GMHBA
Family
$162 pm
[FONT="]Gold Hospital[/FONT]
[FONT="]This fact sheet is to be read in conjunction with the 2009 Member Guide. This information is important and should be retained.[/FONT]
[FONT="]Our Gold Hospital cover provides you with real peace of mind and allows you to choose your doctor. Gold Hospital is available to everybody including singles, single parents, couples and families. You’ll be covered for a wide range of hospital services (subject to bed availability and certification by a medical practitioner for the need of acute care after 35 days).[/FONT]
[FONT="]What’s covered?[/FONT]
[FONT="]Gold Hospital (GH0) provides cover* at participating private hospitals for:[/FONT]
[FONT="]• Accommodation - shared and private room (where available)[/FONT]
[FONT="]• Theatre [/FONT]
[FONT="]• Delivery suite[/FONT]
[FONT="]• Intensive and coronary care[/FONT]
[FONT="]• Same day treatment[/FONT]
[FONT="]• Surgically implanted prostheses (Government prescribed benefits)[/FONT]
[FONT="]• Medical gap [/FONT]
[FONT="]• Other agreed charges[/FONT]
[FONT="]Excess options[/FONT]
[FONT="]No excess applies for child dependants under 21 on GMHBA’s Gold family hospital covers. [/FONT]
[FONT="]Gold Hospital cover is available with either: [/FONT]
·[FONT="]Level 0 nil excess (GH0) or[/FONT]
·[FONT="]Progressively lower premiums in return for admission excesses of:[/FONT]
[FONT="]-[/FONT][FONT="]Level 1 $250 (GH1)[/FONT]
[FONT="]-[/FONT][FONT="]Level 2 $500 (GH2)[/FONT]
[FONT="]Excess options table[/FONT]
[FONT="]Level 0 [/FONT][FONT="]nil excess[/FONT][FONT="] (GH0)[/FONT]
[FONT="]Level 1 [/FONT][FONT="]excess[/FONT][FONT="] (GH1)[/FONT]
[FONT="]GH2 [/FONT][FONT="]excess[/FONT][FONT="] (GH2)[/FONT]
[FONT="]Admission excess (private hospital – overnight)[/FONT]
[FONT="]nil[/FONT]
[FONT="]$250[/FONT]
[FONT="]$500[/FONT]
[FONT="]Admission excess (public hospital or day stay)[/FONT]
[FONT="]nil[/FONT]
[FONT="]$125[/FONT]
[FONT="]$250[/FONT]
[FONT="]Maximum annual excess – per person[/FONT]
[FONT="]nil[/FONT]
[FONT="]$250[/FONT]
[FONT="]$500[/FONT]
[FONT="]Maximum annual excess – singles[/FONT]
[FONT="]nil[/FONT]
[FONT="]$250[/FONT]
[FONT="]$500[/FONT]
[FONT="]Maximum annual excess – families[/FONT]
[FONT="]nil[/FONT]
[FONT="]$500[/FONT]
[FONT="]$1,000[/FONT]
[FONT="]Public hospitals[/FONT]
[FONT="]You’ll also be covered* for hospital accommodation costs when you are admitted to a private or shared room (subject to bed availability) as a private patient in a public hospital.[/FONT]
[FONT="]Other private hospitals[/FONT]
[FONT="]Fixed benefits are payable in non participating private hospitals (see 2009 Member Guide for more details). [/FONT]
[FONT="]*Limited benefits may apply to cosmetic surgery and high cost drugs. Drugs purchased outside of the hospital are not included.[/FONT]
[FONT="]Healthy Start Benefit[/FONT]
[FONT="]Gold Hospital cover provides an additional benefit of up to $500 per childbirth admission to help cover the obstetrics medical gap. For further details see the 2009 Member Guide.[/FONT]
[FONT="]Waiting periods[/FONT]
[FONT="]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.[/FONT]
[FONT="]Waiting periods will apply to:[/FONT]
·[FONT="]New memberships (previously uninsured).[/FONT]
·[FONT="]Additions to a membership (unless the addition/s has already served all waiting periods with GMHBA or another fund) except newborns, adopted and permanent foster children where the family membership has been in existence for at least 2 months. [/FONT]
·[FONT="]Existing GMHBA memberships, and transfers to GMHBA from another fund where the level of cover and/or benefit entitlement is upgraded or increased and/or where the waiting periods have not been completed.[/FONT]
[FONT="]Pre-existing condition waiting periods[/FONT]
[FONT="]A special waiting period applies to new members of hospital tables who have pre-existing conditions. The waiting period also applies to existing members who have recently upgraded their level of hospital cover. If the illness or condition is considered pre-existing:[/FONT]
·[FONT="]new members must wait 12 months for any hospital benefits[/FONT]
·[FONT="]members transferring/upgrading to a higher hospital cover must wait 12 months to get the higher hospital benefits.[/FONT]
[FONT="]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.[/FONT]
[FONT="]Bronze Extras (BE)[/FONT]
[FONT="]This fact sheet is to be read in conjunction with the 2009 Member Guide. [/FONT][FONT="]This information is important and should be retained.[/FONT]
[FONT="]Important note: The extras tables must be read along with the footnotes below.
[/FONT][FONT="]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 1300 4 GMHBA (46422) or visit a branch for a benefit estimate before commencing treatment to confirm the benefit payable.[/FONT]
[FONT="]Extras Services - [/FONT][FONT="]Please refer to the footnotes following this table. (Victoria)[/FONT]
[FONT="]Waiting Periods[/FONT]
[FONT="]Benefit[/FONT]
[FONT="]DENTAL[/FONT]
[FONT="]MAJOR DENTAL [/FONT][FONT="](see important note for dental on page 2)[/FONT]
[FONT="]12 mths[/FONT]
[FONT="]Orthodontic [/FONT]
[FONT="]12 mths[/FONT]
[FONT="]Maximum benefits per calendar year Benefits example: Fixed appliance treatment – upper and lower jaw treatment by a registered specialist. [/FONT]
[FONT="]75% up to $300 per year [/FONT]
[FONT="]Maximum benefit per course of treatment[/FONT]
[FONT="]$900[/FONT]
[FONT="]Lifetime benefit limit[/FONT]
[FONT="]$1,050[/FONT]
[FONT="]Dentures (see important note for dental on page 2)[/FONT]
[FONT="]12 mths[/FONT]
[FONT="]New full upper and lower dentures per 2 years[/FONT]
[FONT="]$420[/FONT]
[FONT="]Combined crown and bridgework (see important note for dental on page 2)[/FONT]
[FONT="]12 mths[/FONT]
[FONT="]Annual limit per person each calendar year[/FONT]
[FONT="]$450[/FONT]
[FONT="]Indirect restorations (see important note for dental on page 2)[/FONT]
[FONT="]12 mths[/FONT]
[FONT="]Annual limit per person/single membership each calendar year[/FONT]
[FONT="]$350[/FONT]
[FONT="]Annual limit per family membership each calendar year[/FONT]
[FONT="]$700[/FONT]
[FONT="]Implants (see important note for dental on page 2)[/FONT]
[FONT="]12 mths[/FONT]
[FONT="]Annual limit per person each calendar year[/FONT]
[FONT="]$400[/FONT]
[FONT="]GENERAL DENTAL [/FONT][FONT="](% of GMHBA schedule fee. For more information see general dental note on page 2)[/FONT]
[FONT="]2 mths[/FONT]
[FONT="]a) Diagnostic services[/FONT]
[FONT="]2 mths [/FONT]
[FONT="]70%[/FONT]
[FONT="]b) Preventative services e.g. periodic examination 2 per 12 mth period, removal of plaque 3 per 12 mth period[/FONT]
[FONT="]2 mths [/FONT]
[FONT="]Up to $200 per person[/FONT]
[FONT="]c) Simple extractions (not including surgical extractions of wisdom teeth)[/FONT]
[FONT="]2 mths [/FONT]
[FONT="]70%[/FONT]
[FONT="]d)Restorative services(limited benefits apply to precious restorations)[/FONT]
[FONT="]2 mths [/FONT]
[FONT="]70%[/FONT]
[FONT="]ANNUAL DENTAL LIMIT[/FONT][FONT="] (see important note for dental on page 2)[/FONT]
[FONT="]12 mths[/FONT]
[FONT="]Annual limit per person each calendar year[/FONT]
[FONT="]$1,000[/FONT]
[FONT="]Fluoride dietary supplement1[/FONT]
[FONT="]2 mths[/FONT]
[FONT="]Benefit of up to[/FONT]
[FONT="]85%[/FONT]
[FONT="]Maximum benefit per person each calendar year[/FONT]
[FONT="]$45[/FONT]
[FONT="]Detailed Fact Sheet Bronze Extras (Be) [/FONT]
[FONT="]Important note for Dental:[/FONT][FONT="] The benefits shown are the annual limits for each type of dental service. There are further sub limits within some of these dental services e.g. the individual benefit for one crown on Bronze Extras (BE) is $225. Therefore, please call 1300 4 GMHBA (46422) or visit a branch for a benefit estimate before treatment to confirm the benefit payable. The annual limit per person/single membership includes combined benefits for general dental and major dental.[/FONT]
[FONT="]For new memberships[/FONT][FONT="] (no previous extras cover) or where 12 months continuous dental cover has not been in existence, all dental benefits will be limited to $200 per person/single membership and $400 per family membership during the first 12 months of membership with GMHBA.[/FONT]
[FONT="]General Dental –[/FONT][FONT="] The benefits listed are examples of dental benefits (% of GMHBA schedule fee).[/FONT]
[FONT="]For services other than dental, benefits for 1 initial consultation per therapy type are available each calendar year.[/FONT]
[FONT="]There are a range of dental procedures that cannot be claimed when provided on the same day e.g. a filling on a tooth that has been removed. There are also limits on the number of dental procedures you can have e.g. periodic examinations are limited to 2 per 12 month period. Dental benefits for some procedures cannot be paid unless tooth identifications (ID) are supplied by the provider.[/FONT]
[FONT="]Extras footnotes[/FONT]
[FONT="]1. [/FONT][FONT="]Fluoride dietary supplement - [/FONT][FONT="]Benefits are only payable towards the cost of dietary fluoride supplements (tablet or liquid form) dispensed by a chemist or dentist in private practice.[/FONT]
[FONT="]Myotherapy [/FONT][FONT="]see Physiotherapy/ Myotherapy / Hydrotherapy[/FONT]
[FONT="]2 mths[/FONT]
[FONT="]Occupational therapy[/FONT]
[FONT="]2 mths[/FONT]
[FONT="]Initial visit[/FONT]
[FONT="]$31[/FONT]
[FONT="]2-10 subsequent visits[/FONT]
[FONT="]$21[/FONT]
[FONT="]Further visits[/FONT]
[FONT="]$17[/FONT]
[FONT="]Annual limit per person/single membership each calendar year[/FONT]
[FONT="]$350[/FONT][FONT="]2[/FONT]
[FONT="]Annual limit per family membership each calendar year[/FONT]
[FONT="]$600[/FONT][FONT="]2[/FONT]
[FONT="]Optical[/FONT][FONT="]3[/FONT]
[FONT="]6 mths[/FONT]
[FONT="]Prescription spectacles, contact lenses and frames – benefit of up to [/FONT]
[FONT="]80%[/FONT]
[FONT="]Annual limit per person each calendar year[/FONT]
[FONT="]$170[/FONT]
[FONT="]Orthopaedic appliances[/FONT][FONT="]4[/FONT]
[FONT="]12 mths[/FONT]
[FONT="]Benefit of up to[/FONT]
[FONT="]80%[/FONT]
[FONT="]Maximum benefit per item[/FONT]
[FONT="]$115[/FONT]
[FONT="]Limit per person every 3 years[/FONT]
[FONT="]$400[/FONT][FONT="] 5[/FONT]
[FONT="]Orthopaedic appliance repairs[/FONT]
[FONT="]2 mths[/FONT]
[FONT="]Annual limit per person each calendar year[/FONT]
[FONT="]$40[/FONT]
[FONT="]Pharmacy – private script[/FONT][FONT="] 6[/FONT]
[FONT="]2 mths[/FONT]
[FONT="]Members pay the first maximum PBS contribution then the following benefit is paid towards the balance.[/FONT]
[FONT="]$40[/FONT]
[FONT="]Annual limit per person/single membership each calendar year[/FONT]
[FONT="]$250[/FONT]
[FONT="]Annual limit per family membership each calendar year[/FONT]
[FONT="]$400[/FONT]
[FONT="]Physiotherapy / Myotherapy / [/FONT]
[FONT="]Hydrotherapy[/FONT][FONT="] 7[/FONT]
[FONT="]2 mths[/FONT]
[FONT="]Initial visit[/FONT]
[FONT="]$31[/FONT]
[FONT="]2-10 subsequent visits[/FONT]
[FONT="]$21[/FONT]
[FONT="]Further visits[/FONT]
[FONT="]$17[/FONT]
[FONT="]Class attendance[/FONT]
[FONT="]$10[/FONT]
[FONT="]Annual limit per person/single membership each calendar year[/FONT]
[FONT="]$350 8[/FONT]
[FONT="]Annual limit per family membership each calendar year[/FONT]
[FONT="]$600 8[/FONT]
[FONT="]Prostheses (non surgical)[/FONT][FONT="] 9[/FONT]
[FONT="]12 mths[/FONT]
[FONT="]Benefit of up to[/FONT]
[FONT="]80%[/FONT]
[FONT="]Maximum benefit per item[/FONT]
[FONT="]$300[/FONT]
[FONT="]Maximum benefit per person every 3 years[/FONT]
[FONT="]$400[/FONT]
[FONT="]
[/FONT]
[FONT="]2. Occupational therapy –[/FONT][FONT="] The annual limit of $350 per person/single membership and $600 per family membership each calendar year includes combined benefits for physiotherapy, myotherapy, occupational therapy and hydrotherapy.[/FONT]
[FONT="]3. [/FONT][FONT="]Optical – [/FONT][FONT="]Non prescription sunglasses and repairs are excluded.[/FONT]
[FONT="]4. [/FONT][FONT="]Orthopaedic appliances (GMHBA approved) – [/FONT][FONT="]Must be custom made or approved by GMHBA. A doctor’s letter recommending the appliance must accompany each claim for benefits. Orthopaedic appliances attract benefits where the application of which has resulted from, and is required immediately following the injury or surgery to the injury necessitating the appliance, for purposes other than or additional to support. For an appliance to be custom made, a plaster cast or mould must be taken. Customising, heat moulding, trimming or adjusting an existing ‘off the shelf’ appliance does not involve this process and therefore does not constitute a custom made appliance. There are some conditions, therefore we recommend you call 1300 4 GMHBA (46422) or visit a branch for a benefit estimate to confirm the benefit payable.[/FONT]
[FONT="]5. [/FONT][FONT="]Orthopaedic appliances (GMHBA approved) –[/FONT][FONT="] The limit of $400 per person is available every 3 years for orthopaedic appliances.[/FONT]
[FONT="]6. [/FONT][FONT="]Pharmacy –[/FONT][FONT="] Private Script Benefits are only payable towards the cost of prescription pharmaceuticals dispensed via a provider in private practice. Benefits are not payable towards the cost of contraceptives or NHS (PBS) prescriptions, food supplements, natural remedies (including modifast/optifast), over the counter items purchased with or without a prescription and pharmaceuticals purchased overseas and not listed on the Australian Register of Therapeutic Goods.[/FONT]
[FONT="]7.[/FONT][FONT="] Physiotherapy/Myotherapy/Hydrotherapy –[/FONT][FONT="] For physiotherapy and hydrotherapy only, class attendance is limited to $240 per person each calendar year and this limit is included within your annual limit. Benefits will only be paid for 1 consultation and/or treatment type per day regardless of the provider within the group of physiotherapy, myotherapy and if eligible, remedial massage.[/FONT]
[FONT="]8. [/FONT][FONT="]Physiotherapy/Myotherapy/Hydrotherapy –[/FONT][FONT="] The annual limit of $350 per person/single membership and $600 per family membership each calendar year includes combined benefits for physiotherapy, myotherapy, occupational therapy and hydrotherapy.[/FONT]
[FONT="]9. [/FONT][FONT="]Prostheses (non surgical) –[/FONT][FONT="] Prostheses include a range of approved non-surgically implanted prostheses (e.g. wigs). A doctor’s letter of recommendation must accompany each claim for benefits. We recommend you contact us on 1300 4 GMHBA (46422) or visit a branch for a benefit estimate to confirm the benefit payable.[/FONT]