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Hospital

Hospital

Hospital
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Options
Hospital Excess
$0 / $250 / $500
$0 / $250 / $500
$0 / $250 / $500

The amount of money a member agrees to pay for a hospital stay before GMHBA pay benefits. The excess is per person, calendar year based.

Choose from three levels of excess. Selecting a higher excess will lower the premium.

No excess applies for child dependants under 21 on GMHBA’s Gold Hospital, Gold Hospital Gap Saver, Fit Ultra and Fit Top family cover.

Add Gap Saver
 
 
 

Gap Saver provides members with access to increased benefits when treated by a doctor or specialist if admitted to hospital. As a member on our comprehensive cover you will have a higher level of protection by receiving more back on selected services. We recommend you contact us for a benefit estimate before commencing treatment to confirm the benefit payable.

Optional IVF and pregnancy services
 
 
 

GMHBA’s Gold Hospital cover gives you the option to reduce your premium by removing IVF and pregnancy services from your cover if you no longer need them.

This option is popular with established families and mature couples who want the extra peace of mind and services of Gold Hospital cover but no longer need pregnancy cover.

Hospital accommodation
Public hospital accommodation
 
 
 

Hospital cover as a private patient in a public hospital provides full cover for accommodation costs when admitted to a shared room as a private patient in a recognised Public Hospital (subject to bed availability).

As a private patient in a public hospital, you can select your own doctor but cannot avoid public hospital queues. The length of a public hospital queue is determined by the hospital and is not influenced by GMHBA.

Note: Bronze Hospital cover only provides accommodation in a public hospital. Bronze Hospital cover is a lower cost alternative to more substantial hospital covers.

Limited benefits may apply to high cost drugs. Drugs purchased outside of the hospital are not included.

Private hospital accommodation
 
 
 

Your accommodation costs (less any applicable excess) will be covered by GMHBA when you are admitted as a private patient to a single or shared room (subject to bed availability) in a recognised private hospital.

Shared room
 
 
 

Gold and Silver Hospital cover provide coverage for shared room accommodation costs in a recognised private hospital.

Note: Bronze Hospital cover only provides accommodation in a public hospital. Bronze Hospital cover is a lower cost alternative to more substantial hospital covers. Bronze Hospital cover provides no coverage for private hospital accommodation costs.

Limited benefits may apply to high cost drugs. Drugs purchased outside of the hospital are not included.

Single room (where available)
 
 
 

Gold Hospital cover provides coverage for single room accommodation costs (where available) in a recognised private hospital.

Silver Hospital cover provides the same single room coverage as Gold Hospital, but co-payments of $100 per day up to a maximum of $700 per admission apply. Co-payments are not the same as hospital excess. Please note: Some private hospitals only have single rooms and co-payments will apply.

Bronze Hospital cover provides no coverage for private hospital accommodation costs.

Hospital treatments and services
Accidental injury
 
 
 

Clinically necessary injury treatment resulting from an accident that requires hospital treatment.

Waiting period: None.

Appendicitis
 
 
 

Surgical removal of the appendix due to appendicitis.

Waiting period: 2 months, 12 months for Pre Existing Conditions.

Cardiac treatments
 
 
 

The medical treatment or surgical procedure for cardiac conditions such as heart disease, arrhythmias, congenital defects.

Waiting period: 2 months, 12 months for Pre Existing Conditions.

Intensive and coronary care
 
 
 

Specialised care for acute conditions. Intensive care provides highly specialised nursing and medical care to critically ill patients and those requiring high dependency care with continuous monitoring.

Coronary care, also known as cardiac intensive care, provides continuous monitoring and treatment for heart-related conditions.

Waiting period: 2 months, 12 months for Pre Existing Conditions.

Joint reconstructions and investigations
 
 
 

Diagnosis investigation or repair of ligament tears, remove loose tissue or treat other damage. Commonly performed on knees, shoulders and ankles.

Waiting period: 2 months, 12 months for Pre Existing Conditions.

Medical gap cover
 
 
 

The "medical gap" is the term given to the difference between the total fee charged by a doctor and the Medicare Benefit Schedule fee plus any health fund benefit.

Medicare pays 75% of this schedule fee for in-patient medical treatment and GMHBA pays the other 25% up to 100% of the Medical Benefit Schedule (MBS) fee.

GMHBA’s medical gap cover is a billing system that provides higher benefits than the scheduled fee which will reduce or even eliminate your out-of-pocket costs for doctor or specialist fees when treated in hospital.

Gynecological procedures
 
 
 

Gynaecological procedures such as a hysteroscopy or colposcopy

Waiting period: 2 months, 12 months for Pre Existing Conditions.

Operating theatre
 
 
 

Operating theatre hire costs

Psychiatric services
 
 
 

Treatment of mental illness or addiction in a psychiatric facility.

Waiting period: 2 months, a 24 month Benefit Limitation Period applies.

Rehabilitation services
 
 
 

Involves physical therapy and exercise programs provided at an approved rehabilitation facility In order to improve a condition.

Rehabilitation generally follows an inpatient admission for stroke, joint replacement or heart attack.

Waiting period: 2 months, a 24 month Benefit Limitation Period applies.

Removal of tonsils and adenoids
 
 
 

Treatment and surgery to remove the tonsils and adenoid glands.

Waiting period: 2 months, 12 months for Pre Existing Conditions.

Surgically implanted prostheses
 
 
 

Surgically implanted equipment to replace or assist a body function or part such as pacemaker, cardiac stent, joint replacement or defibrillator.

Benefits are no higher than the no gap government prescribed benefit.

Waiting period: 2 months, 12 months for Pre Existing Conditions.

Cataract and corneal transplants
 
 
 

Eye surgery and treatment such as cataract removal.

Waiting period: 2 months, 12 months for Pre Existing Conditions.

Dental implant surgery
 
 
 

Surgery for dental implants in hospital as an in-patient

Waiting period: 2 months, 12 months for Pre Existing Conditions.

Joint replacements including hips and knees
 
 
 

Joint replacements are included with surgically implanted prostheses benefit and include the replacement of an entire joint or component of the joint.

Waiting period: 2 months, 12 months for Pre Existing Conditions.

Pregnancy related services (including childbirth)
 
 
 

GMHBA offers pregnancy cover in both public and private hospitals. Pregnancy benefits cover the hospital and doctors’ fees relating to childbirth. This may include:
- Hospital ward accommodation
- Delivery suite
- In-patient hospital doctors services (including anesthetics services

Out of hospital fees charged by the specialist relating to the ongoing management of your pregnancy are not covered.

Waiting period: 12 months.

IVF and assisted reproductive services
 
 
 

Assisted reproductive services, like all hospital cover benefits, are only covered for services provided whilst admitted as an inpatient in hospital. This usually means the actual day stay procedures for embryo collection and embryo transfer.

Usually the IVF process involves a number of consultations, tests, and services received outside of hospital. Many of these costs are covered by Medicare, however if considering IVF, you should discuss the potential costs with your provider.

Waiting period: 12 months.

Healthy Start benefit (pregnancy related services)
 
 
 

The Healthy Start is an additional benefit up to $500 to cover the cost of any obstetrician’s fees for inpatient services.

If you have a hospital admission which results in an out of pocket expense for the birth of your child, we’ll send you a payment up to $500 within 60-90 days of your hospital discharge.

Gastric banding and all obesity surgeries
 
 
 

Waiting period: 2 months, 12 months for Pre Existing Conditions, a 24 month benefit limitation period applies.

Haemodialysis
 
 
 

Treatment in a hospital for kidney failure.

Waiting period: 2 months, 12 months for Pre Existing Conditions, a 24 month Benefit Limitation Period applies.

Additional hospital treatments and services

Our covers also provide coverage for all other medically necessary inpatient services that Medicare covers, unless listed as excluded above.

Connect Rewards Plus member loyalty program
When combined with a GMHBA extras cover
 
 
 

Holding a combined hospital and extras cover allows you to enjoy the benefits of GMHBA’s member loyalty program, Connect Rewards Plus. This program allows members to accumulate Connect Rewards dollars year on year.

GMHBA rewards program allows you to top up out of pocket expenses for select extras services.

The amount of dollars you receive depends on how long you have been a GMHBA member and your level of hospital cover. So, the longer you have been with us the more rewards dollars you will receive.

Health programs
Best Doctors Program
 
 
 

Best Doctors was established to connect people with a health condition to a network of specialists within the Best Doctors network in order to get a second opinion on their health care.

Through this service you will have access to leading specialists from around the world that will:
- Review your medical records.
- Provide answers to any questions you may have.
- Provide a written report on your current diagnosis and either confirm the current treatment plan or suggest an alternative, which you can share with your treating doctor.

All GMHBA members with hospital cover are eligible for the Best Doctors program.

Hospital in the Home
 
 
 

Hospital in the Home is a hospital substitution service that allows members to access acute care services including medication management, intravenous therapy, nursing and continence management in the comfort of their own home.

All GMHBA members with hospital cover are eligible for the Hospital in the Home program.

Rehabilitation in the Home
 
 
 

Rehabilitation in the Home is hospital substitution and provides services that would otherwise be completed in a rehabilitation facility or hospital. Services may include physiotherapy, occupational therapy, care coordination and personal care.

All GMHBA members with hospital cover are eligible for the Rehabilitation in the Home program.

New Family program
 
 
 

The New Family Program is a specialised program to assist parents in the first few months when a baby is welcomed into a family. It is available to members with hospital cover that includes pregnancy.

Members with Gold or Bronze Hospital cover, which includes pregnancy, can register to access the program.

 

Hospital

Hospital

Hospital
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  • Covered
  • Covered in a public hospital as a private patient
  • Partially covered (co-payments apply)
  • Not covered
  • More information about the service, including waiting periods

^The price per week applies to a Victorian premium, receiving a Base Tier Government Rebate, with no LHC loading and a $500 excess. The price shown includes a 2% direct debit discount. Please use our quote tool to determine the price that applies to you. The weekly payment frequency is shown for comparative purposes only and is not an available payment frequency.

Pre Existing Conditions

A pre-existing condition (PEC) is one where signs or symptoms of your ailment, illness or condition, in the opinion of a medical practitioner appointed by GMHBA (not your own doctor), existed at any time during the six months preceding the day on which you purchased your hospital cover or upgraded to a higher level of hospital cover and/or benefit entitlement.

Benefit Limitation Periods

During the first 24 months of cover (after the standard hospital waiting periods have been served), benefits paid for these services will be limited to public hospital benefits only.