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Gold Optimum Hospital and SmartCare Everyday Boost Extras with sub-limits
*For new members joining on combined hospital and extras cover and paying by direct debit, who have not been a GMHBA member in the last 12 months. Must pay first month premium to receive offer. Other waits (including hospital waits), annual and sub limits apply. Extras claims made with a previous fund count towards annual limits. Offer only available via GMHBA website, phone and branch or GMHBA corporate program. Not available in conjunction with any other offer. GMHBA may end this offer at any time without notice.
Inclusions
Hospital treatment of the tonsils, adenoids and insertion or removal of grommets.
Hospital treatment for surgery for joint reconstructions.
Hospital treatment for the investigation and treatment of a hernia or appendicitis.
Hospital treatment for the investigation and treatment of the female reproductive system.
Hospital treatment for surgery to the teeth and gums.
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 for the investigation and treatment of diseases, disorders and injuries of the musculoskeletal system.
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 diagnosis, investigation and treatment of the internal parts of the gastrointestinal system using an endoscope.
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 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.
Hospital treatment for the investigation and treatment of the back, neck and spinal column, including spinal fusion.
Hospital treatment for physical rehabilitation for a patient related to surgery or illness.
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.
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 to correct hearing loss, including implantation of a prosthetic hearing device.
Hospital treatment for the investigation of sleep patterns and anomalies.
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 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 treatment and care of patients with psychiatric, mental, addiction or behavioural disorders.
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 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.
Boost inclusions
Access any remaining annual limit/s (excluding optical) not used in a calendar year for a further 12 months with annual limit rollover.
How does it work?
- Once you are eligible, your annual limit will start to rollover at the next effective annual limits reset date.
- Annual limits reset or rollover on 1 January each year.
- The new calendar year’s annual limit must be reached first before you can access the remaining annual limit rolled over from the previous calendar year.
How can I get it?
- Annual Limit Rollover is offered when you join on combined hospital and SmartCare Extras covers only.
- You must hold active, continuous GMHBA SmartCare Boost Extras cover at the same level (Starter, Everyday or Complete) for a minimum of 12 months before you are eligible for annual limit rollover.
Includes prescription glasses (frames and lenses) and contact lenses. Non-prescription sunglasses and repairs are excluded.
Annual limit
$200* per person, per calendar year
*Excludes annual limit rollover
An additional $100 annual limit is available (per person) at GMHBA Eye Care, once annual limit is utilised.
Benefit
100%
Waiting period
6 months
Inclusions
Diagnostic services, simple extractions (not including surgical extractions of wisdom teeth) and fillings.
Preventative dental
Includes routine dental check-ups, professional cleaning and topical application of remineralisation agents.
Annual limit (sub-limit)
$500 per person, per calendar year
Combined $1,000 annual limit for included services, excluding optical.
Benefit
60% - general dental
100% - preventative dental
Waiting period
2 months
Major dental services including full & partial dentures, crown & bridgework, endodontic services such as root canal, gold fillings, indirect restorations, surgical extractions of a tooth/teeth (including wisdom teeth).
Annual limit (sub-limit)
$500 per person, per calendar year
Combined $1,000 annual limit for included services, excluding optical.
Benefit
60%
Waiting period
12 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.
Annual limit (sub-limit)
$500 per person, per calendar year
Combined $1,000 annual limit for included services, excluding optical.
Benefit
60%
Waiting period
2 months
Chiropractors 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 (sub-limit)
$500 per person, per calendar year
Combined $1,000 annual limit for included services, excluding optical.
Benefit
60%
Waiting period
2 months
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
Annual limit (sub-limit)
$500 per person, per calendar year
Combined $1,000 annual limit for included services, excluding optical.
Benefit
60%
Waiting period
2 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 (sub-limit)
$500 per person, per calendar year
Combined $1,000 annual limit for included services, excluding optical.
Benefit
60%
Waiting period
2 months
Acupuncture treatment involves inserting small needles into various points in the body to stimulate nerve impulses.
Annual limit (sub-limit)
$500 per person, per calendar year
Combined $1,000 annual limit for included services, excluding optical.
Benefit
60%
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 (sub-limit)
$500 per person, per calendar year
Combined $1,000 annual limit for included services, excluding optical.
Benefit
60%
Waiting period
2 months
Treatment of conditions affecting the foot, ankle and related lower extremity structures.
Annual limit (sub-limit)
$500 per person, per calendar year
Combined sub-limit for podiatry and orthotic appliances (foot).
Combined $1,000 annual limit for included services, excluding optical.
Benefit
60%
Waiting period
2 months - standard and comprehensive treatment
12 months - surgical procedures
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 and right to the toe.
Must be custom made by a podiatrist or orthotist, and not by a chiropractor or physiotherapist.
Annual limit (sub-limit)
$500 per person, per calendar year
Combined sub-limit for orthotic appliances (foot) and podiatry.
Combined $1,000 annual limit for included services, excluding optical.
Benefit
60%
Waiting period
12 months
Individual or group consultations with a psychologist.
Annual limit (sub-limit)
$500 per person, per calendar year
Combined sub-limit for psychology and mental health support.
Combined $1,000 annual limit for included services, excluding optical.
Benefit
60%
Waiting period
2 months
Individual and group consultations with a counsellor, mental health social worker or mental health nurse.
Annual limit (sub-limit)
$500 per person, per calendar year
Combined sub-limit for mental health support and psychology.
Combined $1,000 annual limit for included services, excluding optical.
Benefit
60%
Waiting period
2 months
Smart Care Boost 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.
GMHBA SmartCare Boost Extras can have the following benefit limits:
- Smart Limits: This is a flexible annual limit that you can choose to spend across included services (excluding optical) each calendar year, either with or without sub-limits depending on the cover.
- Annual limits reset each calendar year on 1 January. This means if you use all of your Smart 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 policy, unless otherwise specified.
- Annual limit rollover is offered on SmartCare Boost Extras covers only. Once members have served a full 12 months on their SmartCare Boost Extras cover they will become eligible for annual limit rollover. Eligible members can then have their unused annual limits for included extras services (excluding optical) carried over into the next calendar year on 1 January and access these for a further 12 months.
- Sub-limits: A sub-limit is the maximum amount that can be claimed for a particular service or treatment within an overall Smart Limit. SmartCare Extras covers can be taken out with or without sub-limits.
- Combined limits: This is a single limit that can be used across a collection of services.
- Per person limits: All sub-limits and combined limits on SmartCare Extras apply per person meaning that no one person can claim more than the per person limit each calendar year.
- Lifetime limits: This applies for orthodontic treatment only, per person on the membership. Once you have claimed the maximum lifetime limit, you will not be eligible to claim any further orthodontic benefits during your lifetime, and your benefits won’t re-accrue or reset. This information is shared between health funds, and your lifetime limit will not reset if you transfer your policy.
Annual limits reset on 1 January each year for services included on SmartCare Boost Extras.
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.
Annual limit rollover is offered when you join on combined eligible (open) hospital and SmartCare Boost Extras covers only.
Once you are eligible (see below), your annual limit for included services (excluding optical*) will start to rollover at the next effective annual limits reset date. Annual limits reset or rollover on 1 January each year.
Note that the new calendar year’s annual limit must be reached first before you can access the remaining annual limit rolled over from the previous calendar year.
How do I become eligible?
You must hold active, continuous GMHBA SmartCare Boost Extras cover at the same level (Starter, Everyday or Complete) for a minimum of 12 months before you are eligible for annual limit rollover.
*Optical has a standalone annual limit on SmartCare Boost Extras and is not included in the annual limit rollover.
Remaining extras overall annual limits and optical limits can be viewed in the GMHBA app or member area, once extras waiting periods have been served.
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.