How to claim

Claiming works differently depending on whether you're claiming for hospital costs, medical (doctor or specialists costs in hospital) costs, or extras provider costs.

How do I claim for extras services?

There are a number of ways you can claim your extras benefits:

Most claims can be processed on the spot when you have your appointment. Simply swipe your GMHBA membership card when paying for your appointment, and GMHBA pays the provider directly, so you just have to pay the difference. Please note, some providers may not have this facility.

If you need to claim through GMHBA directly, you can do this easily in the online member self service centre, if you're registered for online member services.

Login and claim

If you prefer to claim in person, you can visit a GMHBA branch with an itemised receipt and/or account.

Alternatively, you can complete a GMHBA claim form and post to GMHBA along with your itemised receipt and/or account, or lodge your claim at a Medicare office who will forward to GMHBA for processing. Please note that paper receipts will not be mailed back to members after a claim has been made. If you would like to retain a copy of your receipts for your records, you will need to make a copy prior to mailing your receipts to us. If you would like to keep your original receipt, no problem – you can make your claim online.

Which extras providers can I use?

As long as your provider is registered with the appropriate board for their field, and practising in a private practice, you can claim for their services with GMHBA (provided that you're covered for the relevant service).

If you want to confirm that your provider is listed with GMHBA, you can also contact us, or ask when booking your appointment.

How do I claim if I go to hospital?

Hospital costs

Private hospitals

In a private hospital with health insurance - provided that the hospital you have chosen is on the health fund’s participating hospital list and your membership does not exclude this procedure, the only amount that you have to pay for hospital costs is your excess and co-payments (if applicable) if you have one. All other agreed costs are billed to the health insurer after you’ve gone home.

If you chose to have no excess or co-payments on your hospital cover, there will be nothing to pay.

Public hospitals

In a public hospital with health insurance - referred to as 'private patient in a public hospital' - provided your membership does not exclude the procedure the only amount that you will have to pay for hospital costs is your excess if you have one. All other costs are billed to health insurer after you've gone home.

Which hospitals are on GMHBA's "participating hospital list"?

Check the list of participating private hospitals. This is subject to change, so to be 100% sure, either ask the hospital, or contact us.

Medical costs

Medical costs are processed differently to hospital costs. How they are paid depends upon whether or not your doctor is participating in your health fund's Gap Cover Scheme. You can find out if your doctor is participating by asking them prior to treatment.

If your doctor is participating with your health insurerIf your doctor is not participating with your health insurer
  1. The bill for your medical costs is sent to Medicare and your health insurer.
  2. Medicare and your health insurer pay their portion directly to the doctor.
  3. The doctor sends you a bill for whatever is not covered by Medicare or your health insurer (your out-of-pocket expenses).
  1. After you have left the hospital, take your paperwork to Medicare. They'll issue cheques and medical statements.
  2. You send the medical statements to your health insurer, and your health insurer will send you cheques for payment.
  3. You send these cheques and the Medicare cheques to your doctor.
  4. The doctor sends you a bill for whatever is not covered by Medicare or your health insurer (your out-of-pocket expenses).

Which doctors are participating with GMHBA?

Doctors can opt to use GMHBA's Gap Cover Scheme on a case by case basis, so it's best to confirm with your doctor directly. If they aren't registered you can ask whether they would be willing to participate in GMHBA's Gap Cover Scheme. You can also contact us to check whether your doctor has previously registered to participate in GMHBA's Gap Cover Scheme.