Bronze Plus Hospital & Mid Extras 65%

Private hospital cover with 65% back on popular extras
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Includes services such as dental surgery, joint reconstructions and bone, joint and muscle. View all inclusions
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Excludes services such as pregnancy and birth, heart and vascular, back, neck and spine. View all exclusions
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Emergency ambulance cover
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$1,500 to claim on dental - sublimits apply
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$400 combined limit to claim on physiotherapy
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60 Day Money Back Guarantee
For new members, we'll refund any premiums paid as long as you haven't made a claim.

Hospital cover explained

Hospital Factsheet
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Includes 22 out of 38 clinical categories
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Avoid the Medicare Levy Surcharge (if applicable)
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No excess for hospital day procedures in a private hospital
Understanding what's covered
Inclusions

Hospital treatment for the investigation and treatment of the brain, brain-related conditions, spinal cord and peripheral nervous system.

Hospital treatment for the investigation and treatment of the eyes and content of the eye sockets.

Hospital treatment for the investigation and treatment of the ear, nose, throat, middle ear, thyroid, parathyroid, larynx, lymph nodes and related areas of the head and neck.

Hospital treatment of the tonsils, adenoids and insertion or removal of grommets.

Hospital treatment for the investigation and treatment of diseases, disorders and injuries of the musculoskeletal system.

Hospital treatment for surgery for joint reconstructions.

Hospital treatment for the investigation and treatment of the kidney, adrenal gland and bladder.

Hospital treatment for the investigation and treatment of the male reproductive system including the prostate.

Hospital treatment for the investigation and treatment of the digestive system, including the oesophagus, stomach, gall bladder, pancreas, spleen, liver and bowel.

Hospital treatment for the investigation and treatment of a hernia or appendicitis.

Hospital treatment for the diagnosis, investigation and treatment of the internal parts of the gastrointestinal system using an endoscope.

Hospital treatment for the investigation and treatment of the female reproductive system.

Hospital treatment for the investigation and treatment of a miscarriage or for termination of pregnancy.

Hospital treatment for chemotherapy, radiotherapy and immunotherapy for the treatment of cancer or benign tumours.

Hospital Treatment for pain management that does not require the insertion or surgical management of a device.

Hospital treatment for the investigation and treatment of skin, skin-related conditions and nails.

Hospital treatment for the investigation and treatment of breast disorders and associated lymph nodes, and reconstruction and/or reduction following breast surgery or a preventative mastectomy.

Hospital treatment for the investigation and management of diabetes.

Hospital treatment for the investigation and treatment of blood and blood-related conditions.

Hospital treatment which is medically necessary for the investigation and treatment of any physical deformity.

Hospital treatment for surgery to the teeth and gums.

Hospital treatment for the investigation and treatment of conditions affecting the foot and/or ankle, provided by a registered podiatric surgeon. Benefits are limited to only cover hospital accommodation and the cost of a prosthesis per the Prosthesis List, as laid out in the Private Health Insurance (Prosthesis) Rules. Medical services such as the anaesthetist or the surgeon’s account in respect to Podiatric Surgery are not covered under hospital products.

Restricted

Hospital treatment for physical rehabilitation for a patient related to surgery or illness.

Hospital treatment for the treatment and care of patients with psychiatric, mental, addiction or behavioural disorders.

Hospital treatment for care where the intent is primarily providing quality of life for a patient with a terminal illness, including treatment to alleviate and manage pain.

Exclusions

Hospital treatment for the investigation and treatment of the heart, heart-related conditions and vascular system.

Hospital treatment for the investigation and treatment of the lungs, lung-related conditions, mediastinum and chest.

Hospital treatment for the investigation and treatment of the back, neck and spinal column, including spinal fusion.

Hospital treatment to correct hearing loss, including implantation of a prosthetic hearing device.

Hospital treatment for surgery to remove a cataract and replace with an artificial lens.

Hospital treatment for surgery for joint replacements, including revisions, resurfacing, partial replacements and removal of prostheses.

Hospital treatment for dialysis treatment for chronic kidney failure.

Hospital treatment for investigation and treatment of conditions associated with pregnancy and child birth.

Hospital treatment for fertility treatments or procedures.

Hospital treatment for surgery that is designed to reduce a person’s weight, remove excess skin due to weight loss and reversal of a bariatric procedure.

Hospital treatment for the provision and replacement of insulin pumps for treatment of diabetes.

Hospital treatment for the implantation, replacement or other surgical management of a device required for the treatment of pain.

Hospital treatment for the investigation of sleep patterns and anomalies.

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Hospital 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.  

Hospital waiting periods apply to: 

  • New members to health insurance
  • Members who transfer from another health fund who haven’t fully served the required waiting periods 
  • New members that have had a gap in their hospital cover for more than 30 days
  • Current members that upgrade their cover for newly included services

Waiting Period – 0 days (accidents must occur after joining) 
Accidents- bodily injuries resulting from accidents which occur after the date of joining or upgrading to a higher cover.  

Waiting Period – 2 months
Rehabilitation, palliative care, psychiatric and non-pre-existing conditions. 

Waiting Periods – 12 months
Pre-existing conditions.

An out of pocket cost is a fee charged by the specialist above the benefit that Medicare and GMHBA combined contribute towards an inpatient procedure. Medicare will pay the first 75% of the Medicare Benefits Scheduled fee (MBS) and GMHBA will contribute at least 25% of the remaining amount.

The MBS fee is only a recommendation and private surgeons in Australia are able to charge what they deem appropriate for their services. If the fee they charge is greater than the set MBS fee, you will be required to pay the difference; this is called a ‘medical gap’ or an out-of-pocket cost. 

To reduce medical out of pocket costs associated with medical procedures the Australian Health Service Alliance (AHSA) access gap scheme is an opt in billing scheme that provides higher benefits than the Government’s schedule fee (MBS) and limits the out-of-pocket costs for the procedure. Specialists must be registered for Access Gap Cover (AGC) and choose to opt-in to the scheme for each procedure. 

There are two scenarios for how you may be billed by your specialist when they use the AGC scheme: 

  • No Gap - this is where there will be no gap from the specialist to pay following the procedure 
  • Known Gap – this is where you will be charged a maximum gap of $500 per specialist, per admission to hospital or a maximum of $800 for obstetric services. 

We won't pay on any services that are:

  • excluded on your level of cover
  • received whilst you are within waiting periods
  • treatment with unregistered providers
  • claims for people not listed on the policy
  • treatment outside of Australia
  • emergency department fees
  • procedures that are not claimable through Medicare and
  • treatment that occurred outside of your policy being active
  • any outpatient medical cost

 If you elect to be treated as private patient in a registered public hospital, we pay towards your stay up to the commonwealth default rate for shared room accommodation less any excess or co-payment outlined on your hospital product. As a private patient in a public hospital, you may have a choice of doctor however you cannot avoid public hospital queues. The length of a public hospital queue is determined by the hospital and is not influenced by GMHBA. 

Choosing to be a private patient in a public hospital could result in out-of-pocket medical claim costs. You will receive informed financial consent for any hospital admission.

Extras cover explained

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$350 to claim on psychology
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$300 combined limit to claim on chiropractic and osteopathy
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$250 to claim on podiatry
Understanding what's covered
Inclusions

Bronze Plus Package with AIA Vitality, Silver Package with AIA Vitality, Essential Extras, Core Extras & Premium Extras:

Benefits are per person per calendar year.

Basic Extras, Mid Extras, Top Extras:

The benefits shown are the annual limits for each type of dental service. The annual limit is a combined general and major dental limit. There are further sub limits within some of these dental services.

Overall dental annual limit is per person, per calendar year.

General Dental:

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

Major Dental:

Major dental services (including full & partial dentures, orthodontics, crown & bridgework, endodontic services such as root canal, gold fillings, indirect restorations, surgical extractions of a tooth/teeth including wisdom teeth). Note: Basic Extras, Bronze Plus Package with AIA Vitality and Essential don't cover major dental.

Annual limit per person, per calendar year
$1,500

Combined annual limits for General Dental, Major Dental and Orthodontics

Sub-limit of $400 applies for Preventative Dental

Further sub-limits apply please refer to fact sheet for details

Benefit - General Dental
Periodic oral examination (012) - 65%
Scale & clean (114) - 65%
Fluoride treatment (121) - 65%

Benefit - Major Dental
Surgical tooth extraction (322) - 65%
Full crown veneered (615) - 65%

Waiting period
General Dental - 2 months
Major Dental - 12 months

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

Laser surgery claimable on Gold Extras only.

Annual limit per person, per calendar year
$200

Benefit
65%

Waiting period
6 months

Chiropractors and Osteopaths use manipulation based treatments that can be used for:
- muscle and joint pains and injuries
- back and neck pain and injuries
- frequent headaches
- repetitive strains

Chiropractic x-ray is limited to one x-ray per person, per calendar year.

Annual limit per person, per calendar year
$300

Annual limit per policy, per calendar year
$600

Benefit
Initial consult - 65%
Subsequent consult - 65%

Waiting period
2 months

Treatment by a physiotherapist which uses physical means to relive pain, regain range of movement, restore muscle strength and return patients to 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
$400

Annual limit per policy, per calendar year
$800

Combined annual limits for Physiotherapy, Myotherapy and Hydrotherapy

Benefit- Physiotherapy
Initial consult - 65%
Subsequent consult - 65%

Benefit- Hydrotherapy
Initial consult - 65%
Subsequent consult - 65%

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
$400

Annual limit per policy, per calendar year
$800

Combined annual limits for Physiotherapy, Myotherapy and Hydrotherapy

Benefit
Initial consult - 65%
Subsequent consult - 65%

Waiting period
2 months

Acupuncture treatment involves inserting small needles into various points in the body to stimulate nerve impulses.

Annual limit per person, per calendar year
$300

Annual limit per policy, per calendar year
$600

Combined annual limits for Remedial Massage and Acupuncture

Benefit
Initial consult - 65%
Subsequent consult - 65%

Waiting period
2 months

Orthodontics is a branch of dentistry concerned with the diagnosis, prevention and treatment of problems with the alignment of the teeth and jaws. Please contact GMHBA prior to undergoing any orthodontic treatment to confirm the benefits available.

Annual limit per person, per calendar year
$1,500

Combined annual limits for General Dental, Major Dental and Orthodontics

Sub-limit of $400 applies for Orthodontics

Lifetime limit of $2,400 applies per person

Benefit
Braces for upper and lower teeth (881) - 65%

Waiting period
12 months

Remedial Massage is a blend of approved, scientific massage techniques, promoting efficiency in the body's systems, which in turn enhances the functioning of the entire person.

Annual limit per person, per calendar year
$300

Annual limit per policy, per calendar year
$600

Benefit
Initial consult - 65%
Subsequent consult - 65%

Waiting period
2 months

To be fully covered for Ambulance services, we recommend that you take out an ambulance subscription in your state or territory. You can claim a refund on one ambulance subscription per membership each calendar year under Gold Extras and Silver Extras (excluding TAS/QLD/NSW).

A transport benefit per trip is payable, however this will result in significant out of pocket costs. Publicly funded ambulance services and State Government Ambulance transport schemes are excluded (TAS/QLD/NSW)

Annual limit per policy
1 subscription claim per year

Benefit
65%

Waiting period
0 days

Bronze Package with AIA Vitality, Silver Package with AIA Vitality & Gold Package with AIA Vitality:

AIA Vitality products cover emergency ambulance services by a recognised provider Australia wide. Does not include cover for non-emergency ambulance transport i.e. from a hospital to your home or ambulance transfers between hospitals. Publicly funded ambulance services and State Government transport schemes are excluded (eg. TAS/NSW/ACT/QLD).

Ambulance Transport (All other GMHBA Extras covers):

To be fully covered for Ambulance services, we recommend that you take out an ambulance subscription in your state or territory. You can claim a refund on one ambulance subscription per membership each calendar year under Gold Extras and Silver Extras (excluding TAS/QLD/NSW).A transport benefit per trip is payable, however this will result in significant out of pocket costs. Publicly funded ambulance services and State Government Ambulance transport schemes are excluded (TAS/QLD/NSW)

Annual limit per person, per calendar year
$500

Benefit
65%, up to $300 per claim

Waiting period
0 days

Group or individual sessions with a Psychologist

Annual limit per person, per calendar year
$350

Annual limit per policy, per calendar year
$600

Benefit
Initial consult - 65%
Subsequent consult - 65%

Waiting period
2 months

Any S4 or S8 non PBS products may be claimed (excluding contraception, fertility and IVF).

Annual limit per person, per calendar year
$250

Annual limit per policy, per calendar year
$450

Combined annual limits for Pharmacy and Travel Vaccinations

Benefit
Per script - 65%

Waiting period
2 months

Benefits are payable for selected travel vaccinations administered by a doctor or at a vaccine clinic if you have a pharmacy receipt, doctor's account or vaccine clinic account.

Annual limit per person, per calendar year
$250

Annual limit per policy, per calendar year
$450

Combined annual limits for Pharmacy and Travel Vaccinations

Benefit
Per script - 65%

Waiting period
2 months

Dietitians are experts in food and nutrition. They help promote good health through proper eating. They also supervise the preparation and service of food, develop modified diets, participate in research, and educate individuals and groups on good nutritional habits.

Diabetes education consultation with a registered practitioner.

Annual limit per person, per calendar year
$400

Benefit
Initial consult - 65%
Subsequent consult - 65%

Waiting period
2 months

Audiology is the branch of science that studies hearing, balance, and their disorders.

Annual limit per person, per calendar year
$400

Benefit
Initial consult - 65%
Subsequent consult - 65%

Waiting period
2 months

Eye therapy includes the diagnosis and non- surgical management of eye disorders and abnormalities.

Annual limit per person, per calendar year
$400

Combined annual limits for Eye Therapy and Speech Therapy

Benefit
Initial consult - 65%
Subsequent consult - 65%

Waiting period
2 months

Speech therapy is the diagnosis, management and treatment of people who are unable to effectively communicate or who have difficulty with feeding and swallowing, stroke sufferers and those who stutter.

Annual limit per person, per calendar year
$400

Combined annual limits for Eye Therapy and Speech Therapy

Benefit
Initial consult - 65%
Subsequent consult - 65%

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
$400

Annual limit per policy, per calendar year
$800

Benefit
Initial consult - 65%
Subsequent consult - 65%

Waiting period
2 months

Treatment of conditions affecting the foot, ankle and related lower extremity structures.

Annual limit per person, per calendar year
$250

Benefit
Initial consult - 65%
Subsequent consult - 65%

Waiting period
2 months

Visiting, home and registered nurse (private practice) - The annual limit of $1000 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.

Annual limit per person, per calendar year
$1,000

Benefit
Home (bush) per visit - 65%
Private practice per hour - 65%

Waiting period
2 months

Prostheses include a range of approved non-surgically implanted prostheses (eg. wigs)

Annual limit per person, every three years
$200

Benefit
65%

Waiting period
12 months

Blood Glucose Monitor A device to measure the concentration of glucose in the blood.

A doctor's letter of recommendation is required prior to claiming and are limited to one item per membership every 3 years.

Annual limit per person, every three years
$150

Benefit
65%

Waiting period
12 months

Extremity Pump is designed to aid in the reduction and control of peripheral edema, including lymphedema of the extremities and post mastectomy lymphedema, stasis dermatitis and venous stasis ulcers.

A doctor's letter of recommendation is required prior to claiming and are limited to one item per membership every 3 years.

Annual limit per person, every three years
$300

Benefit
65%

Waiting period
12 months

Nebuliser Pump is a medical device used to administer medication in the form of a mist inhaled into the lungs.

A doctor's letter of recommendation is required prior to claiming and are limited to one item per membership every 3 years.

Annual limit per person, every three years
$150

Benefit
65%

Waiting period
12 months

Sleep aponea monitor is an automatic positive airway pressure device that automatically tunes the amount of pressure delivered to the patient to the minimum required to maintain an unobstructed airway on a breath-by-breath basis by measuring the resistance in the patient's breathing, thereby giving the patient the precise pressure.

A doctor's letter of recommendation is required prior to claiming and are limited to one item per membership every 3 years.

Annual limit per person, every three years
$200

Benefit
65%

Waiting period
12 months

A TENS (Transcutaneous Electrical Nerve Stimulation) monitor is a battery-powered unit which sends electrical impulses through electrodes placed on or near the painful site. This causes a tingling sensation that reduces pain, even pain that hasn't responded to other treatments.

A doctor's letter of recommendation is required prior to claiming and are limited to one item per membership every 3 years.

Annual limit per person, every three years
$100

Benefit
65%

Waiting period
12 months

A Hearing Aid is a device to amplify and change sound to assist people with hearing impairments.

Annual limit per person, every three years
$1,200

Benefit
65%

Waiting period
12 months

Annual limit per person, per calendar year
$40

Benefit
Per repair - 65%

Waiting period
2 months

Foot Orthotics can assist in correcting disorders of the foot, ankle, and sometimes knee, leg and hip, by creating additional support to the foot from the heel, arches & right to the toe.

Must be custom made by a podiatrist or orthotist, and not by a chiropractor or physiotherapist.

Annual limit per person, per calendar year
$200

Annual limit per policy, per calendar year
$400

Benefit
Supply and fit - 65% up to $115 per item

Waiting period
12 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 and are limited to one item per membership every 3 years.

Annual limit per person, every three years
$300

Benefit
Per appliance - 65%

Waiting period
12 months

Garment that applies continual pressure over large areas of healing skin after burns, lymphodaema, or post operative surgery.

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
$200

Benefit
Per garment - 65%

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 - 65%

Waiting period
2 months

Bronze Plus Package with AIA Vitality, Silver Package with AIA Vitality, Essential Extras, Core Extras & Premium Extras:

100% of cost, limited to 1 service per person per year. Where you are entitled to any rebate or reimbursement from Medicare for any extras service, you cannot claim any out of pocket expenses with us.

Quit Smoking Program:

1 per person per year up to the annual limit on Top Extras Set Benefits, Top Extras 75% Benefits, Mid Extras Set Benefits, Mid Extras 65%, Basic Extras Set Benefits and Basic Extras 55%. Combined with Melanoma Surveillance Photography and Nicotine Replacement Patches.

Annual limit per person, per calendar year
$100

Annual limit per policy, per calendar year
$200

Combined annual limits for Melanoma Surveillance Photography, Quit Smoking Programs and Nicotine Replacement Patches

Benefit
1 per year

Waiting period
2 months

Bronze Plus Package with AIA Vitality, Silver Package with AIA Vitality, Essential Extras, Core Extras & Premium Extras:

100% up to 1 x 12 week course of patches per year.

Quit Smoking Program:

1 per person per year up to the annual limit on Top Extras Set Benefits, Top Extras 75% Benefits, Mid Extras Set Benefits, Mid Extras 65%, Basic Extras Set Benefits and Basic Extras 55%. Combined with Melanoma Surveillance Photography and Nicotine Replacement Patches.

Annual limit per person, per calendar year
$100

Annual limit per policy, per calendar year
$200

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

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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 October 2023. | 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, excluding products with AIA Vitality packages| 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. | Health insurance and AIA Vitality are separate products, with the combined price including your health insurance premium and monthly AIA Vitality fee, less 5% discount off both. When packaged with a single or single parent health insurance policy, AIA Vitality costs $10 per month (less applicable discounts) and entitles one eligible adult member to an AIA Vitality membership. When packaged with a couple or family health insurance policy, AIA Vitality costs $20 per month (less applicable discounts) and entitles two eligible adult members to AIA Vitality memberships. If you cancel your AIA Vitality membership, you will lose your associated discount on your health insurance product. | GMHBA with AIA Vitality packages are only available for members paying by direct debit. Please call 1300 425 499 if you would like the health insurance product only.