GMHBA Private Health Fund Review

GMHBA, which was originally an abbreviation for Geelong Medical and Hospital Benefits Association, is an Australian-owned not-for-profit health insurance company that's been running for over 85 years. It also owns two other health insurers, Frank and health.com.au.

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by Gary Andrews

Last update 15 Apr 2021

Overview

Based in Geelong Victoria, the fund has an extensive network of regional branches, providing private health insurance to hundreds of thousands of members across Australia.

GMHBA offers an extensive range of hospital and extras policies, and offers a number of additional allied health services such as dental and optical to regional Victoria.

Key Points

GMHBA offers 10 hospital policies and 6 extras policies.
Rewards and discounts through a partnership with AIA Vitality.'
Members can get discounts at GMHBA Eye Care.

GMHBA isn't on our panel but we're confident we can get you a great deal on your health insurance.

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Hospital cover

Nobody chooses to go to hospital. But when you do, hospital cover will help you get the treatment you need, where and when you want it.

It also helps to pay the bills, as fees for hospital rooms and specialists can add up.

Think about what services you're likely to need, in line with your budget.

If you earn over $90,000 individually or $180,000 as a couple, you could avoid paying the Medicare Levy Surcharge.

With 10 plans to choose from, GMHBA has a wide range of hospital covers, from basic to comprehensive.

Some policies come with access to the AIA Vitality rewards program.

Basic Plus

A low entry-level plan aimed at younger, healthy Australians on a tight budget who want to avoid the Medicare Levy Surcharge.

Key inclusions:

  • Ambulance cover
  • Avoids the Medicare Levy Surcharge

Bronze Essential

GMHBA's second cheapest policy with a wider range of hospital services than Basic, plus access to member rewards and private hospitals for some services.

Key inclusions:

  • Gynaecology
  • Ear, nose and throat
  • Hernia and appendix

Bronze Plus

A more expensive but more comprehensive policy that covers a range of common procedures in private hospitals.

It offers everything in the Bronze Essential policy, plus dental surgery.

Key inclusions:

  • Implantation of hearing devices
  • Sleep studies
  • Palliative care

Silver Core

Private hospital cover for a wide range of services, with some exclusions to keep costs down.

Choose between $500 and $750 excess.

Key inclusions:

  • Back, neck and spine
  • Heart and vascular
  • Podiatric surgery

Silver Plus

GMHBA offers two versions of Silver Plus: a more expensive version that does not include pregnancy items and a cheaper version with a $500 excess.

Covers everything in the Silver Core policy, plus a few extras.

Key inclusions:

  • Implantation of hearing devices
  • Sleep studies
  • Palliative care

Silver Plus Premium

A high level of cover with minimal exclusions.

There are two Silver Plus Premium packages, with one that specifically excludes pregnancy.

The $500 excess version does not include weight loss.

Key inclusions:

  • Insulin pumps
  • Cataracts
  • Kidney dialysis

Silver Plus Classic

Gives you everything in the Silver Plus Premium policy, plus access to the AIA Vitality rewards program.

Doesn't include obstetrics, making it an option for older Australians.

Key inclusions:

  • Insulin pumps
  • Cataracts
  • Joint replacements

Gold Hospital

High level cover with no exclusions, so could be suitable for people looking to start or grow their family.

No excess, but does not come with access to the AIA Vitality rewards program.

Key inclusions:

  • Pregnancy and birth
  • Weight-loss surgery
  • Hospital psychiatric services.

Gold Premium

A top-level combined hospital and extras package aimed at families.

No restrictions on hospital cover and includes limits of up to $1,000 per person on common extras, as well as generous rebates.

Key inclusions:

  • No restrictions on all hospital services
  • 100% back on general dental and optical
  • $1,000 limit on major dental treatments

Gold Ultimate

Offers everything the Gold Premium policy does, plus access to the AIA Vitality program.

Key inclusions:

  • Pregnancy and birth
  • Weight-loss surgery
  • Access to the AIA Vitality rewards program

Ambulance Cover

All GMHBA extras, hospital and combined policies have emergency ambulance cover included (excluding air ambulance).

Extras cover

From dental, to optical, to chiro and more, extras insurance helps cover the bills for routine treatments with rebates of up to 100%.

While we've summarised the key points of each plan below, it's always worth digging a little deeper into any gap fees, how much you can claim back, and whether your preferred healthcare provider, such as your local dentist, has an agreement with the health fund.

Take the time to work out what you need and what you're prepared to pay.

If this feels a bit overwhelming, you can speak to one of our experts who can talk you through what's included in each extras policy.

GMHBA offers a variety of extras, with each level offered as either a set benefits policy or with a designated percentage back on eligible services.

Basic Extras Set Benefits

Low annual limits make this more suitable for budget-conscious singles and couples. Cover includes varying rebates on basics like preventative dental and physio, but does allow up to 80% back on frames and lenses.

Basic Extras 55%

Claim up to 55% on popular services like physio, optical and dental, plus travel vaccinations and occupational therapy. Limits of up to $300 on some extras.

Mid Extras Set Benefits

More comprehensive extras package with set rebates across all extras. Includes remedial massage, osteo and chiro.

Mid Extras 65%

Claim 65% back on an extensive range of services like general and major dental, optical and remedial massage. Comes with larger annual limits than the Basic Extras 55%.

Top Extras Set Benefits

Fully comprehensive set of extras, including hearing aids, acupuncture and podiatry. Higher annual limits than the Basic and Mid extras, and higher set rebates.

Top Extras 75%

GMHBA's most expensive extras cover, giving you 75% back on hearing aids, sleep apnoea monitors, orthopaedic appliances, and much more.

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Waiting periods

To stop people signing up, claiming, then cancelling their health insurance, all insurers apply waiting periods.

Generally, the more expensive the treatment, the longer you'll wait. But keep an eye out for special deals with waiting periods reduced or waived.

And remember, if you're switching to equivalent or lower cover you usually won't have to serve any new waiting periods.

Basic Plus Bronze Essential Bronze Plus Silver Core Silver Plus Silver Plus Premium Silver Plus Classic Gold Premium Gold Classic

  • 0 days -- bodily Injuries resulting from accidents which occur after the date of joining GMHBA or upgrading to a higher cover
  • 2 months -- all other treatments
  • 12 months -- pre-existing ailments, illnesses or conditions (other than psychiatric, rehabilitation and palliative care)

Gold Premium Gold Classic

  • 0 days -- bodily Injuries resulting from accidents which occur after the date of joining GMHBA or upgrading to a higher cover
  • 2 months -- all other treatments
  • 12 months -- pre-existing ailments, illnesses or conditions (other than psychiatric, rehabilitation and palliative care)
  • 12 months -- obstetrics and maternity

Member benefits

Selected policies come with access to a rewards program called AIA Vitality, giving members access to rewards and discounts such as:

  • Up to $500 in rewards at Woolworths, Myer, Bunnings, Rebel and DYMOCKS
  • Up to 50% off eligible Virgin Australia flights
  • Up to 50% off endota spa e-gift vouchers
  • Membership discounts at Anytime Fitness, Fitness First, Virgin Active and Step into Life
  • Up to 25% off Fitbit and Garmin devices

How to claim

Claim online or by swiping your GMHBA membership card when you visit a participating HICAPS provider. You can also lodge a claim at your nearest GMHBA branch or through the post.

Hospital agreements

GMHBA has agreements with many private hospitals and day clinics across Australia. When comparing policies, it's worth checking if your local hospitals and clinics are covered. Our specialists at Compare Club can do this for you.

  • ACT -- 13
  • NSW -- 187
  • NT -- 3
  • QLD -- 102
  • SA -- 52
  • TAS -- 9
  • VIC -- 147
  • WA -- 43

Customer service

GMHBA received 3.5% of complaints in 2019 vs 2.3% market share, indicating customer service may be a little below average.

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FAQs

Is GMHBA a not-for-profit fund?

Yes, GMHBA is not-for-profit.

Who can apply? Are there any restrictions?

GMHBA hospital covers are designed for people who have full Medicare eligibility.

Some people may be responsible for large out of pocket expenses if they’re not a permanent resident, or don’t have full Medicare eligibility.

Unless otherwise approved by GMHBA, any person under the age of 18 is not eligible to be a policyholder.

Is it easy to switch to GMHBA?

GMHBA is not on Compare Club’s panel, but we’re confident we can find you a good deal from the other funds we compare.

You’ll need to contact GMHBA directly if you want to move to them.

Do I need to re-serve waiting periods?

You won’t need to re-serve any waiting periods already served with your previous fund if you are switching to an equivalent or lower level of cover within 30 days of your membership ceasing with your previous fund.

Can I change my level of cover?

Yes, you can choose a lower or higher level of cover.

If you move to a higher level of cover, you will usually need to serve waiting periods on the extra services/higher benefits.

Do I get the government rebate?

Most Australians are eligible to receive a rebate from the government.

This will depend on your age and income.

To learn what you're entitled to, see this rebate guide.

Do I have to pay the Lifetime Health Cover loading?

If you're joining for the first time and you're 31 or over, you usually need to pay 2% loading for each year you've gone without health cover since your 31st birthday.

You can find out more here.

When do extras reset?

Extras reset on 1 January each year.

What age are children covered up to?

Children are covered on GMHBA family policy until the age of 21.

If they’re studying full time, dependents can be covered as a student under a family policy up to the age of 25.

Children must not be married or living in a de facto relationship. Read our guide to learn more.

Who underwrites the health policies?

GMHBA Limited is the parent company.

How do I contact GMHBA?

Visit gmhba.com.au or call 1300 446 422

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This guide is opinion only and should not be taken as medical or financial advice. Check with a financial professional before making any decisions.