GMHBA health fund

GMHBA Health Insurance Hospital Cover

Choose from 3 levels of hospital cover to find the option that meets your needs with GMHBA

GMHBA is a popular not-for-profit health fund, founded as a small group in 1934 and now focused on providing healthcare for more than 230,000 members around Australia.

GMHBA is dedicated to offering value for money, and the right healthcare options for all Australians. You may want to consider GMHBA for your hospital cover thanks to the wide-ranging benefits and exceptional features that you can find even with the most basic plan.

The GMHBA hospital plans

The three cover levels are Bronze, Silver and Gold. You can get the Gold level with or without pregnancy cover to help keep costs down while still accessing a range of other family-related benefits.

  • Bronze Hospital. Wide-ranging cover that is more typical of a high-level policy at a low price. It’s so affordable because it’s for shared rooms in public hospitals only, letting you access important services while keeping gap costs and out-of-pocket expenses down. It’s a pragmatic plan and might be a good choice when affordability and effective cover are the priorities.
  • Bronze Hospital Plus. A policy for those who want affordable cover but prefer private hospital accomodation. It allows you to claim for a similar level of hospital services that Bronze Hospital covers while allowing you to be treated as a private patient in a GMHBA approved private hospital.
  • Silver Hospital. Flexible mid-range cover letting you access both public and private hospitals as the situation warrants while remaining affordable. Certain treatments are excluded to help keep costs down, and it might be suitable for younger or healthier people who want cover for important treatments and a range of options available without breaking the bank.
  • Gold Hospital. High-level cover that is available with or without pregnancy-related benefits. Comprehensive private hospital cover means it might be a good choice for people who are getting older and may want additional security, those with specific health needs or families looking for effective cover.
Bronze HospitalBronze Hospital PlusSilver HospitalGold Hospital
Excess$0, $250 or $500$500$0, $250 or $500$0, $250 or $500
Hospital accommodationPublic hospital onlyPrivate hospital with excessPublic hospital, and private hospital with co-paymentPublic and private hospital
Medical gap cover
  • yes
  • yes
  • yes
  • yes
Best Doctors Program
  • yes
  • yes
  • yes
  • yes
At-home hospital and rehabilitation services
  • yes
  • yes
  • yes
  • yes
Accidental injury
  • yes
  • yes
  • yes
  • yes
Appendicitis
  • yes
  • yes
  • yes
  • yes
Cardiac treatments
  • yes
  • no
  • yes
  • yes
Cancer treatment
  • yes
  • yes
  • yes
  • yes
Intensive and coronary care
  • yes
  • yes
  • yes
  • yes
Joint reconstructions and investigations
  • yes
  • yes
  • yes
  • yes
Gynaecology
  • yes
  • yes
  • yes
  • yes
Operating theatre costs
  • yes
  • yes
  • yes
  • yes
Psychiatric
  • yes
Public hospital benefits onlyBenefit limitation period appliesBenefit limitation period applies
Rehabilitation
  • yes
Public hospital benefits only
  • yes
  • yes
Tonsil and adenoid removal
  • yes
  • yes
  • yes
  • yes
Surgical prostheses
  • yes
  • yes
  • yes
  • yes
Cataract and corneal transplants
  • yes
  • no
  • no
  • yes
Dental implant surgery
  • yes
  • no
  • no
  • yes
Joint replacements
  • yes
  • yes
  • no
  • yes
Pregnancy and childbirth
  • yes
  • no
  • no
With optional pregnancy cover
Assisted reproductive services
  • yes
  • no
  • no
With optional pregnancy cover
Obesity procedures
  • no
  • yes
  • no
Benefit limitation period applies
Haemodialysis
  • no
  • no
  • no
Benefit limitation period applies
Insulin pumps
  • no
  • yes
  • yes
  • yes

What are the additional benefits and special features of GMHBA?

All GMHBA hospital plans include special features that help deliver value for money, while raising the quality of medical care you might access.

No matter which hospital plan you get, you’ll access some important features. These can be found with many other providers, but will often only be available with the more expensive plans. With GMHBA, everyone with hospital cover can get them.

  • Choice of excess. If you’re unlikely to need to go to hospital, you can choose a higher excess to keep premiums down. This is the amount you need to pay per hospital visit, up to once per year with singles policy and twice per year with couples and family cover.
  • Best Doctors Program. This lets you access some of the best doctors and specialists in their field, as nominated by their peers, from all over the world. You can get a review of your medical records, answers to any questions you might have and written reports on your current diagnosis. This is available with even basic cover, letting everyone get a high standard of medical care.
  • Gap Cover. Gap cover lets you keep out-of-pocket expenses to a minimum no matter which GMHBA hospital cover you have. This can help cover gaps that exist when providers charge amounts above the set MBS fees.
  • At-home hospital and rehabilitation. Helps cover the cost of at-home hospital and rehabilitation services, letting you get further treatments in the comfort of your own home and leave from hospital sooner to reduce the chance of infection and promote active recovery.

Pregnancy and family advantages

If your policy covers pregnancy (Gold with pregnancy cover and Bronze policies), medical cover is just the start. You also get access to the following benefits:

  • Healthy Start. An additional benefit of up to $500 to help cover any out-of-pocket expenses that might be incurred for inpatient obstetric and childbirth-related costs in hospital.
  • The New Family Program. GMHBA has partnered with early childhood experts, Safe Sleep Space, to deliver this program. It includes phone consultations with a trained “baby consultant” and a range of resources to help you out, including what to expect from a new baby and much more.

The Connect Rewards program

Everyone with GMHBA hospital cover can join the Connect Rewards program. This is a simple program that lets you accumulate Connect Dollars each year, which you can use to cut costs. For example, you could use your Connect Dollars to automatically pay a gap expense.

If you have GMHBA extras cover, you can use your Connect Dollars to pay for further services under your plan, even if you’ve reached your annual limits.

These Connect Dollars accumulate each year and will remain as long as your cover doesn’t lapse. The table below shows the rewards you earn in different membership periods. These figures are for couples and family policies. For singles cover, the rewards are half of the listed amounts.

Standalone hospital cover1-3 years4-5 years6-7 years8-9 years10+ years
Bronze$0$40$60$80$100
Silver$20$60$80$100$120
Gold (with or without pregnancy)$40$80$100$120$140

Limitations and waiting periods to be aware of

Benefit limitation periods apply to certain services. With these, you are not fully covered for 24 months after the waiting period ends. During the benefit limitation period, you are only able to claim the default public hospital benefits. After it ends, you can start claiming full cover in line with the terms of your policy.

Benefit limitation periods only start counting down after the end of the applicable waiting periods. When you transfer to GMHBA from another health fund where you had the same cover, GMHBA will recognize any served waiting periods. The hospital waiting periods are as follows:

  • 12 months. Pregnancy, fertility treatments or pre-existing conditions.
  • 2 months. All other treatments, as well as psychiatric, rehabilitation and palliative care, even when for a pre-existing condition.

How to claim

Before commencing hospital treatments, it’s a good idea to call GMHBA or visit a branch to get an estimate of what costs, if any, there will be.

To claim hospital expenses, lodge a two-way claim through Medicare, which will then be forwarded to GMHBA for processing. This will need to include a completed claims form and the fully itemised account or the original itemised receipt if you’ve already paid for it.

Receive quotes for GMHBA Hospital Cover

Andrew Munro

Andrew writes for finder.com.au, comparing products, writing guides, sniffing out deals and looking for new ways to help people get the most out of their money.

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