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Basic Plus Starter Hospital and Basic Extras Set Benefits
*For new members joining on combined hospital and extras cover, paying by direct debit. Must pay first month premium to receive discount. Must not have been a member within last 12 months. Offer only available via GMHBA website, phone and branch or GMHBA corporate program. Not available in conjunction with any other offer.
Hospital cover explained
Download hospital factsheet
Understanding what's covered
Inclusions
Hospital treatment of the tonsils, adenoids and insertion or removal of grommets.
Hospital treatment for surgery for joint reconstructions.
Hospital treatment for the investigation and treatment of a hernia or appendicitis.
Hospital treatment for the investigation and treatment of the female reproductive system.
Hospital treatment for surgery to the teeth and gums.
Restricted
Hospital treatment for physical rehabilitation for a patient related to surgery or illness.
Hospital treatment for care where the intent is primarily providing quality of life for a patient with a terminal illness, including treatment to alleviate and manage pain.
Hospital treatment for the treatment and care of patients with psychiatric, mental, addiction or behavioural disorders.
Exclusions
Hospital treatment for the investigation and treatment of the brain, brain-related conditions, spinal cord and peripheral nervous system.
Hospital treatment for the investigation and treatment of the eyes and content of the eye sockets.
Hospital treatment for the investigation and treatment of the ear, nose, throat, middle ear, thyroid, parathyroid, larynx, lymph nodes and related areas of the head and neck.
Hospital treatment for the investigation and treatment of diseases, disorders and injuries of the musculoskeletal system.
Hospital treatment for the investigation and treatment of the kidney, adrenal gland and bladder.
Hospital treatment for the investigation and treatment of the male reproductive system including the prostate.
Hospital treatment for the investigation and treatment of the digestive system, including the oesophagus, stomach, gall bladder, pancreas, spleen, liver and bowel.
Hospital treatment for the diagnosis, investigation and treatment of the internal parts of the gastrointestinal system using an endoscope.
Hospital treatment for the investigation and treatment of a miscarriage or for termination of pregnancy.
Hospital treatment for chemotherapy, radiotherapy and immunotherapy for the treatment of cancer or benign tumours.
Hospital Treatment for pain management that does not require the insertion or surgical management of a device.
Hospital treatment for the investigation and treatment of skin, skin-related conditions and nails.
Hospital treatment for the investigation and treatment of breast disorders and associated lymph nodes, and reconstruction and/or reduction following breast surgery or a preventative mastectomy.
Hospital treatment for the investigation and management of diabetes.
Hospital treatment for the investigation and treatment of blood and blood-related conditions.
Hospital treatment which is medically necessary for the investigation and treatment of any physical deformity.
Hospital treatment for the investigation and treatment of conditions affecting the foot and/or ankle, provided by a registered podiatric surgeon. Benefits are limited to only cover hospital accommodation and the cost of a prosthesis per the Prosthesis List, as laid out in the Private Health Insurance (Prosthesis) Rules. Medical services such as the anaesthetist or the surgeon’s account in respect to Podiatric Surgery are not covered under hospital products.
Hospital treatment for the investigation and treatment of the back, neck and spinal column, including spinal fusion.
Hospital treatment for the investigation and treatment of the heart, heart-related conditions and vascular system.
Hospital treatment for the investigation and treatment of the lungs, lung-related conditions, mediastinum and chest.
Hospital treatment to correct hearing loss, including implantation of a prosthetic hearing device.
Hospital treatment for the investigation of sleep patterns and anomalies.
Hospital treatment for surgery to remove a cataract and replace with an artificial lens.
Hospital treatment for surgery for joint replacements, including revisions, resurfacing, partial replacements and removal of prostheses.
Hospital treatment for dialysis treatment for chronic kidney failure.
Hospital treatment for the provision and replacement of insulin pumps for treatment of diabetes.
Hospital treatment for the implantation, replacement or other surgical management of a device required for the treatment of pain.
Hospital treatment for investigation and treatment of conditions associated with pregnancy and child birth.
Hospital treatment for fertility treatments or procedures.
Hospital treatment for surgery that is designed to reduce a person’s weight, remove excess skin due to weight loss and reversal of a bariatric procedure.
Hospital FAQs
A waiting period is the time between joining GMHBA and when you are covered for a treatment or service. If you receive a service or treatment during a waiting period, you are not eligible to receive a benefit payable from us, regardless of when you submit the claim.
You won’t need to serve waiting periods for anything you have previously served waiting periods for. If your new cover has higher benefits than your old cover, you’ll have to serve the standard waiting periods to receive those higher benefits.
Hospital Waiting periods apply to:
- New members to health insurance or those that do not currently have hospital cover
- Members who transfer from another health fund who have not fully served the required waiting periods
- New members that have had a gap in their hospital cover for more than 30 days.
Waiting Period – 0 days (accidents must occur after joining)
Accidents- bodily injuries resulting from accidents which occur after the date of joining or upgrading to a higher cover.
Waiting Period – 2 months
Rehabilitation, Palliative Care, Psychiatric and non Pre-existing Conditions.
Waiting Periods – 12 months
A pre-existing condition is one where the signs or symptoms of your illness or condition, in the opinion of an independent medical examiner was known to exist at any time during the six months prior to taking out your hospital insurance or upgraded to a higher level of hospital cover.
A waiting period of up to 12 months is applicable for any claims that have found to be Pre-Existing by the independent medical examiner. Further information about Pre-Existing Conditions can be found here.
Going into hospital can be an emotional and confronting experience for either yourself or a loved one. At GMHBA we help you feel comfortable about the upcoming admission and encourage you to contact us as soon as you may need a hospital admission.
Our Going to hospital guide provides a step by step understanding to ensure that you feel comfortable with your upcoming admission.
An out-of-pocket cost is a fee charged by the specialist above the benefit that Medicare and GMHBA combine to contribute towards a procedure. Medicare will pay the first 75% of the Medicare Benefits Scheduled Fee (MBS) towards the procedure and GMHBA will contribute at least 25% of the MBS fee. The MBS Fee is only a recommendation and private surgeons in Australia can set their own fees and any fee greater than the set MBS fee you will need to pay the difference; this is called a ‘medical gap’ or an out of pocket cost.
To reduce medical out of pocket costs associated with medical procedures the Australian Health Service Alliance (AHSA) access gap scheme is an opt in billing scheme that provides higher benefits than the Government’s schedule fee and limits the out-of-pocket costs for the procedure. Specialists must be registered for Access Gap Cover (AGC) and choose to opt in for the procedure.
There are two scenarios for how you may be billed by your specialist when they use the AGC scheme:
- No Gap- this is where there will be no gap from the specialist to pay following the procedure
- Known Gap – this is where you will be charged a maximum gap of $500 per specialist, per admission to hospital or a maximum of $800 for obstetric services.
We will not pay on any services that are excluded on your level of cover, treatment outside of Australia, procedures that are not claimable through Medicare and for treatment that occurred outside of your policy being active.
Extras cover explained
Download extras factsheet
Understanding what's covered
Inclusions
Bronze Plus Package with AIA Vitality, Silver Package with AIA Vitality, Essential Extras, Core Extras & Premium Extras:
Benefits are per person per calendar year.
Basic Extras, Mid Extras, Top Extras:
The benefits shown are the annual limits for each type of dental service. The annual limit is a combined general and major dental limit. There are further sub limits within some of these dental services.
Overall dental annual limit is per person, per calendar year.
General Dental:
Diagnostic services, simple extractions (not including surgical extractions of wisdom teeth) and restorative services (limited benefits apply to precious restorations).
Major Dental:
Major dental services (including full & partial dentures, orthodontics, crown & bridgework, endodontic services such as root canal, gold fillings, indirect restorations, surgical extractions of a tooth/teeth including wisdom teeth). Note: Basic Extras, Bronze Plus Package with AIA Vitality and Essential don't cover major dental.
Annual limit per person, per calendar year
$1,000
Combined annual limits for General Dental and Preventative Dental
Sub-limit of $300 applies for Preventative Dental
Benefit - General Dental
Periodic oral examination (012) - $31.00
Scale & clean (114) - $57.75
Fluoride treatment (121) - $18.15
Excludes Major Dental treatment
Waiting period
2 months
Includes prescription lenses, spectacle frames, and contact lenses. Non-prescription sunglasses and repairs are excluded.
Laser surgery claimable on Gold Extras only.
Annual limit per person, per calendar year
$150
Benefit
80%
Waiting period
6 months
Treatment by a physiotherapist which uses physical means to relive pain, regain range of movement, restore muscle strength and return patients to return patients to normal activities of daily living
Hydrotherapy, involves the use of water for pain relief and treatment. The term encompasses a broad range of approaches and therapeutic methods that take advantage of the physical properties of water, such as temperature and pressure, for therapeutic purposes, to stimulate blood circulation and treat the symptoms of certain diseases
Annual limit per person, per calendar year
$300
Annual limit per policy, per calendar year
$600
Combined annual limits for Physiotherapy, Hydrotherapy and Myotherapy
Benefit - Physiotherapy
Initial consult - $33.00
Subsequent consult - $25.00
Benefit - Hydrotherapy
Initial consult - $33.00
Subsequent consult - $25.00
Waiting period
2 months
Myotherapy is a branch of manual medicine which focuses on the treatment and rehabilitation of musculoskeletal pain and associated conditions. This involves an extensive physical evaluation and an integrated therapeutic approach to affected muscles, joints, nerves, and associated viscera (organs) and is used in the treatment of acute or chronic conditions and in the area of preventative management
Annual limit per person, per calendar year
$300
Annual limit per policy, per calendar year
$600
Combined annual limits for Physiotherapy, Hydrotherapy and Myotherapy
Benefit
Initial consult - $33.00
Subsequent consult - $25.00
Waiting period
2 months
Any S4 or S8 non PBS products may be claimed (excluding contraception, fertility and IVF).
Annual limit per person, per calendar year
$150
Annual limit per policy, per calendar year
$350
Combined annual limits for Pharmacy and Travel Vaccinations
Benefit
Per script - $21
Waiting period
2 months
Benefits are payable for selected travel vaccinations administered by a doctor or at a vaccine clinic if you have a pharmacy receipt, doctor's account or vaccine clinic account.
Annual limit per person, per calendar year
$150
Annual limit per policy, per calendar year
$350
Combined annual limits for Pharmacy and Travel Vaccinations
Benefit
Per script - $21
Waiting period
2 months
Occupational Therapy assists and supports people to participate in day to day life by enhancing their ability to engage in everyday activities.
Annual limit per person, per calendar year
$300
Annual limit per policy, per calendar year
$600
Benefit
Initial consult - $30.00
Subsequent consult - $23.00
Waiting period
2 months
Annual limit per person, per calendar year
$30
Benefit
Per repair - 75%
Waiting period
2 months
Refer to medical devices (such as a knee brace) fitted immediately following surgery or to heal an injury.
Must be custom made and GMHBA specified and approved.
A doctor's letter of recommendation is required prior to claiming and are limited to one item per membership every 3 years.
Annual limit per person, every three years
$200
Benefit
Per appliance - $71.00
Waiting period
12 months
Garment that applies continual pressure over large areas of healing skin after burns, lymphodaema, or post operative surgery.
Garments must be supplied through a private company or therapist in private practice. A doctor's letter recommending the appliance must accompany each claim for benefits.
A doctor's letter of recommendation is required prior to claiming.
Annual limit per person, every three years
$100
Benefit
Per garment - $42
Waiting period
12 months
Fluoride benefits are payable towards the cost of dietary fluoride supplements (tablet or liquid form) when dispensed by a chemist or dentist in a private practice.
Annual limit per person, per calendar year
$45
Benefit
Per supplement - $16.00
Waiting period
2 months
Bronze Plus Package with AIA Vitality, Silver Package with AIA Vitality, Essential Extras, Core Extras & Premium Extras:
100% of cost, limited to 1 service per person per year. Where you are entitled to any rebate or reimbursement from Medicare for any extras service, you cannot claim any out of pocket expenses with us.
Quit Smoking Program:
1 per person per year up to the annual limit on Top Extras Set Benefits, Top Extras 75% Benefits, Mid Extras Set Benefits, Mid Extras 65%, Basic Extras Set Benefits and Basic Extras 55%. Combined with Melanoma Surveillance Photography and Nicotine Replacement Patches.
Annual limit per person, per calendar year
$50
Annual limit per policy, per calendar year
$100
Combined annual limits for Melanoma Surveillance Photography, Quit Smoking Programs and Nicotine Replacement Patches
Benefit
100% - 1 per year
Waiting period
2 months
Bronze Plus Package with AIA Vitality, Silver Package with AIA Vitality, Essential Extras, Core Extras & Premium Extras:
100% up to 1 x 12 week course of patches per year.
Quit Smoking Program:
1 per person per year up to the annual limit on Top Extras Set Benefits, Top Extras 75% Benefits, Mid Extras Set Benefits, Mid Extras 65%, Basic Extras Set Benefits and Basic Extras 55%. Combined with Melanoma Surveillance Photography and Nicotine Replacement Patches.
Annual limit per person, per calendar year
$50
Annual limit per policy, per calendar year
$100
Combined annual limits for Melanoma Surveillance Photography, Quit Smoking Programs and Nicotine Replacement Patches
Benefit
1 x 12 week course of patches per year
Waiting period
2 months
Extras FAQs
A waiting period is the time between joining GMHBA and when you're covered for a treatment or service. If you receive a service or treatment during a waiting period, you are not eligible to receive a benefit payable from us, regardless of when you submit the claim.
Extras waiting periods apply to:
New members to health insurance, existing members who have upgraded their cover or anyone who has transfered to GMHBA from a previous fund and:
- Still have waiting periods to finish serving
- Joined on a higher level of cover and haven't served waits on any new services or increased benefit limits
- Had a gap in their extras cover for more than 30 days
Waiting periods for extras services are as follows:
Waiting Periods - 12 Months
Major Dental including Orthodontics, Hearing Aids, Health Appliances and Foot Orthotics
Waiting Periods - 6 Months
Optical
Waiting Periods - 2 Months
All other services
Waiting Periods - 0 days
Ambulance transport and subscriptions
Our members have freedom of choice when selecting their preferred provider. For members to claim with GMHBA, providers must hold active accreditation, be operating in a private practice and considered an Australian Provider.
We've partnered with smile.com.au to make dental care more affordable and accessible for our members across Australia. This means lower out of pocket costs for all dental treatment, as smile.com.au dentists will reduce their fees by at least 15%.
With more than 2,500 approved dentists in the smile.com.au network, chances are there is one near you.
A extras policy can have four different types of limits:
- Policy limit - The total amount for a service that can be claimed for the policy in a calendar year.
- Person limit - The maximum amount a single person can claim towards a service within the calendar year.
- Membership limit - The maximum total between everyone on the policy, that can be claimed towards a service within the calendar year.
- Sublimit – A cap on benefits set by GMHBA towards a particular service or treatment within the overall annual limit.
Annual limits reset on 1 January each year for most services.
Some services such as hearing aids and health appliances have a benefit period of three years. This means that if you have claimed your full hearing aid benefit you will be unable to claim an additional benefit for three years from the date of the initial claim.
With set benefits you get the same benefit back each time you visit the provider up to your annual limits.
A percentage back allows you to get a percentage of the overall charge back up to your annual limits.
Our promise
Not the right cover for you? We'll refund your premium provided you haven't made a claim.
We’ve been helping Australians manage their health care for 90 years.
We’re not for profit, so we always put the health and wellbeing of our members first.
Find the right cover for you, join online and we'll take care of the rest. Plus, you'll serve no waiting periods if you switch to the same or lower level of cover.
Contact our friendly customer service team
1300 446 422
Disclaimer
This information is important.
Please read and retain for future reference.
Full information about your chosen cover's applicable waiting periods, excess, co-payments, exclusions, restrictions, limits, pre-existing conditions, accident protection and services covered is available within the policy factsheet. The price shown excludes any Lifetime Health Cover (LHC) loading.
Rates are effective 1 April 2024. | All contribution quotes by this calculator are subject to variation and should therefore be considered indicative contribution rates. | Weekly and fortnightly payment frequencies are only available for direct debits | Calculations include the 2% Direct Debit Discount available only via bank account direct debit, excluding products with AIA Vitality packages| All prices include the Australian Government Rebate on Private Health Insurance as chosen | Hospital Cover contributions do not include any applicable Lifetime Health Cover loading. | Health insurance and AIA Vitality are separate products, with the combined price including your health insurance premium and monthly AIA Vitality fee, less 5% discount off both. When packaged with a single or single parent health insurance policy, AIA Vitality costs $10 per month (less applicable discounts) and entitles one eligible adult member to an AIA Vitality membership. When packaged with a couple or family health insurance policy, AIA Vitality costs $20 per month (less applicable discounts) and entitles two eligible adult members to AIA Vitality memberships. If you cancel your AIA Vitality membership, you will lose your associated discount on your health insurance product. | GMHBA with AIA Vitality packages are only available for members paying by direct debit. Please call 1300 425 499 if you would like the health insurance product only.