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1 Fit and active cover

2 Why take out private health insurance? Your fit and active lifestyle keeps you healthy but it pays be take out private health insurance with special rewards for your way of life. We understand the decision to get private health insurance can be challenging and poses many questions: Why do I need it?, What does it cover? and How much can I save on tax? In this brochure, we hope to answer all of these questions and more. We are here to help you at every step. Let us look at your specific needs to help determine the best cover for you. So, here are the basics first. Avoid paying higher premiums after you turn 31 By taking out hospital cover before the 1st of July following your 31st birthday, you will avoid paying a higher premium. After this date, you pay an extra 2% on premiums for each year you don t have hospital cover. The Australian Government introduced the Lifetime Health Cover Loading (LHC) to encourage people to take out hospital cover early in life and maintain it. So, every year you wait adds additional costs to your premium, and when you finally do take out hospital cover, your premium could increase 2% a year up to 70%. If you re a couple, any applicable loadings are shared across your membership. Australian Government Rebate The Australian Government Rebate reduces the cost of private health insurance and makes your cover more affordable. This rebate is available to any Australian who is eligible for Medicare and, depending on your income and the age of the oldest person on your policy, the government may pay a percentage of your premium. The rebate applies to all GMHBA covers and there are a number of ways to claim the Australian Government Rebate: As a premium reduction through GMHBA or as; A lump sum payment when lodging your annual tax return. Minimise tax If your taxable income is over the amount set by the government, you can avoid paying the extra 1%-1.5% Medicare Levy Surcharge by taking out any one of our hospital covers. The cost of some GMHBA hospital covers could be cheaper than paying the Medicare Levy Surcharge. You can find more information at privatehealth.gov.au or ato.gov.au It s easy to avoid the additional loading. Take out hospital cover by the 1st July, following your 31st birthday and ensure you have continuous cover. ii

3 Why choose GMHBA Health Insurance? As an Australian not for profit health fund with 80 years experience, we put people before profit and are the health insurer of choice for more than 230,000 Australians. Our range of affordable health covers deliver real value, great benefits and the freedom to choose your own provider, not one that s chosen for you. Through our personalised approach and exceptional customer service, we provide more choice and flexibility when it comes to the health of you and your family. Not for profit Money back guarantee Multi award winner Established insurer Australia wide Friendly expert staff Easy online claims 1

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5 Fit cover rewards your active lifestyle Fit Rewards is a new way of rewarding people for keeping fit and staying active. Fit Rewards is the first rewards system of its kind in Australia and is exclusive to GMHBA Health Insurance members with Fit packages. Fit Rewards gives you the chance to earn rewards for doing what comes naturally to you being fit and active. You can earn points through a variety of activities, from participating in a fun run to playing your favourite team sport, even getting a health check from your GP. We have partnered with the best names in the sporting and fitness industry to bring you unique sporting benefits. Thanks to our fantastic sporting program partners and other national sporting bodies, we have exclusive rewards that you will not find anywhere else. Here is how it works Fit members will receive points for activities such as: Taking part in a triathlon; Taking part in a Cycling Australia bike ride; Taking part in a fun run; Enrolling in AusKick; Participating in Little Athletics; Purchasing a club membership; Taking part in swimming events; Taking part in walking events; and A number of other health improving activities. The more points you earn, the faster you can access our fantastic range of sporting rewards. So get fit and be rewarded. It really is that easy! For more information on Fit Rewards please visit gmhba.com.au/fitrewards 3

6 About our Fit cover GMHBA is the only health fund with specially designed sports and fitness products to get you back in the game faster. GMHBA Fit packages have been developed alongside some of Australia s most respected sports and medical associations and leading sporting and fitness bodies. GMHBA Fit packages offer you four hospital and extras packages giving you ultimate fitness cover at an affordable price. We know that sport and fitness is important to you, so GMHBA Fit packages offer: Higher benefits for injuries more likely to occur when participating in sport, fitness or adventure activities, such as knee arthroscopies, knee and shoulder reconstructions and fractures; Enhanced claiming limits for physiotherapy, dental and chiropractic so that you can maintain your optimal level or get back in the game with greater confidence; Exclusive membership to Fit Rewards, Australia s first health insurance rewards program of its kind where you earn points for keeping fit and staying active and exchange them for great retail offers and sporting equipment; and More rewards the longer you stay with us such as increased annual limits. Put simply, GMHBA Fit packages give you more to keep fit, play sport and stay active. GMHBA s Fit range is about encouraging, supporting and rewarding active people and their communities. Through various activities, GMHBA is putting significant funding back in the hands of clubs and communities, to improve and protect the health and wellbeing of grassroots fitness and sport participation in Australia. Fit Entry Package Fit Entry Package gives you just in case hospital and extras cover designed specifically for healthy and active people. Fit Standard Package Fit Standard Package offers you cost effective hospital and great extras cover for active sports enthusiasts. Fit Top Package Fit Top Package leaves nothing to chance with top hospital and great extras cover for the weekend warrior. Fit Ultra Package Fit Ultra Package gives you total peace of mind with comprehensive hospital and extras cover for the everyday athlete. 4

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8 Fit Entry Package Providing just in case hospital and extras cover, Fit Entry offers great benefits at an affordable price to help you maintain your active lifestyle. Fit Entry covers you for treatment as a private patient in a public hospital 1 (with some exclusions), plus cover as a private patient in a participating private hospital^ for selected services. What is covered in a participating private hospital? Please note: benefits for a single room in a public hospital or treatment in a private hospital for non-listed selected services when using Fit Standard cover will result in significant out of pocket expenses. For further information please call us on Fit Entry provides cover for the following services in a participating private hospital 1. Knee arthroscope Knee reconstruction Ankle reconstruction Shoulder reconstruction Surgery to repair a fractured collarbone, fractured wrist, hand or finger Surgically implanted prostheses (Government Prostheses List group benefits): benefits are no higher than the no gap government prescribed benefit. 1 Limited benefits may apply to cosmetic surgery and high cost drugs. Drugs purchased outside of hospital are not included. You may be subject to doctors waiting lists in a public hospital. Default benefits are paid for all public hospital episodes. ^ Other private hospitals fixed benefits are payable in non-participating private hospitals. # Publicly funded ambulance services and State Government ambulance transport schemes are excluded. Exclusions Pregnancy and birth related services IVF and related services Joint replacement Cosmetic surgery Cataract and corneal surgery Haemodialysis Gastric banding and all obesity surgeries Cochlear ears Waiting periods Please refer to page 16 regarding waiting periods and pre-existing conditions. What extras are covered? The following extras have been specially selected to support your active lifestyle. Acupuncture Naturopathy Myotherapy Homeopathy Ambulance subscription # Chiropractic Osteopathy Remedial massage Podiatry Major dental General dental Optical Physiotherapy/hydrotherapy Psychology Dietetics Exercise physiology 6

9 Fit Standard Package With cost-effective hospital cover and great extras, Fit Standard is an ideal package for active sports enthusiasts. Ideal for active sports enthusiasts, Fit Standard Package covers you for treatment as a private patient in a public hospital 1 (with some exclusions), plus cover as a private patient in a participating private hospital^ for selected services. What is covered in a participating private hospital? Please note: benefits for a single room in a public hospital or treatment in a private hospital for non-listed selected services when using Fit Standard cover will result in significant out of pocket expenses. For further information please call us on You re covered in a participating private hospital 1 for the following services. Knee arthroscope Knee reconstruction Ankle reconstruction Shoulder reconstruction Surgery to repair a fractured collarbone, fractured wrist, hand or finger Surgically implanted prostheses (Government Prostheses List group benefits): benefits are no higher than the no gap government prescribed benefit. 1 Limited benefits may apply to cosmetic surgery and high cost drugs. Drugs purchased outside of hospital are not included. You may be subject to doctors waiting lists in a public hospital. Default benefits are paid for all public hospital episodes. 2 When provided by a sports titled or sports specialist member of the Australian Physiotherapy Association (APA), or other GMHBA preferred provider. ^ Other private hospitals fixed benefits are payable in non-participating private hospitals. # Publicly funded ambulance services and State Government ambulance transport schemes are excluded. Exclusions Pregnancy and birth related services IVF and related services Joint replacement Cosmetic surgery Cataract and corneal surgery Haemodialysis Gastric banding and all obesity surgeries Cochlear ears Waiting periods Please refer to page 16 regarding waiting periods and pre-existing conditions. What extras are covered? Acupuncture Naturopathy Myotherapy Homeopathy Ambulance subscription # Chiropractic Osteopathy Remedial massage Podiatry Major dental General dental Optical Orthotic appliances (foot) Physiotherapy/hydrotherapy Preventative health assessment 2 Psychology Dietetics Exercise physiology 7

10 Fit Top Package Leave nothing to chance with top hospital and great extras cover for the weekend warrior. We know that leading a healthy and active lifestyle is important. Fit Top cover offers you great benefits to maintain your health and recover well through physiotherapy and massage. Plus, if you re planning to extend your family, Fit Top Package has you covered. What is covered in a private hospital? Fit Top provides cover for the following selected services as a private patient in a participating private hospital 1. Hospital treatment, including accommodation as a private patient in a participating private^ or public hospital Increased medical gap cover (access to increased benefits when treated by a doctor or specialist if admitted to hospital) see page 18 for details Higher medical benefits for injuries more likely to occur playing sport Private hospital accommodation^ single room or shared room (where available) Delivery suite Intensive and coronary care Same day treatment Surgically implanted prostheses (Government Prostheses List group benefits) 2 Benefit limitation periods A 24 month benefit limitation period applies to the following services: psychiatric, haemodialysis, gastric banding and all obesity surgeries. For more information visit gmhba.com.au or call Exclusions Hospital treatment for which Medicare pays no benefit, eg most cosmetic surgery What extras are covered? The following extras have been specially selected to support your active lifestyle. Acupuncture Naturopathy Myotherapy Homeopathy Ambulance subscription # Chiropractic Osteopathy Remedial massage Podiatry Major dental General dental Optical Orthotic appliances (foot) Physiotherapy/hydrotherapy Preventative health assessment 3 Psychology Dietetics Exercise physiology 1 Limited benefits may apply to cosmetic surgery and high cost drugs. Drugs purchased outside of hospital are not included. You may be subject to doctors waiting lists in a public hospital. Default benefits are paid for all public hospital episodes. 2 Benefits are no higher than the no gap government prescribed benefit. 3 When provided by a sports titled or sports specialist member of the Australian Physiotherapy Association (APA), or other GMHBA preferred provider. ^ Other private hospitals fixed benefits are payable in non-participating private hospitals. # Publicly funded ambulance services and State Government ambulance transport schemes are excluded. 8

11 Fit Ultra Package For total peace of mind, Fit Ultra Package offers comprehensive hospital and extras cover for the everyday athlete. We know that sport and fitness can be physically demanding on the body, therefore, Fit Ultra cover gives you great benefits on services like preventative health assessments and mouth guards. What is covered in a private hospital? Fit Ultra provides cover for the following selected services as a private patient in a participating private hospital 1. Hospital treatment, including accommodation as a private patient in a participating private^ or public hospital Higher medical benefits for injuries more likely to occur playing sport Increased medical gap cover (access to increased benefits when treated by a doctor or specialist if admitted to hospital) see page 18 for details Private hospital accommodation^ single room or shared room (where available) Delivery suite Intensive and coronary care Same day treatment Surgically implanted prostheses (Government Prostheses List group benefits) 2 Exclusions Hospital treatment for which Medicare pays no benefit, eg most cosmetic surgery What extras are covered? Acupuncture Naturopathy Myotherapy Homeopathy Ambulance subscription # Chiropractic Osteopathy Remedial massage Podiatry Major dental General dental Optical Orthotic appliances (foot) Physiotherapy/hydrotherapy Preventative health assessment 3 Psychology Dietetics Exercise physiology 1 Limited benefits may apply to cosmetic surgery and high cost drugs. Drugs purchased outside of hospital are not included. You may be subject to doctors waiting lists in a public hospital. Default benefits are paid for all hospital episodes. 2 Benefits are no higher than the no gap government prescribed benefit. 3 When provided by a sports titled or sports specialist member of the Australian Physiotherapy Association (APA), or other GMHBA preferred provider. ^ Other private hospitals fixed benefits are payable in non-participating private hospitals. # Publicly funded ambulance services and State Government ambulance transport schemes are exclluded. Benefit limitation periods A 24 month benefit limitation period applies to the following services: psychiatric, haemodialysis, gastric banding and all obesity surgeries. 9

12 Compare our hospital cover This table provides a quick comparison of the main features of GMHBA s hospital covers and should be read in conjunction with the detailed information in this guide. Hospital inclusions Fit Entry Fit Standard Fit Top Fit Ultra Accident ^ ^ Admission excess waiver for child dependants Cataract surgery 1 Cochlear ears 1 Corneal surgery 1 Cosmetic surgery (where MBS item applies) 1 Delivery suite 1 Gastric banding (and all obesity surgery) 1 # # Haemodialysis 1 # # Higher medical benefits for injuries more likely to occur playing sport Inpatient dental implants 1 Intensive and coronary care 1 IVF and related services 1 Joint reconstruction 1 ^ ^ Joint replacement 1 Medical gap cover Nursing home type patient 2 Pregnancy 1 Private hospital accommodation single room ^ ^ Private hospital accommodation shared room ^ ^ Public hospital accommodation single room Public hospital accommodation shared room Public hospital accommodation day stay ^ ^ Psychiatric # # Rehabilitation ^ ^ Same day treatment 1 ^ ^ Surgically implanted prostheses (Government Prostheses List group beneifits) 3 ^ ^ Theatre 1 ^ ^ Cover provided in participating private hospitals ^ For selected services at participating private hospitals Public hospital cover as a private patient in a shared room only (not recommended for private hospital treatment) No benefits payable # Benefit limitation period applies During the first 24 months of cover (after the standard hospital waiting periods have been served), benefits payable for these services will be limited to public hospital benefits only, during the 24-month benefit limitation period. Once the waiting period and benefit limitation period has been served, you will have access to the benefits applicable on your level of cover. Applicable benefit limitation periods can be found in product descriptions in this guide. 1. A pre-existing condition (PEC) 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 that day on which you purchased your hospital cover or upgraded to a higher level of hospital cover and/or benefit entitlement. Please refer to page 17 for more information. 2. If the fund believe that a patient, following a review of the case (on the basis of information provided by the hospital either internally or using an agreed independent source), is not receiving acute care after 35 days continuous hospitalisation, GMHBA Health Insurance benefits will be reduced to nursing home type patients benefits and will be paid in accordance with the default benefit determined by the Health Department. All Nursing Home Type Patients are required to pay part of the cost of hospital accommodation. 3. Benefits are no higher than the no gap government prescribed benefit. Limited benefits may apply to high cost drugs. Drugs purchased outside of the hospital are not included. Out of pocket costs may apply for admissions to non-participating private hospitals. Contact us for details. Selected services refer to the following MBS item numbers: knee arthorscopes , knee reconstructions 49536, 49539, 49542, fractured clavicles 47462, 47465, fractures to the wrist 47369, 47372, 47375, fracture to the finger , fracture to the hand 47348, 47351, 47336, 47339, 47342, 47345, 47354, 47357, shoulder reconstruction 48960, ankle reconstruction 49709, 49718,

13 Compare our extras cover This table details your extras options at a glance using an easy to follow star system. The more stars shown, the better the coverage and annual limits. For a more detailed benefits comparison see pages Extras services Fit Entry Fit Standard Fit Top Fit Ultra Acupuncture Ambulance Chiropractic Dental general Dental major Dental dentures Dental orthodontics Dietetics Exercise physiology Foot orthotics Homeopathy Myotherapy Naturopathy Optical Osteopathy Physiotherapy/hydrotherapy Podiatry consultation Podiatry surgical procedures Preventative health assessment Psychology Remedial massage 11

14 How much can be claimed on extras? Extras services Waiting period Fit Entry Fit Standard Fit Top Fit Ultra Single Couple/Family Single Couple/Family Single Couple/Family Single Couple/Family Acupuncture/naturopathy/homeopathy 2 months 50% of cost 80% of cost 80% of cost 80% of cost Combined annual limit per calendar year $200 $400 $400 $800 $400 $800 $450 $900 Ambulance subscription # 2 months 50% of cost 80% of cost 80% of cost 100% of cost Annual limit per membership each calendar year $75 $150 $75 $150 $75 $150 $75 $150 Chiropractor/osteopathy/remedial massage/podiatry 2 months 50% of cost 80% of cost 80% of cost 80% of cost Combined annual limit per calendar year Major dental (see important note for dental) Year $400 $800 Orthodontic^ 12 months 75% of cost 75% of cost 75% of cost 85% of cost Maximum benefits per calendar year $300 $300 $300 $450 per year increased to $850 at 10 years Maximum benefits per course of treatment $900 $900 $900 $2,550 Lifetime benefit limit per person $1,050 $1,050 $1,050 $2,900 Other major dental 12 months New upper and lower dentures benefit limit per two years $420 $420 $420 $500 Combined crown and bridge work benefit limit per person per calender year $500 $520 $540 $560 $580 $600 $1,000 $1,040 $1,080 $1,120 $1,160 $1,200 $500 $520 $540 $560 $580 $600 $1,000 $1,040 $1,080 $1,120 $1,160 $1,200 $700 $720 $740 $760 $780 $800 $450 $450 $450 $600 Indirect restorations benefit limit per calender year $350 $700 $350 $700 $350 $700 $400 $700 Implants benefit per person per calender year $400 $400 $400 $400 General dental (For more information see general dental note) 2 months Diagnostic services Set benefits apply Set benefits apply Set benefits apply Set benefits apply Preventative services per person per calender year Up to $200 Up to $200 Up to $200 Up to $300 Simple extractions (not surgical extractions) Set benefits apply Set benefits apply Set benefits apply Set benefits apply Restorative services (limited benefits apply to precious restorations) Annual limit (see important note for dental on page 13) 12 months Set benefits apply Set benefits apply Set benefits apply Set benefits apply Annual limit per person per calender year $1,000 $1,000 $1,000 $2,000 $1,400 $1,440 $1,480 $1,520 $1,560 $1,600 All extras services must be provided by practitioners in private practice who are appropriately registered bodies approved by GMHBA Health Insurance.We recommend you call or visit a branch for a benefit estimate before commencing treatment to confirm the benefit payable. ^ Benefit example: fixed appliance treatment upper and lower jam treatment by a registered specialist. General dental: there are a range of dental procedures which cannot be claimed on the same day by the same provider. There are also limits on the number of dental procedures you can have. Dental benefits will not be paid unless tooth identifications are supplied by the provider. Item numbers included under preventative dental: 011, 012, 013, 014, 015, 016, 017, 018, 111, 113, 114, 115 and 121. Important note for dental: the benefits shown are the annual limits for each type of dental service. The annual limit is a combined general and major dental limit per person per calendar year. There are further sub limits within some of these dental services, eg. The individual benefit for one crown on Fit Ultra is $300. # Ambulance to be fully covered for ambulance services, we recommend that you take out an ambulance subscription in your state or territory. You can claim a refund on one ambulance subscription per membership each calendar year. Publicly funded ambulance services and State Government ambulance transport schemes are excluded.

15 How much can be claimed on extras? Extras services Additional dental benefits (see important note for additional dental benefits) Waiting period Fit Entry Fit Standard Fit Top Fit Ultra Single Couple/Family Single Couple/Family Single Couple/Family Single Couple/Family - Plus 100% of cost up to $1,500 per person, $3,000 per couple, family each calender year for the following: Plus 100% of cost up to $1,500 per person, $3,000 per couple, family each calender year for the following: Plus 100% of cost up to $2,000 per person, $4,000 per couple, family each calender year for the following: Composite restorations ( ) 2 months - $250/item $250/item $250/item Pulp capping (411) 2 months - $50/item $50/item $50/item Subluxed and avolved teeth ( ) 2 months - $500/item $500/item $500/item Consult (013 only) 2 months - $50/item $50/item $50/item Veneers (583) 2 months - $1,000/item $1,000/item $1,000/item X-rays (022) 2 months - $50/item $50/item $50/item Single root canals (415 & 417) 12 months - $250/item $250/item $250/item Crowns ( ) 12 months - $1,500/item $1,500/item $1,500/item Mouth guards 2 months 50% of cost 80% of cost 80% of cost 100% of cost Annual limit each calendar year $50 $100 $200 $400 $200 $400 $250 $500 Optical 6 months 50% of the cost 80% of the cost 80% of the cost 80% of the cost Annual limit each calendar year $250 $500 $250 $500 $250 $500 $250 $500 Orthotic appliances (Foot) 12 months - 80% of the cost 80% of the cost 80% of the cost Annual limit per person/single membership each calendar year - $480 $960 $480 $960 $480 $960 Physiotherapy/hydrotherapy 2 months 50% of cost 80% of cost 80% of cost 80% of cost Combined annual limit per calendar year Year $400 $800 Preventative health assessment 1 2 months - 100% of cost 100% of cost 100% of cost Annual limit per calendar year - $100 $200 $100 $200 $150 $300 Psychology/dietetics 2 /exercise physiology 2 months 50% of cost 80% of cost 80% of cost 80% of cost Combined annual limit per calendar year Year $200 $400 $500 $520 $540 $560 $580 $600 $400 $410 $420 $430 $440 $450 $1,000 $1,040 $1,080 $1,120 $1,160 $1,200 $800 $820 $840 $860 $880 $900 $500 $520 $540 $560 $580 $600 $400 $410 $420 $430 $440 $450 $1,000 $1,040 $1,080 $1,120 $1,160 $1,200 $800 $820 $840 $860 $880 $900 $700 $720 $740 $760 $780 $800 $450 $460 $470 $480 $490 $500 $1,400 $1,440 $1,480 $1,520 $1,560 $1,600 $900 $920 $940 $960 $980 $1,000 Additional Dental Benefits: in order to claim additional dental benefits, members must hold continuous FIT package cover for more than 12 months. To claim members must complete a GMHBA claim form and post to GMHBA along with an itemised receipt and/ or account for processing. 1 When provided by a sports titled or sports specialist member of the Australian Physiotherapy Association (APA), or other GMHBA preferred provider. 2 Benefits increase by 10% when provided by a sports titled or sports specialist member of the APA or an SDA accredited sports dietician, SDA advanced sports dietician or a fellow of SDA.

16 How long are waiting periods? What are waiting periods? A waiting period is the time between joining GMHBA and when you can start claiming. Waiting periods exist to protect members from claims made by those who join the fund or increase their level of cover because they have a condition or illness that may require treatment. Waiting periods exist across all GMHBA hospital and extras covers and apply to: New memberships (previously uninsured); Existing GMHBA members who upgrade to a higher level of cover or reduce their excess payable; Members who transfer from another health fund who have not fully served the required waiting and/or benefit limitation period for equivalent benefits; as well as Treatment for a pre-existing condition. Waiting periods Hospital services (when included on cover) Accidents bodily injuries resulting from accidents that occur after the date of joining GMHBA or upgrading to a higher cover Pregnancy related services Pre-existing ailment, illness or condition (other than psychiatric, rehabilitation and palliative care) Any other benefit for hospital (or hospital substitution) treatment Extras services (when included on cover) All extras benefits except as specified below Optical Major dental services, including full and partial dentures, orthodontics, crowns and bridgework, endodontic services such as root canal, gold fillings, indirect restorations and surgical extractions of a tooth/teeth including wisdom teeth Period None 12 months 12 months 2 months Period 2 months 6 months 12 months 16

17 What about pre-existing conditions? 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 cover. If the ailment, illness or condition is considered pre-existing, then: New members must wait 12 months for any hospital benefits (other than psychiatric, rehabilitation and palliative care); or Members transferring/upgrading to a higher hospital cover must wait 12 months to receive the higher hospital benefits (other than psychiatric, rehabilitation and palliative care). Existing members with at least 12 months membership in total across their old and new cover are entitled to the lower benefits on their old cover. Benefit limitation periods During your first 24 months of cover after the standard hospital waiting periods have been served Fit Ultra and Fit Top package covers are subject to benefit limitations on selected services. The benefits payable on these services are limited to public hospital default benefits during the 24 month benefit limitation period. Once the waiting periods and benefit limitation period has been served, you will have access to the benefits applicable on your level of cover. Excess options You can reduce the cost of your hospital cover by choosing a calendar-year excess. There are different excess levels avaliable. Excess options tables Fit Ultra & Fit Top packages Level 1 excess Level 2 excess Admission excess (private hospital-overnight) * $250 $500 Admission excess (public hospital or day stay) * $125 $250 Maximum annual excess per person $250 $500 Maximum annual excess singles $250 $500 Maximum annual excess couples/families $500 $1,000 * The excess admission on Fit Standard and Fit Entry Packages cover is the maximum annual excess per person. For example, a member on Fit Standard Level 1 excess would pay a $250 excess if admitted to a public hospital as a private patient. 17

18 What is medical gap cover? GMHBA s medical gap cover provides higher benefits than the scheduled fee which will reduce or even eliminate your out of pocket costs for doctor or specialist fees when treated in hospital. What is a scheduled fee (MBS)? The Federal Government has created a schedule of fees (Medicare Benefits Schedule) set for eligible services by doctors in a hospital or day surgery. Medicare pays 75% of this scheduled fee for in-patient medical treatments and GMHBA pays the other 25%, up to 100% of the Medical Benefit Schedule (MBS) fee. Fit Standard and Fit Entry packages On Fit Standard and Fit Entry packages where the actual fee for the anticipated service is greater than the MBS fee, an additional medical gap benefit will be paid equal to 20% of the MBS fee for each service. Fit Ultra and Fit Top packages Fit Ultra and Fit Top packages provide increased medical gap cover. Where the actual fee for the anticipated service is greater than the MBS fee, an additional medical gap benefit will be paid for you, which in most cases will be in excess of 20% of the MBS fee for each service, as paid under our Fit Standard and Fit Entry packages. The additional medical gap benefit under the Fit Ultra and Fit Top packages will vary by eligible service, please contact GMHBA prior to treatment to determine your additional medical gap cover benefit. Fit Ultra & Fit Top packages provide higher medical benefits for injuries more likely to occur playing sports for the following MBS item numbers: Knee arthroscopes: Knee reconstructions: 49536, 49539, Fractured clavicles: 47462, Fractures to the wrist: 47369,47372, Fracture to the finger: Fracture to the hand: 47348, 47351, 47336, 47339, 47342, 47345, 47354, Shoulder reconstruction: Ankle reconstruction: 49709, 49718, Our medical gap cover options include the following: Option 1 Known gap This occurs when your doctor charges a known patient gap (an amount higher than the scheduled fee). Your doctor will generally inform you in writing of the cost of the anticipated services, the Medicare and GMHBA benefits and the patient gap before any treatment commences. In most cases, the doctor will bill us directly for the GMHBA and Medicare benefits. We will arrange to pay these benefits direct to your doctor and all you will need to pay is the known gap. Option 2 No gap If your doctor does not charge a patient gap, your GMHBA benefit and the Medicare benefit will completely cover the doctor s charges. In most instances, your doctor will bill us directly and you will pay nothing. Multiple doctors If other doctors are involved in your treatment (such as anaesthetists), you should ask GMHBA, your doctor or the other medical professionals if they will be using GMHBA s medical gap cover system. Please note: additional medical gap benefits may not be payable towards the cost of imaging or pathology services. Contact GMHBA on for details. 18

19 Payment method options Direct debit You can save 2% by having your premiums deducted directly from your bank, credit union or building society account. Billing and reminder notices are not sent if you pay by automatic direct debit. Credit card When you choose this option, your premiums are automatically debited from your MasterCard or Visa credit card each month, quarter, half year or year whichever you prefer. Please note that automatic payments from a credit card do not attract the direct debit discount. Billing and reminder notices are not sent if you pay by automatic direct debit. Payroll deduction You may also be able to save time by having your employer deduct your premiums directly from your salary and sending them to GMHBA. Call our customer service centre on or visit a branch to find out if this facility is available to you. Direct to GMHBA Your premiums can also be paid using any of the following payment method options: a. GMHBA branches payments can be made in cash, cheque or EFTPOS. b. Australia Post payments can be made in cash, cheque or EFTPOS when you present your billing notice at any Australia Post office with the Billpay facility. c. Pay online payments can be made by credit card through NAB s secure on-line payment facility. Simply visit gmhba.com.au and select the pay by web option. Alternately use the BPay facility of your financial institution. d. Pay by phone payments can be made by credit card over the phone using NAB Transact, simply phone Alternately you can use the BPay facility of your financial institution. e. Mail payments must be made by cheque, money order or credit card. Please do not send cash by mail. When making a direct payment either in person or by mail, you must present your billing notice. A billing notice will be sent to you if your premium is paid directly to GMHBA either monthly, quarterly, half-yearly or yearly in advance. 19

20 Joining is easy Online at gmhba.com.au At your local GMHBA Health Insurance branch Call us on Or complete an application form and mail it back to us Switching to GMHBA is easy Moving your health insurance to GMHBA from another health fund may be easier than you think. Not only is it a simple process, but we can help make sure that you aren t left without cover for any period of time, or have to re-serve any waiting periods. Plus you don t need to contact your previous health fund we can do that on your behalf. When you join, all you have to do is consent for GMHBA to cancel your policy. 60 day money back guarantee If you change your mind within 60 days of joining and haven t made a claim, we ll give you your money back. We make it easy to pay your premium You can choose to pay either by direct debit and receive a 2% discount, credit card, at your local GMHBA branch, by telephone or mail. Privacy We value the relationship between GMHBA and our members. An important part of this relationship is our commitment to protecting the personal information entrusted to us by our members. To access our Privacy Statement or our Privacy Policy you can pick up a copy at one of our branches, visit gmhba.com.au or call us on

21 Notes Private Health Insurance Code of Conduct GMHBA are proud to be a compliant member of the Private Health Insurance Code of Conduct. The Private Health Insurance Code of Conduct is designed to help you by providing clear information and transparency in your relationships with health insurers. The code covers four main areas of conduct in private health insurance ensuring: You receive the correct information on private health insurance from appropriately trained staff; You are aware of the internal and external dispute resolution procedures with GMHBA Health Insurance; Policy documentation contains all the information you require to make a fully informed decision about your purchase and all communications between you and GMHBA are conducted in a way that ensures appropriate information flows between the parties; and All information between you and GMHBA is protected in accordance with national and state privacy principles. You can download the code at privatehealth.com.au/codeofconduct 21

22 Branches Geelong: Moorabool Street Belmont: 178 High Street Newcomb: Bellarine Village, Queenscliff Road Norlane: Bellpost Shopping Centre, Anakie Road Ballarat: 62 Bridge Mall Bendigo: Fountain Court, Mitchell Street Colac: 178 Murray Street Hamilton: 182 Gray Street Perth: Suite 7, Atrium Building, 168 St Georges Terrace Portland: 112a Percy Street Warrnambool: 114 Lava Street Werribee: Wyndham Private Medical Centre, 242 Hoppers Lane gmhba.com.au Moorabool Street, Geelong, Vic 3220 PO Box 761, Geelong, Vic 3220 Call Fax ABN

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