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Basic Extras 55%
We pride ourselves on providing great value health cover. That’s why all our products are backed by a 60 day money back guarantee. If for any reason your circumstances change and you have not claimed, we will fully refund your membership. *For new members.
Inclusions
General dental:
Diagnostic services, simple extractions (not including surgical extractions of wisdom teeth) and fillings.
Preventative dental:
Includes routine dental check-ups, professional cleaning to remove plaque, stains and/or calculus and topical application of remineralisation agents.
Annual limit per person, per calendar year
$1,000
Combined annual limits for General dental and Preventative dental
Sub-limit of $300 applies for Preventative dental
Benefit - General dental
Periodic oral examination (012) - 55%
Scale & clean (114) - 55%
Fluoride treatment (121) - 55%
Excludes Major dental treatment
Waiting period
2 months
Includes prescription glasses (frames and lenses) and contact lenses. Non-prescription sunglasses and repairs are excluded.
Annual limit per person, per calendar year
$150
Benefit
55%
Waiting period
6 months
Treatment by a physiotherapist which uses physical means to relieve pain, regain range of movement, restore muscle strength and return patients to normal activities of daily living.
Hydrotherapy, involves the use of water for pain relief and treatment. The term encompasses a broad range of approaches and therapeutic methods that take advantage of the physical properties of water, such as temperature and pressure, for therapeutic purposes, to stimulate blood circulation and treat the symptoms of certain diseases.
Annual limit per person, per calendar year
$300
Annual limit per policy, per calendar year
$600
Combined annual limits for Physiotherapy, Hydrotherapy and Myotherapy
Benefit
Initial consult - 55%
Subsequent consult - 55%
Group attendance - 55%
Waiting period
2 months
Myotherapy is a branch of manual medicine which focuses on the treatment and rehabilitation of musculoskeletal pain and associated conditions. This involves an extensive physical evaluation and an integrated therapeutic approach to affected muscles, joints, nerves, and associated viscera (organs) and is used in the treatment of acute or chronic conditions and in the area of preventative management.
Annual limit per person, per calendar year
$300
Annual limit per policy, per calendar year
$600
Combined annual limits for Physiotherapy, Hydrotherapy and Myotherapy
Benefit
Initial consult - 55%
Subsequent consult - 55%
Waiting period
2 months
Benefits cannot be paid for PBS scripts, contraceptives, items not on the TGA register or items purchased overseas. Pharmaceuticals must be classed as either Schedule 4 or Schedule 8 for benefits to be paid. The maximum PBS co-payment is applied prior to benefits being payable. A sub-limit per script (after PBS co-payment deduction) applies.
Annual limit per person, per calendar year
$150
Annual limit per policy, per calendar year
$350
Benefit
Per script - 55%
Waiting period
2 months
Occupational therapy assists and supports people to participate in day to day life by enhancing their ability to engage in everyday activities.
Annual limit per person, per calendar year
$300
Annual limit per policy, per calendar year
$600
Benefit
Initial consult - 55%
Subsequent consult - 55%
Waiting period
2 months
Refer to repair or adjustment of medical devices (such as a knee brace) fitted immediately following surgery or to heal an injury.
Annual limit per person, per calendar year
$30
Benefit
Per repair - 55%
Waiting period
2 months
Refer to medical devices (such as a knee brace) fitted immediately following surgery or to heal an injury.
Must be custom made and GMHBA specified and approved.
A doctor's letter of recommendation is required prior to claiming.
Annual limit per person, every three years
$200
Benefit
Per appliance - 55%
Waiting period
12 months
Garment that applies continual pressure over large areas of skin.
Garments must be supplied through a private company or therapist in private practice.
A doctor's letter of recommendation must accompany a claim.
Annual limit per person, every three years
$100
Benefit
Per garment - 55%
Waiting period
12 months
Fluoride benefits are payable towards the cost of dietary fluoride supplements (tablet or liquid form) when dispensed by a chemist or dentist in a private practice.
Annual limit per person, per calendar year
$45
Benefit
Per supplement - 55%
Waiting period
2 months
Melanoma survelliance photography and skin checks are a set of images taken of the body to use in the early detection of potential skin cancers such as melanoma.
Annual limit per person, per calendar year
$50
Annual limit per policy, per calendar year
$100
Combined annual limits for Melanoma surveillance photography, Quit smoking programs and Nicotine replacement patches
Benefit
1 per year
Waiting period
2 months
Patches impregnated with nicotine, which are worn on the skin by a person trying to give up smoking. Nicotine is gradually absorbed into the bloodstream, helping reduce the craving for cigarettes.
Annual limit per person, per calendar year
$50
Annual limit per policy, per calendar year
$100
Combined annual limits for Melanoma surveillance photography, Quit smoking programs and Nicotine replacement patches
Benefit
1 x 12 week course of patches per year
Waiting period
2 months
Programs that provide support and information to help quit smoking and vaping. A doctor’s letter of recommendation must accompany a claim.
Annual limit per person, per calendar year
$50
Annual limit per policy, per calendar year
$100
Combined annual limits for Melanoma surveillance photography, Quit smoking programs and Nicotine replacement patches
Benefit
1 per year
Waiting period
2 months
Extras FAQs
A waiting period is the time between when you first take out health insurance or upgrade your cover and when you're actually covered for a treatment or service.
Extras waiting periods will apply to:
- New members who have never held extras cover before.
- Members who transfer from another health fund and have had a gap in and/or upgraded their cover (see Switching to GMHBA below).
- Additional members added onto a policy (unless they've already served their relevant waiting periods). Exceptions apply for newborns, adopted and permanent foster children (where the family membership has been in existence for at least two months).
Waiting periods for extras services – when included on your cover – are as follows:
Waiting Periods: 0 days
Ambulance transport and subscriptions
Waiting period: 2 months
Any services that are not specified below.
Waiting period: 6 months
Optical
Waiting period: 12 months
Major dental, orthodontics, podiatry surgical procedures and orthotic appliances (foot), orthopaedic appliances (GMHBA approved), other medical devices and aids including hearing aids, blood glucose monitor, extremity pump, nebuliser pump, pressure garments, prostheses (GMHBA approved, non-surgical), sleep apnoea monitor and tens monitor.
Switching to GMHBA
If you have already served your waiting periods on an equivalent or higher level of cover with another fund, and joined GMHBA within 30 days of leaving that fund, you won't have to re-serve your waiting periods. Otherwise, waiting periods will apply from the date you take out your new cover with GMHBA. If you’ve upgraded your cover, your waiting periods for higher cover will start on the date you upgraded, but you can still claim the equivalent benefit to your previous level of cover during that period.
Our members have freedom of choice when selecting their preferred provider. For members to claim with GMHBA, providers must hold active accreditation, be operating in a private practice and considered an Australian Pprovider.
You can use the find a provider tool to locate a dentist or allied health professional near you and search by name, type, specialty or treatment.
We've partnered with smile.com.au to make dental care more affordable and accessible for our members across Australia. This means lower out-of-pocket costs for all dental treatment, as smile.com.au dentists will reduce their fees by at least 15%.
With more than 4,000 approved dentists in the smile.com.au network, chances are there is one near you.
A GMHBA extras policy can have several different types of benefit limits. The limit type for applicable services is outlined in the fact sheet for each cover.
- Annual limits: Most benefit limits are annual limits, which reset each calendar year on 1 January. This means if you use all of your limit in one year, you’ll have to wait until 1 January the following year to start claiming benefits again. Annual limits apply to each individual on the membership, unless otherwise specified. Keep in mind, some services also have a multi-year limit or lifetime limit.
- Annual limit rollover is offered on SmartCare Boost Extras covers only, available when taken out with eligible hospital covers, and allows members to carry over any unused annual limits for included extras services (excluding optical) into the next calendar year, once they have served a full 12 months on their current cover.
- Smart Limit: Offered on SmartCare Extras covers only, a Smart Limit is a flexible annual limit that you can choose to spend across included services (excluding optical) each year, either with or without sub-limits depending on the cover.
- Membership limits: Membership limits are the maximum amounts that can be claimed in a calendar year, and they’re shared between all people on the membership.
- Per person limits: The total amount an individual on the policy can claim on a service per calendar year. This means no one person can claim more than the per person limit each calendar year.
- Sub-limits: A sub-limit is the maximum amount that can be claimed for a particular service or treatment within an overall annual limit. These can vary from service to service.
- Combined limits: This is a single limit that can be used across a collection of services.
- Multi-year limits: This is a rolling limit that resets after the specified number of years on the anniversary date for each claim from this service category.
- Lifetime limits: This applies for orthodontic treatment only, per person on the membership. Once you hit your lifetime limit, you can no longer claim for this service.
Annual limits reset on 1 January each year for most services.
Some services have a multi-year limit and a benefit period of three years. This means that if you have claimed your full benefit for a particular service, you will be unable to claim an additional benefit for three years from the date of the initial claim.
Members eligible for annual limit rollover can have any unused annual limits for included extras services (excluding optical) carried over into the next calendar year on 1 January. Annual limit rollover is offered on SmartCare Boost Extras covers only.
When you claim on an eligible service on your extras cover, you’ll only pay the difference between what you get back from GMHBA and the cost set by your provider.
With set benefits you will receive a set amount back from GMHBA to cover part of your cost for each item or service, up to your annual per person or per membership limit.
Percentage back extras cover allows you to get a percentage of the overall charge back each time you claim, up to your annual per person or per membership limit.
Our promise
Not the right cover for you? We'll refund your premium provided you haven't made a claim.
We’ve been helping Australians manage their health care for 90 years.
We’re not for profit, so we always put the health and wellbeing of our members first.
Find the right cover for you, join online and we'll take care of the rest. Plus, you'll serve no waiting periods if you switch to the same or lower level of cover.
Contact our friendly customer service team
1300 446 422
Disclaimer
This information is important.
Please read and retain for future reference.
Full information about your chosen cover's applicable waiting periods, excess, exclusions, restrictions, limits, pre-existing conditions, accident protection and services covered is available within the policy factsheet. The price shown excludes any Lifetime Health Cover (LHC) loading.
Rates are effective 1 April 2025. | All contribution quotes by this calculator are subject to variation and should therefore be considered indicative contribution rates. | Weekly and fortnightly payment frequencies are only available for direct debits | Calculations include the 2% Direct Debit Discount available only via bank account direct debit | All prices include the Australian Government Rebate on Private Health Insurance as chosen | Hospital Cover contributions do not include any applicable Lifetime Health Cover loading.