Member Guide. Victoria Sept 2012

Transcription

1 Member Guide Victoria Sept 2012

2 Contents atthe heartof ourhealthy community weare Why do I need private health insurance?...2 Why choose GMHBA?...3 Mix and match to suit your needs...4 What life stage are you?...6 An overview of our covers...8 Waiting periods Hospital covers Medical Gap Cover covers Combined Hospital and Packages Connect Rewards Plus Rebate and Medicare Levy Payment and claiming Lifetime health cover loading Important information Direct debit service agreement Established more than 75 years ago, today GMHBA is one of Australia s fastest growing health funds, renowned for great value and outstanding service and we come highly recommended by our members. GMHBA offers a range of hospital, extras and combined covers to suit different budgets and life stages. Whether you are single, a couple, a single parent or a family, GMHBA has an affordable private health insurance cover to suit your needs. GMHBA is a fully compliant member of the private health insurance code of conduct. GMHBA is a not-for-profit private health insurance company governed by the Private Health Insurance Act 2007, Private Health Insurance Rules 2007 and our fund rules. Information in this member guide is designed for people who have full Medicare eligibility and is current as at the 1st of September 2012 and replaces all earlier versions. It summarises our policies, benefits, premiums, and fund rules which are subject to change from time to time. Any personal information provided to GMHBA will be treated in accordance with our Privacy Policy. Please read this member guide carefully including the important information on pages and retain with any other GMHBA documents. Please call our customer service centre on if you would like clarification on any of the terms used, or simply want help choosing your health cover. We recommend you contact GMHBA for a benefit estimate before commencing treatment to confirm the benefit payable.

3 Why do I need private health insurance? Why choose GMHBA? We understand that the decision to get private health insurance can be challenging. So many questions: When do I need it?, What does it cover? and How much can I save on tax? In this Member Guide, we hope to answer all these questions and more. We are here to help you at every step of the way, looking at the specific needs of you and your family to help determine the best cover for you. So let us cover the basics first. Why hospital cover? With hospital cover you can: Be treated as a private patient. Have a greater choice of who treats you.* Have a greater choice about where you are treated.* Have more choice about when you are treated.* Avoid the Medicare Levy Surcharge if it applies to you. Lock in your Lifetime Health Cover age. Have peace of mind knowing you are covered for unexpected medical bills. * As compared to public patients in a public hospital. Why extras cover? cover provides insurance on the common services Medicare will not cover such as: Dental & Orthodontic care to keep your teeth healthy. Visits to the Physio, Chiropractor or Remedial Massage. Optical care including glasses or contact lenses. Plus, you can claim on the spot with your GMHBA membership card at more than 26,000 providers nationally. There are financial benefits too: Save on 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 (depending on your income) by taking out any one of our hospital covers for you and your dependants. You can find more information at privatehealth.gov.au or ato.gov.au Pay less after you turn 31 By taking out hospital cover before the 1st of July after your 31st birthday, you will avoid paying a higher premium. If you join hospital cover after this date, you will pay an extra 2% on the premium for every year you do not have health insurance after you turn 30, up to a total of 70%. See pages for details. More like a family than a business, we put members before profit and work together to provide great value health cover and build stronger, healthier, sustainable communities. We are the fourth largest health insurer in Victoria and the ninth in Australia. Our focus is never about scale or products but the value we provide to each and every member. We love being local and realise it is not what you say but how you think and what you do that makes the real difference. We invest in local branches and an Australian call centre. We live at the heart of healthy communities, supporting local sporting groups, health seminars and local festivals. Here are some key facts: Not-for-profit private health insurer. More than 75 years experience. Exclusive Member loyalty program, (Connect Rewards Plus). Manage your membership and claims online. 60-day money back guarantee: If you find better value health insurance within 60 days of joining and have not made a claim we will refund your money in full. It is that simple! GMHBA is renowned for great value and outstanding service. We are proud that many of our members join because of recommendations from families or friends. In the Ipsos Australia s Health Care & Insurance survey in 2011, GMHBA had the highest rating # of any major, non-restricted health fund in answer to the question Would you recommend your friends and colleagues use your health insurer?. # Compared to other open-access health funds with more than 75,000 policy holders. The sample size for GMHBA was 123 members. aproud localof seventy five years 2 3

4 Mix and match to suit your needs At GMHBA, we offer four different levels of cover to suit your needs. You can choose either Hospital or cover or for maximum coverage choose both. You can mix and match the different levels of Hospital and to customise a perfect level of coverage for your needs. 1. Choose your level of Hospital Cover 2. Choose your level of Hospital Excess 3. Choose your level of Cover Or a combined package with Hospital & Platinum No Excess Platinum Everyday (Level 0 $0 excess) Gold Low Excess Gold Young Singles (Level 1 $250 single & $500 families/couples single parents) Higher Excess Bronze Young Singles (Level 2 $500 single & $1,000 families/couples single parents) Bronze You can reduce the cost of your hospital cover by having a calendar year excess. Bronze Join today Online at gmhba.com.au, call us on , call into a local branch or fill in the enclosed application form For more detailed information about excesses refer to page

5 What life stage are you? We have got you covered for every stage of life At GMHBA, we understand that each member has their own unique needs. We offer covers to suit this, beginning with our types of membership. Choose a cover to suit your life: Single Membership Coverage for one person. Couples Membership Coverage for you and your partner (married or de-facto a person with whom you are living in a bona-fide domestic relationship). Family Membership Coverage for you, your partner and your child dependants under the age of 21 years (including step, adopted and permanent foster children). Family Memberships also cover any student dependants who are under 25 years old, are single and undertaking full-time apprentices, full-time trainees or full-time students at a school, college, university or institution recognised by GMHBA and primarily relies on you (the fund member) for maintenance and support. Single Parents Membership GMHBA offers hospital cover especially designed for Single Parents with coverage for you and your child dependants (as defined under Family Membership). See page 20 for more details. rightfor yourlife Please note: These cover types are a reference guide only and should be read in conjunction with the information in this member guide. If you prefer to speak to a trained health insurance consultant please call or visit a branch. 6 7

6 Hospital covers cover Combined packages Platinum Hospital Page 16 Comprehensive cover for total peace of mind with increased medical gap coverage and a single room guarantee in a Private Hospital. Gold Hospital Page 18 High level of cover for a wide range of treatments in a Private Hospital with medical gap benefits. Excess options You can reduce the cost of your hospital cover by choosing a calendar year excess. There are three different excess levels available: Excess Single Couples & Families Level 0 Nil Nil Level 1 $250 $500 Level 2 $500 $1,000 Platinum Page 28 Comprehensive cover on an extensive range of services for total peace of mind. Get more back with higher benefits and increased annual limits. Gold Page 28 High level of cover on a wide range of services with generous benefits and annual limits. Everyday Package Page 48 Moderate level of cover for common hospital and extras treatments and services. Excludes a range of services and treatments to help reduce the premium. (This cover is available to families, couples, single parents and singles) Young Singles Package Page 50 Hospital Pages 20 or 22 Hospital Single Parents Moderate level of cover for common treatments in a Private Hospital, excluding a select range of treatments and services to help reduce the premiums. Hospital Moderate level of cover for common treatments in a Private Hospital excluding a range of treatments and services to help reduce the premiums. Bronze Hospital Page 24 Basic level of cover for treatment as a Private Patient in a Public Hospital with some exclusions to reduce the premiums. Hospital Single Parents cover is only available with a calendar year excess: Cover Hospital Single Parents Excess $200 Page 28 Standard Moderate level of cover on a commonly used range of services with a medium level of benefits and annual limits. Standard Plus All the benefits of Standard extras plus higher annual limits on a range of services. Special Care All the benefits of Standard cover with additional benefits on a range of services for those with special needs. Bronze Page 28 Basic level of cover on a limited range of extras services. Basic benefits and annual limits. Moderate level of cover for common hospital and extras treatments and services. Excludes a range of services and treatments that young singles may not need to help reduce the premium. (This cover is only available as a single cover) Bronze Young Singles Package Page 52 Basic hospital and extras package that covers you as a private patient in a public hospital. Excludes a range of services and treatments to help reduce the premium. (This cover is only available as a single cover) Combined package products detailed above are fixed packages. All packages include an excess and exclusions. If a combined package is not suitable, you may consider mixing and matching a standalone hospital cover with an extras cover. 8 9

7 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 funds from those who wait until they are sick to join a health fund claiming large sums immediately. Waiting periods to: New members to health insurance (members who have never held hospital or extras cover with a health fund). 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. Treatment for a pre-existing condition. Waiting periods Hospital services (when included on cover) Waiting period Accidents bodily injuries resulting from accidents which occur after the date of joining GMHBA or upgrading to a higher cover. No waiting period Obstetrics and maternity. 12 months Pre-existing ailment, illness or condition (other than psychiatric, rehabilitation and palliative care). 12 months Any other benefit for hospital (or hospital substitution) treatment. 2 months weare herefor younot forprofit services (when included on cover) All extras benefits except as specified below. Optical, home and domestic aids and medical aids. Major dental services (including full & partial dentures, orthodontics, crown & bridgework, endodontic services such as root canal, gold fillings, indirect restorations, surgical extractions of a tooth/teeth including wisdom teeth). Health appliances including nebuliser pump, blood glucose monitor, pressure garments, sleep apnoea monitor, extremity pump, hearing aids, orthopaedic appliances (GMHBA approved), prostheses (GMHBA approved non-surgical), tens monitor, podiatry surgical procedures and orthotic appliances (foot). Waiting period 2 months 6 months 12 months 12 months 10 11

8 Hospital Cover hospital cover Hospital Cover 12 13

9 Hospital Cover Quick Hospital Cover Comparison This table provides a quick comparison of the main features of GMHBA s hospital covers and must be read in conjunction with the detailed information in this member guide. Cover provided in participating private hospital. Public hospital cover as a private patient only. Not recommended for private hospital treatment. No benefits payable. # Partial Coverage, a co-payment of $100 per day applies up to a maximum of $700 per admission. ^ Benefits for a single room in a public hospital will result in significant out-of-pocket expenses. Platinum Hospital Gold Hospital Hospital Single Parents Hospital Bronze Hospital Accidents Single Room Guarantee a Accommodation single room (where available) # # ^ Accommodation shared room Admission excess waiver for child dependants aged under 21 Broader Health Cover Cataract surgery and corneal transplants b Cosmetic surgery b (limited benefits see page 74) Delivery suite b Dental Implants Gastric banding and all obesity surgeries b e Hospital Cover a. We will pay you $50 per day (up to maximum of $150 for 3 days) if you stay in a shared room when you requested a single room. See page 71 for more details. b. 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 the day on which you purchased your hospital cover or upgraded to a higher level of hospital cover and/or benefit entitlement. Please refer to pages 69 & 72 for more information. c. Limited benefits may to high cost drugs. Drugs purchased outside of the hospital are not included. d. If the fund believes 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 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. e. 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. See page 61 for more information. f. Benefits are no higher than the No Gap Government prescribed benefit. Haemodialysis b e Intensive and coronary care b IVF and related services b Joint reconstruction eg knee b Joint replacement eg hip b Medical gap cover Medical gap cover increased benefit Nursing home type patients d Obstetrics b Other agreed charges c Participating private hospital Psychiatric e e e Rehabilitation Same day treatment b Surgically implanted prostheses (Government Prosthesis List group benefits) f Theatre b 14 15

10 Hospital Cover Platinum Hospital What is covered in a public hospital? You will be covered 2 for hospital accommodation costs when you are admitted to a single or shared room (subject to bed availability) as a private patient in a public hospital. *Other private hospitals Fixed benefits are payable in non-participating private hospitals (see page 69 for more details). Hospital Cover Increased medical gap cover Platinum Hospital provides members with access to increased benefits when treated by a doctor or specialist if admitted to hospital. As a member on our comprehensive cover you will have a higher level of protection by receiving more back on selected services. We recommend you contact us for a benefit estimate before commencing treatment to confirm the benefit payable. Waiting periods Please refer pages 11 and regarding waiting periods and pre-existing conditions. 1. We will pay you $50 per day (up to a maximum of $150 for 3 days) if you stay in a shared room when you requested a single room. See page 71 for more details. 2. Limited benefits may to cosmetic surgery and high cost drugs. Drugs purchased outside of the hospital are not included. 3. Benefits are no higher than the No Gap Government prescribed benefit. Platinum Hospital gives you comprehensive cover for total peace of mind with increased medical gap coverage and a single room guarantee. 1 What is covered in a participating private hospital? Platinum Hospital provides cover 2 at participating private hospitals for: Private hospital accommodation. * Single room guarantee. 1 Increased medical gap cover (see pages for details). Delivery suite. Theatre. Intensive and coronary care. Same day treatment. Surgically implanted prostheses (Government Prosthesis List group benefits). 3 Other agreed charges. Excess options You can reduce your premium by selecting one of the following calendar year excess options: Excess options table Admission excess (private hospital overnight) Admission excess (public hospital or day stay) Maximum annual excess per person Maximum annual excess singles Maximum annual excess families Level 0 excess Level 1 excess Level 2 excess nil $250 $500 nil $125 $250 nil $250 $500 nil $250 $500 nil $500 $1,000 To find out more about excess payments see page 66. No excess applies for child dependants under 21 on Platinum Hospital cover

11 Hospital Cover Gold Hospital Gold Hospital gives you a high level of cover for a wide range of treatments with medical gap benefits. What is covered in a participating private hospital? Gold Hospital provides cover 1 at participating private hospitals for: Private hospital accommodation * in a shared or single room (where available). Medical gap (see pages for details). Delivery suite. Theatre. Intensive and coronary care. Same day treatment. What is covered in a public hospital? You will be covered 1 for hospital accommodation costs when you are admitted to a single or shared room (subject to bed availability) as a private patient in a public hospital. Healthy Start Benefit Gold Hospital cover provides an additional benefit of up to $500 per childbirth admission to help cover the obstetrician s medical gap (inpatient services only). For further details see page Limited benefits may to cosmetic surgery and high cost drugs. Drugs purchased outside of the hospital are not included. 2. Benefits are no higher than the No Gap Government prescribed benefit. Hospital Cover Surgically implanted prostheses (Government Prosthesis List group benefits). 2 Other agreed charges. Excess options You can reduce your premium by selecting one of the following calendar year excess options: *Other private hospitals Fixed benefits are payable in non-participating private hospitals (see page 69 for more details). Excess options table Level 0 excess Level 1 excess Level 2 excess Waiting periods Admission excess (private hospital overnight) Admission excess (public hospital or day stay) Maximum annual excess per person Maximum annual excess singles Maximum annual excess families nil $250 $500 nil $125 $250 nil $250 $500 nil $250 $500 nil $500 $1,000 To find out more about excess payments see page 66. No excess applies for child dependants under 21 on Gold Hospital cover. Please refer to the information on pages 11 and regarding waiting periods and pre-existing conditions. Benefit limitation periods A 24 month benefit limitation period applies to the following services: Psychiatric Haemodialysis Gastric banding and all obesity surgeries See page 61 for more information

12 Hospital Cover Hospital Single Parents As a single parent family, you can select any level of cover or you can save with our special Hospital Single Parents cover. Hospital Single Parents gives you a moderate level of cover for common treatments in a Private Hospital, excluding a select range of treatments and services to help reduce the premium. What is covered in a participating private hospital? For services not listed under exclusions, Hospital Single Parents cover provides cover 1 at participating private hospitals for: What is covered in a public hospital? For services not listed under exclusions Hospital Single Parents provides cover 1 as a private patient in a public hospital for accommodation in a shared room or partial cover in a single room (co-payments of $100 per day for single rooms, capped at seven days per admission). Exclusions To reduce the premium, Hospital Single Parents excludes the following services: Obstetrics. IVF and related services. Haemodialysis. Gastric banding and all obesity surgeries. Hospital Cover Hospital accommodation* in a shared room. Partial cover in a single room (a co-payment of $100 per day, capped at seven days per admission applies). 2 Medical gap (see pages for details). Theatre. Intensive and coronary care. Same day treatment. Surgically implanted prostheses (Government Prosthesis List group benefits). 3 Other agreed charges. Dental implants. 1. Limited benefits may to cosmetic surgery and high cost drugs. Drugs purchased outside of the hospital are not included. 2. Please note: Some Private Hospitals only have single rooms and co-payments will. 3. Benefits are no higher than the No Gap Government prescribed benefit. Excess options The Hospital Single Parents cover is only available with a calendar year excess. This excess reduces your premium and you will not pay the calendar year excess unless you are admitted to hospital. Admission type Admission excess (private hospital overnight) Admission excess (public hospital or day stay) Maximum annual excess per person Excess $100 $50 $100 Maximum annual excess $200 To find out more about excess payments see page 68. *Other private hospitals Fixed benefits are payable in non-participating private hospitals (see page 69 for more details). Waiting periods Please refer to the information on pages 11 and regarding waiting periods and pre-existing conditions. Benefit limitation periods A 24 month benefit limitation period applies to the following service: Psychiatric See page 61 for more information. No excess applies for child dependants under 21 on Hospital Single Parents cover

13 Hospital Cover Hospital What is covered in a public hospital? For services not listed under exclusions, Hospital provides cover 1 as a private patient in a public hospital for accommodation* in a shared room or partial cover in a single room (co-payments of $100 per day for single rooms, capped at seven days per admission). Excess options You can reduce your premium by selecting one of the following calendar year excess options. Excess options table Admission excess (private hospital overnight) Level 0 excess Level 1 excess Level 2 excess nil $250 $500 Hospital Cover Exclusions To reduce the premium, Hospital excludes the following services: Obstetrics. Admission excess (public hospital or day stay) Maximum annual excess per person nil $125 $250 nil $250 $500 Hospital gives you a moderate level of cover for common treatments in a Private Hospital, excluding a range of treatments and services to help reduce the premium. What is covered in a participating private hospital? For services not listed under exclusions, Hospital provides cover 1 at participating private hospitals for: Joint replacement. Cosmetic surgery. IVF and related services. Cataract surgery and corneal transplants. Haemodialysis. Gastric banding and all obesity surgeries. Dental implants. 1. Limited benefits may to high cost drugs. Drugs purchased outside of the hospital are not included. 2. Please note: Some Private Hospitals only have single rooms and co-payments will. 3. Limited benefits may to high cost drugs. Drugs purchased outside of the hospital are not included. Maximum annual excess singles Maximum annual excess families nil $250 $500 nil $500 $1,000 To find out more about excess payments see page 66. Unlike Platinum, Gold, Hospital Single Parents covers; an excess applies for child dependants on all Hospital covers. *Other private hospitals Fixed benefits are payable in non-participating private hospitals (see page 69 for more details). Hospital accommodation* in a shared room. Partial cover in a single room (a co-payment of $100 per day, capped at seven days per admission applies). 2 Medical gap (see pages for details). Waiting periods Please refer to the information on pages 11 and regarding waiting periods and pre-existing conditions. Theatre. Intensive and coronary care. Same day treatment. Surgically implanted prostheses (Government Prosthesis List group benefits). 3 Benefit limitation periods A 24 month benefit limitation period applies to the following service: Psychiatric See page 61 for more information. Other agreed charges

14 Hospital Cover Bronze Hospital Additional benefits In both public and private hospitals, our Bronze Hospital cover includes benefits for: Medical gap (see pages for details). Waiting periods Please refer to pages 11 and regarding waiting periods and pre-existing conditions. Hospital Cover Surgically implanted prostheses (Government Prosthesis List group benefits). 2 Nursing home type patients Government prescribed benefits are available towards non-acute hospital care. As a Private Patient in a public hospital you may have the choice of doctor if that doctor is available and has the rights of private practice at that hospital. Depending on the situation this may or may not be the same doctor who would have been allocated to you by the hospital as a public patient. Please note: Benefits for a single room in a public hospital or treatment in a private hospital when using Bronze Hospital cover will result in significant out-ofpocket expenses. For further information on private patient benefits on Bronze Hospital cover, please call us on or visit a branch. 1. Limited benefits may to high cost drugs. Drugs purchased outside of the hospital are not included. 2. Benefits are no higher than the No Gap Government prescribed benefit. Offering an affordable, basic level of cover for treatment as a Private Patient in a Public Hospital, Bronze Hospital gives you a reduced premium because certain treatments and services are excluded. This is an ideal option if you primarily want to avoid the Medicare Levy surcharge (details on pages 56 & 68) or lock in your Lifetime Health Cover (details on pages 58-59) certified age of entry. What is covered in a public hospital? Bronze Hospital provides cover for accommodation costs when you are admitted to a shared room in a recognised public hospital, less any applicable excess. This is for services not listed under exclusions and is subject to bed availability. 1 What is covered in a private hospital? For services not listed under exclusions, fixed benefits are payable for accommodation in private hospitals. The benefit depends on the type of treatment, accommodation or surgery received and length of the hospital stay. Additional private hospital costs such as theatre and delivery suite charges are not covered through Bronze Hospital. Exclusions To reduce the premium, Bronze Hospital excludes the following services: Haemodialysis. Gastric banding and all obesity surgeries. Excess options You can reduce your premium by selecting an excess payable once every calendar year. Choose from one of the following excess options: Excess options table Maximum annual excess per person Maximum annual excess singles Maximum annual excess families Level 0 Level 1 Level 2 excess excess excess nil $250 $500 nil $250 $500 nil $500 $1,000 To find out more about excess payments see page 66. Unlike Platinum, Gold, Hospital Single Parents covers; an excess applies for child dependants on all Bronze Hospital covers

15 Hospital Cover What is Medical Gap Cover? GMHBA s medical gap cover is a billing system that 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. Gold, and Bronze Hospital In the event that your doctor chooses to use GMHBA s medical gap cover and 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. Please note: Additional medical gap benefits may not be payable towards the cost of imaging or pathology services. Contact GMHBA on for details. Our medical gap cover options If your doctor or specialist is one of more than 14,000 who choose to participate in GMHBA s medical gap cover system, two options are available for our hospital products: Option 1 Known Gap Your doctor chooses to use GMHBA s medical gap cover system and charges a known patient gap (an amount higher than the scheduled fee). To participate, your doctor must inform you in writing of the cost of the anticipated services, the Medicare and GMHBA benefits and the patient gap before any treatment commences. They must 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 chooses to use our medical gap cover and not charge a patient gap, your GMHBA benefit and the Medicare benefit will fully cover the doctor s charges. In these 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. If they choose not to, you will still receive a combined Medicare and GMHBA benefit of up to 100% of the MBS fee and (if applicable) any GMHBA member Connect Rewards Plus dollars you may have accrued for medical out of pocket costs that exist. The participation in GMHBA s medical gap cover by any medical practitioner is not a recommendation or endorsement by GMHBA of that practitioner. Platinum Hospital GMHBA s Platinum Hospital product provides medical gap cover regardless of whether your doctor participates or not. 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 Gold, and Bronze Hospital covers. The additional medical gap benefit under the Platinum Hospital cover will vary by eligible service, please contact GMHBA prior to treatment to determine your additional medical gap cover benefit. Important This information is provided as a guide only. Before you have any treatment, we suggest you contact us for the most up to date information. Waiting periods Please refer pages 11 and regarding waiting periods and pre-existing conditions. Hospital Cover Please note: Additional medical gap benefits may not be payable towards the cost of imaging or pathology services. Contact GMHBA on for details

16 Cover extras cover Cover 28 29

17 Cover GMHBA extras covers Coverage comparison table 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 benefits. For a more detailed benefits comparison see pages # Remedial massage benefits and reimbursement of Victorian Ambulance Subscription are only available under Connect Rewards Plus as detailed on pages ^ Special Care extras is only available when combined with a GMHBA Hospital cover. services Platinum Standalone and combined extras products Gold Special Care ^ Standard Plus Standard Bronze Package product extras Everyday Package Young Singles Package Acupuncture Ambulance # # # # # Audiology Blood glucose monitor Chiropractic Dental General Dental Major Dental Dentures Dental Orthodontics Dietetics Extremity pump Eye therapy Dietary fluoride supplement Foot orthotics Hearing aids Home nursing Visiting/Bush/Private Nursing Service Homeopathy Hydrotherapy Medical aids Myotherapy Naturopathy Nebuliser pump Nursing aids Occupational therapy Optical Orthopaedic appliances (GMHBA approved) Osteopathy Oxygen Personal alarm/monitoring (GMHBA approved) Pharmacy Private script Physiotherapy Podiatry Consultation Podiatry Surgical procedures Pressure garments (GMHBA approved) Prostheses (GMHBA approved non-surgical) Psychology Bronze Young Singles Package Cover Remedial massage # # # # # # Respite Sleep apnoea monitor Speech therapy Tens monitor Weight loss programs 30 31

18 Cover Detailed extras comparison services Waiting Periods Acupuncture see Naturopathy/Homeopathy/Acupuncture 2 months Ambulance subscription/transport 1 N/A Platinum Gold Special Care * Standard Plus Standard Bronze Everyday Package^ Young Singles Package^ Annual subscription refund 100% 100% 100% 100% Transport benefit (per trip) $300 $300 Annual limit per person each calendar year $500 $500 Audiology 2 months Initial visit 80% $25 $25 $25 $25 $25 Subsequent visit 80% $20 $20 $20 $20 $20 Bronze Young Singles Package^ Important Note: The table opposite must be read along with the footnotes below. 1. Ambulance To be fully covered for Ambulance services, we recommend that you take out an Ambulance Victoria subscription. You can claim a refund on one ambulance subscription per membership each calendar year under Platinum, Gold, Special Care or Bronze Young Singles Package. Single members may claim 50% of cost when a family ambulance subscription is purchased. Under Platinum and Gold a transport benefit per trip is claimable (see table opposite) however this will not cover the entire cost and therefore will result in significant out of pocket costs. Publicly funded ambulance services and State Government Ambulance transport schemes are excluded. 2. Audiology The annual limit of $400 per person each calendar year includes combined benefits for audiology, speech therapy and eye therapy. Cover Annual limit per person each calendar year $350 $350 $400 2 $400 2 $400 2 $400 2 Blood glucose monitor 12 months Benefit Chiropractic/Osteopathy 4 2 months 80% up to $650 per monitor 3a $200 3b $150 3b $150 3b $150 3b $150 3b Initial visit 80% $26 $25 $25 $25 $25 $17 $17 3a. Blood glucose monitor Benefits are limited to one monitor per membership every three years. A doctor s letter of recommendation must accompany each claim for benefits. Up to 80% per monitor to a maximum of $650, combined limit for blood glucose monitor, nebuliser pump, tens monitor and sleep apnoea monitor. 3b. Blood glucose monitor Benefits are limited to one monitor per membership every three years. A doctor s letter of recommendation must accompany each claim for benefits. 4. Chiropractic/Osteopathy There is a limit of one chiropractic x-ray per person/single membership each calendar year excluding Bronze Young Singles Package and Young Singles package. Benefits will be paid for one consultation and/or treatment per provider per day subsequent visits 80% $21 $17 $17 $17 $17 $17 $17 Further visits 80% $17 $15 $15 $17 $17 Chiropractic x-ray (1 per person) $80 $80 $40 $40 $40 $40 Annual limit per person/single membership each calendar year Annual limit per family membership each calendar year All extras services must be provided by practitioners in private practice who are appropriately registered with recognised bodies approved by GMHBA. We recommend you call or visit a branch for a benefit estimate before commencing treatment to confirm the benefit payable. For services other than dental, benefits for one initial consultation per therapy type are available each calendar year. $700 5 $350 6 $350 7 $350 7 $100 8 $100 8 $350 9 $350 9 $1,000 5 $700 6 $600 7 $600 7 $150 8 $150 8 * Special Care extras is only available when combined with a GMHBA Hospital cover. ^ Everyday extras, Young Singles extras and Bronze Young Singles extras are only available within a combined hospital and extras package. See pages Chiropractic/Osteopathy The annual limit of $700 per person/single membership and $1,000 per family membership each calendar year includes combined benefits for chiropractic (including chiropractic x-rays) and osteopathy. 6. Chiropractic/Osteopathy The annual limit of $350 per person/single membership and $700 per family membership each calendar year includes combined benefits for chiropractic (including chiropractic x-rays) and osteopathy. 7. Chiropractic/Osteopathy The annual limit of $350 per person/single membership and $600 per family membership each calendar year includes combined benefits for chiropractic (including chiropractic x-rays), osteopathy, naturopathy, homeopathy and acupuncture. 8. Chiropractic/Osteopathy The annual limit of $100 per person/single membership and $150 per family membership each calendar year includes combined benefits for chiropractic (excluding chiropractic x-rays), osteopathy, naturopathy, homeopathy and acupuncture. 9. Chiropractic/Osteopathy The annual limit of $350 per single membership each calendar year includes combined benefits for chiropractic (excluding x-rays), osteopathy, naturopathy, homeopathy, acupuncture, physiotherapy, myotherapy and hydrotherapy

19 Cover Detailed extras comparison services Dental Waiting Periods Platinum Gold Special Care * Standard Plus Standard Bronze Everyday Package^ Young Singles Package^ Bronze Young Singles Package^ All extras services must be provided by practitioners in private practice who are appropriately registered with recognised bodies approved by GMHBA. We recommend you call or visit a branch for a benefit estimate before commencing treatment to confirm the benefit payable. Cover Major dental (see important note for dental) 12 months Orthodontic Benefits example: Fixed appliance treatment upper and lower jaw treatment by a 12 months registered specialist Maximum benefits per calendar year 85% up to $500 per year incr. to $850 at 10 years 85% up to $450 per year incr. to $850 at 10 years 75% up to $320 per year incr. to $570 at 6 years 75% up to $300 per year 75% up to $300 per year 75% up to $300 per year 75% up to $300 per year 75% up to $300 per year 75% up to $300 per year Maximum benefit per course of treatment $2,550 $2,550 $1,710 $900 $900 $900 $900 $900 $900 Lifetime benefit limit $2,900 $2,900 $1,900 $1,050 $1,050 $1,050 $1,050 $1,050 $1,050 Dentures (see important note for dental) 12 months New full upper and lower dentures per 2 years $500 $500 $420 $420 $420 $420 $420 $420 $420 For services other than dental, benefits for one initial consultation per therapy type are available each calendar year. * Special Care extras is only available when combined with a GMHBA Hospital cover. ^ Everyday extras, Young Singles extras and Bronze Young Singles extras are only available within a combined hospital and extras package. See pages Important Note: The table opposite must be read along with the footnotes below. 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 Platinum or Gold is $300. Combined crown and bridgework (see important note for dental) 12 months Annual limit per person each calendar year $900 $600 $450 $450 $450 $450 $450 $450 $450 Indirect restorations (see important note for dental) 12 months Annual limit per person/single membership each calendar year $400 $400 $350 $350 $350 $350 $350 $350 $350 Annual limit per family membership each calendar year $700 $700 $700 $700 $700 $700 $700 Implants (see important note for dental) 12 months Annual limit per person each calendar year $400 $400 $400 $400 General dental (For more information see general dental note) 2 months a. Diagnostic services 2 months General Dental There are a range of dental procedures that cannot be claimed when provided on the same day eg a filling on a tooth that has been removed. There are also limits on the number of dental procedures you can have eg periodic examinations are limited to two per calendar year. Dental benefits for some procedures cannot be paid unless tooth identifications (ID) are supplied by the provider. The general dental limits for dental examinations and scale and clean procedures are available per person on a calendar year basis. For services other than Dental, benefits for 1 initial consultation are available each calendar year. Preventative Dental A detailed list of item numbers and definition of benefits payable under preventative dental can be found on page 63. b. Preventative services eg periodic examination 2 per calendar year, removal of plaque 3 per calendar year. Annual limit per person per calendar year. See preventive dental note 2 months Up to $450 per person Up to $300 per person Up to $200 per person Up to $200 per person Up to $200 per person Up to $200 per person Up to $200 per person Up to $200 per person Up to $200 per person c. Simple extractions (not including surgical extractions of wisdom teeth) 2 months d. Restorative services (limited benefits to precious restorations) Annual limit (see important note for Dental note) 2 months 12 months Annual limit per person each calendar year $2,000 $2,000 $1,000 $1,000 $1,000 $1,000 $1,000 $500 $

20 Cover Detailed extras comparison services Waiting Periods Dietetics 2 months Platinum Gold Special Care * Standard Plus Standard Bronze Everyday Package^ Young Singles Package^ Bronze Young Singles Package^ All extras services must be provided by practitioners in private practice who are appropriately registered with recognised bodies approved by GMHBA. We recommend you call or visit a branch for a benefit estimate before commencing treatment to confirm the benefit payable. Cover Initial visit 80% $54 $27 $27 $27 $27 Subsequent visit 80% $25 $21 $21 $21 $21 Class attendance 80% $10 $10 $10 $10 $10 Annual limit per person each calendar year $350 $350 $350 $350 $350 $350 Extremity pump months Benefit $300 $300 $300 $300 $300 $300 For services other than dental, benefits for one initial consultation per therapy type are available each calendar year. * Special Care extras is only available when combined with a GMHBA Hospital cover. ^ Everyday extras, Young Singles extras and Bronze Young Singles extras are only available within a combined hospital and extras package. See pages Important Note: The table opposite must be read along with the footnotes below. Eye therapy and speech therapy 2 months Initial visit 80% $54 $27 $27 $27 $27 Subsequent visit 80% $25 $21 $21 $21 $21 Annual limit per person each calendar year $ $ $ $ $ $ Extremity pump Benefits are limited to one extremity pump per membership every three years. A doctor s letter of recommendation must accompany each claim for benefits. 11. Eye therapy and speech therapy The annual limit of $500 per person each calendar year includes $500 for eye therapy and $500 for speech therapy. Fluoride dietary supplement 13 2 months Benefit of up to 80% 85% 85% 85% 85% 85% 85% Maximum benefit per person each calendar year $45 $45 $45 $45 $45 $45 $45 Hearing aids 12 months Benefit of up to 100% 100% 80% 80% 80% 80% Maximum benefit per person every 3 years $800 $800 $400 $400 $400 $400 Homeopathy see Naturopathy/Homeopathy/Acupuncture 2 months 12. Eye therapy and speech therapy The annual limit of $400 per person each calendar year includes combined benefits for audiology, eye therapy and speech therapy. 13. Fluoride dietary supplement Benefits are only payable towards the cost of dietary fluoride supplements (tablet or liquid form) dispensed by a chemist or dentist in private practice. 14. Incontinence aids Benefits are payable for quick dry absorbent sheet (pads are excluded). 15. Medical aids benefits example Blood pressure/ pulse monitors and electric pulse massagers. A doctor s letter of recommendation must accompany each claim for benefits. Incontinence aids 14 2 months Benefit of up to 100% Maximum benefit 1 item per membership each calendar year $150 Medical aids 15 6 months Benefit of up to 50% Maximum benefit per person each calendar year $100 Myotherapy see Physiotherapy/Myotherapy/ Hydrotherapy 2 months 36 37

21 Cover Detailed extras comparison services Waiting Periods Naturopathy/Homeopathy/Acupuncture 16 2 months Platinum Gold Special Care * Standard Plus Standard Bronze Everyday Package^ Young Singles Package^ Initial visit 80% $25 $19 $19 $19 $19 $17 $ subsequent visits 80% $20 $17 $17 $17 $17 $17 $17 Bronze Young Singles Package^ Important Note: The table opposite must be read along with the footnotes below. 16. Naturopathy/Homeopathy/Acupuncture Benefits will be paid for one consultation and/or treatment per provider per day. 17. Naturopathy/Homeopathy/Acupuncture The annual limit of $600 per person/single membership and $900 per family membership each calendar year includes combined benefits for remedial massage, naturopathy, homeopathy and acupuncture. 18. Naturopathy/Homeopathy/Acupuncture The annual limit of $350 per person/single membership and $700 per family membership each calendar year includes combined benefits for remedial massage, naturopathy, homeopathy and acupuncture. 19. Naturopathy/Homeopathy/Acupuncture The annual limit of $350 per person/single membership and $600 per family membership each calendar year includes combined benefits for naturopathy, homeopathy, acupuncture, chiropractic and osteopathy. 20. Naturopathy/Homeopathy/Acupuncture The annual limit of $100 per person/single membership and $150 per family membership each calendar year includes combined benefits for naturopathy, homeopathy, acupuncture, chiropractic and osteopathy. 21. Naturopathy/Homeopathy/Acupuncture The annual limit of $350 per person each calendar year includes combined benefits for naturopathy, acupuncture, homeopathy, physiotherapy, myotherapy, chiropractic (excluding x-rays), osteopathy and hydrotherapy. 22a. Nebuliser pump Benefits are limited to one monitor per membership every three years. A doctor s letter of recommendation must accompany each claim for benefits. Up to 80% per monitor up to $650 combined limit for blood glucose monitors, nebuliser pump, tens monitor and sleep apnoea monitor. 22b. Nebuliser pump Benefits are limited to one nebuliser pump per membership every three years. A doctor s letter of recommendation must accompany each claim for benefits. 23. Nursing Visiting/home/registered nurse (private practice) The annual limit of $1,000 per person each calendar year includes combined benefits for home (bush) nursing and visiting/registered nurse. Visiting nurse benefits towards a registered nurse in private practice on recommendation from a medical practitioner. 24. Nursing aids Home and domestic Benefits can only be paid for home and domestic nursing aids which were following a hospital stay, not provided by a hospital and which assist the functional activities of daily living. 25. Nursing aids Home and domestic Benefits can only be paid for home and domestic nursing aids which assist daily living and not provided by hospital eg crutches. A doctor s letter of recommendation must accompany each claim for benefits. Cover Further visits 80% $17 $14 $14 $17 $17 Annual limit per person/single membership each calendar year Annual limit per family membership each calendar year Nebuliser pump 12 months Benefit All extras services must be provided by practitioners in private practice who are appropriately registered with recognised bodies approved by GMHBA. We recommend you call or visit a branch for a benefit estimate before commencing treatment to confirm the benefit payable. For services other than dental, benefits for one initial consultation per therapy type are available each calendar year. $ $ $ $ $ $ $ $ $ $ $ $ $ $ % up to $650 per monitor 22a $150 22b $150 22b $150 22b $150 22b $150 22b Nursing Visiting/Home/Registered Nurse (Private Practice) 23 2 months Home (bush) nursing benefit for each visit 80% $8 $8 $8 $8 $8 Visiting/Registered nurse (private practice) benefit per hour 80% $8 $8 $8 $8 $8 Maximum benefit for each day $48 $48 $48 $48 $48 $48 Annual limit per person each calendar year $1,000 $1,000 $1,000 $1,000 $1,000 $1,000 Nursing aids Home and domestic 6 months Equipment hire following a hospital stay benefit of up to Equipment purchase for daily living benefit of up to Maximum benefit per membership each calendar year 50% 24 30% 25 $350 * Special Care extras is only available when combined with a GMHBA Hospital cover. ^ Everyday extras, Young Singles extras and Bronze Young Singles extras are only available within a combined hospital and extras package. See pages