essentials flexi basic plus

Hospital: what is covered

Restricted means partially covered for hospital costs as a private patient in a public hospital; in a private room or private hospital you may face significant expenses.

Excess, waiting periods and hospital

• Tier - Basic Plus
• Hospital - Private hospital, or a shared room in a public hospital
• Excess - Capped per person and per policy per year. $750 per person a year. $1,500 per policy a year.
• Co-payments - None.
• Known gap - Yes, with the fund's doctors
• Age-based discount - Offered for 18 to 29 year olds
• Accident cover - Yes
• Travel and accommodation benefits - No

Waiting periods

• Most treatments - 2 months
• Existing conditions - 12 months
• Rehabilitation, psychiatric and palliative care - 2 months

As filed by the insurer: This cover also includes Accident Override.

Extras: what you get back

Not covered: Major dental, Braces, Prescriptions not on the PBS, Podiatry, Psychology, Acupuncture, Hearing aids, Blood glucose monitors, Audiology, Antenatal and postnatal, Chinese herbal medicine, Dietitian, Exercise physiology, Eye therapy (orthoptics), Health management programs, Home nursing, Occupational therapy, Orthotics, Speech therapy, Vaccinations.

Other services, as filed: With essentials flexi basic plus you get one flexi limit to use on one, or all, of your included extras each financial year and a separate optical limit. The longer you’re a member with us, the more you can claim (capped at year 5). See your product guide for more details.

100% back on optical, up to the annual limit (6 months waiting period apply)

Ambulance

Emergency ambulance. Call-out fees covered. Waiting period for emergency transport: 1 day. No limit on emergency transport.

Agreement hospitals in Tasmania

ahm has agreements with 11 private hospitals here, as filed with the Ombudsman.

This policy's other options

Every state, household and excess the insurer filed for this policy, with the premium before the rebate.

Member retention (hospital cover)

85.4% is the Commonwealth Ombudsman's figure for Medibank, the insurer of ahm, in its State of the Health Funds Report 2024-25 (Table 1, page 15; data at 30 June 2025).

The Ombudsman describes it as one measure of the comparative effectiveness of insurers and of their level of member satisfaction: the percentage of members, hospital memberships only, who have remained with the insurer for 2 years or more (page 12). It is published for the insurer, not for this policy, and is not adjusted for policies that lapse when a member dies. The Ombudsman cautions that no single indicator shows an insurer's overall performance (page 27).

It is shown as published. The list is not sorted, filtered or ranked by it.

Member retention is the Commonwealth Ombudsman's figure, from its State of the Health Funds Report 2024-25. Source: Licensed from the Commonwealth Ombudsman under a Creative Commons 4.0 licence. This report is available from the Commonwealth Ombudsman website at www.ombudsman.gov.au.

Where this comes from

Policy details come from the PrivateHealth.gov.au dataset published by the Private Health Insurance Ombudsman on data.gov.au (release of 1 Oct 2026), licensed under Creative Commons Attribution 3.0 Australia. Statement J103/SFQH20, filed by ahm health insurance, issued 1 Apr 2026.