Skip to content   Skip to footer navigation 

Compare AHM health insurance

How AHM rates for member complaints, gap cover and ambulance.

AHM_lead

AHM summary

AHM originated in Wollongong, NSW 40 years ago, and was bought by Medibank Private in 2009. It has 500,000 members and promotes its 'uncomplicated' cover and 'digital first service'. AHM also offers health insurance policies trading as Kogan Health.

Phone: 134 246

Email: info@ahm.com.au

Website: ahm.com.au

Is AHM nonprofit?

No.

Does AHM get many complaints from members?

AHM complaints rating: Medium

When we score policies we give each fund a complaints rating, based on the number of complaints and serious disputes the Ombudsman deals with. We take into account the size of the fund, so big funds don't get automatically penalised for having more complaints.

  • The ratings are Low, Medium and High. A Low rating is better than a High rating – it means the fund has fewer complaints and fewer serious disputes for its size.
  • The infographic below shows the complaints about the fund to the Ombudsman as a percentage of all complaints. Complaints can be about benefits or customer service. The most serious complaints are escalated for investigation.
  • The higher the share of complaints a fund receives above its market share, the worse its performance compared to other funds. If its share of complaints is below its market share, that's a better result.

How good is AHM's gap cover?

A medical gap is the difference between Medicare's recommended fee and what your doctor actually charges for a treatment or service.

Health funds have agreements with particular doctors and hospitals to cover all of the gap, which are called 'no gap agreements', or part of that gap, which are called 'known gap agreements' (these will have lower out-of-pocket costs, usually less than $500).

Our graphic below displays the CHOICE gap rating, which takes into account the percentage of services where members either paid no gap or a known gap, compared to the state average.

Rating scale

  • Above average
  • Average
  • Below average
  • Well below average

We also display the percentage of medical services that AHM covers with no gap, and compare it to the industry average. The higher the percentage, the more effective the fund's gap scheme is in a state or territory.

How many hospital agreements does AHM have in my state?

The benefit amount your fund pays you for hospital services depends not only on the type of cover you buy, but also whether your fund has an agreement with the hospital where you're treated. 

The table below shows how many hospital agreements AHM has in your state compared to the fund with the highest number (the industry maximum). Note that public hospitals don't have agreements with specific funds and are generally treated as though they're agreement hospitals.

Does AHM offer any discounts?

Discount for direct debit: None

Discount for annual prepay: None

Total discount for annual prepay via direct debit: None

Does AHM offer ambulance cover?

All AHM hospital and combined policies cover emergency ambulance in all states.

Cover is capped for:

  • White-starter, White-lite – one claim per financial year for a Singles policy / two claims per financial year for a Couples or Family policy.

Do you need ambulance cover?

Depending on where you live, you may not need a policy with ambulance cover. 

  • In Queensland or Tasmania, emergency ambulance services are covered by your state government. 
  • In NSW and the ACT, all hospital policies come with emergency ambulance cover – so you'll be covered with any hospital or combined policy you select. 
  • In South Australia, Victoria and the Northern Territory you can buy emergency ambulance cover directly from the ambulance service. Alternatively, some health fund policies will cover ambulance in your state or territory or refund at least part of the cost of the ambulance service cover. 
  • Rural WA: You can buy emergency ambulance cover directly from the ambulance service. Alternatively, some health fund policies will cover ambulance or refund at least part of the cost of the ambulance service cover. 
  • Metropolitan WA: If you want to be covered for ambulance you need to buy a health insurance policy with ambulance cover.

Does AHM offer family policies that cover adult children?

Yes, adult children are covered up to age 25.

Does AHM let you claim online or in-app?

Online claiming for all services.

Leave a comment

Display comments