WhendoIneedfamilycover? Whatismedicalgapcover?
If you’ve chosen a cover for yourself only, The following information is provided as a guide
or one that has obstetrics excluded, you need only. Before you have any treatment, we suggest
to upgrade your cover 12 months before you you contact us for the most up to date information.
have a child. This is to ensure you’ve served all
A schedule of fees has been set by the Federal
your waiting periods at the time you and your
Government for eligible services by doctors in
newborn need the upgraded cover. In most
a hospital or day surgery. Medicare pays 75% of
cases, obstetrics and additions of dependants
this scheduled fee and GMHBA pays the other 25%
to be covered on a family membership will
up to 100% of the Commonwealth Medical Benefit
be subject to waiting periods. Please call our
Schedule (CMBS) fee. It is also sometimes referred
customer service centre on 1300 4 GMHBA
to as the Medicare Schedule fee.
(46422) or visit a branch for advice on when
you should upgrade.
GMHBA’s medical gap cover is a billing system
for participating doctors or specialists to use
You must advise GMHBA when a dependant
when they treat our members in hospital.
ceases full-time study, or a full-time traineeship/
Medical gap cover is included at no extra cost
apprenticeship, or fails to meet any of these
to members of all the hospital covers detailed
requirements for any other reason. If you remove
in this member guide. If your doctor chooses to
your partner, children and/or dependant/s from
use GMHBA’s medical gap cover, a higher benefit
your membership, GMHBA will contact the affected
than the scheduled fee will usually be available
person/s and offer continuation of cover under a
from GMHBA, which will reduce or even eliminate
separate membership.
your out-of-pocket costs.
The extra medical gap cover benefit is available for
all services rendered by participating doctors and
specialists to hospital inpatients, which attract a
Medicare benefit - except pathology, and imaging
services that attract a combined Medicare and
GMHBA benefit of up to 100% of the CMBS fee.
Once you have combined hospital and extras cover
for 12 months, you can also use your connect
rewards plus dollars for inpatient medical gap to
reduce any out-of-pocket expenses even further.
GMHBA’smedicalgapcoveroptions
If your doctor or specialist is one of more than 10,000
who choose to participate in GMHBA’s medical gap
cover system, two options are available:


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