GMHBA Health Insurance Review
GMHBA (Geelong Medical and Benefits Association) commenced its humble beginnings 80 years ago in Geelong, Australia, when a group of Australian Cement Factory workers pooled their resources together to create the Cement Workers Hospital Benefits Scheme. The rising cost of health care prompted them to develop the scheme so that their colleagues and families could have access to quality and affordable health care.
The success of the scheme caught the attention of the Geelong Community and at a public meeting called by the Mayor; a new open scheme was formed, allowing access to individuals and families outside of the industrial sector.
In 1958, the fund became the Geelong Medical and Hospital Benefits Association.
In the year 2000, it became the GMHBA Limited and expanded its reach outside of the Geelong community. GMHBA now provides private health care to over 300,000 Australians across the country and remains a member-based, nonprofit organization that prides itself on playing an active role in the building of community health and wellbeing.
GMBHA is partnered with AIA Vitality, an international wellbeing program that incentivizes members to be proactive with their health by offering rewards for nurturing healthy habits and choices.
GMHBA Key Facts
Founded: 1934
For-Profit or Not-For-Profit?: Not-For-Profit
Private Hospital Agreements Nationwide: 285
Day Hospital Agreements Nationwide: 274
Headquarters: Geelong, VIC
Health Deal Represented?: No
GMHBA Hospital Cover
GMHBA offers policies suitable for all needs and ages, ranging from Basic Plus Hospital to Gold Ultimate Hospital cover. All of these policies provide coverage for your stay as a private patient and as a minimum benefit include restrictive cover for rehabilitation, psychiatric, and palliative services. Here is a list of some of the current hospital covers available:
- Basic Plus Hospital
- Bronze Essential Hospital
- Bronze Hospital Plus
- Silver Core Hospital
- Silver Plus Hospital
- Silver Plus Classic Hospital
- Silver Plus Premium Hospital
- Gold Ultimate Hospital
GMHBA Combined Cover
Hospital and extras covers can be bought individually or combined to provide members with a more comprehensive health care package. Here is a list of some of the current combined covers available:
- Basic Plus Package
- Bronze Plus Package
- Bronze Plus Choice Package
- Silver Package
GMHBA Waiting Periods
GMHBA recognises the waiting periods you have already served with a previous health fund if you switch, this is called “portability”. For first-timers taking out a hospital cover, members who may have lapsed in hospital coverage and those upgrading their level of cover, the waiting periods below will have to be served before members can claim on services:
GMHBA Wait Periods
- New Conditions: 2 Months
- Pregnancy and birth-related services: 12 months
- Pre-existing conditions: 12 months
- Rehabilitation & Palliative care: 2 months
- Weight Loss Surgery: 12 months
How Do You Claim Extras With GMHBA?
On the spot: Swipe your membership card at a health provider that uses the HICAPS system to have your claim processed immediately.
Online: You can log into your online account through their website and lodge your claim by providing the details on your receipt.
Mail: You can lodge your account by posting to GMHBA a completed form along with the relevant accounts and receipts.
What is GMHBA Gap cover?
GMHBA’s gap cover is called Access Gap Cover. If your doctor charges you more than the standard MBS fee, this is known as the ‘gap’ and can leave you with an out-of-pocket expense. Access Gap can help to minimise or eliminate personal expense but it is the choice of the physician to participate in any given gap scheme.
GMHBA Health Insurance: Gap Cover Ratings By State
You can gauge how efficient a gap scheme is by comparing health funds in the same state or territory and determining which of the fund offers a greater proportion of medical services covered at no gap. While it is more likely that a medical service covered under your fund can be utilised at no personal cost to the customer, it is entirely the choice of the physician whether or not to participate in the gap scheme.
Medical Services with No Gaps: The percentage of claims that were fully refunded.
Medical Services with No or Known Gaps: The percentage of claims that were fully refunded, or where the policy holder knew the cost before the surgery was performed.
The information below outlines the percentages of services covered under no-gap and known-gap.
GMHBA Medical Services with No Gap: 50.9%
Industry Average 79.1%
GMHBA Medical Services with No or Known Gap: 77.3%
Industry Average: 90.5%
GMHBA Medical Services with No Gap: 74.6%
Industry Average: 89.5%
GMHBA Medical Services with No or Known Gaps: 90.9%
Industry Average: 95.7%
GMHBA medical services with No Gap: 80.1%
Industry Average: 86.7%
GMHBA medical services with No or Known Gap: 92.8%
Industry Average: 95.1%
GMHBA medical services with No Gap: 81.3%
Industry Average: 89.2%
GMHBA medical services with No or No or Known Gap: 93.7%
Industry Average: 94.5%
GMHBA medical services with No Gap: 80.0%
Industry Average: 89.5%
GMHBA medical services with No or Known Gap: 94.9%
Industry Average: 96.6%
GMHBA medical services with No Gap: 70.8%
Industry Average: 84.4%
GMHBA medical services with No or Known Gap: 85.2%
Industry Average: 96.2%
GMHBA Medical Services with No Gap: 78.3%
Industry Average: 90.2%
GMHBA Medical services with No or Known Gap: 89.5%
Industry Average: 96.7%
GMHBA Medical Services with No Gap: 61.0%
Industry Average: 84.2%
GMHBA Medical Services with No or Known gap: 89.5%
Industry Average: 93.8%
