Importantinformation
Before you join or transfer your health insurance to GMHBA GMHBA will consider your membership void if you provide false • The fully itemised health care account/s, and, if you have paid
please read the following important information. If you have any or incorrect information on your membership application and the account/s, the original receipt/s. Photocopies/facsimiles
questions about your health insurance please call our trained premiums recieved thereon will be refunded. Like most health of accounts and/or receipts cannot be accepted.
Customer Service Advisors on 1300 4 GMHBA (46422) or visit a funds, GMHBA uses the terms ‘fund member’ and ‘dependant’
You’ll also be required to provide additional documentation with
branch. We remind you to contact us for a benefit estimate before to define the people covered by a membership. Only the person
claims for the services/items listed below.
commencing any treatment just to confirm the benefit payable nominated as the ‘fund member’ can authorise changes to the
and that our premiums may vary for each state/territory. Please membership unless the fund member has previously authorised
• A doctor’s letter of recommendation is required to be lodged
retain this member guide with any other GMHBA documents. the spouse/partner to make such changes.
with claims for the following items/services: blood glucose
monitor, extremity pump, nebuliser pump, appliances, sleep
Index
Similarly, correspondence issued by GMHBA will be addressed
apnoea monitor, pressure garments, GMHBA approved
Application for membership with GMHBA 63
to the fund member and it is the fund member’s responsibility
orthopaedic appliances, non-surgical prostheses, oxygen,
Arrears 64
to notify GMHBA of any change of address. The signing of
medical aids, home and domestic nursing aids, defined
Audits 64
the membership application and the payment of any premium
accommodation (respite), nicotine replacement therapy
Check your cover 64
constitutes an acceptance of any conditions laid down in the
patches, learn to swim lessons, blood pressure monitors and
Claiming 64
regulations of the fund in force at that time or as they may be
joint supports.
Code of conduct 66
amended from time to time.
• An orthodontic treatment plan certificate, completed by the
Compensation – see Damages or compensation 67 GMHBA reserves the right to refuse admission to membership of treating orthodontist/dentist is required before orthodontic
Community rating 66 any level of health insurance except Bronze Hospital cover. benefits can commence. You can obtain an orthodontic
Connect rewards plus 66 treatment plan certificate by calling our customer service
Damages or compensation 67
In the event of any policy holder or person named on the policy
centre on 1300 4 GMHBA (46422) or from any GMHBA branch.
Dependants 67
holder’s membership is convicted in a court of law of assault
For the purpose of benefit payments, orthodontic treatment is
Dispute resolution process 68
or similar offence against a staff member related to that staff
regarded as commencing on the date the appliance is originally
Electronic claiming 69
member’s performance of their duties or is convicted in a court
fitted. Limits apply every calendar year.
Excess 69
of law of fraud against the fund, the Board may in its discretion,
declare the policy holder’s membership void. The status of the
Unpaid accounts (other than hospital accounts)
Exclusions 69
policy holder’s membership will be assessed with any outstanding
Claims for unpaid accounts will be paid by direct credit
Insure? Not sure? 70
claims being honoured and any monies shall be refunded. Any
(where available) or cheque. The benefit cheque will be made
Liabilities of fund members to GMHBA 71
rights accrued to the policy holder will be forfeited.
payable to the health care provider. The cheque should be
Medicare levy surcharge 71
immediately forwarded to the health care provider, together
Membership card 71 Arrears
with your payment for any account balance.
Membership for non-residents of Australia 71
GMHBA fund members are responsible for ensuring their
Migrants 71
premiums are up to date. Membership will cease when premiums
Paid accounts
Overseas travel 72
fall into arrears of more than 2 months after the premium due
Benefits for paid accounts will be paid:
Participating providers 72
date. To claim benefits a fund member must be financial at the
• in cash at any GMHBA branch for claims of less than
Payment in advance 73
time of incurring the expense for the service or treatment.
$500, when claimed in person,
Pre-existing ailments (PEA) 73
Audits • by cheque, made payable to the fund member for larger
Privacy 74
GMHBA undertakes audit activities in order to protect members’
claims, and mail claims,
Proof of age 74
assets and contain costs. From time to time, in the general
• directly into the members’ financial institution account
Recommendation or endorsement 75
interest of members, a GMHBA representative may contact you
where these arrangements are in place,
Refunds 75
with a request for assistance to monitor costs - whether relating
• to GMHBA, where the member requests that the benefit
Replacement rule 75
to benefits paid or charges raised by health care providers. Your
refund is, either in part or full, used to pay GMHBA
Restrictions 75
co-operation with such requests is critical to our cost containment
premiums.
Standard Information Statement 76
State of the health funds report 76
efforts, and will be treated in a completely confidential manner.
Medical benefits
Suspension 76 Check your cover
Claims for medical benefits can only be paid after your claim
Transferring from another health fund 76
GMHBA offers a wide range of health insurance options each
for medical services has been assessed by Medicare (except in
Waiting periods 77
providing a different level of benefits. We recommend that you
the case of claims made through GMHBA’s medical gap cover
contact us to confirm your exact benefit entitlement before you
- see pages 15-16 for details) and your claim for hospital
Application for membership with GMHBA
go to hospital or get treatment.
benefits has been assessed and paid. GMHBA benefits are
You’ll be asked to complete a membership application when you not payable for services rendered when the patient is not a
join GMHBA or make changes to your membership. For example,
Claiming
hospital inpatient.
when you change your level of cover or add/remove a person
Claims may be made personally at any GMHBA branch, by post
Agent’s authority
covered by your membership. You can make changes to your
or by the assignment of your benefit entitlement to a hospital or
membership anytime.
health care provider. In order to assess your claim and calculate
You may authorise another person to collect benefits on
your benefit, GMHBA needs the following information:
your behalf by completing the Agent’s Authority section of
When you complete a membership application it’s important the claim form. The fund member and the agent (the person
that you provide us with all the information requested to allow • A completed claim form when remitted by post or via a who is being authorised to collect the benefits) must sign the
us to maintain an accurate record of your membership. It is also provider, and authority. The agent will be requested to sign the claim form
important that the information you provide is true and correct. again when benefits are paid.
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