Hospital and Extras package
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Hospital and Extras package
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Although these services are included, there still may be some out-of-pocket expenses as some doctors and medical practitioners charge more than what is set out in the Medicare Benefits Schedule (MBS).
A note on ambulance: Tasmania and Queensland have state schemes that cover ambulance services for residents of those states. Annual limits apply per person, per financial year.
What’s partially covered
Some of your costs for the above items will be covered but not all, so you will end up with out of pocket expenses if you go to a private hospital or are in a private room in a public hospital.
For these excluded services the cost of treatment won’t be covered at all. This won’t stop you from going to a public hospital as a public patient for treatment.
Spend your extras your way
You’ll get one amount to use on your included extras each financial year. Limits apply per person, per financial year. Sub-limits and waiting periods apply.
Know what you’ll get back
To see what will be paid for each service view the product guide.
Are we a health insurer?
No. All products available through Kogan Health are issued by ahm health insurance which is a business of Medibank Private Limited ABN 47 080 890 259, a registered private health insurer, and is arranged by Kogan Australia Pty Ltd, for which Kogan receives commission.
What if I’m an existing ahm health insurance member?
Existing ahm members are not eligible to join through Kogan Health online. For general enquiries, please call ahm directly 134 246.
All products available through Kogan Health are issued by ahm health insurance which is a business of Medibank Private Limited ABN 47 080 890 259, a registered private health insurer, and is arranged by Kogan Australia Pty Ltd, for which Kogan receives commission.
I’m switching from another insurer, how does it work?
Switching to ahm through Kogan Health is easy - just tell us the name of your current health insurer when you join and it will be organised it for you.
If you switch to ahm through Kogan Health within 30 days of leaving your current health insurer, any waiting periods you’ve already served are generally carried over for comparable services. So this means you may not need to wait to claim and you’ll have cover with ahm from the date your cover starts, even if you’re switching.
When can I start to claim?
As soon as you have served your waiting periods. Check your product guide to see what waiting periods apply to you.
If you’re switching from another private health insurer, any waiting periods already served and annual limits used for comparable benefits will generally be recognised.
A waiting period is a set amount of time before you can claim any money back for a service included on your cover. Waiting periods apply when you first join (or re-join after not having had health insurance for some time) or if you change to a higher level of cover that has additional services or higher limits.
How much can I claim on my extras?
You’ll get one limit to spend on included extras (plus a separate optical limit on applicable products). Refer to your product guide for the limit. If you join a flexi product, that limit will increase after the end of your first full financial year, for 5 years.
With a flexi limit, each member on the policy gets one amount to spend on one, or all of the included extras each financial year. So you might choose to use it all on routine dental, or spread it evenly across all of your services. The choice is yours.
Your extras limit will reset on the 1st July each year for each person on the policy.
Are there any provider restrictions?
You will receive the same benefit at all recognised providers, other than ahm’s no-gap dental offering at select dentists.
This is great because you can see your regular physiotherapists or chiropractor knowing you will receive the same benefits across all recognised providers.
What is my hospital excess?
Your hospital excess will be $500. An excess is an upfront lump sum payment that you agree to pay towards the cost of your hospital stay or day surgery. You’ll have to pay this directly to the hospital and in most cases they will require this on admission.
What will be my medical out-of-pocket expenses?
Your out-of-pocket expenses may vary depending on a range of factors, but significantly if the service is included, partially covered (restricted) or excluded.
For a list of what is paid for each service, view the product guide.
Included hospital services
When you go to hospital, there might be a gap between what is paid for your medical services, and what your doctor charges you. This is the referred to as a medical gap and is your out-of-pocket expense.
Medical gaps exist because some doctors may charge higher fees than what is set out in the Medicare Benefit Schedule (MBS).
That’s where GapCover can help.
Doctors can choose to participate in GapCover or not on a per claim, per treatment and per patient basis, so you should always check with them prior to agreeing to each claim as part of your treatment. If your doctor chooses to participate in GapCover for the claim forming part of your treatment, then benefits up to an agreed fee will be paid and the maximum gap that you’ll have to pay is $500 per claim per provider (i.e. per each doctor’s account).
GapCover doesn’t apply to diagnostic services such as blood tests, x-rays and ultrasounds, out-of-hospital medical services and sevices not included on your policy. GapCover doesn’t apply to things such as excess payments and co-payments. You may still have out of pocket costs.
You can search online for doctors who’ve previously registered to participate in GapCover with our find a provider tool. This doesn’t mean they’ll do so for your claim forming part of your treatment. You should always check upfront with your doctor before agreeing to each claim forming part of your treatment.
Partially covered hospital services
In addition to any out-of-pocket costs as a result of a medical gap, partially covered services only pay limited benefits towards your accommodation and won’t cover the full cost of treatment.
If you choose to use a hospital service that is only partially covered, you may be left with additional out-of-pocket expenses related to your stay in hospital.
To reduce your out-of-pocket expenses, you may choose to be treated as a private patient in a public hospital, rather than a private hospital. However, this will not reduce your out-of-pocket expenses entirely.
Should you need to use a partially covered hospital service, call 134 246 before you go into hospital for your treatment to confirm what you’re covered for.
Excluded hospital services
If you choose to use a hospital service that is not covered, and you use the private health care system, your out-of-pocket will be the entire cost of the treatment. No benefits will be paid towards the cost of your treatment.
Your out-of-pocket expenses for your extras services will be the difference between what your provider charges and what you receive back on that particular service.
Can you explain ‘hospital’ and ‘extras’?
These are types of cover we put together which combine a certain level of hospital and extras. For example, you could get a mid-range cover like Classic Flexi, or the more comprehensive Deluxe Flexi.
You can also take out different levels of hospital and extras cover. All products available through Kogan are combined hospital and extras packaged products.
What’s a pre-existing condition?
A pre-existing condition is any kind of ailment, illness or condition where you had the signs or symptoms (in the opinion of one of ahm’s Medical Practitioner) 6 months before you joined private health insurance or changed your cover.
Medibank’s appointed Medical Practitioner is the only person authorised to decide if an ailment, illness or condition is pre-existing. They must consider any information that was provided by the medical practitioner who treated the ailment, illness or condition.
Check your Member Guide for more information on pre-existing conditions.
How to join
It takes just a few minutes to join. But who’s counting? Just have these goodies handy and you’re set to go:
- Your Medicare card
- Your payment details
Safe and secure payment
MasterCard or Visa cards incur a 0.21% surcharge
All you will need to provide is the name of your insurer, and the rest will be taken care of.
30 day cooling off period
It’s OK if you change your mind. Just let ahm know within 30 days of joining and as long as you’ve made no claims ahm will refund your premiums.