Compare health insurance
Everything you need to know about comparing private health insurance to help you choose the right cover for you.
Compare private health insurance with GMHBA
Navigating the world of health insurance can be overwhelming, but finding the right cover doesn’t have to be. Whether you're switching funds or exploring your options for the first time, GMHBA provides a range of health insurance covers to suit different lifestyles, budgets, and health needs.
This guide is designed to give you the knowledge to compare and choose the GMHBA private health insurance policy that best fits you and your family.
Choose the best private health insurance cover for you
Choosing private health insurance cover really comes down to your individual needs, budget, and health priorities. Need a starting point to help you find cover? You can start by answering a few key questions. Thinking through these questions can help you work out the type and level of cover that’s right for you.
You can always upgrade your policy later, but keep in mind that there will be waiting periods on the higher cover before you’ll be able to claim.
- Are you planning for any upcoming life changes? This could include pregnancy, planned surgery (keeping in mind any waiting periods you may need to serve).
- Do you have any pre-existing conditions or will you need cover for any hereditary health conditions that may impact you?
- Who needs to be covered? Is it just you, or do you also need cover for a partner or children?
- Are you a higher-income earner looking for hospital cover to avoid the Medicare Levy Surcharge (MLS)?
- Do you need cover for ongoing treatments? For example; regular chiropractic care or prescription eyewear.
- Do you have a partner or children that need ongoing treatment like podiatry or eye care?
- How will your health needs change as you get older?
SmartCare extras with hospital cover
$500 flexible limit to spend your way on included services
- 100% back on checkups at any dentist and optical*
- 60% back on other included services
- Annual limit rollover (not including optical)#
- Covers chiro, general dental, osteo, physio and optical
Plus
Entry level hospital cover with some key inclusions and accident protection
- Includes 5 out of 38 clinical categories
- Upgraded cover in the event of an accident
- Excess waiver for same day stays
$1,000 flexible limit to spend your way on included services
- 100% back on checkups at any dentist and optical*
- 60% back on other included services
- Annual limit rollover (not including optical)#
- Covers chiro, general dental, osteo, physio and optical plus 9 other services.
Plus
Great value hospital cover for more than just the basics
- Includes 23 out of 38 clinical categories
- Includes back, neck and spine
- Excess waiver for same day stays.
- $1,500 flexible limit to spend your way on included services
- 100% back on checkups at any dentist and optical*
- 60% back on other claims
- Annual limit rollover (not including optical)#
- Covers chiro, general dental, osteo, physio and optical plus 19 other services.
Plus
A popular choice for hospital cover offering a range of inclusions
- Includes 29 out of 38 clinical categories
- Upgraded cover in the event of an accident
- Excess waiver for same day stays
*Preventative dental includes check-ups and cleans, excludes general & major dental and orthodontics. Must be with a recognised provider.
#Annual limit rollover excludes optical. Available after 12 months of continuous cover on SmartCare Boost Extras at the same level (Starter, Everyday or Complete). Unused eligible annual limits roll over on 1 January and expire after 12 months.
Main types of private health insurance
At GMHBA we provide cover choices for singles, couples, families, and single parent families. Whether you’re after hospital, extras, or combined cover, whatever stage of life you're at, we have private health cover for you.
What to consider when comparing private health insurance
Private health insurance in Australia complements Medicare and the public healthcare system.
Policies can vary depending on whether you choose hospital or extras cover, or combined hospital and extras. What’s included varies depending on the type and level of cover that you choose.
There are several things to consider when comparing health insurance including; any waiting periods, if you have any pre-exisitng conditions, out-of-pocket fees, your eligibility for the Australian Government Rebate on private health insurance, or whether you might have to pay Lifetime Health Cover (LHC) loading if you're over 31 or the Medicare Levy Surcharge (MLS) for higher income earners. These factors could influence the type and level of cover you choose and are further explained below.
Key factors to compare
If you’re joining GMHBA for the first time or changing your cover, it’s important to be aware of waiting periods. A waiting period is the time between when you take out health insurance or upgrade your cover and when you’re actually covered for a treatment or service. These are in place to prevent people from making claims immediately after joining and cancelling their cover, which could lead to higher premiums for all members of the fund.
The Lifetime Health Cover (LHC) loading is a Government loading on your private health insurance hospital cover premiums. It was introduced on 1 July 2000 to encourage people to take out hospital cover earlier, and to maintain their cover. You have until 1 July following your 31st birthday to take out hospital cover. After this time, a 2% loading is added to your hospital cover premium for every year you didn't have cover up to 70%.
The Medicare Levy Surcharge (MLS) is an additional levy paid by higher income earners who do not hold an appropriate level of private health insurance hospital cover. It’s designed to encourage the uptake of private health insurance hospital cover and reduce the load on the public healthcare system.
The rates and thresholds are set by the Australian Government – the higher your annual income, the more you’ll pay in MLS.
This income-tested rebate is provided by the Australian Government to help people meet the cost of private health insurance. It can be claimed as a reduction on your health insurance premiums or as a refundable tax offset.
Out-of-pocket fees refer to the costs you pay yourself when your treatment isn’t fully covered, either by Medicare or your private health insurer. These fees are often called gap fees.
By choosing private health insurance you may reduce these fees, enjoy greater control over your healthcare, and gain peace of mind.
A pre-existing condition refers to any illness, ailment, or condition where signs or symptoms were present in the six months before you joined or upgraded your private health insurance policy. Importantly, the condition doesn’t need to have been formally diagnosed, an external medical advisor appointed by GMHBA will determine if the condition is classified as pre-existing and if it is, a 12-month waiting period will apply before you are covered for the treatment.
What you can get with different types of cover
Compare hospital and extras cover and what’s included. You can also combine hospital and extras policies to give you the benefits of both.
- Gives you the option to be treated as a private patient in both private and public hospitals.
- Can give you more choice over your treating doctor or specialist (subject to availability)
- May offer potentially shorter wait times for elective surgery in a private hospital.
- Avoid paying the Medicare Levy Surcharge (MLS) with GMHBA hospital cover if you are a higher-income earner.
- Choice of a hospital cover that suits your life stage or healthcare needs.
- Avoid Lifetime Health Cover Loading (LHC) when you get hospital cover before you turn 31.
- Provides cover for ancillary health services (typically not covered by Medicare) outside of a hospital setting, like physiotherapy, dental, or chiropractic care.
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You can claim benefits towards the services you prefer, based on the level of extras cover you choose.
- Choice of cover to suit your life stage or healthcare needs.
- Pay less out-of-pocket expenses for included services and treatments services (up to your benefit limits).
Why choose private health insurance?
There are many reasons Australians choose private health insurance cover, including:
- Peace of mind - knowing they are covered for those ‘just in case’ moments
- Avoid extra tax - higher income earners may take out hospital cover to avoid the Medicare Levy Surcharge (MLS)
- Avoid extra financial penalties - by taking out hospital cover before you turn 31 you may avoid Lifetime Health Cover (LHC) loading
- More choice - over your treating doctor, the hospital you are treated at, and typically shorter wait times if you choose to have an elective procedure in a private hospital
- Extras cover - for services not typically covered by Medicare, like dental, optical, physiotherapy, and more
How GMHBA compares
Unlike some of Australia’s biggest private health insurers, GMHBA is not-for-profit, meaning any profit we make gets reinvested back into our members, our services and our community. We don’t have shareholders or overseas investors, so we’re not obliged to chase endless growth and are more invested in supporting the health of our members.
Being not-for-profit health insurer goes hand in hand with supporting our local communities. We do this through meaningful community partnerships, staff volunteering, charitable gifts and social procurement.
Why choose GMHBA cover?
Accidents happen. That’s why when you take out any new GMHBA hospital cover you get accident protection.
All GMHBA hospital covers come with emergency ambulance cover as standard for eligible states.
In 2025, GMHBA has claimed the Canstar Outstanding Value Award – Hospital & Extras Insurance: Victoria.
Since 1934, we’ve believed that health insurance should be run to benefit members, not shareholders.
Join the GMHBA family with our Healthier Together newsletter, podcast and community events.
Unsure? We offer new members 60 days to get to know us and we’ll refund any premiums as long as you haven’t made a claim.
Frequently asked questions about private health insurance
This really depends on your personal circumstances, stage of life, and what matters most to you. Some people value the peace of mind that comes with knowing they can access private health care more quickly, while others are happy sticking with the public system. There’s no right or wrong, just what works best for you.
Australia’s public hospital system does a great job of covering the essentials, and for many, that’s all they need. But if you're looking for more choice and flexibility, private health insurance can offer added peace of mind. With hospital cover, you can choose your doctor, access private hospitals, and may experience shorter wait times for elective procedures. While extras cover pays benefits towards services that Medicare doesn’t typically cover like dental, optical, and physiotherapy.
Hospital cover - contributes to the costs of being admitted into hospital for treatment as a private patient.
Extras cover - extras cover can help with the cost of common services that Medicare generally won’t pay for. Extras cover helps with things like dental, physio, remedial massage, optical and more, depending on your cover.
There’s also combined hospital and extras cover which gives you the advantages of both.
In some circumstances, your annual health insurance premium may be less than what you’d have to pay for the Medicare Levy Surcharge (MLS) at tax time, but it depends on a few factors including:
• Your income tier, as determined by the Australian Government – MLS is only payable if you are in Tier 1 or higher
• Annual taxable income – the MLS rate is calculated as a percentage (0%-1.5%) of your annual taxable income, depending on which tier you fall into
• Type of cover – only hospital cover has an impact on whether you need to pay MLS or not
• Level of cover – premiums increase as your hospital cover includes more clinical categories
• Health needs and how you use the healthcare system – this can influence how much you claim on your cover
Private health insurance isn’t necessarily better than Medicare, however it does help to ease pressure on the public system by giving individuals more options for care. Hospital cover allows people to choose their doctor, access private hospitals, and often experience shorter wait times for elective procedures. Extras cover can also help with services not included under Medicare, like dental, optical, and physiotherapy.
Learn more about Medicare vs Private Health Insurance
Medicare allows people to access essential healthcare services at low or no cost, and is available to all Australian citizens, permanent residents, and some visitors on a reciprocal rights visa.
Private health insurance works alongside Medicare by providing benefits for members towards the cost of services that are not funded or only partially funded by Medicare, helping to reduce your out-of-pocket expenses.