Important information
trainee and the employer. Please contact us on member has a $250 excess on their hospital cover, • Treatment where the member and/or dependant • Benefits for lifestyle related services that primarily
1300 4 GMHBA (46422) for more information. the benefit would reduce by the amount of the excess is eligible for free treatment under any take the form of sport, recreation or entertainment.
2. Other funds
and an adjusted benefit of $4,750 would be paid. Commonwealth or State Government Act.
• Fund benefits, payable under a hospital or extras
Student dependants whose parents are fund Where one member on a couples, family or single • Services/treatment rendered more than 2 years cover shall not exceed the fees and/or charges
members of another registered health fund may parent excess cover is admitted to hospital they will prior to the date of claiming. raised for any treatment and/or services covered
join GMHBA within 2 months of ceasing to be a only pay a maximum amount per person as
• Where more than one consultation and/or
for benefits under the relevant cover, after taking
dependant, on a level of cover equal to or less than opposed to the maximum amount per membership.
treatment type per day has been claimed
into account benefits paid from any other source.
that held by their parents, without serving waiting This is usually half the maximum annual excess per
regardless of provider within the group of • Benefits for services on treatment received
periods. An acceptable transfer certificate and policy.
chiropractor (excluding x-ray), naturopath, overseas.
claims history must be received.
No excess applies for child dependants under 21 homeopath and osteopath.
extras services purchased over the internet
3. Previously uninsured on GMHBA’s Gold and Silver Hospital Single Parents
• Where more than one consultation and/or Benefits will be paid for extras services purchased
Previously uninsured dependants may join GMHBA family hospital covers listed in this member guide.
treatment type per day has been claimed over the internet from Australian providers (optical
within 2 months of leaving school or on completion
exclusions regardless of provider within the group of and pharmaceutical) where a script is provided.
of a full-time apprenticeship/traineeship, and
You cannot claim for the following: physiotherapy, myotherapy and if eligible, Consistent with current GMHBA rules, benefits for
receive immediate Bronze Hospital cover benefits,
• Benefits are only payable on itemised and original
remedial massage. services on treatment received overseas are
except for any pre-existing condition/illness (other
than for psychiatric, rehabilitation and palliative
account/s. Account/s which have been altered in • Services/treatment which is not covered by your
excluded.
care) and maternity cases for which a waiting
any way will not be accepted. Providers are membership and/or is rendered while the Healthy Start Benefit
period of 12 months will apply.
required to re-issue any account/s or endorse any membership is in arrears or is suspended. GMHBA’s Healthy Start Benefit has been introduced
alterations. to reduce medical out of pocket expenses for
All waiting periods must be served for extras
• Services/treatment rendered by a practitioner not
benefits and hospital benefits which are higher than
• The supply of contraceptives, fertility and IVF in private practice and/or not recognised by
child-birth deliveries. For Gold Hospital product
those available from the Bronze Hospital cover.
drugs and items available through the bodies approved by GMHBA.
level 0/1/2, an additional benefit of $500 (up to the
Pharmaceutical Benefit Scheme (PBS).
actual fee less the standard medical benefit and
Child dependant excess
• Pressure garments purchased for reasons other
additional gap medical benefit) is payable where
No excess applies for child dependants under 21 on
• Natural remedies (includes Modifast & Optifast). than treatment of burns, lymphoedema or for
the episode is for the birth of a child. This benefit
GMHBA’s Gold and Silver Hospital Single Parents • Food supplements.
postoperative surgery up to 60 days from hospital
will be paid per episode and not per child (ie: the
family hospital covers listed in this member guide.
discharge only.
• Pharmacy items, where they are available over
additional benefit is up to $500 for multiple births as
electronic claiming the counter and purchased with or without a
• GMHBA specified and approved orthopaedic well as single births). When you have a hospital
When you have GMHBA extras cover you can use prescription.
appliances purchased for support purposes only. admission which results in an out-of-pocket
your GMHBA membership card to claim • Hiring of equipment (unless otherwise stated).
expense from the birth of a child, we’ll send you a
• Supply of liquid filled Temazepam capsules.
electronically on the spot when this facility is
payment of up to $500 within 60-90 days of your
• Pharmaceuticals purchased overseas and not
• Mass immunisation, services rendered in the
available at your health care provider. After the
hospital discharge. For further information on the
listed on the Australian Register of Therapeutic
course of the carrying out of a mass
service has been provided, your membership card
Healthy Start Benefit we recommend you call us on
Goods.
immunisation.
will be swiped through the terminal, your claim
1300 4 46422.
details entered and your claim will usually be
• Dental procedures carried out and charged direct
• Services not rendered face to face (e.g. remotely
If things go wrong
processed electronically within seconds. Once your
to the fund member/dependant by a dental
over the phone).
Our mission to be your trusted partner in the
claim is authorised by GMHBA, you simply pay any
mechanic, other than an advanced dental • Foot orthotics provided by a physiotherapist or
provision of private health insurance goes beyond
difference between the full fee for the treatment
technician. chiropractor.
providing quality affordable products and high
and the amount claimed by GMHBA.
• Additional medical gap benefits where the medical
levels of customer service.
• A range of dental procedures when provided on
If there is an unexpected rejection of your claim at
the same day e.g. a filling on a tooth that has service is rendered by a medical practitioner
While we receive many letters of praise about our
point of service, your provider should contact
been removed. employed full-time in the public sector.
products and customer service advisors like any
GMHBA on 1300 4 GMHBA (46422) to clarify the
• Treatment provided to a member of the providers
organisation we aren’t perfect and on occasions we
• Dental procedures where a limit on the number
issue at the time of the service taking place.
family and/or to a providers business partner and
also receive complaints. We believe that your
you can have has been exceeded.
excess
their family members or any other people not
complaints are of equal or greater importance than
• Dental procedures unless tooth identifications (ID)
GMHBA’s range of hospital covers often feature an
independent from the practice. Family members
praise.
are supplied by the provider.
excess to let GMHBA members share some of the
include: wife/husband, brother/sister, children,
As such we have stringent guidelines in place to
cost of hospital admissions in return for lower
• Services/treatment for which the member and/or
parents, grandparents, grandchildren of the
ensure we acknowledge you in the most efficient
premiums. An excess is deducted from the benefit
dependant has a right to claim damages or
provider/business partners’ and their spouse/
and timely manner.
paid by GMHBA. For example, if GMHBA’s full
compensation from any other person or body.
partner.
benefit for a hospital stay was $5,000 and the
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