1300 4 GMHBA (46422)
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Download the 2009 GMHBA Member Guide

Extras Comparison - Victorian Residents

Extras Services Waiting
Periods		 Gold
Extras
 GE		 Special
Care
 Extras Ye^		 Standard
Extras
Plus Te		 Silver
Extras
SDE		 Bronze
Extras
BE		 Silver Young
Singles 
 Package*

Bronze Young
Singles Package >
Acupuncture see Naturopathy / Homeopathy / Acupuncture  2 months              
Ambulance subscription / transport 1 2 months              
Annual subscription refund   100% 100%         100%
Transport benefit (per trip)   $300            
Annual limit per person each calendar year   $500            
Audiology 2 months              
Initial visit   $25 $25 $25 $25      
Subsequent visit   $20 $20 $20 $20      
Annual limit per person each calendar year   $350 $400 2 $400 2 $400 2      
Blood glucose monitor 3 12 months              
Benefit:   $200 $150 $150 $150      
Chiropractic / Osteopathy 4 2 months              
Initial visit   $26 $25 $25 $25   $17 $17
2-10 subsequent visits   $21 $17 $17 $17   $17 $17
Further visits   $17 $15 $15     $17 $17
Chiropractic x-ray (1 per person)   $80 $40 $40 $40      
Annual limit per person/single membership each calendar year   $350 5 $350 6 $350 6 $100 7   $350 8 $350 8
Annual limit per family membership each calendar year   $700 5 $600 6 $600 6 $150 7      
DENTAL                
MAJOR DENTAL (see important note for dental)  12 months              
Orthodontic
Benefits example: Fixed appliance treatment – upper and lower jaw treatment by a registered specialist		 12 months              
Maximum benefits per calendar year   85% up to
$450 per
year incr.
to $850 at
10 years		 75% up to
$320 per
year incr.
to $570 at
6 years		 75% up
to  $300 per year		 75% up to $300 per year 75% up to $300 per year 75% up to $300 per year 75% up to $300 per year
Maximum benefit per course of treatment   $2,550 $1,710 $900 $900 $900 $900 $900
Lifetime benefit limit   $2,900 $1,900 $1,050 $1,050 $1,050 $1,050 $1,050
Dentures (see important note for dental) 12 months              
New full upper and lower dentures per 2 years   $500 $420 $420 $420 $420 $420 $420
Combined crown and bridgework (see important note for dental) 12 months              
Annual limit per person each calendar year   $600 $450 $450 $450 $450 $450 $450
Indirect restorations (see important note for dental) 12 months              
Annual limit per person/single membership each calendar year   $400 $350 $350 $350 $350 $350 $350
Annual limit per family membership each calendar year   $700 $700 $700 $700 $700    
Implants (see important note for dental) 12 months              
Annual limit per person each calendar year   $400 $400 $400 $400 $400 $400 $400
GENERAL DENTAL (% of GMHBA schedule fee. For more information see general dental note) 2 months              
a) Diagnostic services 2 months 100% 70% 70% 70% 70% 70% 70%
b) Preventative services e.g. periodic examination 2 per 12 month period, removal of plaque 3 per 12 month period 2 months Up to $280 per person Up to $200 per person Up to $200 per person Up to $200 per person Up to $200 per person Up to $200 per person Up to $200 per person
c) Simple extractions (not including surgical extractions of wisdom teeth) 2 months 85% 70% 70% 70% 70% 70% 70%
d) Restorative services (limited benefits apply to precious restorations) 2 months 85% 70% 70% 70% 70% 70% 70%
ANNUAL LIMIT (see important note for Dental note) 12 months              
Annual limit per person each calendar year   $2,000 $1,000 $1,000 $1,000 $1,000 $500 $500
Dietetics 2 month              
Initial visit   $54 $27 $27 $27      
Subsequent visit   $25 $21 $21 $21      
Class attendance   $10 $10 $10 $10      
Annual limit per person each calendar year   $350 $350 $350 $350      
Extremity pump 9 12 months              
Benefit   $300 $300 $300 $300      
Eye therapy and speech therapy 2 months              
Initial visit   $54 $27 $27 $27      
Subsequent visit   $25 $21 $21 $21      
Annual limit per person each calendar year   $500 10 $400 11 $400 11 $400 11      
Fluoride dietary supplement 12 2 months              
Benefit of up to   85% 85% 85% 85% 85%    
Maximum benefit per person each calendar year   $45 $45 $45 $45 $45    
Hearing aids 12 months              
Benefit of up to   100% 80% 80% 80%      
Maximum benefit per person every 3 years   $800 $400 $400 $400      
Homeopathy see Naturopathy/Homeopathy/Acupuncture 2 months              
Incontinence aids 13 2 months              
Benefit of up to      100%          
Maximum benefit - 1 item per membership each calendar year     $150          
Medical aids 14 6 months              
Benefit of up to     50%          
Maximum benefit per person each calendar year     $100          
Myotherapy see Physiotherapy/Myotherapy/ Hydrotherapy 2 months              
Naturopathy / Homeopathy / Acupuncture 15 2 months              
Initial visit   $25 $19 $19 $19   $17 $17
2-10 subsequent visits   $20 $17 $17 $17   $17 $17
Further visits   $17 $14 $14     $17 $17
Annual limit per person/single membership each calendar year   $350 16 $350 17 $350 17 $100 18   $350 19 $350 19
Annual limit per family membership each calendar year   $700 16 $600 17 $600 17 $150 18      
Nebuliser pump 20 12 months              
Benefit   $150 $150 $150 $150      
Nursing – Visiting / Home / Registered Nurse (Private Practice) 21 2 months              
Home (bush) nursing benefit for each visit   $8 $8 $8 $8      
Visiting / Registered nurse (private practice) benefit per hour   $8 $8 $8 $8      
Maximum benefit for each day   $48 $48 $48 $48      
Annual limit per person each calendar year   $1,000 $1,000 $1,000 $1,000      
Nursing aids - Home and domestic  6 months              
Equipment hire following a hospital stay – benefit of up to      50% 22          
Equipment purchase for daily living – benefit of up to     30% 23          
Maximum benefit a membership each calendar year     $350          
Occupational therapy 2 months              
Initial visit   $54 $31 $31 $31 $31    
2-10 subsequent visits   $25 $21 $21 $21 $21    
Further visits   $17 $17 $17 $17 $17    
Annual limit per person/single membership each calendar year   $500 24 $350 25 $350 26 $350 26 $350 26    
Annual limit per family membership each calendar year   $800 24 $600 25 $600 26 $600 26 $600 26    
Optical 27 6 months              
Prescription spectacles, contact lenses and frames – benefit of up to   100% 80% 80% 80% 80% 80% 80%
Annual limit per person each calendar year   $250 $170 $170 $170 $170 $120 $120
Orthopaedic appliances 28 12 months              
Benefit of up to   80% 80% 80% 80% 80%    
Maximum benefit per item   $115 $115 $115 $115 $115    
Limit per person every 3 years   $400 29 $400 30 $400 30 $400 30 $400 31    
Orthopaedic appliance repairs 2 months              
Annual limit per person each calendar year   $40 $40 $40 $40 $40    
Orthotic appliances (foot) 32 12 months              
Benefit of up to   80% 80% 80% 80%      
Maximum benefit per item   $115 $115 $115 $115      
Annual limit per person/single membership each calendar year   $230 $400 33 $400 33 $400 33      
Annual limit per family membership each calendar year   $460            
Osteopathy see Chiropractic / Osteopathy 2 months              
Oxygen 34 2 months              
Benefit of up to     80%          
Maximum benefit per membership each calendar year     $300          
Personal alarm / monitoring 35 2 months              
Personal alarm benefit per calendar year     $50          
Personal monitoring benefit per calendar year     $50          
Pharmacy – private script 36 2 months              
Members pay the first maximum PBS contribution then the following benefit is paid towards the balance.   100% $40 $40 $40 $40    
Annual limit per person/single membership each calendar year   $350 $250 $250 $250 $250    
Annual limit per family membership each calendar year   $550 $400 $400 $400 $400    
Physiotherapy / Myotherapy / Hydrotherapy 37 2 months              
Initial visit   $36 $31 $31 $31 $31 $17 $17
2-10 subsequent visits   $26 $21 $21 $21 $21 $17 $17
Further visits   $18 $17 $17 $17 $17 $17 $17
Class attendance   $10 $10 $10 $10 $10 $10 $10
Annual limit per person/single membership each calendar year   $500 38 $350 39 $350 40 $350 40 $350 40 $350 41 $350 41
Annual limit per family membership each calendar year   $800 38 $600 39 $600 40 $600 40 $600 40    
Podiatry 2 months              
Initial visit   $35 $27 $27 $27      
Subsequent visit   $25 $21 $21 $21      
Comprehensive treatment - initial visit   $35 $35 $35 $35      
Comprehensive treatment - subsequent visit   $25 $25 $25 $25      
Video analysis   $25 $25$25 $25 $25      
Plaster of paris   $25 $25 $25 $25      
Surgical procedures – benefit of up to 12 months 12 months 80% 80% 80% 80%      
Maximum benefit per surgical procedure   $115 $115 $115 $115      
Annual limit per person each calendar year   $350 42 $400 43 $400 43 $400 43      
Pressure garments 44 12 months              
Benefit of up to   80% 80% 80% 80%      
Maximum benefit per item   $115 $115 $115 $115      
Limit per person every 3 years   $350 45 $400 46 $400 46 $400 46      
Prostheses (non-surgical) 47 12 months              
Benefit of up to   85% 80% 80% 80% 80%    
Maximum benefit per item   $300 $300 $300 $300 $300    
Maximum benefit per person every 3 years   $400 48 $400 $400 $400 $400    
Psychology 2 months              
Initial visit   $54 $40 $40 $40      
Second visit   $54 $25 $25 $25      
Subsequent visit   $25 $25 $25 $25      
Group therapy initial visit   $27 $20 $20 $20      
Group therapy second visit   $27 $12.50 $12.50 $12.50      
Group therapy subsequent visit   $12.50 $12.50 $12.50 $12.50      
Annual limit per person/single membership each calendar year   $500 $350 $350 $350      
Annual limit per family membership each calendar year   $800 $600 $600 $600      
Remedial massage 49 2 months              
Initial visit   $20 $17          
Subsequent visit   $20 $17          
Annual limit per person/single membership each calendar year   $100 50 $350 51          
Annual limit per family membership each calendar year     $600 51          
Respite care 52 6 months              
Specialised Registered Nurse – benefit per hour     $15          
Annual limit per membership each calendar year     $300          
Sleep apnoea monitor 53 12 months              
Benefit   $200 $200 $200 $200      
Speech therapy see eye therapy and speech therapy 2 months              
Tens monitor 54 12 months              
Benefit   $100 $100 $100 $100      

Important note: The table above must be read along with the footnotes below.

All extras services must be provided by practitioners in private practice who are appropriately registered with recognised bodies approved by GMHBA. We recommend you call 1300 4 GMHBA (46422) or visit a branch for a benefit estimate before commencing treatment to confirm the benefit payable.

Important note for Dental: The benefits shown are the annual limits for each type of dental service. There are further sub limits within some of these dental services e.g. the individual benefit for one crown on Gold Extras (GE) is $300. Therefore, please call 1300 4 GMHBA (46422) or visit a branch for a benefit estimate before treatment to confirm the benefit payable. The annual limit per person/single membership includes combined benefits for general dental and major dental.

For new memberships (no previous extras cover) or where 12 months continuous dental cover has not been in existence, all dental benefits will be limited to $200 per person/single membership and $400 per family membership during the first 12 months of membership with GMHBA.

General Dental – The benefits listed are examples of dental benefits (% of GMHBA schedule fee).
For services other than Dental, benefits for 1 initial consultation are available each calendar year.

There are a range of dental procedures that cannot be claimed when provided on the same day e.g. a filling on a tooth that has been removed. There are also limits on the number of dental procedures you can have e.g. periodic examinations are limited to 2 per 12 month period. Dental benefits for some procedures cannot be paid unless tooth identifications (ID) are supplied by the provider.

^ Ye is only available when combined with a GMHBA Hospital cover.

Extras comparison footnotes

  1. Ambulance – You can claim a refund on one ambulance subscription per membership each calendar year. The annual limit of $500 per person each calendar year includes benefits for ambulance subscription (GMHBA approved) and transport costs. Single members may claim 50% of the cost when a family ambulance subscription is purchased. Publicly funded ambulance services and State Government ambulance transport schemes are excluded.
  2. Audiology – The annual limit of $400 per person each calendar year includes combined benefits for audiology, speech therapy and eye therapy.
  3. Blood glucose monitor - Benefits are limited to 1 monitor per membership every 3 years. A doctor’s letter of recommendation must accompany each claim for benefits.
  4. Chiropractic/Osteopathy– There is a limit of 1 chiropractic x-ray per person/single membership each calendar year excluding Silver Hospital Young Singles Start package (SHYSZe). Benefits will only be paid for 1 consultation and/or treatment type per day regardless of the provider within the group of chiropractic (excluding x-ray), naturopathy, homeopathy and osteopathy.
  5. Chiropractic/Osteopathy – The annual limit of $350 per person/single membership and $700 per family membership each calendar year includes combined benefits for chiropractic (including chiropractic x-rays) and osteopathy.
  6. Chiropractic/Osteopathy – The annual limit of $350 per person/single membership and $600 per family membership each calendar year includes combined benefits for chiropractic (including chiropractic x-rays), osteopathy, naturopathy, homeopathy and acupuncture.
  7. Chiropractic/Osteopathy – The annual limit of $100 per person/single membership and $150 per family membership each calendar year includes combined benefits for chiropractic (excluding chiropractic x-rays), osteopathy, naturopathy, homeopathy and acupuncture.
  8. Chiropractic/Osteopathy – The annual limit of $350 per single membership each calendar year includes combined benefits for chiropractic (excluding x-rays), osteopathy, naturopathy, homeopathy, acupuncture, physiotherapy, myotherapy and hydrotherapy.
  9. Extremity pump - Benefits are limited to 1 extremity pump per membership every 3 years. A doctor’s letter of recommendation must accompany each claim for benefits.
  10. Eye therapy and speech therapy – The annual limit of $500 per person each calendar year includes $500 for eye therapy and $500 for speech therapy.
  11. Eye therapy and speech therapy – The annual limit of $400 per person each calendar year includes combined benefits for audiology, eye therapy and speech therapy.
  12. Fluoride dietary supplement - Benefits are only payable towards the cost of dietary fluoride supplements (tablet or liquid form) dispensed by a chemist or dentist in private practice.
  13. Incontinence aids - Benefits are payable for quick dry absorbent sheet (pads are excluded).
  14. Medical aids benefits example - blood pressure/pulse monitors and electric pulse massagers.
  15. Naturopathy/Homeopathy/Acupuncture - Benefits will only be paid for 1 consultation and/or treatment type per day regardless of the provider within the group of chiropractic (excluding x-rays), naturopathy, homeopathy and osteopathy.
  16. Naturopathy/Homeopathy/Acupuncture - The annual limit of $350 per person/single membership and $700 per family membership each calendar year includes combined benefits for remedial massage, naturopathy, homeopathy and acupuncture.
  17. Naturopathy/Homeopathy/Acupuncture - The annual limit of $350 per person/single membership and $600 per family membership each calendar year includes combined benefits for naturopathy, homeopathy, acupuncture, chiropractic and osteopathy.
  18. Naturopathy/Homeopathy/Acupuncture - The annual limit of $100 per person/single membership and $150 per family membership each calendar year includes combined benefits for naturopathy, homeopathy, acupuncture, chiropractic and osteopathy.
  19. Naturopathy/Homeopathy/Acupuncture - The annual limit of $350 per person each calendar year includes combined benefits for naturopathy, acupuncture, homeopathy, physiotherapy, myotherapy, chiropractic (excluding x-rays), osteopathy and hydrotherapy.
  20. Nebuliser pump – Benefits are limited to 1 nebuliser pump per membership every 3 years. A doctor’s letter of recommendation must accompany each claim for benefits.
  21. Nursing – Visiting/home/registered nurse (private practice) – The annual limit of $1,000 per person each calendar year includes combined benefits for home (bush) nursing and visiting/registered nurse. Visiting nurse benefits apply towards a registered nurse in private practice on recommendation from a medical practitioner.
  22. Nursing aids - Home and domestic – Benefits can only be paid for home and domestic nursing aids which were following a hospital stay, not provided by a hospital and which assist the functional activities of daily living.
  23. Nursing aids - Home and domestic - Benefits can only be paid for home and domestic nursing aids which assist daily living and not provided by hospital e.g. crutches.
  24. Occupational therapy – The annual limit of $500 per person/single membership and $800 per family membership each calendar year only includes benefits for occupational therapy.
  25. Occupational therapy – The annual limit of $350 per person/single membership and $600 per family membership each calendar year includes combined benefits for physiotherapy, myotherapy, occupational therapy, hydrotherapy and remedial massage.
  26. Occupational therapy – The annual limit of $350 per person/single membership and $600 per family membership each calendar year includes combined benefits for physiotherapy, myotherapy, occupational therapy and hydrotherapy.
  27. Optical – Non-prescription sunglasses and repairs are excluded.
  28. Orthopaedic appliances (GMHBA approved) – Must be custom made or approved by GMHBA. A doctor’s letter recommending the appliance must accompany each claim for benefits. Orthopaedic appliances attract benefits where the application of which has resulted from, and is required immediately following the injury or surgery to the injury necessitating the appliance, for purposes other than or additional to support. For an appliance to be custom made, a plaster cast or mould must be taken. Customising, heat moulding, trimming or adjusting an existing ‘off the shelf’ appliance does not involve this process and therefore does not constitute a custom made appliance. There are some conditions therefore we recommend you call 1300 4 GMHBA (46422) or visit a branch for a benefit estimate to confirm the benefit payable.
  29. Orthopaedic appliances (GMHBA approved) – The limit of $400 per person is available each calendar year for orthopaedic appliances.
  30. Orthopaedic appliances (GMHBA approved) – The limit of $400 per person is available every 3 years. This limit includes combined benefits for orthopaedic appliances and pressure garments.
  31. Orthopaedic appliances (GMHBA approved) – The limit of $400 per person is available every 3 years for orthopaedic appliances.
  32. Orthotic appliances (foot) – Orthotic appliances must be custom made. For an orthosis to be custom made, a plaster cast or mould must be taken. Customising, heat moulding, trimming or adjusting an existing ‘off the shelf’ appliance does not involve this process and therefore does not constitute a custom made appliance.
  33. Orthotic appliances (foot) – The annual limit of $400 per person each calendar year includes combined benefits for podiatry visits, orthotic appliances (foot) and podiatric surgical procedures.
  34. Oxygen - Must be ordered by a medical practitioner.
  35. Personal alarm/monitoring – Systems must be approved by GMHBA. Benefits are payable per calendar year. We recommend you call 1300 4 GMHBA (46422) or visit a branch for a benefit estimate to confirm the benefit payable.
  36. Pharmacy – Private Script Benefits are only payable towards the cost of prescription pharmaceuticals dispensed via a provider in private practice. Benefits are not payable towards the cost of contraceptives or NHS (PBS) prescriptions, food supplements, natural remedies (including modifast/optifast), over the counter items purchased with or without a prescription and pharmaceuticals purchased overseas and not listed on the Australian Register of Therapeutic Goods.
  37. Physiotherapy/Myotherapy/Hydrotherapy – For physiotherapy and hydrotherapy only, class attendance is limited to $240 per person each calendar year and this limit is included within your annual limit. Benefits will only be paid for 1 consultation and/or treatment type per day regardless of the provider within the group of physiotherapy, myotherapy and if eligible, remedial massage.
  38. Physiotherapy/Myotherapy/Hydrotherapy – The annual limit of $500 per person/single membership and $800 per family membership each calendar year includes combined benefits for physiotherapy, myotherapy and hydrotherapy.
  39. Physiotherapy/Myotherapy/Hydrotherapy – The annual limit of $350 per person/single membership and $600 per family membership each calendar year includes combined benefits for physiotherapy, myotherapy, occupational therapy, hydrotherapy and remedial massage.
  40. Physiotherapy/Myotherapy/Hydrotherapy – The annual limit of $350 per person/single membership and $600 per family membership each calendar year includes combined benefits for physiotherapy, myotherapy, occupational therapy and hydrotherapy.
  41. Physiotherapy/Myotherapy/Hydrotherapy – The annual limit of $350 per person each calendar year includes combined benefits for chiropractic (excluding x-ray), osteopathy, naturopathy, homeopathy, physiotherapy, hydrotherapy, myotherapy and acupuncture.
  42. Podiatry – The annual limit of $350 per person each calendar year includes combined benefits for podiatry visits and podiatric surgical procedures.
  43. Podiatry – The annual limit of $400 per person each calendar year includes combined benefits for podiatry visits, podiatric surgical procedures and orthotic appliances (foot).
  44. Pressure garments – Are used for the treatment of burns, lymphodaema or for post-operative surgery up to 60 days from hospital discharge. For benefits to be payable garments must be supplied through a private company or therapist in private practice. A doctor’s letter recommending the appliance must accompany each claim for benefits. We recommend you call 1300 4 GMHBA (46422) or visit a branch for a benefit estimate to confirm the benefit payable.
  45. Pressure garments – The limit of $350 per person is available each calendar year for pressure garments.
  46. Pressure garments – The limit of $400 per person is available every 3 years. This limit includes combined benefits for orthopaedic appliances (GMHBA approved) and pressure garments.
  47. Prostheses (non-surgical) – Prostheses include a range of approved non-surgically implanted prostheses (e.g. wigs). A doctor’s letter of recommendation must accompany each claim for benefits. We recommend you contact us on 1300 4 GMHBA (46422) or visit a branch for a benefit estimate to confirm the benefit payable.
  48. Prostheses (non-surgical) – The limit of $400 per person is the benefit available for prostheses each calendar year.
  49. Remedial massage – Benefits will only be paid for 1 consultation and/or treatment type per day regardless of the provider within the group of physiotherapy, myotherapy and remedial massage.
  50. Remedial massage - The annual limit of $100 per person is included within the $350 per person/single membership and $700 per family membership limit for naturopathy, homeopathy, acupuncture and remedial massage.
  51. Remedial massage – The annual limit of $350 per person/ single membership and $600 per family membership includes combined benefits for occupational therapy, physiotherapy, myotherapy, hydrotherapy and remedial massage.
  52. Respite care – Benefits for respite care are payable for emergency weekend or planned care provided in the home by a specialised registered nurse. A doctor's letter of recommendation must accompany each claim for benefits. Please ensure the letter outlines any change in circumstances which necessitate the need for respite care.
  53. Sleep apnoea monitor – Benefits are limited to 1 sleep apnoea monitor per membership every 3 years. A doctor’s letter of recommendation must accompany each claim for benefits.
  54. Tens monitor –Benefits are limited to 1 tens monitor per membership every 3 years. A doctor’s letter of recommendation must accompany each claim for benefits.

Not sure about something?

Contact us by phone on 1300 4 GMHBA (46422) or start a WebChat between 8.00am and 6.00pm AEST Monday to Friday and one of our friendly Customer Service Advisers will be happy to talk to you.
GMHBA is a registered not-for-profit health insurer | ABN 98 004 417 092 | © 2010 GMHBA