Understand your GMHBA policy
Before you embark on the next steps of your health care, it's important to understand your level of health insurance cover. Checking your cover can help you understand what benefits you're entitled to, and help you with questions for your specialist when you meet them. We can also help if you're having any problems navigating the health system.
Understanding your hospital cover
To avoid unexpected out of pocket expenses and to help you feel more comfortable about a hospital stay, we encourage you to contact our team at GMHBA as soon as you find out that you might need to go to hospital. Some things to ask:
- Am I covered for this procedure?
- Will I need to pay an excess?
- Do I have to serve any waiting periods?
- What benefits can GMHBA pay?
- Does my specialist participate in the Access Gap Cover scheme?
- Does GMHBA have a contract with the hospital I'm going to?
Know your cover
You can view your cover by logging in to the member area and downloading a fact sheet which will give you an overview of what services and benefits you’re entitled to. While the fact sheet will give you an idea of your cover, we recommend contacting GMHBA for a full review so you can have a thorough understanding of your cover, and equip you with questions for your specialist.
A 12 month waiting period applies for hospital treatment for new members who have pre-existing conditions (PEC). This means that both new members and current members who are upgrading to a higher level of hospital cover, must wait 12 months to access higher hospital benefits for that condition (other than for psychiatric, rehabilitation and palliative care which have a 2 month wait).
If you haven’t held your current level of cover for at least 12 months, you are required to go through the PEC check for any hospitalisation. This involves asking your GP and specialist their written opinion on whether your condition is pre-existing. The process can take some time and it’s best to get this done as soon as possible to confirm whether GMHBA can cover your procedure. The documentation will then be assessed by a medical practitioner appointed by GMHBA, who will decide whether your condition is deemed pre-existing or not.
If you need more information about the PEC process, please contact us.