GMHBA health fund

GMHBA Health Insurance

Compare health insurance policies from GMHBA and find cover that's right for you.

GMHBA Health Insurance was founded in 1934 in Geelong by a group of workers from the Australian Cement Company. Today, this not-for-profit, member-based organisation offers a choice of health insurance policy options to suit the cover needs of a wide range of Australians.

Currently, the engine can only compare GMHBA policies for residents of Victoria. We apologise for any inconvenience. If you are not a resident of Victoria you can compare your options from 30+ funds on the health insurance homepage, or compare policies from a specific participating fund via the navigation sidebar to the left.

What policies are available from GMHBA

Hospital and extras

Depending on your personal situation and budget, GMHBA allows you to combine elements of both Hospital and Extras cover to achieve the balance you want. For example, if you are looking for low cost cover or you are earning over $90,000 as a single and are looking to minimise tax, you can choose Bronze Hospital and Bronze Extras for basic combined cover. If you are planning a family, Gold Hospital and Silver Extras (with pregnancy and IVF) would be a good choice. While for full comprehensive cover, Gold Hospital (no pregnancy) and Gold Extras would provide total peace of mind.

GMHBA also offers FIT Hospital and Extras packages for those wishing to maintain their active lifestyles. These include FIT Entry, FIT Standard, FIT Top and FIT Ultra.

  • FIT Entry. Provides basic cover in a public hospital as a private patient and includes knee, shoulder and ankle reconstructions plus surgery to repair a fractured collarbone, wrist, hand or finger. It also includes a great range of extras including, optical, dental, physio, chiro, osteo, dietetics, naturopathy and ambulance.
  • FIT Standard. Cost-effective cover that includes everything in FIT Entry, but with higher benefit amounts and with the addition of a preventative health assessment.
  • FIT Top. Top cover in a shared / single room in a private hospital, with same day treatment, higher benefit amounts for injuries more likely to occur playing sport, plus all the extras offered in FIT Standard.
  • FIT Ultra. Comprehensive cover for the everyday athlete, this includes everything in the FIT Top package, but with higher benefit amounts.

Hospital only

GMHBA is a not-for-profit fund offering a range of cover levels to its members. These include Bronze, Silver and Gold Hospital and Bronze, Silver and Gold Extras; all of which can be combined according to needs and budget. They also offer FIT Hospital and Extras packages for active sports enthusiasts.

  • Bronze Hospital. Entry level cover that covers treatment resulting from an accident in a public hospital as a private patient and includes knee and shoulder reconstructions.
  • Bronze Hospital Plus. Affordable hospital health insurance for those who don't want to be treated in a public hospital. It covers you for essential treatments in a GMHBA affiliated private hospital.
  • Silver Hospital. Moderate cover with some exclusions covering treatment resulting from an accident in a shared / single room in a private hospital and including knee and shoulder reconstructions.
  • Gold Hospital. High level hospital cover (with or without pregnancy and IVF services) covering treatment in a shared / single room in a private hospital and including knee and shoulder reconstructions.

Extras only

  • Bronze Extras. Covers the three most popular extras; optical, general and preventative dental and physio.
  • Silver Extras. Covers general, preventative and major dental, optical, physio plus chiro, osteo, naturopathy, ambulance, psychology, pharmacy, dietetics, audiology, eye and speech therapy, occupational therapy, podiatry, prostheses, hearings aids, orthotics and more.
  • Gold Extras. Top level extras cover with higher benefit amounts and including everything in Silver Extras plus additional extras such as exercise physiology, antenatal and postnatal classes and weight loss programs.

GMHBA Family Cover

GMHBA’s family health insurance packages are specifically designed to meet the needs of Australian families. None of the policies charge a hospital excess for children under the age of 21, while all three levels of cover also include an ambulance subscription and 100% back on preventative dental. There are three family packages available:

  • Starter Family Package. This entry-level package covers public hospital treatment as a private patient following an accident, and offers 100% back on the cost of optical and preventative dental. It also covers 55% of the cost of a range of basic extras.
  • Everyday Family Package. GMHBA’s Everyday Family Package offers a high level of health cover and treatment in a single or shared room in a private hospital. Pregnancy and birth-related services are included in cover, along with 65% back on a range of extras.
  • Premium Family Package. This is the most comprehensive family package and it includes a pregnancy option, a single-room guarantee, and cover for 75% of the cost of a huge range of extras services.

How many hospital agreements does GMHBA have in my state and in total?

There are two crucial factors that impact the benefit your health fund pays when you receive hospital services:

  • Your level of cover
  • Whether or not your health fund has an agreement with the treating hospital

The table below contains a list of the number of hospital agreements GMHBA has in each Australian state and territory compared to the maximum of any health fund across the industry:

Private hospital agreementsDay hospital agreements
NSW89 (industry maximum: 101)84 (industry maximum: 96)
ACT5 (industry maximum: 7)9 (industry maximum: 9)
VIC76 (industry maximum: 84)67 (industry maximum: 75)
QLD51 (industry maximum: 57)42 (industry maximum: 51)
SA29 (industry maximum: 29)23 (industry maximum: 27)
WA17 (industry maximum: 23)21 (industry maximum: 26)
TAS5 (industry maximum: 8)3 (industry maximum: 5)
NT1 (industry maximum: 2)1 (industry maximum: 1)

How many members does GMHBA service?

GMHBA provides health insurance cover to more than 230,000 Australians. This gives it a 2.1% market share of the Australian health insurance industry (NB: this market share figure also includes Budget Direct and Frank, two health fund brands owned by GMHBA).

Complaints

GMHBA (including Budget Direct and Frank) accounts for:

  • 2.1% of the Australian health insurance market
  • 1.7% of all complaints about benefit payments
  • 0.9% of all complaints about service
  • 0.9% of all complaints that require investigation

Source: Private Health Insurance Ombudsman, State of the Health Fund Report 2016

Does GMHBA offer Overseas Visitor Health Cover (OVHC)?

If you’re a temporary Australian resident and do not have full Medicare eligibility, phone GMHBA or visit a branch to discuss your health insurance needs. You can also consider Frank Overseas Visitor Health Cover, which is a brand offered by GMHBA Limited.

What additional benefits are available from GMHBA?

GMHBA members can also access the following benefits:

  • Bowel Cancer Risk Identification Program
  • GMHBA Farmer Health Clinics
  • Chronic Disease Management Program
  • Strong Knees Program
  • Best Doctors Network
  • New Family Program
  • Midwifery Group Practice Program

Paying your GMHBA health insurance premiums

You can pay your GMHBA health insurance premiums monthly, quarterly, half-yearly or yearly – whichever option is most suitable for your budget.

The following payment methods are accepted:

  • Direct debit from your bank account
  • Automatic debit from your credit card
  • Online using your credit card or BPAY
  • Over the phone using your credit card or BPAY
  • Payroll deduction
  • Cash, cheque and EFTPOS at GMHBA branches and Australia Post locations
  • Cash and cheque at GMHBA agents
  • Mail payments by cheque, money order or credit card

What can't you claim on your GMHBA policy?

Your GMHBA Health Insurance claim will not be paid if:

  • You are claiming treatment provided to you by a family member or business partner
  • It is for services or treatment received overseas
  • It is for services that would generally be classed as sport, recreation or entertainment
  • It is for services not rendered face to face, for example if they were rendered over the phone
  • It is for a medical service rendered by a medical practitioner employed full-time in the public health sector
  • You do not provide itemised and original receipts
  • It is for food supplements
  • It is for pharmacy items that can be purchased over the counter with or without a prescription
  • It is for a dental procedure where you have exceeded a limit on the number you can have
  • It is for services or treatment rendered more than two years prior to you lodging a claim
  • It is for services or treatment rendered while your membership is suspended.

What affects the cost of a policy from GMHBA?

The following factors will affect your GMHBA Health Insurance premium:

  • The level of cover you choose. A high-level policy will obviously cost more to take out than one that simply offers the most basic level of cover.
  • Whether you combine cover. Choosing standalone hospital or extras cover can be more affordable than a policy that offers combined cover for more comprehensive protection.
  • Number of people on the policy. Whether you take out a single, couples or family policy.
  • Your age when you take out cover. A premium loading may apply under the Lifetime Health Cover scheme.
  • Your income. Your annual income influences your eligibility for private health insurance rebates.
  • The excess you choose. A higher excess means lower premiums.

How to save on your GMHBA policy

  • Choose a higher excess. Your premium will be reduced as a result.
  • Choose a lower level of cover. Bronze Cover has a lower cost than Silver Cover, which in turn is more affordable than Gold Cover. As with most other things in life, you get what you pay for.
  • Choose standalone hospital or extras cover. This will be more affordable than a combined policy.
  • Avoid premium loadings. Signing up for private health insurance cover before you turn 30 will save you money under the Lifetime Health Cover scheme.
  • Use rewards points. Members can use reward points they earn as part of the Connect Rewards Plus member loyalty program to reduce out-of-pocket expenses for things like dental and optical, while they can also claim the inpatient medical gap and reduce their hospital excess.

How do you lodge a claim with GMHBA?

GMHBA members can lodge an extras claim in the following ways:

  • By swiping their membership card. You can swipe your GMHBA membership card at the provider when paying the account to claim instantly.
  • Online. You can claim online through the GMHBA member self-service centre.
  • At a GMHBA branch. Take your itemised receipt and/or account to your nearest GMHBA branch.
  • By post. Download a claim form from the GMHBA website, complete it and return it to the health fund along with your itemised receipt and/or account.
  • At a Medicare office. You can also lodge a claim at your nearest Medicare branch. It will then be sent to GMHBA for processing.

If you need to make a claim for medical costs, the claims process differs depending on whether or not your doctor participates in GMHBA’s Gap Cover Scheme. If the doctor does participate, the bill for your medical costs will be sent to Medicare and GMHBA. 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

Still have questions about GMHBA?

Yes.

You can use the services of any extras provider as long as they are registered with the appropriate board for their field and operate a private practice.

GMHBA allows you to pay your premiums online (credit card or BPAY), over the phone (credit card) or by mail (cheque, money order or credit card). Direct payroll deductions are also available.

While it’s not compulsory to take out private health insurance cover, a 2% premium loading will apply to the cost of your cover for each year you are past the age of 31.

This can be found in the policy documents that apply to your health insurance plan.

You are classified as an inpatient if you are admitted to hospital and stay there overnight.

GMHBA hospital policies do not provide any emergency ambulance cover for members in Victoria, WA, NT, SA. However, the following GMHBA extras policies and combined hospital and extras policies refund a specified percentage of the cost of ambulance subscriptions:

  • Silver Extras 65%
  • Silver Extras Set Benefits
  • Gold Extras 75%
  • Gold Extras Set Benefits
  • Fit Entry Package 50%
  • Fit Standard, Top and Ultra Packages 80%,
  • GMHBA Starter, Everyday and Premium Packages 100%

A benefit of $300 per trip for non-emergency ambulance transport also applies, up to an annual limit of $500 per person.

Yes. All of GMHBA’s extras cover policies and combined hospital and extras policies include some level of dental cover.

Yes. All of GMHBA’s extras cover policies and combined hospital and extras policies include some level of optical cover.

Yes. All of GMHBA’s extras cover policies and combined hospital and extras policies include some level of physio cover.

Yes. Cover for chiropractic services is included on the following GMHBA policies:

  • Extras cover: Silver Extras Set Benefits, Silver Extras 65%, Gold Extras Set Benefits, Gold Extras 75%
  • Combined hospital and extras cover: FIT Entry, FIT Standard, FIT Top, FIT Ultra, Everyday Family Package, Premium Family Package
  • Extras cover: Bronze Extras Set benefits, Bronze Extras 55%, Silver Extras Set Benefits, Silver Extras 65%, Gold Extras Set Benefits, Gold Extras 75%
  • Combined hospital and extras cover: Premium Family Package, Everyday Family Package
  • Extras cover: Silver Extras Set Benefits, Silver Extras 65%, Gold Extras Set Benefits, Gold Extras 75%
  • Combined hospital and extras cover: FIT Entry, FIT Standard, FIT Top, FIT Ultra, Starter Family Package, Everyday Family Package, Premium Family Package
  • Extras cover: Silver Extras Set Benefits, Silver Extras 65%, Gold Extras Set Benefits, Gold Extras 75%
  • Combined hospital and extras cover: FIT Entry, FIT Standard, FIT Top, FIT Ultra, Starter Family Package, Everyday Family Package, Premium Family Package
  • Extras cover: Silver Extras Set Benefits, Silver Extras 65%, Gold Extras Set Benefits, Gold Extras 75%
  • Combined hospital and extras cover: FIT Entry, FIT Standard, FIT Top, FIT Ultra, Everyday Family Package, Premium Family Package
  • Extras cover: Bronze Extras Set Benefits, Bronze Extras 55%, Silver Extras Set Benefits, Silver Extras 65%, Gold Extras Set Benefits, Gold Extras 75%
  • Combined hospital and extras cover: FIT Top, FIT Ultra, Starter Family Package, Everyday Family Package, Premium Family Package
  • Extras cover: Silver Extras Set Benefits, Silver Extras 65%, Gold Extras Set Benefits, Gold Extras 75%
  • Combined hospital and extras cover: Everyday Family Package, Premium Family Package

No. GMHBA does not offer any overseas student health cover (OSHC) policies for international students.

No. GMHBA does not offer OVHC policies.


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6 Responses

  1. Default Gravatar
    BasilAugust 4, 2017

    Can hearing aids be claimed on our private health cover

    • Staff
      ArnoldAugust 5, 2017Staff

      Hi Basil,

      Thanks for your inquiry.

      Some private health care plans cover the costs of audiological tests, a hearing aid evaluation, and even partial or full coverage of a hearing aid. Be sure to check with your health insurance company or your employer’s benefits manager to find out.

      Hope this information helped.

      Cheers,
      Arnold

  2. Default Gravatar
    SanFebruary 18, 2017

    What are the major eye surgeries that are covered under the
    GMHBA Gold Hospital Level 2 cover?

  3. Default Gravatar
    AnnieNovember 23, 2016

    Do you cover cosmetic surgery

    • Staff
      RichardNovember 23, 2016Staff

      Hi Annie,

      Thanks for getting in touch. Depending the level of benefits provided by your policy, you may be covered for cosmetic surgery if it’s deemed to be medically necessary. You should contact GMHBA directly about the specifics of your cover. You may also find our article about cosmetic surgery and health insurance helpful.

      All the best,
      Richard

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