Medibank and ahm FAQs

When can clients claim benefits towards counselling consultations on Medibank and ahm products?
Medibank and ahm are introducing benefits towards counselling consultations that occur on or after 15 October 2020. 

Medibank members whose Extras products include 'Mental health Support' can claim a benefit for counselling consultations with Medibank recognised Providers, that have occurred on or after this date, up to their annual limit.

ahm members whose Extras products include 'Psychology and Counselling' can claim a benefit for Counselling consultations with an ahm recognised Provider, that has occurred on or after this date, up to their annual limit.

Is there a waiting period before a member can claim benefits towards counselling consultations?
There is no waiting period for counselling benefits, so both Medibank and ahm members with Counselling included in their policy can claim a benefit towards counselling consultations on or after 15 October 2020, up to their annual limits.

How will my client know if their cover includes counselling?
To find out if a Medibank member can claim benefits towards Counselling, ask them to refer to their Cover Summary which is available on My Medibank App on their phone, or by logging into the Member Area on the Medibank website. If their extras cover includes ‘mental health support’, then they can claim a benefit for counselling up to the annual limit.

To find out if an ahm member can claim benefits towards Counselling, ask them to refer to their Product Guide which is available on the ahm website. If their extras cover includes ‘Psychology and Counselling’, then they can claim a benefit up to their annual limit.

What is the eligibility to become a Medibank and ahm provider?

From 10th October 2020, all new applicants for a Medibank and/or ahm Provider Number must meet the following eligibility criteria:

• Providers must be Clinical members of PACFA;
• Providers must have completed a Bachelor Degree (AQF level 7) or a Masters Degree (AQF level 9) specifically in Counselling/Psychotherapy, or have been assessed by VETASSESS as having completed an equivalent overseas Bachelor or Masters qualification;
• Providers must hold current Professional Indemnity Insurance of $1,000,000 minimum per claim;
• This professional indemnity insurance policy must cover each practice location and each modality; and
• Providers must hold a current Provide First Aid (HLTAID003/HLTAID011) certificate.

How do I apply to become accredited with Medibank and ahm?
Members of PACFA who meet the eligibility criteria can apply for a Medibank Provider number by completing the Online Application Form

What Medibank products will counselling benefits be offered on?
Counselling benefits have been included on the following Medibank products from 15 October 2020:

Resident Products:
Blue Ribbon, Gold Advantage, Priority Optimal, Priority Optimal A, Blue Ribbon Premier, Gold Premier, Medibank Silver Plus Families, Gold Ultra Health WA, Gold Ultra Health, Growing Family 60, Growing Family 60 Extras Only, Growing Family 70, Growing Family 70 Extras Only, Healthy Start Extras, Silver Plus New Families Comprehensive, Silver Plus New Families Essentials, Silver Plus Security Comprehensive, Silver Plus Security Essentials, Silver Plus Settled Families Comprehensive, Smart Choice, Silver Plus Smart Options, Priority Standard, Priority Standard A, Super Extras, Top Extras 60, Top Extras 75, Top Extras 90,

Corporate Products:
VIP Super Extras, Better Health 60, Better Health 70, Better Health 80, Better Value 80, Extras 55, Extras 70, Extras 85, Flexi 70, Flexi 80, Flexi 80 MC

Overseas Products:
Better Health 60 Working Visa, Better Health 70 Working Visa, Better Health 80 Working Visa, Better Health 90 Working Visa, Better Value 80 Working Visa, Intermediate Visitors Health Insurance, Overseas Workers Premium Extras, Top 85 Visitors Health Insurance, Top Visitors Health Insurance, Top Working Visa Health Insurance, Intermediate 70 Visitors Health Insurance, Comprehensive OSHC

What ahm products will counselling benefits be available on?
Counselling benefits have been included on the following ahm products from 15 October 2020:

super extras, black 70 boost, family extras, lifestyle extras, boost package basic plus, boost flexi basic plus, first step bronze plus, top hospital package gold, lite package bronze plus, lite flexi bronze plus.

Note:  The product list is correct as of 15th October 2020, however may change from time to time.  Medibank members should check their cover summary and ahm members check their product guide to see if counselling is included in their cover.

What will members get back for a Counselling consultation?
Medibank members should refer to their Cover Summary to see if their product pays a fixed benefit amount towards counselling or a % back of the consultation cost.  This is determined by what product the member is on.  Benefits are subject to annual limits which are displayed on the Cover Summaries.

All ahm members should refer to their Product Guide for this information.  Benefits are subject to annual limits, which are also found on the Product Guide.

What should be displayed on the invoice from a Counselling provider for Medibank and ahm to accept the claim?
For Medibank and ahm to accept a Counselling claim, the claim must include your name, practice address, and provider number, as well as your patient's name, item code (see below), and the date of service.

All invoices must be issued electronically, as no handwritten or partially handwritten invoices will be accepted by Medibank and ahm.

If the invoice doesn’t include the correct item code and provider number, the claim will be rejected.

What are the item codes that must be displayed on the invoices?
The below item codes should be added to the invoices for face to face consultations so Medibank and ahm can accept and pay the claim (subject annual limits).

Will Medibank and ahm pay benefits towards telehealth consultations?
Medibank and ahm introduced telehealth codes as part of the response to the COVID-19 pandemic, and have since made the decision to keep telehealth provisions as a permanent feature of eligible extras products.

The below item codes should be added to the invoices for telehealth consultations so Medibank and ahm can accept and pay the claim (subject annual limits).

No counselling benefits are payable towards Group telehealth consultations, and HICAPS does not support telehealth claims at this stage.

To download the Medibank Private FAQs, click here.

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