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 2026. | 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. 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.
Some of your selected services may be excluded or restricted in this lower level of cover.
Included
Treatment or service is included on this cover as a private patient in a private or public hospital.
Excluded
Not included on this cover. Benefits not payable for this service, procedure or treatment.
Restricted
Service is 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. This may come with large out-of-pocket expenses when this service is provided in a private hospital. This does not cover things like theatre costs, a private room in a public hospital, or any room in a private hospital.
Available as hospital, extras or combined cover (to get the best of both hospital and extras), you get to choose what’s most important to you.
Hospital cover pays benefits towards medical treatment, services and accommodation provided when you’re admitted to hospital as a private patient.
Extras cover helps with the costs of everyday health care services provided outside of a hospital – things like dental, optical, chiro and other therapies.
We’ll take you through the different types of health insurance in more detail soon.
Here are some things to consider when choosing who to cover on your membership:
- If you have a partner, you can choose to take out two single policies or one couples policy.
- A “couple” can be married or in a de facto relationship with no minimum time requirement.
- 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.
- Different health care needs in the household? Some people can take out separate policies and hold a higher level of cover than others.
- Couples and family hospital covers cost the same, so eligible dependants can be added to a couples hospital cover without impacting premiums.
- If you include eligible 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 income falls above the government’s family threshold, all members of your household will need to hold eligible hospital cover for you to avoid having to pay the Medicare Levy Surcharge (MLS).
If you’re transferring your health insurance to GMHBA, we’ll contact your previous fund for you to cancel your cover and request a transfer certificate. This history of your health insurance helps us check whether you need to serve waiting periods, what limits remain, and whether any Lifetime Health Cover loading (LHC) or age-based discount applies to your new GMHBA cover.
Upgrading your cover? Waiting periods apply for newly included services, higher extras benefits or annual limits, or a reduced hospital excess on your new policy.
An age-related loading, rebate and/or discount may affect the cost of your cover, if applicable.
- The Australian Government's Lifetime Health Cover (LHC) loading adds 2% to hospital premiums for every year you delay taking out hospital cover after 1 July following your 31st birthday, up to a maximum of 70%. Once applied, the loading remains for 10 continuous years before it's removed.
- If the oldest person on your policy is 65 or over, you may be eligible for a higher Australian Government Rebate, which can reduce your premiums or be claimed at tax time. This applies to both hospital and extras cover.
- If you're under 30, you may qualify for an age-based discount on hospital cover. Discounts start at 2% per year under age 30, up to a maximum of 10% for 18- to 25-year-olds. It can be retained until age 41 if you maintain your cover and is then gradually reduced by 2% each year.
The income-tested Australian Government Rebate on private health insurance can help to cover the costs of hospital and/or extras cover. If you’re eligible, you can claim it as either a reduction on your GMHBA premium or a lump sum at tax time. And if you choose not to receive the rebate as a premium reduction, that’s up to you – you can always apply for it later if you change your mind.
If your income is over the government-set 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 Medicare Levy Surcharge, or MLS, is an additional tax of 1% to 1.5% of your income and may apply if you’re a high-income earner and don’t have eligible hospital cover.
Hospital cover helps pay for treatment, services and accommodation when you’re admitted to hospital as a private patient.
Some people take out hospital cover to help avoid the Medicare Levy Surcharge if they’re a high-income earner or Lifetime Health Cover loading, while others value the peace of mind it can bring.
Thanks to Community Rating, the cost of private health insurance isn't based on your health, medical or claims history. This means you won’t be charged more for things like being a smoker, having a pre-existing condition or any claims you’ve made previously.
The right cover can give you more choices in your hospital care including where you’re treated, who by, and potentially shorter wait times for elective surgery in a private hospital.
Cover varies by service, so it’s important to check what’s included, restricted, or excluded as well as any waiting periods, and whether a hospital excess applies.
Switching from another fund? You won’t need to serve waits on an equivalent or lower level of cover.
When choosing hospital cover, think about what you need today and what might matter in the future. If you have a current health concern, family history, or expect life changes such as pregnancy, it’s worth considering cover that includes those services.
In general, higher hospital tiers (Basic, Bronze, Silver and Gold) include more services and have higher premiums.
Understanding your options
- Select Choose my own services to explore all 38 clinical categories and select what matters most to you. Hospital covers come with set inclusions, so if there’s no exact match, we’ll recommend the closest option.
- Want some help selecting services? Choose from the following and we’ll make some suggestions based on the level of cover you’re looking for.
- Just the essentials
- More than the essentials
-
- High-level cover for peace of mind
Pregnancy and birth and hospital psychiatric services are only included on our gold hospital cover. If you select either of these services, we’ll recommend this cover.
The hospital services you select determine the tier of cover – basic, bronze, silver or gold – recommended for you. The higher the tier, the more treatments covered and the higher the price.
Each tier has a minimum set of clinical categories for treatment that must be included. That means a service may appear in your cover recommendation even if you don’t select it here.
GMHBA also offers “plus” policies which meet the minimum requirements for each tier and include additional services.
Always check what’s covered as services can be included, restricted (limited benefits in public hospitals only) or excluded entirely.
Start with what matters most to you now and into the near future.
- Do you have a current condition or family history to plan for?
- Could you need services in future (like cataracts or joint replacements)?
- How much are you comfortable spending for peace of mind?
There are 38 clinical categories to choose from. You may not need them all – pick as many or as few as feel right for you. From there, we’ll match your selections to the closest cover available.
You can review and update your cover later if your needs change. Just keep in mind:
- Waiting periods apply for new services or higher benefits
- A 12-month waiting period applies for pre-existing conditions.
More included services usually mean a higher tier and premium.
Extras health insurance helps cover the cost of everyday health services delivered outside of hospital – things like dental, optical, physio, chiro and remedial massage.
What you get back for each claim depends on your cover and service limits.
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 or lower level of cover. Limits are adjusted based on previous claims.