GMHBA health fund

GMHBA Health Insurance Hospital Cover

Choose from a range 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 policy.

Top 3 features
  1. Good for people who like rewards. Most policies come with AIA Vitality, a market leading rewards program.
  2. Good for people who like a lot of choice. With 8 policies to choose from, there's something for everyone.
  3. Good for people who just want basic cover. The Basic policy covers all 36 clinical categories of treatment on a restricted basis.

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What GMHBA hospital policies are available?

All policies come with access to the AIA Vitality rewards program unless otherwise stated.

  • Basic Plus 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 all 35 clinical categories of treatment while keeping gap costs and out-of-pocket expenses down. Does not come with AIA Vitality.
  • Bronze Essential Hospital with AIA Vitality. Offers full cover for all 18 clinical categories required for a Bronze policy plus a few more including joint reconstructions and diabetes management. Comes with the AIA Vitality program that lets you earn up to 50% off eligible flights.
  • Bronze Plus Hospital. Covers everything the Bronze Essential policy does plus Dental Surgery. Does not come with AIA Vitality.
  • Silver Core Hospital with AIA Vitality. Covers all 26 clinical categories required for the Silver label, including cover digestive issues and pain management. Comes with access to the AIA rewards program.
  • Silver Plus Hospital. Covers a bit more than the 26 clinical categories required of a Silver policy, including sleep studies and full instead of restricted cover for rehabilitation and palliative care. Does not come with AIA Vitality.
  • Silver Plus Premium Hospital. Covers everything the Silver Plus Hospital policy does plus a few more categories of treatment including joint replacements, insulin pumps and pain management with device. Does not come with AIA Vitality.
  • Silver Plus Premium Hospital with AIA Vitality. Exactly the same as Silver Plus Premium but with access to the AIA Vitality program.
  • Gold Ultimate Hospital with AIA Vitality. Covers all 38 clinical categories required for a Gold label including weight loss surgery, pregnancy and birth and assisted reproductive services like IVF. Also comes with access to the AIA Vitality rewards program.
Basic PlusBronze Essential w/AIA VitalityBronze PlusSilver Core w/AIA VitalitySilver PlusSilver Plus PremiumSilver Plus Premium with AIA VitalityGold Ultimate w/AIA Vitality
AIA Vitality
Emergency Ambulance
Hospital Psychiatric ServicesRestrictedRestrictedRestrictedRestrictedRestrictedRestrictedRestricted
Palliative CareRestrictedRestrictedRestrictedRestricted
Brain & Nervous SystemRestricted
Eye (not cataracts)Restricted
Ear, nose and throatRestricted
Tonsils, adenoids and grommetsRestricted
Bone, joint and muscleRestricted
Joint reconstructionsRestricted
Kidney and bladderRestricted
Male reproductive systemRestricted
Digestive systemRestricted
Hernia and appendixRestricted
Gastrointestinal endoscopyRestricted
Miscarriage and termination of pregnancyRestricted
Chemo, radio and immunotherapy cancerRestricted
Pain managementRestricted
Breast surgery (mc)Restricted
Diabetes management (excl insulin pumps)Restricted
Heart and vascular systemRestricted
Lung and chestRestricted
Back, neck and spineRestricted
Plastic and reconstructive surgeryRestricted
Dental surgeryRestricted
Podiatric surgeryRestricted
Implantation of hearing devicesRestricted
Joint replacementsRestricted
Dialysis for chronic kidney failure
Pregnancy and birthRestricted
Assisted reproductive servicesRestricted
Weight loss surgery
Insulin pumps
Pain management with deviceRestricted
Sleep studiesRestricted

Other benefits of GMHBA hospital cover

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.

  • Access to the AIA Vitality rewards program. Vitality is a market leading program that gives you tons of great rewards like 25% off Fitbit and Garmin fitness trackers, 50% off your Fitness First and Virgin Active gym memberships and up to 50% off Virgin Australia flights.
  • 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.

How do the costs work?

All of GMHBA's hospital policies have an excess, which can range from $250-$750 depending on the policy and on the excess you choose.

Every time you are admitted to the hospital, you will pay this excess. If you're in a private hospital, you might also incur out-of-pocket costs known as your gap. This is when a private provider charges above what the standard benefit amount is for the service.

You can minimise some of these costs by choosing a hospital that is part of GMHBA's Gap Cover scheme.

Waiting periods and limitations

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:

  • No waiting period. Accidents.
  • 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 make a claim

The claims process differs based on whether or not your doctor participates in GMHBA's Gap Cover Scheme.

If your doctor does participate, your bill will be sent to Medicare and GMHBA automatically. If the doctor does not participate, you'll need to follow these steps:

  1. Take your bill and paperwork to Medicare to receive a medical statement and a cheque
  2. Send the medical statement to GMHBA
  3. GMHBA will send you a cheque for payment
  4. Send the cheques from Medicare and GMHBA to your doctor
  5. The doctor will bill you for any expenses not covered by Medicare and your health fund
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