Basic Extras Set Benefits

Get a set amount back on entry level extras
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$1,000 to claim on general dental - sublimits apply
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80% back on optical up to $150
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$300 combined limit to claim on physiotherapy
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GMHBA is rated 4.2 on value, transparency & service
4.2 out of 5 stars on productreview.com.au - August 2024

Extras cover explained

Download extras factsheet
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$300 to claim on occupational therapy
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$150 to claim on pharmacy
Understanding what's covered
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Inclusions

General Dental:

Diagnostic services, simple extractions (not including surgical extractions of wisdom teeth) and restorative services (limited benefits apply to precious restorations).

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) - $31.00
Scale & clean (114) - $57.75
Fluoride treatment (121) - $18.15

Excludes Major dental treatment

Waiting period
2 months

Includes prescription lenses, spectacle frames, and contact lenses. Non-prescription sunglasses and repairs are excluded.

Annual limit per person, per calendar year
$150

Benefit
80%

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 - $33.00
Subsequent consult - $25.00
Group attendance - $10.00

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 - $33.00
Subsequent consult - $25.00

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. 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 - $21

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 - $30.00
Subsequent consult - $23.00

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 - 75%

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 - $71.00

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 recommending the appliance must accompany each claim for benefits.

A doctor's letter of recommendation is required prior to claiming.

Annual limit per person, every three years
$100

Benefit
Per garment - $42

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 - $16.00

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

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Extras FAQs

A waiting period is the time between joining GMHBA and when you're covered for a treatment or service. If you receive a service or treatment during a waiting period, you are not eligible to receive a benefit payable from us, regardless of when you submit the claim.  

Extras waiting periods apply to:

New members to health insurance, existing members who have upgraded their cover or anyone who has transfered to GMHBA from a previous fund and:

  • Still have waiting periods to finish serving
  • Joined on a higher level of cover and haven't served waits on any new services or increased benefit limits
  • Had a gap in their extras cover for more than 30 days

Waiting periods for extras services are as follows: 

Waiting Periods - 12 Months
Major Dental including Orthodontics, Hearing Aids, Health Appliances and Foot Orthotics 

Waiting Periods - 6 Months 
Optical 

Waiting Periods - 2 Months
All other services 

Waiting Periods - 0 days
Ambulance transport and subscriptions

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 Provider. 

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 2,500 approved dentists in the smile.com.au network, chances are there is one near you.  

A extras policy can have four different types of limits:

  • Policy limit - The total amount for a service that can be claimed for the policy in a calendar year. 
  • Person limit - The maximum amount a single person can claim towards a service within the calendar year.
  • Membership limit - The maximum total between everyone on the policy, that can be claimed towards a service within the calendar year.
  • Sublimit – A cap on benefits set by GMHBA towards a particular service or treatment within the overall annual limit. 

Annual limits reset on 1 January each year for most services.  

Some services such as hearing aids and health appliances have a benefit period of three years. This means that if you have claimed your full hearing aid benefit you will be unable to claim an additional benefit for three years from the date of the initial claim.

With set benefits you get the same benefit back each time you visit the provider up to your annual limits. 

A percentage back allows you to get a percentage of the overall charge back up to your annual limits.  

Disclaimer

This information is important.
Please read and retain for future reference.

Full information about your chosen cover's applicable waiting periods, excess, co-payments, 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.