogether by:

• Checking if you have the right level of cover
• Providing you with access to a network of Agreement Private Hospitals 
• Helping to cap doctors costs with nib’s MediGap Scheme
• Please call us on 13 22 44 for more information

Public hospital waiting lists are lists of patients who require non-emergency – but medically necessary – elective surgery. Patients are generally categorised by who needs the most urgent medical attention and the likelihood of their condition becoming an emergency.

No. Under all covers, no benefits are payable towards procedures or hospital costs associated with cosmetic surgery to enhance appearance. Cosmetic Surgery and non-surgical cosmetic procedures are not recognised by Medicare and health insurers do not pay benefits for these procedures or the hospital costs associated with them.

Extras Cover is insurance for everyday services that are conducted outside hospital, services that may not covered by Medicare like physio, optical, and dental.

An Extras provider is a health service professional or organisation, such as a dentist, physiotherapist or optometrist.

With AAMI Health Insurance, depending on the level of health cover you choose, you can claim either 60% (Starter, Starter Boost and Everyday Active) or 70% (Premium Active) of the cost back on Extras every time you claim, until you reach your annual limit.

Extras Cover annual limits are the maximum amount you can claim on a particular service per calendar year. These limits vary depending on your level of extras health cover. For example, with AAMI Health Insurance Premium Active Extras Cover there’s an annual limit of $500 on physio.

Orthodontia is specialist dental work carried out by an orthodontist. This dental work often includes straightening teeth, and correcting irregular teeth alignment and bite patterns. Having braces attached is an example of orthodontia that's included with some extras insurance.

A 30 day cooling off period applies to all AAMI Health Insurance products. If you change your mind in the first 30 days after joining AAMI Health Insurance you can request a full refund of any premiums you've paid providing no claims have been made during that time.

When you switch to AAMI Health Insurance we get in touch with your old insurer and handle the paperwork on your behalf. Once you join up with us, we'll request a Transfer Certificate from your previous insurer so that you can start using your Health Insurance as soon as possible.

Related FAQs

If I change providers, do I have to restart my waiting periods?

How can I join AAMI Health Insurance?

Any waiting periods you’ve already served with your previous health insurer will be recognised in full, so you can start getting the most out of your new AAMI Health Insurance straight away. Waiting periods may apply for services and higher annual limits not covered with your previous insurer. Any annual limits you have already used with your previous insurer will also carry across to AAMI Health Insurance until they're reset on January 1st. To ensure you receive this continuity of cover, make sure you switch to AAMI Health Insurance within 59 days of cancelling your previous policy. Find out more about AAMI Health Insurance's no waiting period.

You should review your Health Insurance cover at least once a year, or when your circumstances change. Reviewing your cover will ensure you’re getting the most out of your Health Insurance. Reviewing what you are and aren’t covered for is a great way of assessing whether you’re paying too much for any services you don’t use.

When you've found the AAMI Health Insurance Cover that best suits your needs you can join online or over the phone on 13 22 44 (8am-6pm Mon-Fri AEST/AEDT, Closed Weekends and Public Holidays).

Related FAQs

When does my AAMI Health Cover begin?
What are my payment options?

You can elect the date you would like your AAMI Health Insurance Cover to begin. Before you can start claiming for your Hospital and Extras, you must be in your chosen cover for a set period of time, (known as a waiting period). AAMI Health Insurance customers can only claim benefits after they have served their waiting periods. To find out what waiting periods apply on your policy please contact us on 13 22 44

You can pay your AAMI Health Insurance premium via direct debit, over the phone, through BPAY, at your nearest Australia Post Office, or by mail. Check your payment details by logging into your AAMI online account. For details on how you can make a payment, including setting up direct debit, visit the payments page.

A dependant for family health insurance purposes is classified as a person under the age 21. However, you may also be a classified as a 'student dependant' if you're a full-time student under the age of 25. Additionally, if you're single, under 25, and not studying full-time, you may be able to stay on your family's policy as an 'adult dependant', for an additional fee.

Related FAQs

How do I add my newborn to my cover?

Can I add a dependant to my cover?

Yes. So long as the person you're adding is classified as a dependant for family health insurance purposes. To add a dependant, or to see if your child classifies as a dependant, give us a call on 13 22 44 (8am-6pm Mon-Fri AEST/AEDT, Closed Weekends and Public Holidays).

Related FAQs

How do I add my newborn to my cover?

There are several ways to claim with your AAMI Health Insurance Cover: you can claim online or by swiping your card at your health service provider, if you have any questions please call us on 13 22 44 (8am-6pm Mon-Fri AEST/AEDT, Closed Weekends and Public Holidays).

Related FAQs

Is the claims process the same for Hospital and Extras?

Yes. There are several things you should consider when claiming for Hospital or Extras, such as: how much excess will you have to pay on your hospital admission, have the waiting periods been met for the claimed services, and have I reached my annual benefit limits on extras services. Need to make a claim? Visit AAMI Health Insurance claims page.

Related FAQs

How do I make a claim?

A waiting period is an initial period of time when a you first take out a policy where no benefit is payable for certain procedures or services.

Related FAQs

How do I know if a waiting period applies to me?

Waiting periods will apply when you first takes out a policy. Waiting periods also apply to any additional benefits when you transfer from one fund to another, or from one AAMI product to another if a particular service has not been covered previously.

Related FAQs

What are waiting periods?

The Medicare Levy Surcharge is a tax paid by Australian taxpayers who don’t have private hospital cover and who earn above a certain annual income – $90,000 for singles and $180,000 for families. Find out more information about the Medicare Levy Surcharge

All AAMI Health Insurance hospital products are suitable to help you avoid paying the Medicare Levy Surcharge (MLS). You are exempt from paying the MLC providing you hold a complying hospital product for the entire financial year.

Lifetime Health Cover (LHC) loading is an Australian Government initiative designed to take some burden off the public healthcare system by encouraging people to take out private health insurance hospital cover earlier in life.

You can avoid Lifetime Health Cover loading by taking out hospital cover by 1 July after you turn 31.

The Australian Government Rebate (AGR) is a contribution paid by the Federal Government towards the cost of private health insurance. The level of rebate entitlement is based on the age of the oldest person on your policy and your taxable income, or combined family income for couples and families. The rebate percentages are set annually by the Australian Government.

Most eligible customers claim the rebate as a reduction to their premium as it reduces the amount they pay AAMI Health Insurance. Let us know which income bracket you fall into and we can apply the corresponding rebate to your policy.

Other options for claiming the rebate:

You can choose to receive a rebate which is higher than you are entitled to from the Government. If you do this you may need to pay back the difference over and above your entitlement in the form of a tax bill when you lodge your tax return. You can choose to receive a rebate which is lower than you are entitled to from the Government. If you do this you should see the difference returned to you when you lodge your tax return. Alternatively, you can choose not to receive any rebate upfront and claim your entire entitlement from the Government (if eligible) when you lodge your tax return.

Your Health Insurance tax statement outlines important information to help you complete your tax return, such as the premiums you paid and the amount of rebates you received during the financial year. Click here for more information on how to read your Private Health Insurance Statement.

AAMI Health Insurance is issued by nib health funds limited ABN 83 000 124 381, a registered private health insurer, and is arranged by Suncorp Insurance Ventures Pty Ltd ABN 53 158 182 042 (SIV), for which SIV receives commission.