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 and services provided when you’re admitted to hospital as a private patient, while extras cover helps with the costs of certain health care services provided outside of a hospital.
While some people choose hospital cover for tax purposes or to avoid costs – think Medicare Levy Surcharge 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.
Waiting periods apply, and you’ll need to make sure you’re covered for the clinical category to receive hospital and medical benefits for your private inpatient treatment.
Extras health insurance helps pay for everyday health care services usually provided outside of hospital – things like dental, optical, physio, chiro and other therapies.
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 and services 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, such as planning a pregnancy or needing prescription glasses, 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 after the first.
· 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.
Health insurance in Australia is available as hospital and extras 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% will be applied to your hospital cover premiums for a period of 10 continuous years.
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 included services, higher extras benefits or a reduced hospital excess on your new policy.
Waiting periods apply to both hospital and extras and are outlined in the summary page and fact sheet for each cover.
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.
Switching from another health fund? We’ll contact them 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, how much of your extras limits will carry over, and whether any Lifetime Health Cover loading or discounts apply 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.
Lifetime Health Cover (LHC) loading is an age-based government initiative that can lead to higher hospital premiums for those who delay taking out cover. It’s designed to encourage people to take out hospital cover earlier in life, and keep it.
You can take out hospital cover up until 1 July following your 31st birthday without paying LHC. If you take out hospital cover after this date, a 2% loading is added to your hospital premium for each year you didn’t have cover, up to a maximum of 70%.
Once you’ve held hospital cover continuously for 10 years, any LHC loading is removed.
Your LHC loading is worked out based on your age when you first take out hospital cover. If you join after 1 July following your 31st birthday, the applicable loading is calculated according to your age at that time.
Just keep in mind that if you cancel your cover during the 10 year period, or suspend your cover for longer than the allowable absence days, you may face the LHC loading again if you choose to take out hospital cover down the track.
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.
Watch the short videos below to learn why your health insurance history matters.
Your age is an important factor in determining the most suitable health insurance plan for you. Different age groups have varying healthcare needs and risks, so understanding your age helps in selecting a plan that provides appropriate coverage and benefits tailored to your life stage.
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.
Your annual income is important for determining your eligibility for the Australian Government Rebate on Private Health Insurance. This rebate can help reduce your premiums or provide a lump sum at tax time, making health insurance more affordable. Knowing your income ensures you can take advantage of any available financial assistance.
Your annual income is important for determining your eligibility for the Australian Government Rebate on Private Health Insurance. This rebate can help reduce your premiums or provide a lump sum at tax time, making health insurance more affordable. Knowing your income ensures you can take advantage of any available financial assistance.