Gmhba Member Guide Nonvic

8/4/2019 Gmhba Member Guide Nonvic

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I you fnd better value healthinsurance within 60 days o

joining and havent madea claim, simply cancel yourmembership and well giveyou your money back!

Simply Great Value HealtH INSURaNCeAPRIL 2011 MEMBER GUIDE


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Contents

Why get private health insurance ................................................................................................ 4

Why join GMHBA? .......................................................................................................................................... 5

What li e stage are you? ............................................................................................................................ 6

How to join in 3 simple steps ............................................................................................................ 7

Choosing the right cover ................................................................................................................. 8-10

Waiting periods ................................................................................................................................................. 11

Hospital covers ......................................................................................................................................... 12-25

Medical Gap Cover ............................................................................................................................... 26-27

Extras covers ............................................................................................................................................... 28-43

Combined Hospital & Extras Packages ...................................................................... 44-49

Connect Rewards Plus .................................................................................................................... 50-51

Payment and claiming options ............................................................................................. 52-53

Li etime Health Cover loadings ............................................................................................ 54-55

Important information .................................................................................................................... 56-69

Direct Debit service agreement.....................................................................................................

70Application orms .......................................................................................................................... (inserts)

GMHBA is a ully compliant member o the private health insurance code o conduct.GMHBA is a not- or-proft private health insurance company governed by the PrivateHealth Insurance Act 2007, Private Health Insurance Rules 2007 and our und rules.

In ormation in this member guide is designed or people who have ull Medicare eligibility and iscurrent as at the 1st o April 2011 and replaces all earlier versions. It summarises our policies,benefts, premiums, and und rules which are subject to change rom time to time. Any personalin ormation provided to GMHBA will be treated in accordance with our Privacy Policy.

Please read this member guide care ully including the important in ormation on pages 56-69and retain with any other GMHBA documents. Please call our customer service centre on1300 4 GMHBA (46422) i youd like clarifcation on any o the terms used, or simply want helpchoosing your health cover.

We recommend you contact GMHBA or a beneft estimate be ore commencing treatment toconfrm the beneft payable.

Why

GMHBA?Outstanding Value.Outstanding Service.

Established more than 75 years ago, today GMHBA is one o Australiasastest growing health unds, renowned or great value and outstanding

service - and we come highly recommended by our members.GMHBA o ers a range o hospital, extras and combined covers to suitdi erent budgets and li e stages. Whether you are single, a couple, a singleparent or a amily, GMHBA has an a ordable private health insurance coverto suit your needs.


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4 5

GMHBA are renowned for our great valueand outstanding service and as proofwe're recommended by our members.

Value & Service Great value Leading independent

consumer magazine voted most overallbest buys of top 16 health funds in2007, 2008 and 2010.

Outstanding service GMHBA was theonly health fun d to be recognised as analist i n the annual BRW awards forour service in 2008 and 2010.

Most recommended by members* Ipsos Australia, who conduct a HealthCare & Insurance survey, in 2009 foundthat GMHBA had the highest rating ofany major, non-restricted health fund inanswer to the question Would yourecommend your fr iends and colleaguesuse your health insurer? .

Member loy alty program ConnectRewards Plus

Not-for-prot private health insurer

More th an 75 years experience

Manage membership online atgmhba.com.au

Why get private health insurance? Why join GM HBA?

60-day money back guarantee:If you nd better value healthinsurance within 60 days of

joining and havent made a claim

well refund your money in full.Its that simple!

*Compared to other open-access health funds withmore than 75,000 policy holders. The sample sizefor GMHBA was 137 members.

Why hospital?Some of the most comm on reasons forpeople taking out hospital cover include:

Greater choice of w ho treats you.

More choice of where your e treated.

Peace of mind knowing that you arecovered when you need it the most.

Having cover makes out of pocket costsmuch more manageable, providingnancial protection.

There are nancial benets too...

Save on taxIf your taxable income exceeds $80,000 peryear as a single or $160,000 for families,couples and single parents, you will pay anadditional 1% of your income if you donthold eligibl e hospital cover.

Pay less after you turn 31By taking out hospital cover before the 1stof July after your 31st birthday youll avoidpaying a higher premium. If you joinhospital cover after this date youll pay anextra 2% on the premium for every yearyou dont have health insurance after youturn 30, up to a total of 70%. See pages54-55 for details.

Why extras?Access to benets for services Medicarewont cover such as:

a dental check-up and clean to keep yoursmile looking br ight and teeth healthy.

if your e active or into sport, then atsome stage youre going to visit thephysio, or perhaps want a r emedialmassage.

its not uncommo n that at some stagewe m ay need glasses or contact lenses.

and you can claim on the spot usingyour GMHBA membership card at morethan 26,000 provi dersnationally.

Essentially, extras is thehealth insurance you wantto use.


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6 7

Join to ay. Its as easy as 1, 2, 3What life stage a e yo ?

2. Yo g co ples membership: covering you and yourpartner (as de ned above in 1b). With some exclusions orservices you might not need.

3. Mat re co ples membership: covering you and yourpartner (as de ned above in 1b).

4. Si gle pare ts hospital: covering you, your children anddependants as de ned above in 1c) and 1d).

5. Si gle membership: covering one und member only.

Please ote: These li e stage illustrations are a re erence guide only and shouldbe read in conjunction with the in ormation in this member guide. I you pre erto speak to a trained health insurance consultant please call 1300 4 GMHBA (46422).

1. Family membership covering:a) You (the und member).b) Your partner - a person with whom you are living in a bona- dedomestic relationship.c) Your child dependants under the age o 21 years (including step,adopted and permanent oster children).d) Your student dependants who are under 25 years old who are:- single- ull-time apprentices, ull-time trainees or ull-time students at a

school, college, university or institution recognised by GMHBA and- primarily relies on you (the und member) or maintenance & support.

Follow our easy to use guide to help you nd the most suitable Hospital or Packagecover or your current li estage. STEP 1: Choose yo r cover

Do you want hospital or extras cover, or both? Many people get both hospital andextras cover, but you could choose just one. I you do want combined cover, eitherchoose rom one o our specially designed combined packages or create your own.

STEP 3: Joi GMHBAThere are 3 simple ways to join:1. Get a quote and join online at gmhba.com.au2. Call 1300 4 GMHBA (46422)3. Fill in the application orm at the back o this member guide

STEP 2: Choose yo r level o coverSelect the level that best suits your needs.

Choose yo excess le elYou can reduce the cost o your hospital cover by having a calendar year excess.

Le el 0($0 excess)

Le el 1$250 single and$500 amilies /couples/ single parents

Le el 2$500 single and$1000 amilies/couples/ single parents

Choose yo ext as co e

Platin m

Gol

Sil e

B onze

O choose one of o combine packages with hospital an ext as co e

Sil e E e y ay

Sil e Yo ng Singles

B onze Yo ng Singles

Choose yo hospital co e

Premium Hospital range Everyday Hospital range

GOLd PLuS

SILvEr PLuS

Gol

Sil e

B onze


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Choosing the ight hospital

Excess optio sYou can reduce the cost o your hospital cover by choosing a calendar year excess.There are 3 di erent excess levels available on Gold, Silver and Bronze Hospital:

Level 0 Nil excessLevel 1 ($250 single and $500 amilies/couples/single parents)Level 2 ($500 single and $1000 amilies/couples/single parents)

Silver Hospital Single Parents $200

P emi m Hospital P o cts

E e y ay Hospital P o cts

Our top cover or totalpeace o mind with increased

medical gap and a singleroom guarantee.

Page 14

Extensive cover with increasedmedical gap bene ts and a single room

guarantee. To reduce the premiumthere are some exclusions or services

that you might not need, such asobstetrics and joint replacement.

Page 16

Gol

Comprehensive cover ora wide range o services

with standard medical gapbene ts payable.

Page 18

Silver Hospital Single Parents

Comprehensive coverexcluding obstetrics, gastricbanding, haemodialysis and

IVF related services toreduce premiums.

Page 20

Sil e

Extensive private cover excludessome services that might

not be needed such asobstetrics and cataract surgery,

to reduce premiums.Page 22

B onze

Our most basic hospital coveror treatment as a private patient

in a public hospital.

Page 24

B onze Ext as

Our most basic extras coverwhich includes some cover or

requently used services likedental, optical and physiotherapy.

Page 28

Sil e Stan a Ext as

Essential extras cover on a broadrange o services with a medium

level o bene ts and annual limits.Page 28

Platin m Ext as

Our best extras cover with up to80% back on most services.

Get more back with higher bene tsand increased annual limits or a widerange o services including remedialmassage and weight loss programs.

Page 28

Gol Ext as

Comprehensive extras coverwith generous bene ts and annuallimits on a wide range o services

including orthodontic,general dental and optical.

Page 28

Choosing the ight ext as

Mix a d match yo r hospital a d extras prod ctsTake out hospital or extras standalone or choose to join a comprehensive hospitalwith basic extras or vice versa. Get the cover that suits you best.

GOLd PLuS SILvEr PLuS


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A combine package may s it yo bette

Sil e E e y ay Package

Combined extensive private hospital and a broad range o extrascover including obstetrics and IVF related services. This packageexcludes some services that you might not need such as cataract

and cosmetic surgery, to reduce the premium.Page 44

(This cover is available to amilies, couples, single parents and singles)

Sil e Yo ng Singles Package

Combined extensive private hospital and basic extras cover,designed with active young singles in mind. This package excludes

some services you may not need and covers the most requentlyused extras services that Medicare doesn't cover.

Page 46(This cover is only available as a single cover)

A basic hospital and extras package suitable or avoidingGovernment surcharges as taxes. This package covers you as

a private patient in a public hospital with some exclusionsto reduce the premium. Has some extras cover such as dental, optical,

chiropractic, physiotherapy and ambulance.

Page 48(This cover is only available as a single cover)

Bronze Young Singles Package

Products detailed on this page are xed packages. All packages include anexcess and exclusions. I a combined package is not suitable, you may consider

mixing and matching a standalone hospital cover with an extras cover.

Waiting Pe io s

Hospital services (whe i cl ded o cover) Waiti g period

Accidents - Bodily injuries resulting rom accidents which occur a ter thedate o joining GMHBA or upgrading to a higher cover No waiting period

Obstetrics and maternity 12 months

Pre-existing ailment, illness or condition (other than psychiatric, rehabilitationand palliative care) 12 months

Any other bene t or hospital (or hospital substitution) treatment. 2 months

Extras services (whe i cl ded o cover) Waiti g period

All extras be e ts except as speci ed below 2 mo ths

Optical, home and domestic aids and medical aids 6 months

Major dental services (Including ull & partial dentures, orthodontics, crown &bridgework, endodontic services such as root canal, gold fllings, indirect restorations,surgical extractions o a tooth/teeth including wisdom teeth)

12 months

Health appliances including nebuliser pump, blood glucose monitor, pressuregarments, sleep apnoea monitor, extremity pump, hearing aids, orthopaedicappliances (GMHBA approved), prostheses (GMHBA approved non-surgical),tens monitor, podiatry surgical procedures and orthotic appliances ( oot)

12 months

Waiti g periods

What are waiti g periods?A waiting period is the time between whenyou join GMHBA and when you can startclaiming. Waiting periods exist to protectmembers unds rom those who wait untilthey are sick and then join a health undjust to claim large sums immediately.

Waiting periods apply to:

New members to health insurance(members who have never held hospitalor extras cover with a health und)

Existing GMHBA members whoupgrade to a higher level o cover orreduce their excess payable

Members who transfer from anotherhealth und who have not ully servedthe required waiting and/or bene tlimitation period or equivalent bene ts

Treatment for a pre-existing condition

De tal be e t limitatioFor new memberships (no previousextras cover) or where 12 monthscontinuous dental cover has not beenin existence, the ollowing dental limitsapply in the rst 12 months omembership with GMHBA:

Platinum Extras - $450 per person up to$900 per policy

Gold Extras - $300 per person up to $600per policy

Silver Extras & Bronze Extras - $200 perperson up to $400 per policy


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Q ick hospital co e compa ison

a We will pay you $50 per day (up to maximum o $150or 3 days) i you stay in a shared room when you

requested a single room. See page 67 or more details.

b A pre-existing condition (PEC) is one where signs orsymptoms o your ailment, illness or condition, in theopinion o a medical practitioner appointed by GMHBA(not your own doctor), existed at any time during the

six months preceding the day on which you purchasedyour hospital cover or upgraded to a higher level ohospital cover and/or bene t entitlement. Please re erto pages 66 and 68 or more in ormation.

c Limited bene ts may apply to high cost drugs. Drugspurchased outside o the hospital are not included.

d I the und believes that a patient, ollowing a review othe case (on the basis o in ormation provided by thehospital either internally or using an agreedindependent source), is not receiving acute care a ter35 days continuous hospitalisation, GMHBA bene tswill be reduced to Nursing Home Type Patientsbene ts and will be paid in accordance with the de aultbene t determined by the Health Department. AllNursing Home Type Patients are required to pay part othe cost o hospital accommodation.

e During the rst 24 months o cover (a ter the standardhospital waiting periods have been served), bene tspayable or these services will be limited to PublicHospital bene ts only. See page 57 or morein ormation.

Q ick hospital cover comparisoEveryday Hospital Ra ge

Gold Hospital Si gle Pare ts Silver Hospital Bro ze Hospital

Accidents 3 3 3 3 3 3

Single Room Guarantee a 3 3

Accommodation - single room (where available) 3 3 3 3 3

Accommodation - shared room 3 3 3 3 3 3

Admission excess waiver or child dependantsaged under 21

3 3 3

Broader Health Cover 3 3 3 3 3 3

Cataract surgery and corneal transplants b 3 3 3 3

Cosmetic surgery b (limited bene ts - see page 69) 3 3 3 3

Delivery suite 3 3 3

Gastric banding 3 3 3 e

Haemodialysis 3 3 3 e

Intensive and coronary care b 3 3 3 3 3 3

IVF and related services b 3 3 3

Joint reconstruction e.g. knee b 3 3 3 3 3 3

Joint replacement e.g. hip b 3 3 3 3

Medical gap cover 3 3 3 3 3 3

Medical gap cover - increased bene t 3 3

No co-payments 3 3 3 3 3 3

Nursing home type patients d 3 3 3 3 3 3

Obstetrics b 3 3 3

Other agreed charges c 3 3 3 3 3 3

Participating private hospital 3 3 3 3 3

Psychiatric 3 3 3 e 3 e 3 e 3

Rehabilitation 3 3 3 3 3 3

Same day treatment 3 3 3 3 3 3

Surgically implanted prostheses b(Govt. prescribed bene ts)

3 3 3 3 3 3

Theatre 3 3 3 3 3 3

This table provides a q ickcompariso o the mai eat reso GMHBAs hospital covers a dm st be read i co j ctiowith the detailed i ormatio ithis member g ide.

3 Cover provided in participating private hospital

3 Public hospital cover as a private patient only.Not recommended or private hospital treatment

No bene ts payable

GMHBA has two ranges o hospitalcover, Premium and Everyday.I you pre er increased bene ts anda single room guarantee our

Premium Hospital range might besuitable or you. Our Everyday rangehas a series o choices i you arelooking or a comprehensive productor a more basic cover.

PREMIuM HOSPITAL RAnGE

GOLD PLuSHOSPITAL

SILVER PLuSHOSPITAL


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Gold Pl s Hospital rom o r Premi m ra ge givesyo comprehe sive cover or total peace o mi d.

As o r top cover, othi g is le t to cha ce with evebetter be e t limits a d a si gle room g ara tee. # All yo eed to make yo r stay a d recovery lesspai l.

Whats covered?Gold Plus Hospital provides cover* at participating privatehospitals or:3 Private hospital accommodation^3 Single room guarantee #

3 Increased medical gap cover (see pages 26 & 27 or moredetails)

3 Delivery suite3 Theatre3 Intensive and coronary care3 Same day treatment3 Surgically implanted prostheses (Government prescribed

bene ts)3 Other agreed charges.

P blic hospitalsYoull be covered* or hospital accommodation costs whenyou are admitted to a single or shared room (subject to bedavailability) as a private patient in a public hospital.

I creased medical gap coverGold Plus Hospital provides members access to increasedbene ts when treated by a doctor or specialist i admitted tohospital. As a member on our top cover you will have a higher

level o protection by receiving more back on selected services.We recommend you contact us or a bene t estimate be orecommencing treatment to con rm the bene t payable.

Excess optio s table Level 0excessLevel 1excess

Level 2excess

Admission excess(private hospital overnight)

nil $250 $500

Admission excess(public hospital orday stay)

nil $125 $250

Maximum annual excess

per personnil $250 $500

Maximum annual excess singles nil $250 $500

Maximum annual excess amilies nil $500 $1,000

To nd out more about excess payments see page 62.

Excess optio sYou can reduce your premium byselecting one o the ollowing calendaryear excess options:

No excess applies or child dependantsunder 21 on Gold Plus Hospital cover.

Waiti g periodsPlease re er pages 11 and 68-69regarding waiting periods andpre-existing conditions.

* Limited bene ts may apply to cosmetic surgeryand high cost drugs. Drugs purchased outside othe hospital are not included.

# We will pay you $50 per day (up to a maximum o $150or 3 days) i you stay in a shared room when you


^Other private hospitalsFixed bene ts are payable in nonparticipating private hospitals(see page 65 or more details).

Recommended or:

GOLd PLuS HOSPITAL


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Silver Pl s Hospital rom o r Premi m ra ge providescomprehe sive cover with better be e t limits a da si gle room g ara tee. #

Its a great optio i yo wa t cover with betterbe e ts b t do t eed the top cover. Take o t SilverPl s Hospital cover a d yo r premi ms are red cedby excl di g some services yo may ot eed.

Excl sio sTo reduce the premium, Silver Plus Hospital excludes the

ollowing services: Obstetrics Joint replacement Cosmetic surgery IVF and related services Cataract surgery and corneal transplants.

Whats covered?Silver Plus Hospital provides cover* at participating privatehospitals or:3 Private hospital accommodation^3 Single room guarantee #

3 Increased medical gap cover (see pages 26 & 27or more details)

3 Theatre3 Intensive and coronary care3 Same day treatment3 Surgically implanted prostheses (Government prescribed


P blic hospitalsFor services not listed under exclusions youll be covered*

or hospital accommodation costs when you are admitted to asingle or shared room (subject to bed availability) as a privatepatient in a public hospital.

I creased medical gap coverSilver Plus Hospital provides members access to increasedbene ts when treated by a doctor or specialist i admittedto hospital. As a member on one o our best covers, you will havea higher level o protection by receiving more back on selectedservices. We recommend you contact us or a bene t estimatebe ore commencing treatment to con rm the bene t payable.


Unlike Gold Plus,Gold and SilverHospital SingleParents covers theexcess applies orchild dependants onall Silver Hospitalcovers.

Excess optio s tableLevel 0excess

Level 1excess

Level 2excess


nil $250 $500


nil $125 $250






Waiti g periodsPlease re er to the in ormation onpages 11 and 68-69 regarding waitingperiods and pre-existing conditions.


# We will pay you $50 per day (up to a maximum o $150or 3 days) i you stay in a shared room when you



Recommended or:

SILvEr PLuS HOSPITAL


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No excess applies or child dependants under 21 on GoldHospital cover.

Gol Hospital

Gold Hospital rom o r Everyday ra ge gives yocomprehe sive cover or a wide ra ge o hospital a dmedical services.

Whats covered?Gold Hospital provides cover* at participating privatehospitals or:3 Private hospital accommodation^ in a shared

or single room (where available)3 Medical gap (see pages 26-27 or details)3 Delivery suite3 Theatre3 Intensive and coronary care

3 Same day treatment3 Surgically implanted prostheses

(Government prescribed bene ts)3 Other agreed charges.


Healthy Start Be e tGold Hospital cover provides an additional bene t o up to$500 per childbirth admission to help cover the obstetriciansmedical gap (inpatient services only). For urther details seepage 63.


Level 2excess


nil $250 $500


nil $125 $250






Recommended or:

* Limited bene ts may apply to cosmeticsurgery and high cost drugs. Drugs purchasedoutside o the hospital are not included.


Be e t limitatio periods

A 24 month bene t limitation periodapplies to the ollowing services: Psychiatric Haemodialysis Gastric banding See page 57 or more in ormation.


No excess applies or child dependantsunder 21 on Gold Hospital cover.



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Si gle pare t amilies ca select a y level o amilycover or ca save with o r special Silver HospitalSi gle Pare ts cover rom o r Everyday ra ge.

Silver Hospital Si gle Pare ts cover has a red cedpremi m by i cl di g a excess a d excl des servicesyo may ot eed, like obstetrics a d IVF relatedservices.

Excl sio sTo reduce the premium, Silver Hospital Single Parents excludesthe ollowing services: Obstetrics IVF and related services Haemodialysis Gastric banding

Whats covered?Silver Hospital Single Parents cover provides cover* atparticipating private hospitals or:3 Private hospital accommodation^ in a shared or single

room (where available)3 Medical gap (see pages 26-27 or details)3 Theatre3 Intensive and coronary care3 Same day treatment3 Surgically implanted prostheses (Government prescribed


P blic hospitals Youll be covered* or hospital accommodation costs whenyou are admitted to a single or shared room (subject to bedavailability) as a private patient in a public hospital.

Sil e Hospital Single Pa ents

Excess optio sBy taking up Silver Hospital SingleParents cover, you agree to pay an excess.The excess reduces your premium andyou wont pay the calendar year excessunless you are admitted to hospital.


Admissio type Excess

Admission excess(private hospital overnight) $100

Admission excess(public hospital or day stay) $50


- per person$100

Maximum annual excess $200

No excess applies or child dependantsunder 21 on Silver HospitalSingle Parents cover.

Recommended or:





A 24 month bene t limitation periodapplies to the ollowing service: Psychiatric See page 57 or more in ormation.


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Silver Hospital rom o r Everyday ra ge gives yoexte sive cover, with some excl sio s o services yomay ot eed to red ce the premi m. A great optio iyo wa t to be covered i a private hospital b t do twa t the top cover.

Excl sio sTo reduce the premium, Silver Hospital excludes the ollowingservices: Obstetrics Joint replacement Cosmetic surgery IVF and related services Cataract surgery and corneal transplants Haemodialysis Gastric banding

Whats covered?Silver Hospital provides cover* at participating privatehospitals or:3 Private hospital accommodation^ in a shared or single

room (where available)3 Medical gap (see pages 26-27 or details)3 Theatre3 Intensive and coronary care3 Same day treatment3 Surgically implanted prostheses (Government prescribed


P blic hospitals Youll be covered* or hospital accommodation costs whenyou are admitted to a single or shared room (subject to bedavailability) as a private patient in a public hospital.


Unlike Gold Plus, Gold and SilverHospital Single Parents coversthe excess applies or childdependants on all SilverHospital covers.

Sil e Hospital


Level 2excess


nil $250 $500


nil $125 $250

Maximum annual excess per person nil $250 $500



* Limited bene ts may apply to high cost drugs. Drugspurchased outside o the hospital are not included.


Recommended or:




A 24 month bene t limitation periodapplies to the ollowing service: Psychiatric See page 57 or more in ormation.


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Bro ze Hospital rom o r Everyday ra ge gives yocost e ective cover or treatme t as a private patie ti a p blic hospital.

A s itable optio i yo wa t to avoid the MedicareLevy s rcharge (details o page 64) or lock i yo rLi etime Health Cover (details o pages 54-55) certi edage o e try.

Excl sio sTo reduce the premium, Bronze Hospital excludes the ollowingservices: Haemodialysis Gastric banding

Whats covered?

P blic hospitals Bronze Hospital cover provides cover or accommodationcosts when youre admitted to a shared room in a recognisedpublic hospital less your excess i applicable (subject to bedavailability).*

Private hospitalsFixed bene ts are payable or accommodation in privatehospitals. The bene t depends on the type o treatment,accommodation or surgery received and length o the hospitalstay. Additional private hospital costs such as theatre anddelivery suite charges are not covered by Bronze Hospital cover.

Additio al be e tsIn both public and private hospitals, our Bronze Hospital cover

includes bene ts or: Medical gap (see pages 26-27 for details) Surgically implanted prostheses (Government prescribed

bene ts) Nursing home type patients - Government prescribed bene ts

are available towards non-acute hospital care.

Excess optio s You can reduce your premium byselecting an excess which is payable onceevery calendar year. Choose rom one othe ollowing excess options:

Unlike Gold Plus, Gold and Silver HospitalSingle Parents covers the excess applies

or child dependants on all BronzeHospital covers.

B onze Hospital



Level 2excess

Maximum annual excess per person nil $250 $500



Waiti g periodsPlease re er to pages 11 and 68-69regarding waiting periods andpre-existing conditions.

Please ote: Bene ts or a singleroom in a public hospital ortreatment in a private hospital whenusing Bronze Hospital cover willresult in signi cant out-o -pocketexpenses. For urther in ormationon private patient bene ts on Bronze

Hospital cover, please call us on1300 4 GMHBA (46422).

* Limited bene ts may apply to high cost drugs. Drugspurchased outside o the hospital are not included.

Recommended or:


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What is Me ical Gap Co e ?

Impo tant: This in ormation isprovided as a guide only. Be ore youhave any treatment, we suggest youcontact us or the most up to datein ormation.

I a emerge cyIn the case o an emergency, it maynot be possible or a participatingdoctor to advise you o their ees inadvance. Please contact us shouldthis occur.

A schedule o ees has been set by theFederal Government or eligible servicesby doctors in a hospital or day surgery.Medicare pays 75% o this schedule ee

or in-patient medical treatment andGMHBA pays the other 25% up to 100% othe Medical Bene t Schedule (MBS) ee.

GMHBAs medical gap cover is a billingsystem that provides higher bene ts thanthe scheduled ee which will reduce or eveneliminate your out-o -pocket costs or doctoror specialist ees when treated in hospital.

Medical Gap Cover - EverydayHospital Ra geIn the event that your doctor chooses touse GMHBAs medical gap cover andwhere the actual ee or the anticipatedservice is greater than the MBS ee, anadditional medical gap bene t will bepaid equal to 20% o the MBS ee oreach service.Note: Additional medical gap bene ts are not payabletowards the cost o imaging or pathology serviceswithin the Everyday Hospital range.

GMHBAs medical gap cover optio sI your doctor or specialist is one o morethan 14,000 who choose to participatein GMHBAs medical gap cover system,two options are available or our

Everyday Hospital range:Optio 1 - K ow GapYour doctor chooses to use GMHBAsmedical gap cover system - and charge aknown patient gap. To participate, yourdoctor must in orm you in writing o thecost o the anticipated services, theMedicare and GMHBA bene ts and thepatient gap be ore any treatmentcommences. They must bill us direct orthe GMHBA and Medicare bene ts. Wellarrange to pay these bene ts direct toyour doctor and all youll need to pay isthe known gap.

Optio 2 - no GapI your doctor chooses to use our medicalgap cover and not charge a patient gap,your GMHBA bene t and the Medicarebene t will ully cover the doctors charges.In these instances, your doctor will bill usdirect and youll pay nothing.

M ltiple doctorsI others are involved in your treatment(such as anaesthetists) you should askGMHBA, your doctor or the other medicalpro essionals i they will be usingGMHBAs medical gap cover system.I they choose not to, youll still receive acombined Medicare and GMHBA bene to up to 100% o the MBS ee and (iapplicable) any Connect Rewards Plusdollars you may have accrued or medicalout o pocket costs that exist.

The participation in GMHBAs medicalgap cover by any medical practitioner isnot a recommendation or endorsementby GMHBA o that practitioner.

Medical Gap Cover - Premi mHospital ra geGMHBAs Premium Hospital rangeprovides medical gap cover regardless owhether your doctor participates or not.Where the actual ee or the anticipated

service is greater than the MBS ee, anadditional medical gap bene t will bepaid, that in most cases will be in excesso 20% o the MBS ee or each service,as paid under our Everyday HospitalRange. The additional medical gapbene t under the Premium Hospitalrange will vary by eligible service, pleasecontact GMHBA prior to treatment todetermine your additional medical gapcover bene t.Note: Additional medical gap bene ts are not payabletowards the cost o most imaging or pathology serviceswithin the Premium Hospital range.


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GMHBA ext as co e s

Coverage compariso tableThis table details your extras optionsat a glance using an easy to ollow starsystem.

The more stars shown, the better thecoverage and bene ts.

For a more detailed bene ts comparisonsee pages 30-43.

# Remedial massage bene ts are only available underConnect Rewards Plus as detailed on pages 50-51

Extras services

Sta dalo e a d combi ed extras prod cts Package Prod ct Extras

Plati mExtras

GoldExtras

SilverSta dard

Extras

Bro zeExtras

SilverEverydayPackage

SilverYo g Si gles

Package

Bro zeYo g Si gles

Package

Ac p ct re

Amb la ce

A diology

Blood gl cose mo itor

Chiropractic

De tal General

De tal Major

De tal Dentures

De tal Orthodontics Dietetics

Extremity p mp

Eye therapy

Dietary f oride s ppleme t

Foot orthotics

Heari g aids

Home rsi g - Visiting/Bush/Private Nursing Service

Homeopathy

Hydrotherapy

Myotherapy

nat ropathy

neb liser p mp

Occ patio al therapy

Optical

Orthopaedic applia ces (GMHBA approved)

Osteopathy

Pharmacy Private script

Physiotherapy

Podiatry Consultation

Podiatry Surgical procedures

Press re garme ts (GMHBA approved)

Prostheses (GMHBA approved non-surgical )

Psychology

Remedial massage # # # # #Sleep ap oea mo itor

Speech therapy

Te s mo itor

Weight loss programs


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Importa t ote: The table opposite m st be readalo g with the oot otes below.1. Amb la ce You can claim a re und on oneambulance subscription per membership eachcalendar year. The annual limit o $500 per personeach calendar year includes bene ts or ambulancesubscription (GMHBA approved) and transport costs.Single members may claim 50% o the cost when a

amily ambulance subscription is purchased. Publiclyunded ambulance services and State Government

ambulance transport schemes are excluded.2. A diology The annual limit o $400 per personeach calendar year includes combined bene ts oraudiology, speech therapy and eye therapy.3a. Blood gl cose mo itor Bene ts are limited to 1monitor per membership every 3 years.A doctors letter o recommendation must accompanyeach claim or bene ts. Up to 80% per monitor to amaximum o $650, combined limit or blood glucosemonitor, nebuliser pump, tens monitor and sleepapnoea monitor.3b. Blood gl cose mo itor Bene ts are limited to 1

monitor per membership every 3 years.A doctors letter o recommendation must accompanyeach claim or bene ts.4. Chiropractic/Osteopathy There is a limit o1 chiropractic x-ray per person/single membershipeach calendar year excluding Bronze Young SinglesPackage and Silver Young Singles package. Bene tswill only be paid or 1 consultation and/or treatmenttype per day regardless o the provider within thegroup o chiropractic (excluding x-ray), naturopathy,homeopathy and osteopathy.5. Chiropractic/Osteopathy The annual limit o $700per person/single membership and $1,000 per amilymembership each calendar year includes combinedbene ts or chiropractic (including chiropractic x-rays)and osteopathy.6. Chiropractic/Osteopathy The annual limit o $350per person/single membership and $700 per amilymembership each calendar year includes combinedbene ts or chiropractic (including chiropractic x-rays)and osteopathy.7. Chiropractic/Osteopathy The annual limit o $350per person/single membership and $600 per amilymembership each calendar year includes combinedbene ts or chiropractic (including chiropracticx-rays), osteopathy, naturopathy, homeopathy andacupuncture.8. Chiropractic/Osteopathy The annual limit o $350per single membership each calendar year includescombined bene ts or chiropractic (excluding x-rays),

osteopathy, naturopathy, homeopathy, acupuncture,physiotherapy, myotherapy and hydrotherapy.

detaile ext as compa ison

Extras services Waiti gPeriodsPlati m

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Ac p ct resee Naturopathy/Homeopathy/Acupuncture 2 months

Amb la ce s bscriptio / tra sport 1 N/A

Annual subscription re und 100% 100% 100% 100% 100%

Transport bene t (per trip) $300 $300 $300 $300

Annual limit per person each calendar year $500 $500 $500 $500

A diology 2 months

Initial visit 80% $25 $25 $25

Subsequent visit 80% $20 $20 $20

Annual limit per person each calendar year $350 $350 $400 2 $400 2

Blood gl cose mo itor 12 months

Bene t:80% up to$650 per

monitor 3a$200 3b $150 3b $150 3b

Chiropractic / Osteopathy 4 2 months

Initial visit 80% $26 $25 $25 $17 $17

2-10 subsequent visits 80% $21 $17 $17 $17 $17

Further visits 80% $17 $15 $15 $17 $17

Chiropractic x-ray (1 per person) $80 $80 $40 $40

Annual limit per person/singlemembership each calendar year $700

5 $350 6 $350 7 $350 7 $350 8 $350 8

Annual limit per amily membershipeach calendar year $1,000

5 $700 6 $600 7 $600 7

^ Silver Everyday extras, Silver Young Singles extras andBronze Young Singles extras are only available within acombined hospital and extras package. See pages 44-49.

All extras services must be provided by practitioners in private practice who are appropriately registered withrecognised bodies approved by GMHBA.

We recommend you call 1300 4 GMHBA (46422) or a bene t estimate be ore commencing treatment to con rm thebene t payable.

For services other than dental, bene ts or 1 initial consultation per therapy type are available each calendar year.


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DEnTAL

MAJOR DEnTAL (see important note or dental) 12 months

Orthodo tic Bene ts example: Fixed appliancetreatment upper and lower jaw treatment by aregistered specialist

12 months

Maximum bene ts per calendar year

85% up to$500 per

year incr. to$850 at

10 years

85% up to$450 per

year incr. to$850 at

10 years

75% up to$320 per

year incr. to$570 at6 years

75% up to$300

per year

75% up to$320 per

year incr. to$570 at6 years

75% up to$300

per year

75% up to$300

per year

Maximum bene t per course o treatment $2,550 $2,550 $1,710 $900 $1,710 $900 $900

Li etime bene t limit $2,900 $2,900 $1,900 $1,050 $1,900 $1,050 $1,050

Dentures (see important note or dental) 12 months

New ull upper and lower dentures per 2 years $500 $500 $420 $420 $420 $420 $420

Combined crown and bridgework(see important note or dental) 12 months

Annual limit per person each calendar year $900 $600 $450 $450 $450 $450 $450

Indirect restorations (see important noteor dental) 12 months

Annual limit per person/single membershipeach calendar year $400 $400 $350 $350 $350 $350 $350

Annual limit per amily membership eachcalendar year $700 $700 $700 $700 $700

Implants (see important note or dental) 12 months


GEnERAL DEnTAL (For more in ormation see general dental note) 2 months

a) Diagnostic services 2 monthsSet bene ts

applySet bene ts

applySet bene ts

applySet bene ts

applySet bene ts

applySet bene ts

applySet bene ts

apply

b) Preventative services e.g. periodicexamination 2 per 12 month period, removalo plaque 3 per 12 month period. Annual limitper person per calendar year. See preventivedental note

2 months Up to $450per person Up to $300per person Up to $200per person Up to $200per person Up to $200per person Up to $200per person Up to $200per person

c) Simple extractions (not including surgicalextractions o wisdom teeth) 2 months

Set bene tsapply

Set bene tsapply

Set bene tsapply

Set bene tsapply

Set bene tsapply

Set bene tsapply

Set bene tsapply

d) Restorative services (limited bene ts apply toprecious restorations) 2 months

Set bene tsapply

Set bene tsapply

Set bene tsapply

Set bene tsapply

Set bene tsapply

Set bene tsapply

Set bene tsapply

AnnuAL LIMIT (see important note or Dental note) 12 months

Annual limit per person each calendar year $2,000 $2,000 $1,000 $1,000 $1,000 $500 $500

Importa t ote: The table opposite m st be readalo g with the oot otes below.Importa t ote or De tal: The bene ts shown are theannual limits or each type o dental service. Theannual limit is a combined General and Major Dentallimit per person, per calendar year. There are urthersub limits within some o these dental services e.g. theindividual bene t or one crown on Platinum or GoldExtras is $300.De tal be e t limitatio For new memberships (noprevious extras cover) or where 12 months continuousdental cover has not been in existence, the ollowingdental limits apply in the rst 12 months omembership with GMHBA: Platinum Extras - $450 per person up to $900 per

policy Gold Extras - $300 per person up to $600 per policy Silver Extras & Bronze Extras - $200 per person up to

$400 per policyGe eral De tal There are a range o dentalprocedures that cannot be claimed when provided onthe same day e.g. a lling on a tooth that has been

removed. There are also limits on the number odental procedures you can have e.g. periodicexaminations are limited to 2 per 12 month period.Dental bene ts or some procedures cannot be paidunless tooth identi cations (ID) are supplied by theprovider.For services other than Dental, bene ts or 1 initialconsultation are available each calendar year.Preve tative De tal A detailed list o item numbersand de nition o bene ts payable under preventativedental can be ound on page 59.


We recommend you call 1300 4 GMHBA (46422) or a bene t estimate be ore commencing treatment to con rm thebene t payable.




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Dietetics 2 months



Class attendance 80% $10 $10 $10

Annual limit per person each calendar year $350 $350 $350 $350

Extremity p mp 9 12 months

Bene t $300 $300 $300 $300

Eye therapy a d speech therapy 2 months

Initial visit 80% $54 $27 $27Subsequent visit 80% $25 $21 $21

Annual limit per person each calendar year $500 10 $500 10 $400 11 $400 11

Fl oride dietary s ppleme t 12 2 months

Bene t o up to 80% 85% 85% 85% 85%

Maximum bene t per person eachcalendar year $45 $45 $45 $45 $45

Heari g aids 12 months

Bene t o up to 100% 100% 80% 80%

Maximum bene t per person every 3 years $800 $800 $400 $400

Homeopathysee Naturopathy/Homeopathy/Acupuncture 2 months

Myotherapysee Physiotherapy/Myotherapy/ Hydrotherapy 2 months


We recommend you call 1300 4 GMHBA (46422) or a bene t estimate be ore commencing treatment to con rmthe bene t payable.



Importa t ote: The table opposite m st be readalo g with the oot otes below.9. Extremity p mp Bene ts are limited to1 extremity pump per membership every3 years. A doctors letter o recommendation mustaccompany each claim or bene ts.10. Eye therapy a d speech therapy The annuallimit o $500 per person each calendar year includes$500 or eye therapy and $500 or speech therapy.11. Eye therapy a d speech therapy The annuallimit o $400 per person each calendar year includescombined bene ts or audiology, eye therapy andspeech therapy.12. Fl oride dietary s ppleme t Bene ts are onlypayable towards the cost o dietary fuoridesupplements (tablet or liquid orm) dispensed by achemist or dentist in private practice.


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nat ropathy / Homeopathy / Ac p ct re 13 2 months

Initial visit 80% $25 $19 $19 $17 $17

2-10 subsequent visits 80% $20 $17 $17 $17 $17

Further visits 80% $17 $14 $14 $17 $17

Annual limit per person/single membershipeach calendar year $600

14 $350 15 $350 16 $350 16 $350 17 $350 17

Annual limit per amily membership eachcalendar year $900

14 $700 15 $600 16 $600 16

neb liser p mp 12 months

Bene t80% up to$650 per

monitor 18a$150 18b $150 18b $150 18b

n rsi g Visiti g / Home / Registered n rse(Private Practice) 19 2 months

Home (bush) nursing bene t or each visit 80% $8 $8 $8

Visiting / Registered nurse (private practice)bene t per hour 80% $8 $8 $8

Maximum bene t or each day $48 $48 $48 $48

Annual limit per person each calendar year $1,000 $1,000 $1,000 $1,000





Importa t ote: The table opposite m st be readalo g with the oot otes below.13. nat ropathy/Homeopathy/Ac p ct re Bene ts will only be paid or 1 consultation and/ortreatment type per day regardless o the providerwithin the group o chiropractic (excluding x-rays),naturopathy, homeopathy and osteopathy.14. nat ropathy/Homeopathy/Ac p ct re The annual limit o $600 per person/singlemembership and $900 per amily membership eachcalendar year includes combined bene ts orremedial massage, naturopathy, homeopathy andacupuncture.15. nat ropathy/Homeopathy/Ac p ct re The annual limit o $350 per person/singlemembership and $700 per amily membership eachcalendar year includes combined bene ts orremedial massage, naturopathy, homeopathy andacupuncture.16. nat ropathy/Homeopathy/Ac p ct re The annual limit o $350 per person/singlemembership and $600 per amily membership each

calendar year includes combined bene ts ornaturopathy, homeopathy, acupuncture, chiropracticand osteopathy.17. nat ropathy/Homeopathy/Ac p ct re The annual limit o $350 per person each calendaryear includes combined bene ts or naturopathy,acupuncture, homeopathy, physiotherapy,myotherapy, chiropractic (excluding x-rays),osteopathy and hydrotherapy.18a. neb liser p mp Bene ts are limited to 1monitor per membership every 3 years. A doctorsletter o recommendation must accompany eachclaim or bene ts. Up to 80% per monitor up to $650combined limit or blood glucose monitors, nebuliserpump, tens monitor and sleep apnoea monitor.18b. neb liser p mp Bene ts are limited to1 nebuliser pump per membership every 3 years.A doctors letter o recommendation must accompanyeach claim or bene ts.19. n rsi g Visiti g/home/registered rse (privatepractice) The annual limit o $1,000 per person eachcalendar year includes combined bene ts or home(bush) nursing and visiting/registered nurse. Visitingnurse bene ts apply towards a registered nurse inprivate practice on recommendation rom a medicalpractitioner.


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Importa t ote: The table opposite m st be read alo gwith the oot otes below.20. Occ patio al therapy The annual limit o $500 perperson/single membership and $800 per amilymembership each calendar year only includes bene ts

or occupational therapy.21. Occ patio al therapy The annual limit o $350 perperson/single membership and $600 per amilymembership each calendar year includes combinedbene ts or physiotherapy, myotherapy, occupationaltherapy, hydrotherapy and remedial massage.22. Occ patio al therapy The annual limit o $350 perperson/single membership and $600 per amilymembership each calendar year includes combinedbene ts or physiotherapy, myotherapy, occupationaltherapy and hydrotherapy.23. Optical Non-prescription sunglasses and repairsare excluded.24. Orthopaedic applia ces (GMHBA approved) Must be custom made or approved by GMHBA.A doctors letter recommending the appliance mustaccompany each claim or bene ts. Orthopaedicappliances attract bene ts where the application owhich has resulted rom, and is required immediately

ollowing the injury or surgery to the injurynecessitating the appliance, or purposes other than oradditional to support. For an appliance to be custommade, a plaster cast or mould must be taken.Customising, heat moulding, trimming or adjusting anexisting o the shel appliance does not involve thisprocess and there ore does not constitute a custommade appliance. There are some conditions there orewe recommend you call 1300 4 GMHBA (46422)

or a bene t estimate to con rm the bene t payable.25. Orthopaedic applia ces (GMHBA approved) The limit o $400 per person is available each calendaryear or orthopaedic appliances.26. Orthopaedic applia ces (GMHBA approved) The limit o $400 per person is available every 3 years.This limit includes combined bene ts or orthopaedicappliances and pressure garments.27. Orthopaedic applia ces (GMHBA approved) The limit o $400 per person is available every 3 years

or orthopaedic appliances.28. Orthotic applia ces ( oot) Orthotic appliancesmust be custom made. For an orthosis to be custommade, a plaster cast or mould must be taken.Customising, heat moulding, trimming or adjusting anexisting o the shel appliance does not involve thisprocess and there ore does not constitute a custommade appliance.29. Orthotic applia ces ( oot) The annual limito $400 per person each calendar year includescombined bene ts or podiatry visits, orthoticappliances ( oot) and podiatric surgical procedures.


ExtrasGold

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Occ patio al therapy 2 months

Initial visit 80% $54 $31 $31 $31

2-10 subsequent visits 80% $25 $21 $21 $21

Further visits 80% $17 $17 $17 $17


20 $500 20 $350 21 $350 22 $350 21

Annual limit per amily membership eachcalendar year $800

20 $800 20 $600 21 $600 22 $600 21

Optical 23 6 months

Prescription spectacles, contact lensesand rames bene t o up to(Laser eye surgery claimable onPlatinum Extras only)

100% 100% 80% 80% 80% 80% 80%


Orthopaedic applia ces 24 12 months

Bene t o up to 80% 80% 80% 80% 80%

Maximum bene t per item $115 $115 $115 $115 $115

Limit per person every 3 years $400 25 $400 25 $400 26 $400 27 $400 26

Orthopaedic applia ce repairs 2 months

Annual limit per person each calendar year $40 $40 $40 $40 $40

Orthotic applia ces ( oot) 28 12 months

Bene t o up to 80% 80% 80% 80%

Maximum bene t per item $115 $115 $115 $115

Annual limit per person/single membership eachcalendar year $230 $230 $400

29 $400 29

Annual limit per amily membership each calendaryear $460 $460

Osteopathy see Chiropractic / Osteopathy 2 months


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Pharmacy private script 30 2 months

Members pay the rst maximum PBScontribution then the ollowing bene t is paidtowards the balance.

100% 100% $40 $40 $40

Annual limit per person/single membershipeach calendar year $350 $350 $250 $250 $250

Annual limit per amily membership eachcalendar year $550 $550 $400 $400 $400

Physiotherapy / Myotherapy / Hydrotherapy 31 2 months

Initial visit 80% $36 $31 $31 $31 $17 $17

2-10 subsequent visits 80% $26 $21 $21 $21 $17 $17

Further visits 80% $18 $17 $17 $17 $17 $17

Class attendance 80% $10 $10 $10 $10 $10 $10


32 $500 33 $350 34 $350 35 $350 35 $350 36 $350 36

Annual limit per amily membership eachcalendar year $1,000

32 $800 33 $600 34 $600 35 $600 34

Podiatry 2 months



Comprehensive treatment - initial visit 80% $35 $35 $35

Comprehensive treatment - subsequent visit 80% $25 $25 $25

Video analysis 80% $25 $25 $25

Plaster o paris 80% $25 $25 $25

Surgical procedures bene t o up to 12 months 80% 80% 80% 80%

Maximum bene t per surgical procedure $115 $115 $115 $115

Annual limit per person each calendar year $350 37 $350 37 $400 38 $400 38





Importa t ote: The table opposite m st be readalo g with the oot otes below.30. Pharmacy Private Script Bene ts are only payabletowards the cost o prescription pharmaceuticalsdispensed via a provider in private practice. Bene tsare not payable towards the cost o contraceptives orNHS (PBS) prescriptions, ood supplements, naturalremedies (including modi ast/opti ast), over thecounter items purchased with or without a prescriptionand pharmaceuticals purchased overseas and not listedon the Australian Register o Therapeutic Goods.

31. Physiotherapy/Myotherapy/Hydrotherapy For physiotherapy and hydrotherapy only, classattendance is limited to $240 per person each calendaryear and this limit is included within your annual limit.Bene ts will only be paid or 1 consultation and/ortreatment type per day regardless o the providerwithin the group o physiotherapy, myotherapy and ieligible, remedial massage. Physiotherapy consultationmust be or a minimum o 15-20 minutes to quali y orone-on-one physiotherapy bene ts.

32. Physiotherapy/Myotherapy/Hydrotherapy

The annual limit o $700 per person/singlemembership and $1,000 per amily membership eachcalendar year includes combined bene ts orphysiotherapy, myotherapy and hydrotherapy.

33. Physiotherapy/Myotherapy/Hydrotherapy The annual limit o $500 per person/singlemembership and $800 per amily membership eachcalendar year includes combined bene ts orphysiotherapy, myotherapy and hydrotherapy.

34. Physiotherapy/Myotherapy/Hydrotherapy The annual limit o $350 per person/singlemembership and $600 per amily membership eachcalendar year includes combined bene ts orphysiotherapy, myotherapy, occupational therapy,hydrotherapy and remedial massage.

35. Physiotherapy/Myotherapy/Hydrotherapy The annual limit o $350 per person/singlemembership and $600 per amily membership eachcalendar year includes combined bene ts orphysiotherapy, myotherapy, occupational therapy andhydrotherapy.

36. Physiotherapy/Myotherapy/Hydrotherapy The annual limit o $350 per person each calendar yearincludes combined bene ts or chiropractic (excludingx-ray), osteopathy, naturopathy, homeopathy,physiotherapy, hydrotherapy, myotherapy andacupuncture.

37. Podiatry The annual limit o $350 per person eachcalendar year includes combined bene ts or podiatry

visits and podiatric surgical procedures.38. Podiatry The annual limit o $400 per person eachcalendar year includes combined bene ts or podiatryvisits, podiatric surgical procedures and orthoticappliances ( oot).


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Press re garme ts 39 12 months

Bene t o up to 80% 80% 80% 80%

Maximum bene t per item $115 $115 $115 $115

Limit per person every 3 years $350 40 $350 40 $400 41 $400 41

Prostheses ( o -s rgical) 42 12 months

Bene t o up to 85% 85% 80% 80% 80%

Maximum bene t per item $300 $300 $300 $300 $300

Maximum bene t per person every 3 years $400 43 $400 43 $400 $400 $400

Psychology 2 months


Second visit 80% $54 $25 $25Subsequent visit 80% $25 $25 $25

Group therapy initial visit 80% $27 $20 $20

Group therapy second visit 80% $27 $12.50 $12.50

Group therapy subsequent visit 80% $12.50 $12.50 $12.50Annual limit per person/single membershipeach calendar year $500 $500 $350 $350

Annual limit per amily membership eachcalendar year $800 $800 $600 $600

Remedial massage 44 2 months

Initial visit 80% $20

Subsequent visit 80% $20Annual limit per person/single membership eachcalendar year $150

45 $100 46

Annual limit per amily membership each calendaryear

Sleep ap oea mo itor 12 months


person 47a$200 47b $200 47b $200 47b

Speech therapy see eye therapy andspeech therapy 2 months

Te s mo itor 12 months


person 48a$100 48b $100 48b $100 48b

Weight loss program 49 2 months

Bene t on achieving 10% o start weight $100

Bene t on achieving goal weight (with in 24 mths) $100

Li etime bene t limit per policy $400


All extras services must be provided by practitioners in private practice who are appropriately registered withrecognised bodies approved by GMHBA. We recommend you call 1300 4 GMHBA (46422) or a bene t estimatebe ore commencing treatment to con rm the bene t payable. For services other than dental, bene ts or 1 initialconsultation per therapy type are available each calendar year.

Importa t ote: The table opposite m st be read alo gwith the oot otes below.

39. Press re garme ts Are used or the treatment oburns, lymphodaema or or post-operative surgery upto 60 days rom hospital discharge. For bene ts to bepayable garments must be supplied through a privatecompany or therapist in private practice. A doctors letterrecommending the appliance must accompany eachclaim or bene ts. We recommend you contact GMHBA

or a bene t estimate to con rm the bene t payable.

40. Press re garme ts The limit o $350 per person isavailable each calendar year or pressure garments.

41. Press re garme ts The limit o $400 per person isavailable every 3 years. This limit includes combinedbene ts or orthopaedic appliances (GMHBA approved)and pressure garments.

42. Prostheses ( o -s rgical) Prostheses include arange o approved non-surgically implanted prostheses(e.g. wigs). A doctors letter o recommendation mustaccompany each claim or bene ts. We recommendyou contact GMHBA or a bene t estimate to con rm the

bene t payable.43. Prostheses ( o -s rgical) The limit o $400 perperson is the bene t available or prostheses eachcalendar year. 44. Remedial massage Bene ts will only be paid or1 consultation and/or treatment type per day regardlesso the provider within the group o physiotherapy,myotherapy and remedial massage.45. Remedial massage The annual limit o $150 perperson is included within the $600 per person/singlemembership and $900 per amily membership limit ornaturopathy, homeopathy, acupuncture and remedialmassage.46. Remedial massage The annual limit o $100 perperson is included within the $350 per person/singlemembership and $700 per amily membership limit ornaturopathy, homeopathy, acupuncture and remedialmassage.47a. Sleep ap oea mo itor Bene ts are limited to 1monitor per membership every 3 years. A doctors lettero recommendation must accompany each claim orbene ts. Up to 80% per monitor to a maximum o $650,combined limit or blood glucose monitor, nebuliserpump, tens monitor and sleep apnoea monitor.47b. Sleep ap oea mo itor Bene ts are limitedto 1 sleep apnoea monitor per membership every3 years. A doctors letter o recommendation mustaccompany each claim or bene ts.48a. Te s mo itor Bene ts are limited to 1 monitor permembership every 3 years. A doctors letter orecommendation must accompany each claim orbene ts. Up to 80% per monitor to a maximum o $650,combined limit or blood glucose monitor, nebuliserpump, tens monitor and sleep apnoea monitor.48b. Te s mo itor Bene ts are limited to 1 tensmonitor per membership every 3 years. A doctors lettero recommendation must accompany each claim orbene ts.49. Weight loss program Bene t payable only whenparticipation in a recognised weight loss program isrecommended in writing by a doctor. See page 58 ormore details.


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Sil e E e y ay Package

Silver Everyday Package rom o r specially desig edcombi ed packages o ers yo exte sive privatehospital cover, b t ot the top, that i cl desobstetrics a d IVF related services as well as a broadra ge o extras. Yo r premi ms are red ced byexcl di g some hospital services yo may ot eed.

Excl sio sTo reduce the premium, Silver Everyday Package excludes the

ollowing services: Joint replacement Cosmetic surgery Cataract surgery and corneal transplants Haemodialysis Gastric banding

Whats covered? For services not listed under exclusions Silver EverydayPackage provides cover* at participating private hospitals or:3 Private hospital accommodation^ in a shared or single

room (where available)3 Medical gap (see page 26-27 or details)3 Delivery suite3 Theatre3 Intensive and coronary care3 Same day treatment3 Surgically implanted prostheses (Government prescribed



ExcessBy taking the Silver Everyday Package,you agree to pay an excess. The calendaryear excess reduces your premium andyou won't pay the excess unless you areadmitted to hospital.





Maximum annual excess- per person $250

Maximum annual excess- singles $250

Maximum annual excess- amilies $500

Unlike Gold Plus, Gold and Silver HospitalSingle Parents covers, the excess applies

or child dependants on Silver EverydayPackage.


ExtrasSilver Everyday Package providesbene ts or services listed in thechart on pages 28-29.

*Limited bene ts may apply to high cost drugs. Drugspurchased outside o the hospital are not included.


Recommended or:

Be e t limitatio periodsA 24 month bene t limitation periodapplies to the ollowing service: Psychiatric See page 57 or more in ormation.


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Sil e Yo ng Singles Package

Silver Yo g Si gles Package rom o r speciallydesig ed combi ed packages o ers yo privatehospital a d esse tial extras.

Its a great package i yo are a active yo g si gle whowa ts exte sive hospital cover a d some basic extras.Excl sio s a d restrictio s apply or some hospitalproced res yo may ot eed to red ce the premi m.

Excl sio sTo reduce the premium, Silver Young Singles Package excludesthe ollowing services: Obstetrics Joint replacement Cosmetic surgery IVF and related services Cataract surgery and corneal transplants Haemodialysis Gastric banding

Restrictio sPublic hospital level o bene ts (which means you will havesigni cant out o pocket expenses i you go to a private hospital)apply or the ollowing services: Psychiatric care Rehabilitation treatment.

Whats covered? For services not listed under exclusions and restrictions SilverYoung Singles Package provides cover* at participating privatehospitals or:3 Private hospital accommodation^ in a shared or single room #

(where available).3 Medical gap (see pages 26-27 or details)3 Theatre3 Intensive and coronary care3 Same day treatment3 Surgically implanted prostheses (Government prescribed bene ts)3 Other agreed charges.# Please note some private hospitals only have single rooms and co-payments will apply

in private room accommodation o $100 per day, capped at 7 days per admission.

P blic hospitalsYoull be covered* or hospital accommodation costs when youare admitted to a single or shared room (subject to bed availability)as a private patient in a public hospital.

ExcessBy taking up Silver Young SinglesPackage, you agree to pay an excess.The calendar year excess reduces yourpremium and you won't pay the excessunless you are admitted to hospital.






Our Silver Young Singles Packagecover is more a ordable becauseyou agree to pay a part o the cost

or each hospital stay - up to $250 ina calendar year.

Waiti g periods

Please re er to the in ormation onpages 11 and 68-69 regarding waitingperiods and pre-existing conditions.

ExtrasSilver Young Singles Packageprovides bene ts or services listedin the chart on pages 28-29.

*Limited bene ts may apply to high cost drugs. Drugspurchased outside o the hospital are not included.

Recommended or:


Restrictio sThe services listed are covered toa limited extent, which meansgreater out o pocket expenses ina private hospital.


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Bro ze Yo g Si gles Package rom o r speciallydesig ed combi ed packages o ers yo cover asa private patie t i a p blic hospital a d extras orthe thi gs yo eed the most.

Its a ideal package i yo wa t basic hospital cover,excl di g some proced res yo may ot eed,a d extras cover most req e tly sed i cl di g de tal,optical, chiropractic, physiotherapy a d amb la ce.

Excl sio s To reduce the premium, Bronze Young Singles Package excludesthe ollowing services: Cataract surgery and corneal transplants Joint replacement Gastric banding Haemodialysis Obstetrics IVF and related services

P blic HospitalsFor services not listed under Exclusions your Bronze YoungSingles Package provides cover* or accommodation costswhen youre admitted to a shared room in a recognised publichospital (subject to bed availability). This cover is notrecommended or members who would like to be covered ina private hospital.

Private hospitals Fixed bene ts apply or services and accommodation in a privatehospital and will result in signi cant out o pocket expenses.Please call 1300 4 GMHBA (46422) or urther details.Note: No bene ts are payable or services listed under Exclusions or additional hospitalcosts such as theatre ees when admitted to a private hospital.

Additio al be e ts In both public and private hospitals, your Bronze Young SinglesPackage includes bene ts or:3 Medical gap (see pages 26-27 or details)3 Surgically implanted prostheses Government prescribed

bene ts3 Nursing home type patients Government prescribed

bene ts are available towards non-acute hospital care.

Excess By taking the Bronze Young SinglesPackage, you agree to pay an excess.The excess is payable once a calendaryear and reduces your premium and youwont pay the excess unless you areadmitted to hospital.

B onze Yo ng Singles Package

*Limited bene ts may apply to high cost drugs. Drugs

purchased outside o the hospital are not included.

Waiti g periodsPlease re er to in ormation on pages11 and 68-69 o the GMHBA MemberGuide regarding waiting periods andpre-existing conditions.

ExtrasBronze Young Singles Packageprovides bene ts or services listedin the chart on pages 28-29.

Excess table Excess



Recommended or:


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Get mo e f om yo membe shipwith Connect rewa s Pl s

Heres how it worksThe tables below break down the ConnectRewards Plus dollars earned based onmembership tenure and level o hospitalcover.

Take o t combi ed hospital a dextras cover a d e joy the extrabe e ts o GMHBAs member loyaltyprogram, Co ect Rewards Pl s.

Co ect Rewards Pl s rewardsmembers o combi ed coverswith Co ect Rewards dollars.The amo t o dollars yo receivedepe ds how lo g yo ve beea GMHBA member a d yo r levelo hospital cover. So the lo ger yohave bee with s the more rewardsdollars yo ll receive!

note: Bene ts listed in this table apply to Family, Couplesand Single Parent memberships. Rewards or singles arehal those listed in the table.

Be e t examples1. A amily on Gold Hospital and Gold Extras who have

held continuous combined cover or 8 years will receive$120 Connect Rewards Plus dollars in that year.

2. A single on Silver Plus Hospital and Bronze Extras a tertheir 1st year o cover will receive $20 Connect RewardsPlus dollars.

Connect Rewards Plus bene t entitlementsremain available while combined hospitaland extras cover is continuously maintained.

We have combined the bene ts omembership tenure and level o coverin the below table to detail the entirebene t you will receive.

CoverYears o Membership

1 - 3 4 & 5 6 & 7 8 & 9 10 +

Premi mRa ge

GoldPl s $80 $120 $140 $160 $180

SilverPl s $40 $80 $100 $120 $140

EverydayRa ge

Gold $40 $80 $100 $120 $140

Silver $20 $60 $80 $100 $120

Bro ze $0 $40 $60 $80 $100

Premi mra ge

Everydayra ge

Cover GoldPl sSilverPl s Go ld S ilv er B ro z e

Prod ctBo s $80 $40 $40 $20 $0

Years o Membership

1 - 3 4 & 5 6 & 7 8 & 9 10+

Te re $0 $40 $60 $80 $100

+

Note: *Only available on services already included in your extras cover and only when annual limitshave been reached.

Yo ca also save mo ey o services ot coveredClaim up to 70% o the cost o the ollowing when purchased rom a GMHBAapproved provider:3 Ambulance subscription (claim once per year). Publicly unded services and

State Government Ambulance transport schemes are excluded. Only claimablei ambulance subscription is not already covered withinyour extras cover

3 Remedial massage (up to $17 per visit)3 Swimming lessons ( see page 61 or urther details)3 Orthopaedic shoes - must be supplied by a registered

podiatrist and be custom made3 Joint supports3 Melanoma surveillance photography3 Nicotine replacement therapy patches

3 Quit smoking programs3 Blood pressure monitor (limited to 1 monitor per

membership every 3 years)3 Bowel Cancer Risk Identi cation Kit (up to 100% o the cost

limited to one kit per person each 2 years)3 Antenatal class bene ts up to $70 per year. (Classes must

be provided by the hospital and not included in thehospital contract. Excludes Silver Plus Hospital, SilverHospital, Silver Hospital Single Parents, Silver YoungSingle Package and Bronze Young Singles Package).

Please note: Services listed within the program must be provided by practitionerswho are registered with recognised bodies approved by GMHBA. Contact us on1300 4 GMHBA (46422) to con rm i a supplier is recognised. A doctors letter orecommendation may be required to claim some items. Details can be ound in theConnect Rewards Plus section on page 60-61 with Important In ormation.

use yo r rewards to red ce or elimi ate o t o pocket expe ses

3 Claim inpatient medical gap3 Double your optical limit3 Reduce your hospital excess3 * Increase annual limits or:

pharmacy physiotherapy hearing aids chiropractic/osteopathic

3 * Increase major dental bene tsincluding: c rowns bridgework dentures surgical extractions implants indirect restorations gold llings orthodontic endodontic services

GoldPl s

GoldPl s

SilverPl s

SilverPl s

Premi mra ge


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Payment an claiming options

Payme t method optio s:Direct debit You can save 2% by having yourpremiums deducted directly rom yourbank, credit union or building societyaccount.

Billing and reminder notices are not senti you pay by automatic direct debit.

Credit cardWhen you choose this option, yourpremiums are automatically debited romyour MasterCard or Visa credit card eachmonth, quarter, hal -year or year -whichever you pre er. Please note thatautomatic payments rom a credit card donot attract the direct debit discount. Billingand reminder notices are not sent i youpay by automatic direct debit.

Payroll ded ctio You may also be able to save time byhaving your employer deduct yourpremiums directly rom your salary andsending them to GMHBA.Call our customer service centre on1300 4 GMHBA (46422) to nd out i this

acility is available to you.

Direct to GMHBAYour premiums can also be paid usingany o the ollowing payment methodoptions:

a) GMHBA branches - payments can bemade in cash, cheque or EFTPOS.

b) GMHBA agents - payments can bemade in cash or cheque.

c) Australia Post - payments can be madein cash, cheque or EFTPOS when youpresent your billing notice at anyAustralia Post o ce with the Billpay

acility.

O ce yo have chose thecover that best s its yo r

eeds yo will eed to selecta payme t optio a d do t how to claim.

ExcessBy selecting an amount youre preparedto pay be ore claiming, you cansigni cantly reduce your premiums.So i you dont think youll be hospitalised,an excess is a great way to save money.See page 62 or more in ormation.

Private Health Members RebateAs long as all people covered on themembership have ull Medicare eligibility,you are eligible or the Private HealthMembers Rebate. The rebate percentageyou receive back is dependent on yourage shown in the table below.

note: As soon as one member on the membershipmoves to the next age bracket the entire membership willreceive either 35% or 40%.

How to claim the Private HealthMembers RebateYou can claim the rebate as a reduction toyour premiums, as a tax rebate when youlodge your annual tax return or as a directpayment rom the Government throughany Medicare o ce.

The easiest way or you to claim therebate is to register with GMHBA. Wellthen deduct the rebate rom yourpremiums - and youll pay less. To apply

or the rebate as a reduced premium,simply complete the Application toreceive the Federal Government Rebate asa reduced premium orm at the end othis member guide and return it with yourapplication orm.

d) Pay online - payments can be made bycredit card through NAB's Secureon-line payment acility. Simply visitgmhba.com.au and select the 'pay byweb' option. Alternately use the BPay

acility o your nancial institution.e) Pay by phone - payments can be made

by credit card over the phone usingNAB Transact, simply phone 1300 238959. Alternately you can use the BPay

acility o your nancial institution.) Mail - payments must be made by

cheque, money order or credit card.Please do not send cash by mail.

When making a direct payment either inperson or by mail, you must present yourbilling notice. A billing notice will be sentto you i your premium is paid direct toGMHBA, either monthly, quarterly,hal -yearly or yearly in advance.

How to claimThere are a number o ways you can claimyour bene ts including:

Bulk bill or electronic payment systemsdirect at your provider (dependent onyour provider, some may not have this

acility) Complete a GMHBA claim form and post

to GMHBA along with your itemisedreceipt and/or account

Lodge your claim at a Medicare of cewho will orward to GMHBA orprocessing.

2% Direct Debit Disco t

AgeRebate Red ctio

(% o whole membership)

64 or under 30%

65-69 35%

70 or over 40%


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Lifetime health co e loa ing

I youre over the age o 30, the sooneryou take out hospital cover, the less youllpay later. In summary, the FederalGovernments Li etime Health Cover (LHC)loading applies i you were aged 31 orover on the 1st o July just passed and aretaking out hospital cover or the rst time.Under LHC, in addition to the rates listedin GMHBAs rate charts, a 2% loading isapplied or each year you are aged over30 when you join. The Private HealthMembers Rebates apply to your totalpremiums, including any LHC loading.Li etime health cover applies to hospitalcover and does not apply to extras.

To se the LHC table o the oppositepage, ollow these steps.

I yo r sit atio cha ges

Periods o abse ce As members may need to discontinuetheir hospital cover membership or brieperiods, li etime health cover allows aperiod or periods o absence through amembers li etime without a ecting theirCAE. Li etime Health Cover rules providemembers o private health insurance whoneed to drop their membership, or

The Federal Gover me ti trod ced the Li etime HealthCover (LHC) i itiative o the 1st oJ ly 2000.

From this date, a yo e who joi sa hospital cover o a registeredhealth d will be give a Certi edAge at E try (CAE) stat s - whichreprese ts their age whe they rst

joi ed a hospital cover a ter the 1sto J ly 2000.

I you joined a hospital cover be ore thisdate you are assigned a CAE o 30 andyoull pay the base rate (the lowestpremium) or your hospital cover (thepremiums listed in GMHBAs rate chartsare qu

Documents

Gmhba Member Guide Nonvic