Accident Protection

We understand that no one sees an accident coming, so you might not have thought to include some services on your cover. That’s why, as of 1 April 2023, we will pay benefits towards hospital treatment for services that are normally excluded or restricted on your cover if you need them because of an accident on eligible GMHBA hospital products.

GMHBA will pay benefits towards participating private hospital theatre surgery costs, plus shared or private room accommodation charges in a private hospital or shared room accommodation charges in a public hospital. Outpatient medical treatment and Emergency Department fees are not claimable. Fixed benefits are payable in a non-participating private hospital.

What counts as an accident?

An accident is defined as an unforeseen event occurring by chance and caused by an external force or object, which results in involuntary injury to the body. We will pay benefits towards any accidental injuries that happen after joining GMHBA. No waiting period applies, but the accident must have occurred after joining.

What is Accident Protection Cover?

If you have an accident, we will pay benefits towards treatments that are normally excluded or restricted on your cover, when initial treatment is sought through a doctor or an Emergency Department within 48 hours of sustaining the injury. Any related hospital admission must occur within 90 days from date of injury, and a doctor’s letter or hospital report must be supplied to GMHBA for benefits to be paid.

For example, if you held GMHBA Basic Plus Starter hospital cover, the Bone, joint and muscle clinical category is excluded. If you were unlucky enough to have an accident playing social sport that resulted in a bone fracture, you would still be eligible for benefits for this treatment even though the category is not an inclusion on your policy.

There are some services that are not eligible to be considered an accident. GMHBA’s definition of Accident excludes:

  • Medical conditions (disease or illness that is not immediately due to an external injury)
  • Pre-existing conditions
  • Pregnancy, birth and IVF procedures
  • Accidents arising from surgical procedures
  • Elective cosmetic surgery
  • Podiatric surgery by an accredited podiatrist
  • Sudden illness
  • Injuries due to [or caused by] alcohol or drug use, or drugs not prescribed by a registered practitioner
  • Aggravation of an existing condition
  • Damage to teeth caused by eating or drinking
  • Claims covered by third parties (such as Workcover and TAC)

Following the initial admission that has occurred within 90 days, if you require a follow up procedure that is directly related to the accident, we will also pay benefits under your Accident Protection cover. Benefits are limited to inpatient hospital treatment for services with a valid Medicare Benefits Schedule item.

Please view your product fact sheet to determine if your policy includes Accident Protection cover.