COVID-19 information for members

• GMHBA has introduced new support measures, which mean existing members with hospital cover will be covered for all COVID-19 related hospital treatments as a private patient, as long as you have served your initial two-month waiting periods.
• This COVID-19 coverage will be provided initially until the end of September 2020, with the intent to review and consider any possible further extension prior to 30 September 2020.
• We have added wording to hospital eligibility checks to confirm coverage for all of our members with hospital cover so the hospitals are aware that you will be covered. 

• Coronavirus does not have its own clinical category or MBS item number.
• If you are admitted into hospital to determine the root cause of the presenting illness, this is covered the same way as it would for any other medical admission, eg. flu/pneumonia.
• If you are admitted to hospital as a result of a condition developed following contracting coronavirus, the condition will come under the applicable clinical category, eg. Lung and Chest.

• We don't cover outpatient appointments such as GP appointments, blood tests etc.
• These rules will continue to apply as normal, including for coronavirus.

• If you buy health insurance now to be covered for coronavirus, the standard two-month hospital waiting periods will apply before you are able to claim benefits.
• The rules in relation to pre-existing conditions for hospital cover will not apply.

Yes. You may be able to suspend your cover due to financial hardship if you've had an active GMHBA health insurance policy for at least six months. 

During a suspension period, you won't need to pay your premium, but you also won't be able to claim on services for this period of time.

Additional suspension measures we have put in place for members who may be experiencing financial hardship as a result of the COVID-19 pandemic include:

• Suspension for up to 12 months.
• Waiving the minimum suspension period so you can reactivate at any time you need.  

Find out more or talk to one of our customer service representatives about your situation and they can guide you through the things to consider, ensure you have the right level of affordable cover and answer any questions.

As with any other type of suspension, you are not able to claim benefits while your cover is suspended.

• On 21 April, the Federal Government announced that elective surgery will resume from 27 April.
• The reintroduction of elective surgeries will be staged, determined by clinicians and include:
  • procedures representing low risk, high value care as determined by specialist societies
  • selection of patients who are at low risk of post-operative deterioration
  • children whose procedures have exceeded clinical wait times
  • assisted reproduction; endoscopic procedures; screening programs; and critical dental procedures.
• If you have a pre-booked hospital admission or ongoing hospital treatment, we encourage you to regularly check in with your doctor and hospital before your admission for the most up-to-date information.

• Increasing premiums is not a decision GMHBA has made lightly. Going ahead with the 1 October increase is about ensuring we can continue to be here for our members in the short and long term.
• No health fund wants to increase premiums, however premiums go up each year because health care costing are increasing. Health inflation has not been affected by the COVID-19 pandemic.
• Putting our 1 April premium increases on hold was a significant support measure GMHBA provided to members and the 1 October premium increase is still one of the lowest average increases in the past 10 years. 
• We are now focusing on providing more targeted financial relief to those who are still experiencing hardship at this time.

Eligible members who are continuing to experience financial hardship due to COVID-19 can access either:

• Temporary premium reduction of 30% for a period of three months if you are accessing JobKeeper or JobSeeker.
• Membership suspension, with the ability to reactivate your cover at any time you need.

Find out more details on our financial assistance options including eligibility criteria.  

• During elective surgery restrictions, health funds have continued to cover vital surgery, mental health treatments, telehealth and allied health services.
• We also introduced telehealth benefits for a wide range of extras services for members with extras cover to ensure services can still be utilised.

We won’t be rolling over unused extras limits, however GMHBA has introduced the following initiatives to ensure extras services can still be utilised:

• Telehealth benefits are available for a wide range of services for members with extras cover.
• GMHBA partnered with Kieser to offer our members access to the Kieser Konnect app, as well as telehealth or in-centre Kieser physiotherapy, with no out of pocket costs, up to annual limits.
• Benefits for telehealth and face-to-face physiotherapy consultations with no out of pocket costs up to annual limits are also available to GMHBA members in partnership with Geelong Physiotherapy.

Yes – your premium amount from 1 October 2020 is the same amount that was originally due to take effect from 1 April 2020, which we communicated to members in February 2020.

If you’ve paid your premiums in advance prior to 1 October, there’s nothing you need to do. These payments have been locked in at your pre-1 October rate.

• As a not for profit health, GMHBA will not profit from the COVID-19 pandemic and will continue to provide ongoing support for our members during this difficult time.
• Since the start of the pandemic, GMHBA has continued to put our members first and has provided a significant member support package to help our members throughout the pandemic.
• During elective surgery restrictions, health funds have continued to cover vital surgery, mental health treatments, telehealth and allied health services.

Australia’s private health insurance is based on a system of community rating. All members pay the same premium for the same policy and insurers cannot discriminate against members based on health status or claims history. This system is intended to keep health insurance fair and accessible for all Australians.

We review the premium of each product individually and make changes based on the type of product (e.g. hospital or extras, level of cover), claiming activities and the state that members live in. These changes are needed to make sure the fund and our products are sustainable and we can keep paying claims.