| GMHBA | |
|---|---|
| Registered insurer | GMHBA Limited |
| Who can join | Open to anyone |
| Business structure | Member-owned mutual, not-for-profit |
| Hospital policies (30 June 2025) | 139,614 (2.3% of all hospital policies), covering 276,474 people |
| Hospital tiers on sale (1 September 2026) | Gold, Silver Plus, Silver, Bronze Plus, Bronze, Basic Plus, Basic |
| Excess options on open hospital policies | $500, $750 |
| Age-based discount (18-29) | Offered on its open hospital policies |
| Ambulance | Emergency ambulance included on its open hospital policies |
| Question | What the official data shows |
|---|---|
| Out-of-pocket costs in hospital | 86.3% of in-hospital medical services had no gap for the member (industry 87.1%), and 89.2% of hospital charges were covered (industry 89.0%), 2024-25 |
| Waiting periods and pre-existing conditions | The legal maximums apply: 12 months for a pre-existing condition (signs or symptoms in the 6 months before you joined or upgraded) and for pregnancy and birth, 2 months for other hospital treatment. Every hospital policy open to new members in the Government's data at 1 October 2026, at every fund, used the 12-month pre-existing wait |
| Switching from another fund | Waits you've already served on the same or a lower level of cover carry across to GMHBA, and from it. Ask your old fund for a clearance certificate and keep the break between policies short |
| The Medicare Levy Surcharge | Excess options on its open hospital policies go up to $750, so all are within the $750 singles limit, and every policy was flagged as meeting the surcharge rules in the Government's data at 1 October 2026 |
| Adult children (dependants) | Up to age 24, studying or not, in the fund's own record (Government data, 1 October 2026). Adult dependants often need an extended family option |
| Claims experience | 1.8% of Ombudsman complaints about insurers on a 2.1% market share (ratio 0.86), and 0.0% of the complaints the Ombudsman investigated, 2024-25 |
General advice only. This information doesn't take into account your objectives, financial situation or needs. Consider whether the product is right for you and read the Product Disclosure Statement (PDS) and Target Market Determination (TMD) before you decide. We don't compare every product in the market, and we may earn a commission if you take up a product through our links.
Structure: a regional mutual with a digital brand
PrivateHealth.gov.au describes GMHBA Limited as a mutual organisation operating on a not-for-profit basis, and lists Frank Health Insurance as one of its brands. The fund says it has provided health insurance since 1934. Frank is covered in its own review; because both brands are one insurer, the performance figures below include Frank.
Complaints and retention
GMHBA accounted for 1.8% of Ombudsman complaints about insurers in 2024-25 against a 2.1% market share, and 0% of investigated complaints. Retention was weaker: 79.9% of hospital members stayed over the year, against 85.0% across the industry.
Benefits, costs and gaps
GMHBA paid 81.9% of its premium income as benefits (industry 84.5%) and its management expenses were 14.5% of contribution income, among the higher ratios of the mid-sized funds (industry 10.9%). Hospital charges covered were 89.2% and 86.3% of in-hospital medical services had no gap (industry 89.0% and 87.1%). Its extras paid 45.6% of charges on average, below the industry's 50.7%.
In the ACT, the share of hospital charges GMHBA covered (70.6%) was well below the industry result for the territory (80.1%). Canberra residents should check the specific hospitals they'd use.
What GMHBA sells
GMHBA-branded open hospital policies at 1 September 2026 cover Gold, Silver Plus, Bronze Plus, Basic Plus and Basic (an accident-only policy), with $500 or $750 excess. All of its open hospital policies were listed with the age-based discount, and all include emergency ambulance.
GMHBA against the industry: 2024-25 data
Every year the Private Health Insurance Ombudsman compares all insurers on the same measures, and PrivateHealth.gov.au republishes the results on each insurer's profile. The table below is GMHBA's, with the industry result beside each figure. Its complaints-to-market-share ratio was 0.86: a figure of 1.00 means complaints exactly in proportion to size.
| Measure | GMHBA | Industry | Reading |
|---|---|---|---|
| Share of all Ombudsman complaints | 1.8% | Market share 2.1% | Fewer complaints than its size |
| Share of investigated complaints | 0.0% | Market share 2.1% | |
| Member retention (hospital cover) | 79.9% | 85.0% | Weaker than industry |
| Benefits paid as % of premiums | 81.9% | 84.5% | Weaker than industry |
| Management expenses % of premium income | 14.5% | 10.9% | Weaker than industry |
| Hospital charges covered | 89.2% | 89.0% | In line with industry |
| Medical services with no gap | 86.3% | 87.1% | Weaker than industry |
| Medical services with no gap or a known gap | 95.6% | 97.1% | Weaker than industry |
| Extras (general treatment) charges covered | 45.6% | 50.7% | Weaker than industry |
How to read it: complaint share is the fairest single comparison of service across funds of different sizes, because it's measured against market share. Benefits as a % of premiums shows how much of the premium pool went back to members as claims; a mutual that returns more is not necessarily cheaper, and a fund can move this figure by changing prices. The gap measures show how often members avoided an out-of-pocket medical bill after a hospital stay, which is what most people mean by "good cover".
Hospital agreements
| ACT | NSW | VIC | QLD | SA | WA | TAS | NT | |
|---|---|---|---|---|---|---|---|---|
| Private hospitals | 5 | 81 | 63 | 51 | 17 | 22 | 7 | 1 |
| Most held by any insurer | 7 | 95 | 73 | 63 | 17 | 23 | 7 | 1 |
| Day hospitals | 8 | 83 | 57 | 47 | 25 | 22 | 9 | 2 |
| Most held by any insurer | 11 | 109 | 73 | 58 | 35 | 28 | 12 | 2 |
What to check before you join GMHBA
- Management expenses (14.5%) were above the industry result in 2024-25.
- ACT members: hospital charges covered in the ACT were well below the territory's industry result.
- GMHBA and Frank are the same insurer. Compare their policies on what they cover, not on the brand.
- Over 31 and joining for the first time? Work out your Lifetime Health Cover loading first, and if you earn over the threshold, check the Medicare Levy Surcharge you'd avoid.
Common questions about GMHBA
Is GMHBA not-for-profit?
Yes. PrivateHealth.gov.au lists GMHBA Limited as a mutual organisation operating on a not-for-profit basis.
Is Frank part of GMHBA?
Yes. PrivateHealth.gov.au lists Frank Health Insurance as a brand of GMHBA Limited.
Can anyone join GMHBA?
Yes. GMHBA is an open fund that operates in every state and territory.
Other fund reviews
See every registered health insurer compared on complaints and benefits, or read how the private health insurance rebate and hospital cover tiers work.
General advice only. It doesn't consider your circumstances. Read the PDS and TMD before you decide.
This review is general information based on published government and regulator data. We don't rate or rank funds, and it doesn't consider your circumstances. Check a policy's Private Health Information Statement before you buy.