GMHBA Health Insurance Review

Published: May 29, 2017

Whether you’re looking for private health insurance for the very first time, or want to switch from your current provider, it’s important to compare options from a variety of health insurers, like GMHBA Health Insurance.

GMHBA_logo

Hospital cover options

  • Bronze Hospital
  • Silver Hospital
  • Gold Hospital

Packages & Extras 

  • Family Packages
  • Silver Extras
  • Gold Extras

Need to know

  • Waiting periods
  • Excess amounts
  • Co-payments

Comparing health funds enables you to determine if they provide the best option for your needs if they offer true value for money, and if they exclude cover for anything that might be important to you.

We’ve reviewed GMBHA’s features, benefits and exclusions, so you can decide if their policies will suit your unique requirements and your budget.

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About GMHBA Private Health Insurance

GMHBA Limited is a not-for-profit, 100% member-based private health insurer with over 80 years’ experience and has become Australia’s leading regionally based health insurance company with more than 230,000 members. Select GMHBA health insurance policies now include AIA VItality membership!

What is the difference between Frank and GMHBA Health Insurance?

In October 2009, GMHBA launched a second health insurance brand called Frank Health Insurance. Frank offers simple private health insurance, with easy to understand policies and terms and conditions, at a low cost. Both provide private health insurance solutions. However, each has their own branding, their own unique marketing style, and their own terms and conditions.

GMHBA Hospital cover options

Bronze Hospital

  • Entry level cover as a private patient for in-hospital treatments, including accommodation in a shared room in a public hospital only.
  • Covers GMHBA approved hospital-substitution and chronic disease management services, Joint investigations and reconstruction, cancer treatment, intensive and coronary care and rehabilitation services.
  • Excludes cover for hospital treatments that Medicare pays no benefit for (for example, cosmetic surgery), also excludes operating theatre costs, insulin pump, dialysis, gastric banding and related services.

Silver Hospital

  • Provides a moderate level of cover.
  • Private room guarantee.
  • The cover includes cancer treatment, intensive and coronary care and rehabilitation services.
  • Excludes cover for dental implants and corneal implants performed in a hospital. Further excludes: Pregnancy, assisted reproductive services and birth related services, joint replacement, dialysis and gastric banding, and hospital treatments Medicare does not pay for.

Gold Hospital

  • Most comprehensive hospital cover.
  • Covers everything in Silver, plus: Joint investigations and reconstruction, pregnancy and birth related services, although you can choose to remove this and receive lower premiums.
  • Covers also include dental implant surgery and rehabilitation services.
  • Excludes cover for hospital treatments that Medicare does not pay any benefit for.
  • No co-payments.
Is GMHBA The Better Option? Find Out

GMHB Combined Family Packages

The health fund strives to offer families total peace of mind through their comprehensive family packages. No Hospital excess is required for kids under the age of 21 and you receive up to 100% back on optical, preventative dental and ambulance subscription, up to your annual limits.

Starter Family Package

For the family on a strict budget. Hospital treatment and accommodation as a private patient in a private or public hospital for removal of wisdom teeth, appendix, tonsils and includes grommets, colonoscopies and hernia repair. 55% back on basic extras up to your annual limit:

  • General and major dental, as well as orthodontics.
  • Optical.
  • Physiotherapy.
  • Remedial massage, acupuncture and naturopathy.

Everyday Family Package

A higher level of health cover with or without pregnancy. You’ll also have access to the New Family Program and chronic disease management services. Receive 65% back on a range of extras. Same extras as the Starter Family Package, but also includes:

  • Non PBS Pharmaceuticals (sub-limits apply).
  • Chiropractic and podiatry.
  • Psychology.
  • Hearing aids and blood glucose monitors.

Premium Family Package

This is GMHBA’s most comprehensive package with or without pregnancy cover – you choose. You’ll receive 75% back on services from providers of your choice, up to your annual limits. Includes all extras cover offered by the Everyday Family Package, but with higher benefit limits.

Compare GMHBA Extras Insurance

GMBHA Extras cover can provide benefits for treatments usually not covered by Medicare, like visits to the dentist, physio, or chiropractor. GMHBA offers three levels of Extras cover. These include Bronze, Silver, and Gold, and each gives you cover for a defined set of treatments and services.

  • For each of the three GMHBA Extras policies, you can choose to claim from set benefits, or you can claim to get a certain percentage of the total cost back. If you choose the percentage policies, you will pay slightly higher premiums, but this could work out in your favour if you plan on claiming a lot or have specific health needs as you will not reach your benefit cap as quickly.
  • There are more inexpensive set benefit options for each plan, allowing you to claim for the total cost of a service. But for longer or more expensive sessions, you could be reimbursed with a lower percentage of the costs.
  • Certain services must be medically recommended by a registered treatment provider who may need to fill out part of claims form for you to get reimbursed.

Bronze Extras Cover

The most affordable option with cover for the three most popular extras: optical, general and preventative dental, and physiotherapy.

Silver Extras Cover

While the premiums are higher than Bronze, Silver Extras generally provides you with a wider range of treatments and services. These include general and major dental, optical, ambulance, psychology, pharmacy, dietetics, occupational therapy, hearings aids, and more.

Gold Extras Cover

Ideal for those able to afford to pay for comprehensive cover. It includes everything in Bronze and Silver Extras, as well as additional services like exercise physiology, antenatal and postnatal classes, and weight loss programs.

What’s covered? GMHBA Bronze Extras Cover GMHBA Silver Extras Cover GMHBA Gold Extras Cover
Percentage received back. 55% 65% 75%
Ambulance subscription
Ambulance transport
Antenatal and postnatal classes
Audiology
Blood glucose monitors
Chiropractic and osteopathy
Dietetics
Exercise physiology
Extremity Pump
Eye therapy and speech therapy
Fluoride dietary supplements
General dental services (includes basic services: check-ups, simple tooth extractions, etc.)
Hearing aids
Major dental services (includes complex services: dentures, crowns, bridges, endodontics, etc.)
Naturopathy, homoeopathy, acupuncture, and remedial massage
Nebuliser
Non-surgical prostheses
Nursing
Occupational therapy
Orthodontics
Optical services $150 $200 $250 (includes laser eye surgery)
Orthopaedic appliances
Orthopaedic repairs
Orthotic appliances
Pharmacy and travel vaccinations
Physiotherapy, myotherapy, and hydrotherapy
Podiatry
Preventative health benefits
Pressure garments
Psychology
Sleep apnoea monitor
TENS monitor (TENS is transcutaneous electrical nerve stimulation, a therapy to relieve pain)
Weight loss programme

GMHBA Additional Features & Benefits

  • You gain access to their Connect Rewards program upon joining a combined hospital & extras policy. This reward program lets you accumulate Connect Dollars each year that you are with GHMBA. You can then use your Connect Dollars to pay for further services under your plan, even if you’ve reached your annual limits.
  • You gain access to preventative health benefits, including Bowel cancer screening (1 every 2 years), quit smoking programmes (1 per year), nicotine replacement patches (a single 12-week patch course per year), and melanoma surveillance photography (1 per year).

GMHBA Waiting Periods and Excesses

Waiting periods apply to people taking out a new GMHBA policy, upgrading their policy or have a pre-existing medical condition, for example, cancer or diabetes.

Waiting periods

  • New policy or upgrading: 12 months.
  • Obstetrics and Maternity: 12 months.
  • Pre-existing injuries or illnesses: 12 months. Excluding psychiatric, rehabilitation and palliative care.
  • Most extras benefits: 2 months.
  • Optical, home and domestic aids: 6 months.
  • Major dental services: 12 months.
  • Health Appliances: 12 months.

Excess amounts 

  • An excess allows you to share some of the costs associated with hospital admissions and in return, you pay lower premiums.
  • Your hospital cover excess will be deducted from the benefit paid by the health fund.
  • GMHBA members have the flexibility of choosing from a $0, $250 or $500 excess which will be deducted from the benefit amount they receive.
  • There is no excess payable for child dependants under 21 on GMHBA’s Gold Hospital cover.

How do I claim online from my GMHBA health fund policy?

To claim online, you first need to sign into the GMHBA member self-service centre. After that, you need to fill in the details of your claim for services received in the last two months and already paid for. Lastly, save and store your receipts because they may be audited later.

Even though GMHBA provides many benefits, it’s important to shop around and compare their features, benefits, and exclusions to other health insurance companies and decide if they’re the best option for you and your family.

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Ask an Expert?

2 Comments

  • Dianne Taylor |

    I have been a gold extras customer for years. How much can I claim on chiropractic services and do you have a preferred provider near Dromana, Victoria?

    • SPECIALIST
      Anneke Van Aswegen |

      Hi Dianne,
      I’m not sure the exact health insurance policy you have with GMHBA, but according to the privatehealth.gov.au website, for GMHBA’s Gold Extras Set Benefits you can claim chiropractic services of $350 per person, up to $700 per policy.

      Regarding a preferred chiropractic provider, you’ll need to contact GMHBA directly for this information. You can call them on 1300 446 422.