The Lifetime Health Cover (LHC) loading is a Government loading on your private hospital cover premiums. It was introduced on July 1, 2000 to encourage people to take out private hospital cover earlier, and to maintain their cover.
This determines what government rebate will be applied, find out more.
Hospital services
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 hospital treatment.
Hospital waiting period durations – when treatment or service is included on your cover – are as follows:
Waiting period: 0 days (accidents must occur after joining)
Accidents - bodily injuries resulting from accidents which occur after the date of joining GMHBA or upgrading to a higher cover.
Waiting period: 2 months
Any other benefit for hospital (or hospital substitution) treatment unless otherwise stated.
Waiting period: 12 months
Obstetrics and maternity, pre-existing ailment, illness or condition (other than psychiatric, rehabilitation and palliative care).
Extras services
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.
Waiting periods for extras services – when included on your cover – are as follows:
Waiting period: 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), 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.
A pre-existing condition is one where signs or symptoms of your ailment, illness or condition, in the opinion of a medical practitioner appointed by GMHBA (not your own doctor), existed at any time during the six months preceding the day on which you purchased your hospital insurance or upgraded to a higher level of hospital cover and/or benefit entitlement.
A special waiting period applies to obtain benefits for hospital treatment for new members who have pre-existing conditions. The waiting period also applies to existing members who have recently upgraded their level of hospital cover. If the ailment, illness or condition is considered pre-existing:
New members
New members must wait 12 months for any hospital benefits (other than psychiatric, rehabilitation and palliative care).
Existing members (transferring or upgrading)
Members transferring/upgrading to a higher hospital cover must wait 12 months to get the higher hospital benefits (other than psychiatric, rehabilitation and palliative care).
GMHBA extras can have several different types of benefit limits, depending on your cover. The limit type for applicable services is outlined in the fact sheet for each cover.
Annual limits – Most benefit limits are annual limits, which reset each calendar year on 1 January. Annual limits apply to each individual on the membership, unless otherwise specified. Keep in mind, some services also have a multi-year limit or lifetime limit.
Smart limits – Offered on SmartCare Extras covers only, a Smart Limit is a flexible annual limit that you can choose to spend across included services (excluding optical) each year, either with or without sub-limits depending on the cover.
Per person limits – The total amount an individual on the policy can claim on a service per calendar year.
Membership limits – The maximum amount that can be claimed in a calendar year per policy. This limit is shared between all people on the membership.
Sub-limits – The total amount you can claim on a particular service or treatment within the overall annual limit. These can vary from service to service.
Combined limits – This is a single limit that can be used across a collection of services.
Multi-year limit – The maximum amount you can claim, every few years.
Lifetime limit – This applies for orthodontic treatment only, per person on the membership, and is the maximum amount that can be claimed for the service during your lifetime.
Restricted services are limited to a minimum (default) benefit as set by the Australian Government for accommodation as a private patient in a shared room of a public hospital. The benefit does not cover the cost of a private room in a public hospital or any room in a private hospital, and does not cover theatre costs. If you are admitted to a private hospital for treatment that is restricted by your policy, large out-of-pocket expenses will apply.
Services, procedures and treatments included in your health insurance cover.
Services, procedures, or treatments not included in your health insurance cover.
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 2026. | 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.
Price shown is inclusive of any discount entitlement. Premium may vary if your details change. Pricing and displayed product can change if details vary.
If you're 18-29, you will receive the below discount on your hospital cover as determined by your age. Learn more about how this works.
| Age when taking out cover | % age based discount |
|---|---|
| 18-25 years old | 10% |
| 26 years old | 8% |
| 27 years old | 6% |
| 28 years old | 4% |
| 29 years old | 2% |
| 30 years old | 0% |
Each year private health insurers review the cost of healthcare and use this information to adjust premiums. Any change must be reasonable and approved by the Federal Health Minister.
We want you to know now so you're not disappointed when you sign up today and see your premium change in April.
The amount of money a member agrees to pay for a hospital stay before GMHBA pay benefits. The excess is per person, calendar year based. Selecting a higher excess will lower the premium. No excess applies for child dependants under 21 on select GMHBA hospital covers. Please check your fact sheet for more information.
With SmartCare Extras you can choose how you'd like to spend your Smart Limit on included services (excluding optical*) each year.
No sub-limits
Choose how much of your Smart Limit you’d like to use on any of the included services*.
With sub-limits
For a slightly lower price, included services* will have a sub-limit, meaning you can claim up to a certain amount on each service up to your total Smart Limit.
*Optical is only available on SmartCare Boost Extras when you purchase combined cover (extras and eligible hospital cover) and has its own separate annual limit.
What's the difference?
Percentage back allows you to get a percentage of the overall charge for each claim, up to your annual limits or sub-limits.
With set benefits you get a set dollar amount back on each claim, each time you visit the provider (up to your annual limits, sub-limits or dental service limits). To see the exact benefit amount for popular services, simply click on the drop-down in the cover details below.