How to make a claim 

Download the GU Health Hospital Factsheet for a comprehensive list of questions to ask before you’re admitted to hospital. If you have an excess on your cover you will be required to pay it before you are admitted. Once you have paid your excess to the hospital, GU Health will then pay for all eligible hospital benefits in accordance with your chosen level of cover.

Generally, the hospital will send the claim direct to GU Health. If the claim has been paid in full, we will send the benefit to you.

Claims relating to pre existing conditions may be referred to GU Health's consulting doctor prior to being approved for payment. We recommend that you contact GU Health before any hospital treatment if there is any doubt as to whether a condition is pre existing.

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Claims for medical services (doctors and anaesthetists)

There are two steps required for claiming your medical expenses when you're in hospital:

1. Take these expenses to Medicare and obtain a Statement of Benefit Advice confirmation letter.
2. Complete your GU Health claim form and attach your Medicare Statement of Benefit Advice. FreePost, FreeFax or email this claim to us.

OR:

If your doctor participates in Access Gap Cover, their bills may be sent directly to GU Health.

Access Gap Cover is designed to cut down the out of pocket expenses. All GU Health members with hospital cover are eligible for Access Gap Cover, providing their doctor is willing to participate.

For more information on Access Gap Cover, please contact our Member relations team on 1800 249 966 or corporate@guhealth.com.au 

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Making dental and other extras claims

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Your treatment by registered GU Health providers

Benefits are only payable for services performed by accredited providers. To find out if your practitioner is registered, or how they can register with GU Health, call your Member Relations Team.

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What benefits are excluded?

Naturally, there are some things that GU Health can't cover. In addition to specific product exclusions, benefits cannot be paid:

• if an application form contains false or inaccurate information of the member and/or registered dependants
• for services attained during waiting periods 
• for any period in which a member is not a financial member as defined by GU Health 
•  when health services are claimed or claimable under any policy of insurance, third party or workers' compensation
• for the remainder of a membership year where an annual benefit limit has already been reached
• for any claim lodged after two years from the date of service
• for any claim made for professional services rendered by a provider to members of his/her own family or to a partner or partner's family (except for the wholesale costs involved in providing the services)
• for services received or products purchased while/from overseas, except where payable under an applicable GU Health cover
• for services provided by a practitioner who is not a registered GU Health provider
• for hospital costs for items not covered by Medicare
• for treatment as a Nursing Home Type Patient (requiring non acute care after 35 consecutive days hospitalisation) limited to the amounts set down by the Minister for Health and Ageing
• for exceptional drugs not covered by our agreements, drugs covered by the Pharmaceutical Benefit Scheme (PBS), and drugs issued for discharge
• for treatment at a private hospital emergency ward if you are not admitted to hospital unless you hold an Inpatriate hospital and medical cover with applicable benefits
• for allied health services provided by a private practitioner in hospital, e.g. physiotherapy
• for personal items while in hospital such as newspapers and magazines, and STD, mobile and international phone calls.

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Updating your personal information

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