GMHBA Health Insurance Review
GMHBA is a not-for-profit insurer with a wide range of hospital and extras policies and a generous rewards program.
If you like the idea of a not-for-profit health insurer that puts people before profit, you might like GMHBA. They offer a wide range of hospital and extras policies giving you a ton of choice and allowing you to be flexible with your cover.
They also keep things interesting by offering access to a fully featured and highly generous rewards program on most policies.
Top 3 features
- Good for people who want the flexibility to mix and match their hospital and extras cover.
- Good for people who want access to a generous rewards program.
- Beware if you get overwhelmed by too many choices.
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Who is myOwn?
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.
What health insurance options are available?
All policies come with access to the AIA Vitality rewards program unless otherwise stated.
- Basic Plus. This meets the government's requirement for Basic cover by offering restricted cover for psychiatry, rehabilitation and palliative care. However, it goes well beyond that by providing restricted cover for all additional 32 additional clinical categories including cancer treatment, pregnancy, heart issues and broken bones. This policy does not come with access to the AIA Vitality rewards program.
- Bronze Essential. This policy offers cover for the 18 clinical categories the government requires all Bronze policies to have, including joint reconstructions, ear/nose/throat treatments and diabetes management (except for insulin pumps).
- Bronze Plus. This policy covers everything the Bronze Essential policy does plus dental surgery.
- Silver Core. This policy covers all 26 clinical categories required to get the Silver designation, including cover for dental surgery, heart treatments and podiatric surgery.
- Silver Plus. This covers everything the Silver Core policy does plus a few more like sleep studies and full instead of restricted cover for rehabilitation and palliative care. This policy does not come with access to the AIA Vitality rewards program.
- Silver Plus Premium. This covers everything the Silver Plus policy does plus additional cover including cataracts, joint replacements, kidney dialysis and insulin pumps. This policy does not come with access to the AIA Vitality rewards program.
- Silver Plus Classic with AIA Vitality. Exactly the same as Silver Plus Premium except that you do get access to the AIA Vitality rewards program..
- Gold Ultimate. This includes all 38 clinical categories required for a Gold label including pregnancy, weight loss surgery, assisted reproductive services (like IVF) and pain management with device.
- Basic Extras Set Benefits. This offers cover for preventative dental, optical, a range of therapies, some pharmaceuticals, health aids and preventative treatments. It gives you a set benefit you'll get back per treatment, meaning you'll get the same dollar amount back for a specific treatment no matter how much the provider charges.
- Basic Extras 55. Exactly the same as Basic Extras Set Benefits but instead of set benefits, you'll get 55% of your costs back regardless of what your provider charges.
- Mid Extras Set Benefits. Gives you a bit more than Basic Extras including orthodontics, major dental, psychology and a wider variety of health aids. Each treatment-type gives you back a set benefit amount no matter how much the provider charges.
- Mid Extras 65. Exactly the same as Mid Extras Set Benefits except you get 65% of your costs back for most treatment types regardless of what the provider charges.
- Top Extras Set Benefits. Covers most of what the Mid Extras policies cover with the inclusion of prenatal and antenatal services and exercise physiology. The benefit limits are higher than Mid and the set benefits for each treatment visit are also higher in most cases.
- Top Extras 75. Exactly the same as Top Extras Set Benefits but instead of set benefits, you'll get back 75% of your costs back on most treatments regardless of what the treatment provider charges.
A majority of GMHBA hospital policies include access to the AIA Vitality health and wellbeing program that rewards you for a healthy lifestyle.
<With AIA Vitality, you'll get:
- Discounts on shopping, flights, spa treatments and more.
- Steep discounts on your gym membership.
- The opportunity to earn hundreds of dollars in gift certificates.
- Access to a website and app where you can learn healthy habits and track your health.
Young people discounts
GMHBA offers an age-based discount to customers under 30, but only if you buy one of two combined hospital plus extras policies: the Basic Plus Package or the Bronze Plus package.
The percentage discount you receive is based on the age you are on 1 April 2019 or when you purchase your policy, whichever is later. You get to keep that discount until you are 40 and then it decreases by 2% per year.
Here is the discount you'll receive based on how old you are on the date mentioned above:
- 18-25: 10% discount
- 26: 8% discount
- 27: 6% discount
- 28: 4% discount
- 29: 2% discount
How to make a claim
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:
- Take your bill and paperwork to Medicare to receive a medical statement and a cheque
- Send the medical statement to GMHBA
- GMHBA will send you a cheque for payment
- Send the cheques from Medicare and GMHBA to your doctor
- The doctor will bill you for any expenses not covered by Medicare and your health fund
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