GMF Health Insurance

Compare policies from GMF Health Insurance and find cover that is right for you

Having health insurance provides options for quicker and better health treatment and saves any cost which might not be covered by Medicare. Within this industry, GMF health insurance is an ideal option which provides good cover at low premiums. GMF has been around for over 60 years and is a Members Own Health Fund.

They provide three levels of Hospital cover and three levels of Extras, which fulfils the requirement of all age groups and income levels. They have an efficient claims fulfilment process that allows on-the-spot claims processing for extras using GMF card. There is also an online self-service portal – myGMF – where claims can be made and policy managed by members themselves.

finder.com.au does not currently have access to this health insurance brand. You may wish to compare options available on the health insurance homepage.

GMF Health Insurance options for cover

GMF has an easy-to-understand health insurance structure. All the policies are divided into two major categories: Hospital cover and Extras Cover.

Hospital cover

This covers different types of expenses incurred during unexpected trips to hospitals. These expenses include ambulatory services, hospital accommodation, medical gap cover, psychiatric care, heart procedures, dialysis, joint replacement and many more. It is available in three different levels of cover: Lite Hospital cover, Mid Hospital cover and Complete Hospital cover.

There are different levels of cover provided by GMF. For Hospital cover the different insurance levels are:

  • Lite Hospital Cover. This is the basic level of hospital cover. It covers expenses for ambulance, medical gap cover, theatre fees, broader health, psychiatric care, plastic & reconstructive and rehabilitation. It also covers a shared room in a public or GMF Health contracted private hospital.
    This cover is ideal for customers looking for tax exemption. The government charges a Medicare Levy Surcharge (MLS) which varies from 1% to 1.5% for higher income earners and who do not have private health insurance. It is also ideal for young and single customers who require only basic coverage and are not looking for cover for health issues like joint replacement or dialysis, which generally occur in advanced ages.
  • Mid Hospital cover. In addition to the expenses listed in Lite Hospital cover, this also provides cover for maternity and birth (optional), assisted reproductive (optional) and heart procedures. This level also provides for a private room in a public hospital or GMF contracted private hospital.
    The optional categories can be removed if customers are not looking to have any kids in the foreseeable future. This will reduce the premiums for this level. This cover is ideal for customers who want a balance between value and level of cover. Also, young couples would find this cover suitable if they are planning to start a family.
  • Complete Hospital cover. Besides the expenses mentioned for mid hospital cover it also covers dialysis, gastric and obesity, major eye surgery and joint replacement. This cover is ideal for customers who are getting older and require a wider coverage.

Extras cover

This covers other expenses which are incurred on health other than on hospital visits.  It includes optical, dental, chiropractic, pharmacy, physiotherapy, home nursing, nutritionist, hearing aids and more. The Extras cover is also available in three levels: Lite extras, mid extras and complete extras.

A customer can choose the hospital and extras cover according to their individual circumstances and needs which makes these options a good value for money and helps in providing adequate insurance cover.

There are also three levels of Extras cover which cover out of hospital expenses. They are:

  • Lite Extras cover. This covers expenses like optical, general dental, chiropractic, physiotherapy, osteopathy, ambulance, natural therapy, pharmacy and podiatry. This is a good alternative for customers on a budget and covers nine of the most common health services used.
  • Mid Extras cover. In addition to the expenses for lite cover it also covers major dental, antenatal, dietetics, clinical psychology, occupational therapy, accommodation, travel, health appliances, speech and eye therapy, audiology, hearing aids, home nursing and hospital boarders. This cover is useful for people looking for a cover for expenses like braces, new glasses, etc.
  • Complete Extras cover. Besides the expenses covered under mid extras cover, it also covers expenses for exercise physiology, nutrition and natural therapies.

General exclusions for GMF Health

Some general exclusions for the policy provided by GMF Health are:

  • Waiting period. Treatments received during the waiting period will not be covered. The waiting period is different for different categories, like three months for optical, six months for general dental, two months for physiotherapy and podiatry to one day for home nursing, dieticians or accommodation. Waiting period for pre-existing ailments and maternity is 12 months.
  • Level of cover. The treatment should be covered within the level of cover taken through the policy. For example, if Lite hospital cover is taken it will not cover heart procedures and any expenses for this treatment will be paid by the customer.
  • Time period. The claims must be lodged within two years of the date of service in order to receive the benefits.
  • Cosmetic surgery. Some cosmetic and reconstructive items are excluded from the cover.

All health policies have these general exclusions and customers should carefully look at them before deciding the final level of cover they wish to take.

Cover amounts by treatment

The table below shows GMF Health Insurance and Medicare's (MBS) results from the Australian Medical Association's annual Private Health Insurance Report Card for 2016, which rates Australia's health funds by the benefit amounts they pay for specific treatments and conditions.

GMF Health Insurance falls under the title AHSA, which is an organisation that represents a number of providers nationwide. More information on the AHSA can be found at the bottom of the table:

ProcedureMBSAHSA*
Appendicectomy$445.40$632.10
Basal Cell Carcinoma or Squamous Cell Carcinoma removal from nose, eyelid, lip, ear, digit or genitalia$221.35$366.10
Breast, benign lesion surgical biopsy of excision$260.05$356.40
Carpal Tunnel Release$276.80$440.20
Cataract Surgery$760.55$1,239.70
Cholecystectomy$739.35$1,091.90
Colonoscopy$334.35$435.00
Complicated Delivery (of baby)$1,629.35$1,855.90
Coronary Artery Bypass$2,200.00$3,783.30
Craniotomy$1,586.75$2,420.80
Cytotoxic Chemotherapy$97.95$107.80
Femoral on Inguinal Hernia$464.50$909.70
Haemorrhoidectomy$367.75$602.90
Hip Replacement$1,317.80$2,214.50
Knee Replacement$2,047.60$2,563.40
Overnight investigation for sleep apnoea$588.00$682.20
Tonsils or Tonsils and Adenoid$295.70$513.90
Uncomplicated Delivery (of baby)$693.95$1,484.50
Vaginal Hysterectomy$674.70$1,066.20
Varicose Veins$109.80$164.80
Vasectomy$229.85$343.80

*NSW, #AHM

I recognise most of these funds except for the AHSA, what is that?

The Australian Health Service Alliance is a management services organisation that represents a number of small to medium sized health insurance funds, allowing them to combine resources to deliver a higher quality of service to their members.

The funds represented by the ASHA are:

  • ACA Health Benefits Fund
  • Australian Unity Health Limited
  • CBHS Health Fund Limited
  • CUA Health Limited
  • Defence Health
  • GMF Health
  • GMHBA
  • Budget Direct Health Insurance
  • Frank Health Insurance
  • GU Health
  • HBF Health Ltd
  • Health Care Insurance Limited
  • health.com.au
  • Health Insurance Fund of Australia Limited
  • Health Partners
  • Navy Health
  • onemedifund
  • Peoplecare Health Insurance
  • Phoenix Health Fund
  • Police Health Limited
  • Queensland Country Health Fund Limited
  • Reserve Bank Health Society Ltd
  • rt health fund
  • Teachers Health Fund > UniHealth Insurance
  • Teachers Union Health
  • The Doctors' Health Fund Pty Ltd
  • Transport Health
  • Westfund

How much does GMF Health insurance cost?

The cost structure depends on a number of parameters. They are:

  • Cost structure varies for different regions. A Lite hospital cover with no excess and no extras will cost $19.75/week in Northern Territory whereas it will cost $30.35/week in South Australia.
    • Level of cover. Lite cover provides the basic treatment cover and has the lowest premium. Mid cover is a bit higher with couple of extra benefits and complete cover has the highest premium.
    • Maternity cover. In case a person is not planning to start a family in the near future the maternity cover can be removed. This will reduce the premium substantially.
    • Excess payments. There are three options for having an excess payment. They are $0, $300 or $500. Choosing a higher excess payment will help in reducing the premium payments.
  • The government provides rebate on private insurance which varies according to the income levels and age group of the customer. These rebates are from 0% to 35.722%.  For a general single cover having an income less than $90,000 and an age less than 65 years, they will get a rebate of 26.791%.

How does it work?

Example 1

Matt is 28 years old and has an income of $60,000. He takes a lite hospital cover with $500 excess and no extra cover. He lives in Western Australia. This cover will cost him $10.95/week after getting a 26.791% rebate from the government.

Example 2

Jane is 55 years old. She had an earlier policy and is now getting transferred to GMF Health. She lives in South Australia and wants a Complete Hospital cover and Complete Extras cover with $0 excess. Her current income is $85,000. This cover will cost her $54/week. In her case she can reduce the premium by taking Complete No maternity cover which will cost her $52.50/week.

GMF Health insurance excess

Excess charges are an alternative method in which the premiums are reduced. It is an upfront amount which is paid when there is a need for hospital stay or day surgery on admission. There are three alternatives for excess payments. Either have a $0 or $300 or $500 excess. A policy where the excess payment is $500 will require an initial payment of $500 on the first hospital visit. Any subsequent charges or payments will be paid by the insurer.

For example a Lite hospital cover in Victoria with no excess will cost $22.05/week and with $500 excess the same policy will cost $17.55/week.

How to save on your GMF Health insurance policy?

There are a couple of ways in which the premiums can be reduced. They are:

  • Planning for a family. There is an option to remove maternity benefits which in turn reduces the premium. Customers who are not planning to start a family can remove this benefit from their cover.
  • Reasonable cover. Not everyone requires complete hospital cover with complete extras. The exact level of cover required depends on the age group and health history of a person. For singles in their 20s or early 30s it might be beneficial to go for lower levels of cover as they would rarely need a joint replacement or a heart procedure.
  • Excess payments. By choosing a higher excess payment, you can drastically reduce your premium payments. This excess payment is made only when there is a need to visit the hospital, and so if such a need does not arise it will save excess payments and also help in reducing premium payments.

How do I make a claim?

GMF Health has a fast claim processing system in place. Policy holders are provided GMF Health member card through which they can make on the spot claims if the providers have electronic claiming facilities. This facility is available for services like dental, optical, physiotherapy, chiropractic, podiatry, clinical psychology and more. Using this, customers need to pay for only out-of-pocket cost to the provider.

For hospital claims most of the accounts are directly forwarded to GMF. In case this is not possible the customers should complete the claim form and send it to GMF.

GMF FAQs

Q. What are the tax benefits?

  • A. There is a Medical Levy Surcharge (MLS) for people who do not have private insurance and who are earning more than a certain income. This is from 1% to 1.5%, so there is considerable tax benefits to choose a private insurance for higher income earners.

Q. Is my kid covered under my policy?

  • A. Children are covered under their parent’s policy until their 21st birthday, unless they are already married or are living in a de-facto relationship. Children who are under 25, earning less than $22,000 and not married or living in a de-facto relationship are also covered under the parent’s policy.

Q. At what time should I start private health insurance?

  • A. You can start private health insurance anytime, whether you're 27 or 77. However, it is beneficial to start it at certain points, like when a person turns 31. There is a 2% loading for every year a person does not have a private health cover after the age of 30. So by your 40th birthday you can end up paying up tp 20% higher for a hospital cover. It is also better to go for private insurance if you are planning to start a family.

Is there an option for overseas visitors?

For people visiting Australia, GMF has two ideal options. They are:

  • Overseas Lite Hospital cover. It covers ambulance, hospital accommodation, theatre fees, rehabilitation, maternity & birth, heart procedures, medication and prostheses expenses.
  • Overseas Complete Hospital cover.  This has a wider coverage, and besides covering expenses on Lite cover it also covers organ transplant, bone marrow transplant, out-of-hospital medical services and PBS benefits and also provides Medical gap cover.

There is an option to take Lite, Mid or Complete overseas extra cover also.

Compare your cover options today

GMF Health provides health insurance that can be useful for different age groups, income levels and health conditions. They have tailored the policies in a way which makes them easy to understand and easy to get requisite benefits. Customers can use it to get the right hospital cover with complete extras or use it in case they are planning to start a family or even in case they want to save on tax.

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8 Responses to GMF Health Insurance

  1. Default Gravatar
    James | April 11, 2016

    On our recent receipt, the Table was given,followed by “Mid”Extras. What exactly does that mean,please?

    • Staff
      Richard | April 11, 2016

      Hi James,

      Thanks for your question. finder.com.au is a comparison service and not an insurer. Mid extras is just the level of extras you’re covered for. Please follow this link to the product disclosure statement (PDS).

      I hope this was helpful,
      Richard

  2. Default Gravatar
    Joyce | March 29, 2016

    is there a health fund that covers removal and re – implanting of breast prosthesis. I am a long standing health fund member and have high cover

  3. Default Gravatar
    paul | March 29, 2016

    I wish to clarify regarding the excess, is it paid for day of surgery? Also I have read reviews that state it is a minefield to make a claim against your health cover? This is a problem as I live in Qld.

    • Staff
      Richard | March 29, 2016

      Hi Paul,

      Thanks for your question. You’ve come through to finder.com.au and not GMF Health. If you would like clarification about your cover, you should head to the GMF contact us page.

      I hope this was helpful,
      Richard

  4. Default Gravatar
    Maria | November 18, 2015

    My husband is having cataract surgery at hospital costing $400 is this fully covered

    • Staff
      Richard | November 19, 2015

      Hi Maria,

      Thanks for your question. finder.com.au is a comparison service and not an insurer. All levels of GMF Health Hospital cover entitle you to a benefit for prostheses as long as you are admitted to hospital for the procedure and the item is listed on the Federal Government Prosthesis List. How much you’re covered for will depend on your policy. You should contact GMF Health directly to find out the specifics of your policy, which you can do by calling 1300 653 099 or emailing welcome@gmfhealth.com.au.

      I hope this was helpful,
      Richard

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