GMHBA Health Insurance Review
GMHBA Health Insurance offers 13 Health Insurance plans, including Basic Plus Starter Hospital, Silver Plus Premium Hospital, and Top Extras 75, starting from $19.25 per week up to $3,269.80 per year.
GMHBA Health Insurance offers a Youth Discount feature to reduce premiums for policyholders aged 18 to 29. It includes Access Gap Cover arrangements, helping members minimise out-of-pocket expenses when using participating hospitals.
| 📌 Date Established | 1934 |
| 📍 Headquartered | Geelong, Victoria, Australia |
| ↪️ Registration Number | ABN 98 004 417 092 |
| 👤 Average Number of Members | Over 320,000 members |
| 👥 Number of Employees | 201-500 |
| 📉 APRA-Regulated | ✅Yes |
| 📈 The most recent Market Cap reported | None indicated; net profit of $12.6 million (2023-24) |
| 📊 Average Customer Rating | 4.5/5 |
| 💹 Average Number of Reviews | Thousands |
| 💱 Market Share | Positioned as Australia’s leading regionally-based health insurer |
| 🔟 Number of plans offered | 13 Plans (Health-only plus extras) |
| ❤️ Sponsorships | Sponsors Geelong Cats football club and partners with several local community initiatives |
| ▶️ Is a Mobile App offered | Through the GMHBA app for members |
| ⚙️ Medical Claims Portal | Claims can be submitted through the online Member Area and the mobile app |
| ⏰ Customer Support Operating Hours | Monday to Friday, 8:30 am to 5 pm AEDT |
| 🗃️ Information Hub and Blog | Provides health-related articles and updates on the website |
| 💊 Chronic Illness Benefits | Includes specialised health programs and care coordination |
| 🩺 Screening and Prevention offered | Includes emergency ambulance cover and accident protection on all hospital products |
| 🍼 Maternity Benefit | Yes, but restricted |
| 👩⚕️ Health Insurance Premium Range (AUD) | From $19.25 per week on Accident Only to $3,269.80 per year on Gold Optimum |
| ⌛ Average Waiting Period | 2 months – 12 months |
| 🅰️ Is International Medical Cover Offered | None |
| 🅱️ International Travel Benefit | Not offered directly |
GMHBA Health Insurance Plan Overview
| 🔎 Plan | 💴 Premium Range AUD (Min to Max, Weekly to Yearly) | 🚨 Exclusions | ❤️ Ideal For | ↪️ Gap Cover | 📌 Rebate Percentage | 📍 Average Waiting Period | ⭐ Key Features |
| 🥇 Accident Only Hospital | From $19.25 per week - $1,001.40 per year | Elective surgeries, pregnancy, mental health, and dental services | Those needing basic accident coverage | Yes | 8.202% to 32.812% | 2 to 12 months | Covers emergency treatments after accidents occurring within 48 hours |
| 🥈 Basic Plus Starter Hospital | From $19.40 per week - $1,011.15 per year | Pregnancy-related services, major surgeries | Young individuals and couples | Yes | 8.202% to 32.812% | 2 to 12 months | Includes essential coverage for hospital admission and day surgeries, accident protection |
| 🥉 Bronze Plus Hospital | From $23.30 per week to $1,214.20 per year | Joint replacements, cataract surgery, IVF, pregnancy | Budget-conscious individuals | Yes | 8.202% to 32.812% | 2 to 12 months | Includes basic hospital care, accident protection, and a wide range of general treatments |
| 🏅 Bronze Plus Advantage Hospital | From $23.70 per week to $1,232.35 per year | Pregnancy and birth-related services, joint replacements | Families and young singles | Yes | 8.202% to 32.812% | 2 to 12 months | Includes hospital services and additional cover like blood treatments and diabetes management |
| 🎖️ Silver Plus Hospital | From $30.10 per week wo $1,567.05 per year | Elective procedures, some specialised surgeries | Couples and families | Yes | 8.202% to 32.812% | 2 to 12 months | Comprehensive hospital coverage, including mental health and palliative care |
| 🥇 Silver Plus Premium Hospital | From $42.25 per week - $2,197.45 | Non-essential treatments, cosmetic surgeries | Families and mature singles | Yes | 8.202% to 32.812% | 2 to 12 months | Broader coverage, including complex surgeries, hospital psychiatric services, and dialysis |
| 🥈 Gold Optimum Hospital | From $62.85 per week to $3,269.80 per year | Cosmetic procedures and services not covered by Medicare | Those needing extensive medical cover | Yes | 8.202% to 32.812% | 2 to 12 months | Comprehensive benefits with no restrictions on essential treatments |
GMHBA Health Insurance Plans – Features and Benefits
GMHBA Health Insurance offers 13 plans across hospital-only and extras. Each plan is uniquely crafted, ranging from basic accident-only coverage to comprehensive hospital services with extras.
GMHBA provides clear and targeted coverage options, focusing on affordability, essential hospital services, and additional benefits that cater to specific demographics, such as singles, couples, families, and single parents.
Accident Only Hospital (Basic)
This plan is designed to offer essential protection against hospital costs arising from accidents, making it an ideal choice for members seeking targeted accident coverage without extensive hospital services.
| 💴 Premium Range | $19.25 per week to $1,001.40 per year |
| 💚 Ideal For | Singles, couples, families, and single parents concerned primarily with accident-related risks |
| 🏥 Hospital Benefits | Private hospital coverage for accident-related admissions, shared room benefits in public hospitals |
| 📌 Excess | $750 per hospital admission, waived for dependents under 21 |
| 📍 Restricted Services | Rehabilitation, psychiatric services, palliative care |
| 🚨 Ambulance Cover | Emergency ambulance services only |
Key Features
Immediate Coverage
Hospital treatments are covered within 48 hours of an accident, ensuring timely access to care.
Single Room Compensation
Members can receive $100 per night for up to three nights if a requested single room is unavailable.
Flexible Excess Options
Excess choices are tailored to different budgets, making them affordable for younger members.
Youth Discount
Applied for members aged 18-29, reducing premium costs.
Gap Cover
Arrangements to cover medical costs that exceed the Medicare Benefits Schedule fee.
Family-Friendly Excess Waivers
Dependents under 21 benefit from waived excesses in family policies.
Emergency Focus
This plan strictly limits coverage to emergency services and accidental injuries.
Affordable Premiums
They offer lower premiums than more comprehensive plans, which is ideal for those primarily concerned with accidents.
Basic Plus Starter Hospital
The “Basic Plus Starter” plan provides essential protection for accidents and specific hospital treatments, offering budget-conscious members a basic (albeit decent) level of hospital coverage.
| 💶 Premium Range | $19.40 per week to $1,011.15 per year |
| 🩷 Ideal For | Young singles and couples looking for accident and limited hospital services |
| 🏥 Hospital Benefits | Accident-related costs and limited inpatient services like dental surgeries |
| 📌 Excess | $750 per hospital admission, set annually |
| 📍 Restricted Services | Psychiatric services, rehabilitation, and palliative care |
| 🚨 Ambulance Cover | Emergency ambulance coverage only |
Key Features
Accident Protection
Comprehensive benefits for hospital costs arising from accidents within 48 hours of injury.
Dental Surgery Coverage
Inpatient dental surgery benefits for accidents or emergency dental needs.
Predictable Excess
A set excess of $750 per admission, enabling members to budget effectively.
Youth Discount
Cost reductions for policyholders aged 18-29, making the plan more accessible for younger adults.
Bronze Plus Hospital
The “Bronze Plus” plan balances affordability and essential hospital services, focusing on moderate coverage levels for key treatments.
| 💵 Premium Range | $23.30 per week to $1,214.20 per year |
| 🧡 Ideal For | Budget-conscious individuals, couples, and families needing basic hospital services |
| 🏥 Hospital Benefits | Inpatient benefits for treatments like diabetes management and blood treatments |
| 📌 Excess | $750 per admission, annual cap applicable |
| 📍 Restricted Services | Rehabilitation, palliative care, psychiatric services |
| 🚨 Ambulance Cover | Emergency coverage included |
Key Features
Specific Inclusions
Coverage for diabetes, blood issues, and nervous system treatments.
Dental and Podiatric Inpatient Care
Coverage for hospital costs related to dental and podiatric surgeries.
Accident Protection
Benefits are extended to accidental injuries, with no waiting period for such incidents.
Family-Friendly Excess Waivers
Dependents benefit from waived excess fees under family plans.
Gap Cover
Access Gap Cover arrangements to limit out-of-pocket costs above the MBS rates.
Bronze Plus Advantage Hospital
The “Bronze Plus Advantage” plan builds on the Bronze Plus coverage, offering more extensive hospital services while maintaining affordability.
| 💷 Premium Range | $23.70 per week to $1,232.35 per year |
| 💜 Ideal For | Individuals, couples, and families needing enhanced services beyond basic hospital coverage |
| 🏥 Hospital Benefits | Comprehensive inpatient care for diabetes, blood disorders, and gynaecological treatments |
| 📌 Excess | $500 or $750 per admission, depending on plan choice |
| 📍 Restricted Services | Rehabilitation, psychiatric, and palliative care |
| 🚨 Ambulance Cover | Nationwide emergency ambulance coverage |
Key Features
Enhanced Hospital Coverage
Includes critical treatments like diabetes management and pain relief services.
Flexibility in Excess
Members can choose between $500 and $750 excess options to suit their budget.
Accident Care
Comprehensive accident-related hospital care within 48 hours of injury.
Gap Cover Options
Capped out-of-pocket costs for inpatient services beyond the MBS rate.
Silver Plus Hospital
The Silver Plus plan offers more comprehensive hospital coverage, including a broader range of medical treatments and benefits.
| 💴 Premium Range | $30.10 per week to $1,567.05 per year |
| 💛 Ideal For | Members seeking moderate coverage for essential services, including accident and inpatient care |
| 🏥 Hospital Benefits | Comprehensive care for back, neck, and spine conditions, chemotherapy, and eye treatments |
| 📌 Excess | Choice of $500 or $750 per admission |
| 📍 Restricted Services | Rehabilitation, psychiatric, and palliative care |
| 🚨 Ambulance Cover | Emergency services nationwide |
Key Features
Comprehensive Inclusions
Key medical services are covered, including heart conditions and chemotherapy.
Flexible Excess Options
Members can adjust excess to manage their costs effectively.
Regional Travel Benefits
Reimbursement for members travelling over 100km for essential medical services.
Family-Friendly Features
Additional benefits for children and youth discounts for members aged 18-29.
Silver Plus Premium Hospital
The Silver Plus Premium plan provides a comprehensive range of hospital services for broader coverage with additional benefits. This plan covers certain treatments and procedures that offer elevated hospital coverage.
| 💵 Premium Range | $42.25 per week to $2,197.45 per year |
| 💚 Ideal For | Individuals, couples, families, and single parents seeking extensive coverage without the top-tier cost |
| 🏥 Hospital Benefits | Coverage for joint replacements, heart and vascular conditions, and diabetes management |
| 📌 Excess | Choice of $500 or $750 per admission, capped annually |
| 📍 Restricted Services | Rehabilitation, psychiatric services, and palliative care |
| 🚨 Ambulance Cover | Nationwide emergency ambulance services included |
Key Features
Wide-Ranging Hospital Inclusions
Benefits include joint replacements, diabetes care, and heart treatments.
Excess Flexibility
Options between $500 and $750 to manage upfront costs effectively.
Regional Travel Support
Reimbursements for members needing to travel over 100km for essential medical treatments.
Youth Discounts
Lower premiums for policyholders aged 18-29.
Comprehensive Accident Coverage
Immediate hospital treatment benefits for accident-related injuries.
Emergency Ambulance Coverage
Full coverage for emergency ambulance transport across Australia.
Specialised Treatment Benefits
Extended benefits for key medical conditions and surgeries.
Gold Optimum Hospital
The “Gold Optimum” plan by GMHBA represents the most comprehensive hospital coverage, providing extensive benefits across a broad spectrum of services. This plan is tailored for members seeking complete protection and top-tier hospital benefits.
| 💴 Premium Range | $62.85 per week to $3,269.80 per year |
| ❤️ Ideal For | Members looking for comprehensive coverage, including pregnancy, birth services, and complex surgeries |
| 🏥 Hospital Benefits | Unrestricted access to joint replacements, heart and vascular treatments, dialysis, and reconstructive surgeries |
| 📌 Excess | Choice of $500 or $750 per admission, with annual limits |
| 📍 Restricted Services | None |
| 🚨 Ambulance Cover | Full emergency coverage with a single-room guarantee at private hospitals |
Key Features
Complete Hospital Coverage
Includes all major treatments without restrictions on key medical categories.
Single Room Guarantee
Compensation of $100 per night for up to three nights if a single room is not provided.
Extensive Inclusions
Coverage for pregnancy, birth, dialysis, joint replacements, and more.
Flexible Excess Levels
Members can choose their excess based on financial preferences.
Full Gap Cover Arrangements
Capped costs beyond the Medicare Benefits Schedule (MBS) fee.
Youth Discounts
Cost reductions for members aged 18-29.
Family-Friendly Features
Waived excesses for children under 21, offering financial relief to families.
GMHBA Extras Options
Explore a range of GMHBA Extras options tailored to fit your needs and budget, starting from as low as $5.55 per week.
| 📉 Basic Extras Set Benefits | From $5.55 per week to $289.90 per year |
| 📈 Basic Extras 55% | From $7.70 per week to $400.75 per year |
| 📊 Mid Extras Set Benefits | From $10.30 per week to $536.40 per year |
| 💹 Mid Extras 65 | From $15.35 per week to $800.15 per year |
| 📉 Top Extras Set Benefits | From $19.50 per week to $1,013.80 per year |
| 📈 Top Extras 75 | From $24.80 per week to $1,290.56 per year |
User Reviews
🥇 GMHBA has been rather good.
For routine procedures like dental and physio, GMHBA has been rather good. I appreciate how thoroughly most essential services are covered and how user-friendly their online claims platform is. The restrictions on extras, however, might be quite onerous if you want more extensive care, so make sure you are getting what you truly need. – John
🥈 Cheap Rates.
The cheaper rates at GMHBA are a direct result of their non-profit status, which is why I selected them. I don’t think of myself as just another number. Although it may not provide the most extensive accessories, what they do offer is reasonably priced. I like that members, not stockholders, are the ones who manage them.- Sarah
GMHBA Health Insurance vs NIB Health Insurance vs Qantas Health Insurance
| 🔎 Provider | 🥇 GMHBA Health Insurance | 🥈 NIB Health Insurance | 🥉 Qantas Health Insurance |
| 📌 Years in Operation | 90 years | Over 70 years | Since 2016 (as Qantas Assure) |
| 👤 Average Number of Members | Over 320,000 members | Over 1.7 million members | Not specified; under NIB umbrella, 9.6% market share |
| 🛡️ APRA Regulation | ✅Yes | ✅Yes | ✅Yes |
| 👥 Number of Employees | 201-500 | Approximately 1,500 employees | 26,000+ (including partnerships and subsidiaries under NIB) |
| 📉 Market Share | Positioned as Australia’s leading regionally-based health insurer | 9.6% of the Australian private health insurance market | Operates under Nib Holdings (with a 9.6% market share), has a 52.5% market share (more or less) |
| 📈 Market Coverage | Australia-wide coverage | Australia-wide coverage | Nationwide with a focus on digital tools like the Wellbeing App |
| 🩷 Customer Rating | 4.5/5 | Average of 4.8 out of 5 | Average rating of 4.11/5 |
| 📊 Number of reviews | 1,000+ | 1,000+ reviews | Thousands |
| 📲 Mobile App | The GMHBA app is for members | Offers the “Well with nib” health app | Qantas Wellbeing App |
| 💴 Premium Range (AUD) | $19.25 per week to $3,269.80 per year | From $3.34 per week to $3,067.69 per year, depending on the plan and coverage options | $19.83 per week to $3,057 annually, depending on the plan |
| 🌎 International Travel Benefit | Not offered directly | Comprehensive international travel insurance is available | Limited coverage for medical emergencies while abroad |
| 💹 Market Capitalisation | None indicated; net profit of $12.6 million (2023-24) | AUD 2.90 billion | Under Nib Holdings (Nib reported solid market position) |
| ⭐ Unique Features | Youth Discount, Access Gap Cover, Online Member Area, Emergency Ambulance Cover | GreenPass membership, partnership with Priceline for branded hospital and ancillary cover, sponsorship of notable sports teams, comprehensive mobile app support | Qantas Points Earning, Accidental Injury Cover, 24/7 Assistance via Wellbeing App |
GMHBA Health Insurance Advantages
GMHBA is a not-for-profit health insurer focusing on reinvesting its revenue to benefit its members and regional communities. One of its key advantages is the Age-Based Discount Program, which aims to make private health insurance more accessible for younger members.
This program includes a tiered discount structure for members aged 18 to 29, significantly reducing premiums for this group. GMHBA offers enhanced coverage options, such as accident cover and various specialized health support programs, along with its not-for-profit and community-oriented approach.
All of GMHBA’s hospital products include accident coverage, and the insurer also provides comprehensive support programs like Hospital in the Home, Rehab in the Home, and chronic disease management.
GMHBA Health Insurance Gap Cover
GMHBA Health Insurance provides an Access Gap Cover to help minimise out-of-pocket expenses for its members. GMHBA partners with the Australian Health Service Alliance (AHSA) to structure a system that reduces members’ financial burdens during hospital stays.
GMHBA’s Access Gap Cover system enhances affordability for members by paying higher benefits than the government-scheduled Medicare fee. This system operates through a network of registered healthcare providers who have agreements with AHSA, offering two billing scenarios:
No Gap
When a specialist limits their fees within the Access Gap Cover limits, members don’t face additional costs, ensuring they don’t experience unexpected out-of-pocket payments.
Known Gap
Where there’s still a gap, GMHBA caps it at $500 per specialist per admission and up to $800 for obstetrics services.
Key Points to Consider
GMHBA’s Access Gap Cover comes with specific guidelines and limitations. Not all providers participate in the scheme, so members should confirm participation before proceeding. The cover only applies to hospital stays and inpatient services under approved specialists.
Additionally, members must receive treatment from a specialist registered with the AHSA and discuss potential costs before undergoing any procedures.
GMHBA Health Insurance App Features
GMHBA invests in digital solutions that enhance the member experience. The GMHBA app offers practical features that help members manage their policies, submit claims digitally, and stay informed about their health insurance.
- Members can use the app to submit claims digitally, eliminating paperwork and reducing processing times.
- The app offers an overview of members’ coverage and policy benefits, making reviewing limits, coverage, and exclusions easy.
- Members can access their digital membership card through the app, providing convenient access to their details without requiring a physical card.
- The app has real-time updates on claims status to help members stay informed about pending and completed claims.
Members can review and update their contact and policy details.
How to apply for GMHBA Health Insurance
GMHBA has a streamlined and accessible application process using online tools and a dedicated member portal. Here’s how you can apply for health insurance with GMHBA Health Insurance:
- Go to the GMHBA website and use the quick quote tool to explore different plan options. Use the quick quote tool to compare coverage and premiums to find suitable options.
- If you decide on a plan, you can register on GMHBA’s secure member portal. You can create an account with basic personal information, contact details, and identification documents.
- Follow the prompts to fill out the online application form. You must provide essential details like your chosen plan, preferred coverage start date, and any additional information required for your selected policy.
- Upload your proof of identity and Medicare details directly through the portal.
Once you’ve completed the application, review all the details for accuracy. Confirm your application and choose your preferred payment method, direct debit or a credit card.
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How to apply for Gap Cover with GMHBA
The application process for GMHBA’s Gap Cover focuses on helping members manage out-of-pocket costs when receiving medical treatment.
- GMHBA collaborates with the Australian Health Service Alliance (AHSA) to offer its Access Gap Cover, which works through agreements with healthcare providers to limit unexpected expenses for policyholders.
- Ensure that you hold an eligible hospital cover policy under GMHBA. Members must have an appropriate level of hospital cover that aligns with the Access Gap Cover requirements.
- Identify whether your chosen specialist or hospital participates in the Access Gap Cover scheme.
- Before you undergo any medical treatment, your specialist must provide a written fee estimate outlining potential out-of-pocket costs.
If you require assistance finding a participating provider or understanding the conditions, contact GMHBA’s member support services.
How to Submit a Claim with GMHBA Health Insurance
GMHBA Health Insurance provides members with multiple convenient channels to submit claims:
Electronic Claiming
Visit a healthcare provider supporting electronic claims and use the GMHBA membership card to process claims.
Online Claiming
GMHBA members can submit claims for eligible extra services using the secure Online Member Area. To use this method, members must first register for online services.
After receiving a service, members must retain their receipts for two years in case of audits. Claims can be lodged for services provided within the last two years.
By Post
For traditional methods, claims can be submitted by completing a GMHBA claim form and mailing it with itemized receipts or invoices. Members must first process their claims with Medicare using a two-way claim form. Medicare can then forward the claim to GMHBA for further processing.
Submitting Unpaid and Paid Accounts
GMHBA pays the health provider directly through direct credit or a cheque. Benefits are transferred directly to the member’s nominated bank account if the member has already paid the account.
Authorising an Agent
Members can authorise a third party to collect benefits on their behalf by completing the agent’s authorisation section on the claim form. When receiving the payment, the designated agent must provide a signature to confirm their authorization.
How to Downgrade My Plan with GMHBA Health Insurance
GMHBA Health Insurance allows members to downgrade their plans hassle-free. To downgrade, members should first review their current plan and compare it with available options to ensure the new plan meets their needs.
Downgrades can be requested through several methods: by logging into the secure online Member Area to manage and modify policy details, by contacting GMHBA’s customer service team for personalized assistance, or by visiting a local GMHBA branch for face-to-face support.
Members will need to confirm their identity and provide membership details. It’s important to note that downgrading a plan may result in changes to coverage features, waiting periods, or benefits, so members should carefully review these details to avoid any unexpected limitations or additional waiting periods.
How do I add a Beneficiary to GMHBA Health Insurance?
If you want to add a child or adult dependent to your GMHBA Health Insurance plan, you can log into your profile and follow a few simple steps. First, ensure the person qualifies under GMHBA’s eligibility rules. Dependents can be added as long as the policy supports such changes.
For adult children, GMHBA allows dependents to remain covered until age 25 if they are full-time students, apprentices, or trainees. To add a beneficiary, log into GMHBA’s secure online Member Area, where you can update your membership details to add or remove dependents.
After entering the information for the new dependent, verify that the details match GMHBA records. You will also need to provide supporting documentation, such as proof of university student registration or identification for new beneficiaries.
How to Submit a Compliment or Complaint with GMHBA Health Insurance
GMHBA values member feedback and provides the following avenues for submitting complaints or compliments:
- Member Area: Members can submit feedback securely through the GMHBA Online Member Area.
- Phone: GMHBA offers dedicated phone support for members looking to share their experiences or report issues. The customer service team is available from 8:30 am to 5:00 pm AEDT, Monday to Friday.
- Visit a branch: If members prefer in-person communication, feedback can be provided by visiting any GMHBA branch.
Submit a complaint form or email: Members can email GMHBA using the secure address available on the website or complete a complaints form available online.
How to Switch my Health Insurance to GMHBA Health Insurance
Switching your health insurance to GMHBA is a straightforward process. The following steps outline transitioning from your current health insurer to GMHBA.
- Explore GMHBA’s range of health insurance policies to find one that aligns with your current and future healthcare needs. Consider key features such as hospital cover, extras, and unique benefits like age-based discounts.
- Once you have chosen a suitable plan, you can join GMHBA through one of the following channels: online, over the phone, or in person at a GMHBA branch.
- During this process, provide details about your current health fund, including your membership number. GMHBA will take over from there, handling the cancellation of your previous policy.
- GMHBA will work with your former health fund to obtain a transfer certificate, which documents your coverage history and confirms waiting periods already served.
To maintain uninterrupted health coverage, ensure your new GMHBA policy starts within 30 days of leaving your previous insurer.
GMHBA Health Insurance Travel Insurance
GMHBA does not provide travel insurance benefits directly. However, for overseas visitors and migrants, GMHBA recommends exploring alternative cover options to safeguard against medical expenses while travelling abroad. However, while GMHBA’s core policies don’t include international travel insurance, they provide regional travel and accommodation benefits within Australia.
These benefits support members who need specialist medical treatment while traveling. Eligible members who travel more than 100km can claim back on personal vehicle travel and approved accommodation.
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GMHBA Health Insurance Corporate Responsibility
GMHBA takes a proactive approach towards corporate responsibility, focusing on community engagement, partnerships, employee volunteering, and regional support initiatives.
| 🔎 CSR Area | 📌 Description |
| 💛 Community Engagement | GMHBA supports local communities through health webinars, partnerships, and employee engagement programs Partnerships with The Resilience Project and Read the Play |
| ⭐ Environmental Sustainability | GMHBA acknowledges the Traditional Custodians of the lands throughout Australia and pays respect to Elders past, present, and emerging Head office located on Wadawurrung land, recognising and respecting cultural heritage and values |
| 🎗️ Health and Wellbeing | Nourish Baby for new parents, Healthy Weight For Life Program, and partnerships with Kieser for physical therapies |
| 📒 Health Education | Healthier Together newsletter and podcasts |
| 🌟 Accessibility and Inclusion | Commitment to making health insurance simple and understandable, exemplified by the brand Frank, to demystify health insurance terms and conditions |
GMHBA Health Insurance Regulation
The Australian Prudential Regulation Authority (APRA) and the Australian Competition and Consumer Commission (ACCC) regulate private health insurance in Australia. GMHBA Health Insurance is a member of APRA under the Registered Name GMHBA Limited (ABN 98 004 417 092).
The primary regulatory framework comes under the Private Health Insurance Act 2007, alongside the oversight functions of APRA and ACCC. Specific Responsibilities and Regulatory Focus Areas of APRA and ACCC:
- Maintaining Financial Stability: The APRA actively monitors private health insurers through regular risk assessments and financial stress testing to ensure their solvency.
- Ensuring Fair Pricing and Transparency: The ACCC oversees premium adjustments, reviewing increases to confirm they meet regulatory standards and safeguard consumer fairness.
APRA and ACCC are dedicated to enforcing market integrity and shielding members from misconduct and potential financial threats.
Customer Support and Contact Details
GMHBA offers responsive customer support through various channels. Members can reach phone support at 1300 382 403 (Mon- Fri, 8:30 am–5:00 pm AEDT), use the web chat service (Mon- Fri, 9:00 am–4:30 pm AEDT), or visit local branches for face-to-face assistance. The secure online Member Area allows members to manage claims, pay premiums, and access policy documents. GMHBA also offers email support through a member enquiry form and provides services like Eye Care and Dental Care, as well as support for health provider inquiries.
Rebates and Discounts
GMHBA provides rebates and discounts focused on government-backed programs and age-based reductions. These programs support members and make premiums more manageable without sacrificing coverage.
Government Rebate on Private Health Insurance
GMHBA members can benefit from the Australian Government Rebate on Private Health Insurance, which offers financial relief based on income and age. The rebate is structured into four tiers:
- Base Tier: For singles earning up to $97,000 or couples/families earning up to $194,000, with a maximum rebate of 24.608% for members under 65.
- Tier 1: For singles earning $97,001–$113,000 or families up to $226,000, with a rebate of 16.405%.
- Tier 2: For singles earning $113,001–$151,000 or families up to $302,000, with a rebate of 8.202%.
- Tier 3: No rebate is provided for incomes over $151,001 for singles or $302,001 for families.
Age-Based Discount
GMHBA also offers age-based discounts to younger members who take out a hospital cover policy before 30. Discounts range from 2% to 10%, depending on the member’s age at the time of taking out their cover:
- 18–25 years old: 10% discount
- 26 years old: 8% discount
- 27 years old: 6% discount
- 28 years old: 4% discount
- 29 years old: 2% discount
Promotional Offers
GMHBA periodically offers promotional discounts on health services to enhance member value:
- Eye Care Offer: Members can enjoy a 50% discount on a second pair of prescription glasses when purchasing two complete pairs within a single transaction. This offer is available at participating GMHBA Eye Care locations.
- Dental Care Welcome Offer: New patients at GMHBA’s Belmont and Geelong dental clinics can receive a comprehensive initial check-up package for $199. This includes a dental examination, X-rays, cleaning, and fluoride treatment, subject to clinical suitability.
- Physiotherapy Discount: New patients at GMHBA’s Belmont and Geelong Physiotherapy clinics can get an initial consultation for $69.
- Medicare Levy Surcharge (MLS) Exemption: GMHBA’s hospital covers exempt members from the Medicare Levy Surcharge, an additional tax for individuals earning above $97,000 (or $194,000 for families) without eligible hospital cover.
The Lifetime Health Cover (LHC) loading initiative encourages Australians to take out hospital cover before turning 31. A 2% loading applies each year over 30 if a person remains uninsured.
Additional Health Services and Products
| 🔎 Service/Product | 📌 Details |
| 🦷 Dental Care Services | Professional dental care at GMHBA locations, $199 welcome offer for new patients, check-ups, X-rays, professional clean |
| 🤓 Eye Care Services | 50% discount on a second pair of prescription glasses, savings on eyewear, applicable on two-pair purchases |
| 🦴 Physiotherapy Services | Physiotherapy at Belmont and Geelong clinics, $69 discounted initial consultation, personalised care, chronic and acute conditions |
| ⚠️ AIA Vitality Program | Health and wellness program, earn AIA Vitality Points, up to $500 in shopping rewards, 50% cash back on Virgin Australia flights, 50% off gym memberships, $5 weekly activity vouchers |
| 🧬 Telehealth Services | Permanent telehealth benefits, covers physiotherapy, psychology, exercise physiology, dietetics, antenatal and postnatal classes, seamless electronic claiming |
| 🩺 Ambulance Coverage | Emergency ambulance coverage across Australia, 100% reimbursement on annual subscriptions in VIC/SA/WA, state-based schemes in QLD/TAS, and automatic coverage in NSW/ACT with hospital cover |
Pros and Cons
| ✅ Pros | ❌ Cons |
| Members benefit from direct access to GMHBA Dental Care and optical benefits | Policies focus on domestic benefits and lack overseas travel insurance |
| Exclusive clinics in Belmont and Geelong provide specialised care | Restrictive Psychiatric and Palliative Care Benefits |
| Waived excess fees for dependents under 21 on family policies. | Restrictions on some additional services like extensive dental or physio |
| Premium reductions for members aged 18 to 29 | Differences in ambulance cover based on regional schemes |
| Strong presence and engagement with regional health facilities and community programs | Not all specialists are part of the Access Gap Cover network |
In Conclusion
GMHBA Health Insurance takes a thoughtful approach to healthcare, prioritising services that cater to members and providing support within the community. GMHBA maintains its promise of affordability and personalised coverage options by returning revenue to community support and member benefits.
The range of plans available, like the comprehensive Gold Optimum Hospital plan, provides flexibility in excess levels and strong coverage for significant medical needs.
The Youth Discount and Access Gap Cover from GMHBA offer important financial support, especially for younger members and those looking to reduce out-of-pocket costs.
GMHBA does well with member-focused programs and gap coverage, but there are a few limitations when it comes to extras and some elective services. GMHBA stands out as a great option for health insurance that truly cares about the community while providing essential protection.
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Frequently Asked Questions
What types of coverage does GMHBA provide?
GMHBA offers hospital-only coverage, extras-only coverage, and combined policies.
Does GMHBA offer ambulance cover?
Yes, GMHBA offers emergency ambulance coverage throughout Australia.
What steps do I take to upgrade or downgrade my GMHBA cover?
Members can upgrade or downgrade their coverage by contacting GMHBA’s customer service or using the online member portal.
Does GMHBA provide international medical coverage?
No, GMHBA doesn’t have international medical coverage. GMHBA offers regional travel support within Australia for essential medical treatments.
