Silver Extras Set Benefits

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Your guide to Silver Extras Set Benefits 1800 640 159

1 Your guide to Silver Extras Set Benefits Questions? Need Advice? Our consultants are available to help. Comparethemarket.com.au ACN Level 2, 80 Jephson Street, Toowong Qld 4066 PO Box 301, Toowong Qld 4066 Australia

Waiting Periods Waiting periods exist to protect members from claims made by those who join the fund or increase their level of cover because they have an ailment or illness that may require

2 SILVER EXTRAS SET BENEFITS Effective 1 April 2018 This information is important, please read and retain for future reference. GMHBA Silver Extras Set Benefits provides a moderate level of cover on a commonly used range of services with a medium level of benefits and annual limits. Waiting Periods Waiting periods exist to protect members from claims made by those who join the fund or increase their level of cover because they have an ailment or illness that may require treatment. Waiting periods will apply to: New memberships (previously uninsured). 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. 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. Extras Services Waiting Period Benefit Limits Ambulance subscription/transport Please note: To be fully covered for Ambulance services, we recommend that you take out an ambulance subscription in your state or territory. You can claim a refund on one ambulance subscription per membership each calendar year. A transport trip is claimable however this will result in significant out-of-pocket costs. Publicly funded ambulance services and State Government transport schemes are excluded (eg. TAS/NSW/QLD). Ambulance subscription annual refund (1 claim per membership) 100% Ambulance transport benefit (per trip) $300 Ambulance transport annual limit per calendar year $500 Audiology N/A Initial visit $35 Subsequent visit $27 Blood Glucose Monitor 12 Months One per membership every three years 100% up to $150 Chiropractic / Osteopathy Initial visit $26 Subsequent visit $20 Chiropractic x-ray ( 1 per person) $40 Annual limit per person, per calendar year $300 Annual limit per family membership, per calendar year $600 Dental From 1 May 2018, GMHBA members who have extras with dental cover will save 15-40% off dental treatments performed by any smile.com.au approved dentist across Australia. Savings may vary between dentists. It is recommended that members obtain a quote prior to treatment. Please note: The annual limit is a combined general dental and major dental limit. The following limits shown are the annual limits for each type of dental service. There are further sub limits within some of these dental services. Annual dental overall limit per person, per calendar year $1,500 Dentures 1 Full upper and lower dentures, every 2 years (sublimits apply) Set benefits apply $600

3 Combined crown and bridgework 1 Annual sublimit per person, per calendar year Set benefits apply $600 Indirect restorations 1 Annual sublimit per person, per calendar year Set benefits apply $350 Annual sublimit per family membership, per calendar year Set benefits apply $700 Implants 1 Annual sublimit per person, per calendar year Set benefits apply $600 Orthodontic Please note: Orthodontic sublimit is based on tenure at current product level 1 Annual sublimit per person, per calendar year Year 1-3: 75% $400 Year 4: 75% $500 Year 5: 75% $600 Year 6: 75% $700 Lifetime benefit limit per person $2,400 General dental There are a range of dental procedures that cannot be claimed when provided on the same day eg. a filling on a tooth that has been removed. There are also limits on the number of dental procedures you can have eg. periodic examinations are limited to two per calendar year. Dental benefits for some procedures cannot be paid unless tooth identifications (ID) are supplied by the provider. Preventative dental Preventative services e.g. periodic examination 2 per calendar year, removal of plaque 3 per calendar year. Set benefits apply Annual sublimit per person, per calendar year $400 Dietetics & diabetes education consultations Initial visit $56 Subsequent visit $41 Dietetics class attendance $10 Extremity pump 1 Benefit 100% One per membership, every 3 years $300 Eye therapy and speech therapy Initial visit $30 Subsequent visit $23 Fluoride dietary supplement Benefits are only payable towards the cost of dietary fluoride supplements dispensed by a chemist or dentist in private practice Annual limit per person, per calendar year Up to $19 $45 Hearing aids 1 Benefit per hearing aid 100% $744 Maximum per person, every 3 years $1,200 Naturopathy/Homeopathy/Acupuncture/Remedial Massage Initial visit $26 Subsequent visit $20 Annual limit per person, per calendar year $300 Annual limit per family membership, per calendar year $600 Nebuliser pump 1

4 One per membership, every 3 years 100% $150 Nursing Home (bush) nursing benefit per visit $8 Registered nurse visit (private practice) benefit per hour $8 Registered nurse visit (private practice) maximum benefit each day $48 Annual limit per person, per calendar year $1,000 Occupational therapy Initial visit $36 Subsequent visit $27 Annual limit per family membership, per calendar year $800 Optical Non-prescription sunglasses and repairs are excluded 6 months Prescription spectacles, contact lenses and frames 80% Annual limit per person, per calendar year $200 Exclusive GMHBA Eye Care additional annual limit per person, per calendar year $100 Additional limit of $100 per person is available once $200 annual limit has been utilised Orthopaedic appliances 1 Must be custom made or approved by GMHBA. A doctor s letter of recommendation is required prior to claiming and is limited to one item per person, every 3 years. Orthopaedic appliances attract benefits where the application of which has resulted from, and is required immediately following the injury or surgery to the injury. 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. Orthopaedic appliances benefit of up to $84 Orthopaedic appliances limit per person, every 3 years $300 Orthopaedic appliance repairs 75% Orthopaedic appliance repairs annual limit per person, per calendar year $40 Orthotic appliances 1 Orthotic appliances must be custom made by a podiatrist or orthotist and not by a chiropractor or physiotherapist. For an orthosis 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. Benefit Set benefits apply Annual limit per person, per calendar year $200 Annual limit per family membership, per calendar year $400 Pharmacy including travel vaccinations - private script Private script benefits are only payable towards the cost of prescription pharmaceuticals that are dispensed through a provider in private practice. Pharmaceuticals must be classed as either Schedule 4 or Schedule 8 for benefits to be paid. Contraceptive, IVF and fertility drugs excluded. Benefit after deduction of the PBS co-payment $24 Annual limit per person, per calendar year $250 Annual limit per family membership, per calendar year $450 Physiotherapy/Myotherapy/Hydrotherapy Class attendance for physiotherapy and hydrotherapy is limited to $240 per person each calendar year and this limit is included within your annual limit. Physiotherapy consultation must be for a minimum of minutes to qualify for one-on-one physiotherapy benefits. Initial visit $38 Subsequent visits $29 Class attendance (physiotherapy and hydrotherapy only) $20 Annual limit per family membership, per calendar year $800

5 Podiatry Initial visit $28 Subsequent visit $22 Comprehensive treatment initial visit $36 Comprehensive treatment subsequent visits $28 Surgical procedures 1 Set benefits apply Annual limit per person, per calendar year $250 Pressure garments 1 Are used for the treatment of burns, varicose veins, lymphodaema or for post-operative surgery up to 60 days from hospital discharge. Garments must be supplied through a private company or therapist in private practice. A doctor s letter recommending the garment must accompany each claim for benefits. Benefit of up to $49 Limit per person, every 3 years $200 Prostheses (non surgical) Prostheses include a range of approved non-surgically implanted prostheses (eg wigs). 1 Benefit of up to 100% up to $130 Limit per person, every 3 years $200 Psychology Initial visit $41 Subsequent visits $31 Group therapy initial visit $42 Group therapy subsequent visits $31 Annual limit per person, per calendar year $350 Annual limit per family membership, per calendar year $600 Sleep apnoea monitor 1 One claim per membership every 3 years 100% $200 Tens monitor 1 One claim per membership every 3 years 100% $100 Preventative health Melanoma Surveillance Photography Approved quit smoking programs Nicotine replacement patches 1 per year 1 per year 1 x 12 week course of patches per year Annual limit per person, per calendar year $100 Annual limit per family membership, per calendar year $200 Important All extras services must be provided by practitioners in a private practice who are appropriately registered with recognised bodies approved by GMHBA. We recommend you contact us for a benefit estimate before commencing treatment to confirm the benefit payable. For services other than dental, benefits for one initial consultation per therapy type are available each calendar year. For further information regarding benefits and fund rules, please refer to our Important Information Guide at or contact us. Find out more If you re planning treatment, please call us to discuss your options to ensure you re covered and have served all relevant waiting periods. For further information please call , visit your local branch or gmhba.com.au. SS 22 March 2018

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Flexi Extras. Your guide to. Questions? Need Advice? Our consultants are available to help.

Flexi Extras. Your guide to. Questions? Need Advice? Our consultants are available to help. Your guide to Flexi Extras 1800 640 15 Questions? Need Advice? Our consultants are available to help. Comparethemarket.com.au ACN 117 33 378 Level, 80 Jephson Street, Toowong Qld 4066 PO Box 301, Toowong