The Lifetime Health Cover (LHC) loading is a Government loading on your private hospital cover premiums. It was introduced on July 1, 2000 to encourage people to take out private hospital cover earlier, and to maintain their cover.
This determines what government rebate will be applied, find out more.
Hospital services
A waiting period is the time between when you first take out health insurance or upgrade your cover and when you're actually covered for a hospital treatment.
Hospital waiting period durations – when treatment or service is included on your cover – are as follows:
Waiting period: 0 days (accidents must occur after joining)
Accidents - bodily injuries resulting from accidents which occur after the date of joining GMHBA or upgrading to a higher cover.
Waiting period: 2 months
Any other benefit for hospital (or hospital substitution) treatment unless otherwise stated.
Waiting period: 12 months
Obstetrics and maternity, pre-existing ailment, illness or condition (other than psychiatric, rehabilitation and palliative care).
Extras services
A waiting period is the time between when you first take out health insurance or upgrade your cover and when you're actually covered for a treatment or service.
Waiting periods for extras services – when included on your cover – are as follows:
Waiting period: 0 days
Ambulance transport and subscriptions
Waiting period: 2 months
Any services that are not specified below
Waiting period: 6 months
Optical
Waiting period: 12 Months
Major dental, orthodontics, podiatry surgical procedures and orthotic appliances (foot), orthopaedic appliances (GMHBA approved), medical devices and aids including hearing aids, blood glucose monitor, extremity pump, nebuliser pump, pressure garments, prostheses (GMHBA approved, non-surgical), sleep apnoea monitor and tens monitor.
A pre-existing condition 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 insurance or upgraded to a higher level of hospital cover and/or benefit entitlement.
A special waiting period applies to obtain benefits for hospital treatment for new members who have pre-existing conditions. The waiting period also applies to existing members who have recently upgraded their level of hospital cover. If the ailment, illness or condition is considered pre-existing:
New members
New members must wait 12 months for any hospital benefits (other than psychiatric, rehabilitation and palliative care).
Existing members (transferring or upgrading)
Members transferring/upgrading to a higher hospital cover must wait 12 months to get the higher hospital benefits (other than psychiatric, rehabilitation and palliative care).
GMHBA extras can have several different types of benefit limits, depending on your cover. The limit type for applicable services is outlined in the fact sheet for each cover.
Annual limits – Most benefit limits are annual limits, which reset each calendar year on 1 January. Annual limits apply to each individual on the membership, unless otherwise specified. Keep in mind, some services also have a multi-year limit or lifetime limit.
Smart limits – Offered on SmartCare Extras covers only, a Smart Limit is a flexible annual limit that you can choose to spend across included services (excluding optical) each year, either with or without sub-limits depending on the cover.
Per person limits – The total amount an individual on the policy can claim on a service per calendar year.
Membership limits – The maximum amount that can be claimed in a calendar year per policy. This limit is shared between all people on the membership.
Sub-limits – The total amount you can claim on a particular service or treatment within the overall annual limit. These can vary from service to service.
Combined limits – This is a single limit that can be used across a collection of services.
Multi-year limit – The maximum amount you can claim, every few years.
Lifetime limit – This applies for orthodontic treatment only, per person on the membership, and is the maximum amount that can be claimed for the service during your lifetime.
Restricted services are limited to a minimum (default) benefit as set by the Australian Government for accommodation as a private patient in a shared room of a public hospital. The benefit does not cover the cost of a private room in a public hospital or any room in a private hospital, and does not cover theatre costs. If you are admitted to a private hospital for treatment that is restricted by your policy, large out-of-pocket expenses will apply.
Services, procedures and treatments included in your health insurance cover.
Services, procedures, or treatments not included in your health insurance cover.
This information is important.
Please read and retain for future reference.
Full information about your chosen cover's applicable waiting periods, excess, exclusions, restrictions, limits, pre-existing conditions, accident protection and services covered is available within the policy factsheet. The price shown excludes any Lifetime Health Cover (LHC) loading.
Rates are effective 1 April 2025. | All contribution quotes by this calculator are subject to variation and should therefore be considered indicative contribution rates. | Weekly and fortnightly payment frequencies are only available for direct debits | Calculations include the 2% Direct Debit Discount available only via bank account direct debit | All prices include the Australian Government Rebate on Private Health Insurance as chosen | Hospital Cover contributions do not include any applicable Lifetime Health Cover loading.
Price shown is inclusive of any discount entitlement. Premium may vary if your details change. Discount not available on GMHBA products with AIA Vitality. Pricing and displayed product can change if details vary.
If you're 18-29, you will receive the below discount on your hospital cover as determined by your age. Learn more about how this works.
| Age when taking out cover | % age based discount |
|---|---|
| 18-25 years old | 10% |
| 26 years old | 8% |
| 27 years old | 6% |
| 28 years old | 4% |
| 29 years old | 2% |
| 30 years old | 0% |
Each year private health insurers review the cost of healthcare and use this information to adjust premiums. Any change must be reasonable and approved by the Federal Health Minister.
We want you to know now so you're not disappointed when you sign up today and see your premium change in April.
The amount of money a member agrees to pay for a hospital stay before GMHBA pay benefits. The excess is per person, calendar year based. Selecting a higher excess will lower the premium. No excess applies for child dependants under 21 on select GMHBA hospital covers. Please check your fact sheet for more information.
Health insurance in Australia is available as hospital and extras cover.
What’s the difference?
Hospital cover pays benefits towards medical treatment, services and accommodation provided when you’re admitted to hospital as a private patient, while extras cover helps with the costs of everyday health care services provided outside of a hospital – things like dental, optical, chiro and other therapies.
While some people choose hospital cover for tax purposes or to avoid additional costs – think Medicare Levy Surcharge for higher income earners or the Lifetime Health Cover loading (more on these later), there are other important reasons to consider it for yourself or your family.
Having hospital cover can give you greater control over your care if you do need to go to hospital, such as:
- more choice in where you’re treated – in a private or public hospital
- the option to pick your preferred doctor or specialist, and
- potentially shorter wait times for elective surgery in a private hospital.
You’ll need to make sure you’re covered for the clinical category to receive hospital and medical benefits for your private inpatient treatment.
Waiting periods apply for new and upgrading members on both hospital and extras covers.
When choosing health insurance, it’s up to you whether you take out hospital cover, extras cover or combine the two to get the best of both.
We’ll tailor the following questions and information based on whether you’re looking for hospital, extras or combined cover so you’re not jumping through hoops for no reason.
Health insurance 101 refresher:
- Hospital cover helps to cover the costs of medical treatment, services and accommodation provided when you’re admitted to hospital as a private patient.
- Extras cover helps to cover the costs of everyday health care services like dental, optical and physiotherapy – treatments that aren’t generally covered by Medicare.
- Combined cover is just what it sounds like with a separate hospital cover and extras cover combined, so you get the best of both.
Here are some things to consider when choosing who to cover on your membership:
- If you have a partner, it’s your choice whether you take out two single policies or one couples policy.
- A “couple”, for the purposes of couples cover, includes anyone who’s married, in a registered relationship, or in a recognised de facto relationship. There’s no minimum time duration for the relationship to be considered a ‘couple’.
- Child dependants aged under 21 and eligible student dependants aged between 21 and 25 years can be included on single parent family and family policies.
- If some family members have specific healthcare or general treatment needs, it may make sense for some individuals to take out separate policies and hold a higher level of cover than others.
- The price of a couples and family hospital cover is the same, meaning that eligible child and student dependants can be added to a couples hospital cover at no additional cost.
- If you include eligible child or student dependants on a single parent or family extras cover, the good news is your premium is not impacted by the number of dependants on the membership.
- If you and/or your partner are high-income earners and your combined annual taxable income falls above the family threshold set by the Australian Government, all members of your household will need to hold eligible hospital cover for you to avoid having to pay the Medicare Levy Surcharge (MLS).
Health insurance covers can be taken out as a single, couple, single parent family or family, and are determined by the individuals included on the policy.
Child dependants can be covered on a family or single parent membership until age 21 regardless of whether they’re studying or working. From age 21 and until they turn 25, they need to qualify as a student dependant (i.e. be single and completing an apprenticeship, traineeship or studying full time) to be added or remain on your cover.
When you take out health insurance for the first time, waiting periods will apply before you can claim for services or treatments included on your cover.
Waiting periods apply to both hospital and extras and are outlined in the summary page and fact sheet for each cover.
When taking out hospital cover for the first time, Lifetime Health Cover loading – or LHC for short – may apply.
If you take out hospital cover before 1st July, following your 31st birthday, and keep it, you won't have to pay any Lifetime Health Cover. If you take it out after this date, a loading of 2% per year (up to 70%) will be applied to your hospital cover premiums and must be paid for a period of 10 continuous years before it is removed.
Switching from another fund?
When you take out health insurance after a gap in your cover, you may need to re-serve waiting periods. If you’re upgrading your current cover, waiting periods may apply for newly included services, higher extras benefits or annual limits, or a reduced hospital excess on your new policy.
You can transfer your health insurance from another health fund to GMHBA without re-serving waiting periods provided you’ve served all relevant waiting periods on your previous cover and transfer to an equivalent or lower level of cover within 30 days of your membership ceasing with your previous fund.
We’ll contact your previous fund for you to cancel your cover and request a transfer certificate. We’ll use this history of your health insurance to check whether you need to re‑serve waiting periods, what limits remain, and whether any Lifetime Health Cover loading or age-based discount applies to your new GMHBA cover.
If you’re aged over 31, Lifetime Health Cover loading may apply to your hospital premiums, so we’ll check your Certified Age of Entry with your previous fund to see if you’re eligible for an exemption.
Depending on whether you’re new to health insurance, have had a gap in your cover or are currently insured, waiting periods may apply for your new cover.
When taking out hospital cover, Lifetime Health Cover loading – LHC for short – may also apply. Your LHC loading will be calculated during the sign-up process and if you’re switching to GMHBA or have previously held hospital cover, we’ll confirm this with your former health fund.
Find out more about why your health insurance history matters below.
To help reduce pressure on the public health system, the Australian Government encourages people to take out hospital cover earlier in life and keep it as they age.
Lifetime Health Cover (LHC) loading adds 2% to hospital premiums for every year someone delays taking out cover after 1st July following their 31st birthday, until it’s capped at 70%. This loading – based on your Certified Age of Entry – applies for 10 continuous years before it’s removed.
For couples and families, the Lifetime Health Cover loading is applied as an average of the two adults’ loadings.
Your age also affects the Australian Government Rebate for private health insurance. If the oldest person on the policy is 65 or over, you may receive a higher rebate. This can be applied as a premium reduction or claimed at tax time, and it applies to both hospital and extras cover.
GMHBA offers age-based discounts to encourage younger members to take out hospital cover before turning 30. The discount is based on your age when you first take out hospital cover, at a rate of 2% for each year you’re aged under 30. The highest age-based discount that can be applied to hospital premiums is 10% for 18- to 25-year-olds. If you maintain your hospital cover, you keep this discount until age 41. It’s then gradually reduced by 2% each year.
For couples and families, this discount is averaged across the adults. Child and student dependants over 18 are not eligible for an age-based discount.
We need to work out if any discount, loading or rebate will apply to your premium – some of which are linked to your age.
If you’re eligible for the Australian Government Rebate on private health insurance or the age-based discount, these will be included in your quote. Any Lifetime Health Cover (LHC) loading will be confirmed during the sign-up process.
Find out more about how your age can impact the cost of your cover below.
We’ll need this information to be able to provide you with an accurate quote for your premium.
Private health insurance premiums vary between the different states and territories in Australia, and can be impacted by:
- the costs of service delivery – this depends on the rate that patients are accessing healthcare as well as service availability, e.g. the number and location of private and public hospitals and healthcare providers
- regulatory and funding arrangements, and
- state or territory-specific factors – such as ambulance funding or state-based health insurance levies.
Australian Government Rebate on private health insurance
This is an income-tested rebate that helps reduce the cost of your health insurance premiums.
It’s one of the ways the government encourages more Australians to take out private health insurance, which also helps reduce pressure on the public health system.
You may be eligible for the rebate if you’re entitled to Medicare and have a complying hospital and/or extras policy (which all GMHBA covers are).
The rebate works on a tiered system. Your rebate tier depends on your household income and the age of the oldest person on your policy. There are four tiers in total: Base, Tier 1, Tier 2 and Tier 3.
Income thresholds are based on household income and are different for singles and families. Couples and single parents use the family thresholds, and for families with children, the threshold increases by $1,500 for each child after the first.
You can receive the rebate in one of two ways – either as a reduction on your GMHBA premiums, or as a lump sum when you lodge your annual tax return.
It’s important to let us know if your annual income changes during the year, as this can affect your rebate entitlement.
And if you choose not to receive the rebate as a premium reduction, that’s completely up to you – you can always apply for it later if you change your mind.
Find out more about the rebate.
Medicare Levy Surcharge (MLS)
The Medicare Levy Surcharge, or MLS, is an additional tax that may apply if you earn above a certain income and don’t have eligible hospital cover.
If your income is over the government threshold and you don’t hold hospital cover – or you only had cover for part of the financial year – you may have to pay extra at tax time.
The surcharge applies if your income places you in Tier 1, Tier 2 or Tier 3, and you, your partner or dependants (if applicable) don’t have the appropriate level of hospital cover for the full year.
The amount you may need to pay depends on your income tier and ranges from 1% to 1.5% of your annual taxable income.
Having hospital cover for the full year can help you steer clear of the surcharge – and the additional tax bill.
The income-tested Australian Government Rebate on private health insurance can help to cover the costs of hospital and/or extras cover, and can be claimed as either a premium reduction or a lump sum at tax time.
Select your income threshold below and we’ll apply the relevant rebate rate to your quoted price.
Couples and families, please select the annual taxable income for your household.
Hospital cover helps with the costs of treatment, services and accommodation when you’re admitted to hospital as a private patient.
When choosing a hospital policy, think about the treatments you want covered, what you’re happy to go without, waiting periods and any excess that may apply.
Hospital cover comes in four tiers: basic, bronze, silver and gold. Each tier includes a minimum set of hospital treatment (clinical) categories, set by the Australian Government, making it easier to compare policies across insurers. The higher the tier, the more treatments are covered and the higher the price.
Some funds, like GMHBA, offer “plus” policies with additional services included above the minimum requirements for that tier.
Services may be included, restricted, or excluded, so it’s important to check what’s covered.
Remember, waiting periods apply to new and upgraded covers. If you’re switching from another health fund, you won’t need to serve waits on an equivalent level of cover.
Choosing the right hospital cover is a personal decision – think about your health needs now and in the future, your lifestyle, and your budget.
When choosing hospital cover, it helps to think about what you may need now – and what could matter more in the future.
If you have a current health concern or family history of specific illnesses, you may be after condition-specific cover. Other treatments – such as joint replacements, cataracts, or pregnancy and birth – can become more relevant at certain life stages.
Not sure where to start?
Select I want to choose my own services to explore all clinical categories and include what’s important to you. Hospital covers come with a fixed set of inclusions so if we don’t have an exact match, we’ll find the closest option(s).
Keep in mind, the higher the hospital tier (Basic, Bronze, Silver, Gold) generally the more services included, and the higher the premiums.
Pregnancy and hospital psychiatric services are only included on our gold‑tier hospital cover. If you select either of these, we’ll guide you to this recommendation.
Your selection here will influence the covers you’re recommended.
Depending on what you choose, we’ll either:
- list all 38 clinical categories for you to pick the ones that matter most, or
- if there’s only one cover that matches your selection, we’ll jump straight to our recommendation.
You’ll be given the option to go back and change your selections at any stage.
The hospital services you select here will determine the tier of cover we recommend for you.
Hospital cover comes in four tiers: basic, bronze, silver and gold.
Each tier has a minimum set of standard hospital treatment (clinical) categories, set by the Australian Government.
The higher the tier, the more treatments are covered and the higher the price. Basic policies might cover accidents only, or just a few services, while gold policies cover all clinical categories with no exclusions or restrictions.
Some funds, like GMHBA, offer “plus” policies which meet the minimum requirements for each hospital tier, with additional services included.
Services can be included, restricted – meaning limited benefits in public hospitals only – or excluded entirely, so it’s important to check what’s covered.
Extras health insurance helps cover the cost of everyday health services delivered outside of hospital – things like dental, optical, physio, chiro and remedial massage.
Medicare doesn’t usually provide a rebate for these services, so having extras cover can help reduce your out‑of‑pocket costs.
You can take out extras on its own or combine it with hospital cover. Some extras features – like GMHBA’s annual limit rollover – are only available on certain combined covers.
What you get back for each claim depends on your cover and service limits.
It’s also worth knowing that waiting periods may apply when you join or upgrade your cover.
Switching from another fund? We’ll take care of the paperwork and make sure you won’t need to re-serve waits on an equivalent level of cover. Limits are adjusted based on previous claims.
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Select the services you’re interested in to help us narrow down your cover recommendation.
Think about the services you’ll actually use, like general dental for regular check-ups, optical if you need prescription glasses, or remedial massage and physio if you’re an active type – and the ones you want to be covered for just in case.
Below is a list of some of our commonly claimed extras services.