Frequently Asked Questions
What is Community Rating?
How do I find a GMF Health Contracted Hospital?
How long will my children be covered on my policy?
What is the Federal Government 30% Rebate on private health insurance?
I recently joined and have now changed my mind about my health cover.
What is Lifetime Health Cover?
What is the Medical Gap?
What is the Medicare Levy Surcharge?
What is a pre-existing ailment?
Tax Statements
Why do we have waiting periods?
What if I have a complaint?
Will I be covered for treatment received overseas?
State of the Health Funds Report
Fund Rules
Standard Information Statements
What is Community Rating?
The Private Health Insurance Act 2007 prevents health insurers from charging a premium based on a person’s health or history of claims – this is called Community Rating.
Community Rating was developed by the Government to make sure that people with a higher level of claims are not disadvantaged – for example, if you have a history of health issues, this doesn’t mean you should pay a much higher premium. Private health insurance is there to cover everyone, whether you have a health condition or not.
How do I find a GMF Health Contracted Hospital?
GMF Health has contracts with many Australian private hospitals and registered day surgery centres – and you’ll receive much higher benefits if you have treatment at these hospitals.
To check if your hospital is a GMF Health contracted hospital, you can contact one of our Member Service Consultants by calling 1300 653 099 or select from the list below:
Western Australian members
Australian Capital Territory members
New South Wales members
Northern Territory members
Queensland members
South Australian members
Tasmanian members
Victorian members
How long will my children be covered on my policy?
Children can be covered on their parent’s policy up until the end of the year they turn 18, unless they are in a de-facto relationship.
Children under 25 who are not married or living in a de-facto relationship and not earning more than $19,500 per annum from employment are also eligible to remain on their parent’s policy.
What is the Federal Government 30% Rebate on private health insurance?
The Federal Government provides everyone with a rebate on their private health insurance.
The rebate is not means tested, so everyone can benefit. The level of rebate you receive depends on the age of the oldest person covered on the policy.
If the policy covers anyone 70 years of age or older then the rebate is 40%.
If the oldest person covered on the policy is aged between 65 and 70 then the rebate is 35%.
For anyone under 65 the rebate is 30% of the total premium.
I recently joined and have now changed my mind about my health cover.
If you decide that the health cover you've chosen isn't right for you, you can transfer to a different level of cover at any time. Keep in mind that you may have to serve additional waiting periods if you transfer up to a higher level of cover.
Alternatively, if you have taken out your cover within the last 30 days, GMF Health have a 'cooling off period' which means you can cancel your policy and receive a full refund provided that you haven't made a claim.
What is Lifetime Health Cover?
Lifetime Health Cover is a Government initiative that recognises the length of time a person has had private hospital cover.
People who take out hospital cover earlier in life and maintain their hospital cover will pay lower premiums throughout their life compared to someone who joins when they are older. This is to reward people who have had private hospital cover from a young age.
To lock in the lowest possible premiums for life under Lifetime Health Cover, you need to take out private hospital cover by 1 July following your 31st birthday. If you choose to take out hospital cover later in life, you will pay a 2% loading on top of your premium for every year you are aged over 30. For example, someone who first takes out hospital cover at age 40 will pay 20% more than someone who first took out hospital cover at age 30. For more information about Lifetime Health Cover visit the Private Health Government web site at www.privatehealth.gov.au/information/surcharges/lifetime.htm
What is the Medical Gap?
The Medical Gap is the difference between the Medicare Benefit Schedule (MBS) fee set by the Federal Government, and the amount Medical Practitioners charge private patients when they are admitted to a hospital or day hospital facility.
Some Medical Practitioners only charge the MBS fee. In these cases, there is no Medical Gap to pay because Medicare covers 75% of the cost of treatment, and the remaining 25% is covered by GMF Health Hospital cover (provided that the treatment is not specifically excluded from your level of cover).
However, many Medical Practitioners charge more than the MBS fee. It is the amount above the MBS fee that is known as the Medical Gap. Having GMF Health Hospital cover (excluding Bronze Hospital) means that you may be able to substantially reduce this gap, and in some cases avoid having to pay the gap at all.
For full details of GMF Health's Medical Gap arrangements please refer to our Membership Guide or call 1300 653 099.
What is the Medicare Levy Surcharge?
At tax time, the Federal Government applies an additional 1% Medicare Levy to people who don't have private hospital cover and who earn over a certain income threshold.
If you have GMF Hospital cover you’ll never have to pay this additional surcharge, so you’ll save money at tax time every year.
To find out if this surcharge would apply to you or for further information just contact a Member Service Consultant on 1300 653 099.
What is a pre-existing ailment?
A pre-existing ailment or condition is an illness or condition which in the opinion of a Medical Practitioner (appointed by GMF Health) was known to exist, or where signs or symptoms were evident, during the 6 month period before you became a member or transferred to a higher level of cover.
Members have to serve a 12 month waiting period for pre-existing conditions before they can claim benefits. This is to prevent people joining when they discover they have a health issue. As you can imagine, this would be unfair to existing members.
Tax Statements
In July each year we send a tax statement to everyone who has been a GMF Health member during the previous financial year. This statement identifies you as being entitled to the Federal Government 30% Rebate on private health insurance.
Your tax statement includes how much you have paid in premiums during the financial year and the value of your rebate. It is issued in accordance with Government legislation and is sent to members regardless of whether they receive the rebate as a reduced premium, claim it via their tax return, or directly from Medicare.
In each Tax Pack there is a reference to a Private Health Insurance Statement for the Private Health Insurance Rebate. If you receive the rebate as a reduced premium or want to claim the rebate via your tax return you will need to retain this statement to correctly complete your return. Alternatively you can claim the rebate directly from Medicare – to do this you'll need to obtain a premium receipt from us.
If you receive your rebate as a reduced premium and you are not lodging a tax return you only need to keep your Private Health Insurance Statement for your personal records.
Why do we have waiting periods?
Once you are a member of GMF Health, there are waiting periods that apply before you can receive benefits. These waiting periods also apply when transferring to a higher product.
We have waiting periods to protect existing members from situations where people simply join for an expensive operation and then cancel their cover once they have been treated.
If we allowed this, the cost of claims would dramatically increase and these costs would have to be passed on to all members through premium rate increases.
Waiting periods therefore simply provide a way for GMF Health to protect long-term existing members.
Full details of waiting periods are available in our Membership Guide.
What if I have a complaint?
GMF Health is continually looking for ways to provide you with exceptional service and quality health care. If you have any concerns regarding your GMF Health membership, contact us directly on 1300 653 099 so they can be resolved as quickly as possible.
Making a Complaint
If you have a complaint, please talk it over with one of our employees. Our people are well trained and have specialist knowledge in health insurance matters.
GMF Health has a complaints handling process where our people can, if needed, escalate your issue to a senior manager.
However, if we still can't resolve your issue, GMF Health has an Internal Dispute Resolution process. You can access the Internal Dispute Resolution process by addressing your complaint to:
Member Relations Manager
GMF Health
GPO Box D158, Perth WA 6840
GMF Health would also like to advise you that the Private Health Insurance Ombudsman has been established to deal with complaints regarding health funds. We sincerely hope that you would contact us first with any concerns, but if we cannot resolve the matter, the Ombudsman can be contacted TOLL FREE on 1800 640 695, or you can write to Level 7, 362 Kent Street, Sydney NSW 2000.
Will I be covered for treatment received overseas?
We don't pay benefits for treatment that occurs outside Australia, including general treatment such as dental and glasses and any hospital or medical treatment. In this case, it might be best to consider taking out travel insurance.
State of the Health Funds Report
Every year the Private Health Insurance Ombudsman publishes a State of the Health Funds report to assist consumers in assessing the comparative performance and service delivery of Australia's private health insurance providers. A copy of the report can be downloaded from www.phio.org.au.
Fund Rules
General terms and conditions are contained in our Fund Rules.
Standard Information Statements
The Private Health Insurance Standard Information Statement (SIS) is a Federal Government requirement and provides an overview of cover and waiting periods.As it is only an overview, it does not take into consideration individual circumstances, including your length of membership or waiting periods.
If you wish to find out exactly what your policy covers, please refer to your membership summary, which is provided in your GMF Health tax statement each year. If you need a copy of your current membership summary, please email us at welcome@gmfhealth.com.au
Why are the details on the Statement different to my membership summary? The Federal Government requires private health insurers to provide a SIS so members can review their cover and compare private health insurance products.SIS only give a summary of the key product features and the benefits and premiums shown are indicative only. The format is set by the Government and is the same across all health insurers. SIS help you see if your broad needs are covered and where products differ in both price and features.
The premiums and benefits on SIS are provided for comparison only:
- The actual premium may vary depending on your circumstances, for example, your age and your age when you first took out health insurance.
- Benefits will vary depending on your policy, the treatments you are having, the hospital you visit and who treats you.
For more information on Standard Information Statements visit www.privatehealth.gov.au/sis.htm
