Important information
trainee and the employer. Please contact us on 1300 benefit for a hospital stay was $5,000 and the • Treatment where the member and/or dependant • Benefits for lifestyle related services that primarily
4 GMHBA (46422) or visit a branch for more member has a $250 excess on their hospital cover, is eligible for free treatment under any take the form of sport, recreation or entertainment.
information. the benefit would reduce by the amount of the excess Commonwealth or State Government Act.
• Fund benefits, payable under a hospital or extras
2. Other funds
and an adjusted benefit of $4,750 would be paid.
• Services/treatment rendered more than 2 years cover shall not exceed the fees and/or charges
Student dependants whose parents are fund Where one member on a couples, family or single prior to the date of claiming. raised for any treatment and/or services covered
members of another registered health fund may parent excess cover is admitted to hospital they will
• Where more than one consultation and/or
for benefits under the relevant cover, after taking
join GMHBA within 2 months of ceasing to be a only pay a maximum amount per person as
treatment type per day has been claimed
into account benefits paid from any other source.
dependant, on a level of cover equal to or less than opposed to the maximum amount per membership.
regardless of provider within the group of • Benefits for services on treatment received
that held by their parents, without serving waiting This is usually half the maximum annual excess per
chiropractor (excluding x-ray), naturopath, overseas.
periods. An acceptable transfer certificate and policy.
homeopath and osteopath.
claims history must be received.
extras services purchased over the internet
No excess applies for child dependants under 21
• Where more than one consultation and/or Benefits will be paid for extras services purchased
3. Previously uninsured on GMHBA’s Gold and Silver Hospital Single Parents
treatment type per day has been claimed over the internet from Australian providers (optical
Previously uninsured dependants may join GMHBA family hospital covers listed in this member guide.
regardless of provider within the group of and pharmaceutical) where a script is provided.
within 2 months of leaving school or on completion
exclusions physiotherapy, myotherapy and if eligible, Consistent with current GMHBA rules, benefits for
of a full-time apprenticeship/traineeship, and
You cannot claim for the following: remedial massage. services on treatment received overseas are
receive immediate Bronze Hospital cover benefits,
except for any pre-existing condition/illness (other
• Benefits are only payable on itemised and original • Services/treatment which is not covered by your
excluded.
than for psychiatric, rehabilitation and palliative
account/s. Account/s which have been altered in membership and/or is rendered while the Healthy Start Benefit
care) and maternity cases for which a waiting
any way will not be accepted. Providers are membership is in arrears or is suspended. GMHBA’s Healthy Start Benefit has been introduced
period of 12 months will apply.
required to re-issue any account/s or endorse any
• Services/treatment rendered by a practitioner not
to reduce medical out of pocket expenses for
alterations. child-birth deliveries. For Gold Hospital product
All waiting periods must be served for extras
in private practice and/or not recognised by
benefits and hospital benefits which are higher than
• The supply of contraceptives, fertility and IVF bodies approved by GMHBA.
level 0/1/2, an additional benefit of $500 (up to the
those available from the Bronze Hospital cover.
drugs and items available through the
actual fee less the standard medical benefit and
• Pressure garments purchased for reasons other
Pharmaceutical Benefit Scheme (PBS).
additional gap medical benefit) is payable where
Child dependant excess
than treatment of burns, lymphoedema or for
the episode is for the birth of a child. This benefit
No excess applies for child dependants under 21 on
• Natural remedies (includes Modifast & Optifast). postoperative surgery up to 60 days from hospital
will be paid per episode and not per child (ie: the
GMHBA’s Gold and Silver Hospital Single Parents • Food supplements.
discharge only.
additional benefit is up to $500 for multiple births as
family hospital covers listed in this member guide.
• Pharmacy items, where they are available over
• GMHBA specified and approved orthopaedic well as single births). When you have a hospital
electronic claiming the counter and purchased with or without a
appliances purchased for support purposes only. admission which results in an out-of-pocket
When you have GMHBA extras cover you can use prescription. • Hiring of equipment (unless otherwise stated).
expense from the birth of a child, we’ll send you a
your GMHBA membership card to claim
payment of up to $500 within 60-90 days of your
• Supply of liquid filled Temazepam capsules. • Mass immunisation, services rendered in the
electronically on the spot when this facility is
hospital discharge. For further information on the
• Pharmaceuticals purchased overseas and not
course of the carrying out of a mass
available at your health care provider. After the
Healthy Start Benefit we recommend you call us on
listed on the Australian Register of Therapeutic
immunisation.
service has been provided, your membership card
1300 4 46422.
will be swiped through the terminal, your claim
Goods. • Services not rendered face to face (e.g. remotely
If things go wrong
details entered and your claim will usually be
• Dental procedures carried out and charged direct
over the phone).
Our mission to be your trusted partner in the
processed electronically within seconds. Once your
to the fund member/dependant by a dental • Foot orthotics provided by a physiotherapist or
provision of private health insurance goes beyond
claim is authorised by GMHBA, you simply pay any
mechanic, other than an advanced dental chiropractor.
providing quality affordable products and high
difference between the full fee for the treatment
technician.
• Additional medical gap benefits where the medical
levels of customer service.
and the amount claimed by GMHBA.
• A range of dental procedures when provided on service is rendered by a medical practitioner
While we receive many letters of praise about our
If there is an unexpected rejection of your claim at
the same day e.g. a filling on a tooth that has employed full-time in the public sector.
products and customer service advisors like any
point of service, your provider should contact
been removed.
• Treatment provided to a member of the providers
organisation we aren’t perfect and on occasions we
GMHBA on 1300 4 GMHBA (46422) to clarify the
family and/or to a providers business partner and
also receive complaints. We believe that your
• Dental procedures where a limit on the number
issue at the time of the service taking place.
their family members or any other people not
complaints are of equal or greater importance than
you can have has been exceeded.
excess
independent from the practice. Family members
praise.
• Dental procedures unless tooth identifications (ID)
GMHBA’s range of hospital covers often feature an
include: wife/husband, brother/sister, children,
As such we have stringent guidelines in place to
are supplied by the provider.
excess to let GMHBA members share some of the
parents, grandparents, grandchildren of the
ensure we acknowledge you in the most efficient
cost of hospital admissions in return for lower
• Services/treatment for which the member and/or
provider/business partners’ and their spouse/
and timely manner.
premiums. An excess is deducted from the benefit
dependant has a right to claim damages or
partner.
paid by GMHBA. For example, if GMHBA’s full
compensation from any other person or body.
56 57
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