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.
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 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.
- 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.
- 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 agreements||Day hospital agreements|
|NSW||89 (industry maximum: 101)||84 (industry maximum: 96)|
|ACT||5 (industry maximum: 7)||9 (industry maximum: 9)|
|VIC||76 (industry maximum: 84)||67 (industry maximum: 75)|
|QLD||51 (industry maximum: 57)||42 (industry maximum: 51)|
|SA||29 (industry maximum: 29)||23 (industry maximum: 27)|
|WA||17 (industry maximum: 23)||21 (industry maximum: 26)|
|TAS||5 (industry maximum: 8)||3 (industry maximum: 5)|
|NT||1 (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).
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:
- 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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