GUIDES & RESOURCES

GMHBA Health Insurance: Product & Policy Information

As with most health funds, there are two product types for you to consider when it comes to taking out health insurance with GMHBA: Hospital cover and Extras cover.
gmhba health insurance

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What makes GMHBA different?

GMHBA is a not for profit Health Insurance and care company who have over 85 years of experience within health care1.

They pride themselves on providing a high number of gap-free services across Australia. In fact, on average, 86.5% of GMHBA’s services were gap-free across Australia, according to the 2021 Private Health Insurance Ombudsman’s State of the Health Funds Report2.

What is included in a GMHBA Health Insurance policy?

  • Hospital cover: This helps you pay for treatment as a private patient in either a public or private hospital. The type of treatment you are covered for will vary depending on the level of cover you choose.
  • Extras cover: This covers some of the costs for out-of-hospital care and services not covered by Medicare. Depending on your level of cover, Extras cover helps you take care of the things that are important to your lifestyle including dental, optical, physio and chiro.

With GMHBA Hospital and Extras cover, you have access to a wide range of care and treatment options. 

GMHBA Hospital Cover policy products

GMHBA offers a range of private Hospital policies to combine with Extras coverHere’s what’s currently available with iSelect:3:

  • Accident Only Hospital (Basic):  
    • Cover for treatment as a private patient in a private hospital when treatment is required as the result of an accident; 
    • Hospital psychiatric services, palliative care and rehabilitation as a private patient in a public hospital; 
    • An excess fee-waiver for same day hospital stays; and 
    • Emergency Ambulance

  • Basic Plus Starter Hospital  
    • Basic surgeries like joint reconstructions, hernia and appendix, tonsils, adenoids and grommets and dental surgery; 
    • An excess fee-waiver for same day hospital stays; and 
    • Emergency Ambulance

  • Bronze Plus Hospital  
    • Services for bone, joint and muscle; 
    • Cancer treatments; 
    • Dental surgery; and 
    • An excess fee-waiver for same day hospital stays.

  • Bronze Plus Advantage Hospital:  
    • Services for back, neck and spine;  
    • An excess fee-waiver for same day hospital stays; 
    • Medically necessary plastic and reconstructive surgery; and 
    • Dental surgery 

  • Silver Plus Hospital: 
    • Services for back, neck, spine, bones, muscles and joints; 
    • Heart and vascular system and lung and chest; 
    • An excess-fee waiver for same day hospital stays; and 
    • No excess for dependents under 21 

Extras Cover with GMHBA

GMHBA also offers a range of Extras policies to bundle with your hospital cover, providing you with a range of health care services outside of hospital. There are two types of extras policies: ‘Set Benefit’ policies give you a set dollar value benefit per service, whereas percentage-based policies give you back a percentage of the service fee. Here’s what’s currently available through iSelect:4

  • Basic Extras 55% 
  • Basic Extras Set Benefits
    These policies include cover for preventative dental and optical and some therapeutic services like physio. 
  • Mid Extras 65% 
  • Mid Extras Set Benefits
    These policies include cover for a range of services including general and major dental, optical, and remedial massage.
  • Top Extras 75% 
  • Top Extras Set Benefits
    These policies include cover for a range of services including general and major dental, orthodontics, optical, remedial massage and hearing aids. 

What other health services does GMHBA offer?

GMHBA is dedicated to helping Australians live their lives to the fullest. They know that taking care of your health and wellbeing is a lifelong commitment and offer a range of information, support and educational resources to help you on your journey.

Post-hospital support programs

Sometimes going to hospital is unavoidable, but if you do have to go, the last thing you want to do is stay longer than you need to.

To help you get back home as soon as possible, GMHBA offers eligible hospital policy holders access to its Hospital in the Home (HITH)5 and Rehabilitation in the Home (RITH) programs6.

HITH offers an alternative to an in hospital stay for eligible patients. If you take part in a HITH program you will be provided with the appropriate rehabilitation healthcare, such as physiotherapy, occupational therapy, dietetics, speech pathology, nursing and home support if required.

RITH allows eligible patients to undertake all or part of their rehabilitation in the comfort and privacy of their own home. As part of the RITH program, GMHBA will make sure the home is safe and provide a treatment program to help restore strength and mobility.

Care Coordination Service (CCS)

For customers living in the Greater Geelong area in Victoria, CCS organises care for eligible members with complicated health problems7. It doesn’t matter what level of hospital cover you hold, GMHBA’s care coordination service can provide you with support, information and access to health services, at no extra cost.

Chronic Disease Management Program (CDMP)

CDMP provides eligible members who suffer from chronic diseases with the care and support they need to maintain optimal health8.

Services include phone-based coaching and monitoring, care coordination, and devising strategies to help delay or avoid hospital admission if possible.

How do I make a claim with GMHBA?

Typically, most Extras claims can be processed when you have your appointment with your GMHBA membership card. 

 Members can also make claims online, in a local GMHBA branch, or by submitting a claim form via email or post.  

 Keep in mind that claiming through GMHBA works differently depending on whether you’re claiming for Extras provider costs9, Hospital costs10, or medical (doctor or specialists costs in hospital) costs11. 

Looking to compare Health Insurance policies?

With iSelect, you can compare Health Insurance from our range of providers and policies to find a policy which suits you*. Start comparing online today, or call our friendly team on 1800 784 772.


Sources:
1 GMHBA - Why choose GMHBA?
Commonwealth Ombudsman of Private Health Insurance - State of the Health Funds Report 2021, pages 20-21.
GMHBA - All Health Insurance Products
4 GMHBA - Hospital and Extras Cover
GMHBA - Hospital in the Home
GMHBA - Rehab in the Home
GMHBA - Care Coordination Service
GMHBA - Chronic Disease Management Program
GMHBA - Extras Providers Costs
10 GMHBA - Hospital Costs
11 GMHBA - Medical Costs

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