GMHBA’s 2025-26 annual results show new membership policies grew 94% year-on-year. Total membership rose 7% to 337,720 Australians – the fund’s strongest growth in 92 years.
That scale of new policy movement is unusual in a market where most policyholders renew without comparing options. The Private Health Insurance Ombudsman has consistently found, across its annual State of the Health Funds reports, that membership cancellation complaints largely reflect consumers transferring between funds rather than leaving private health insurance entirely – pointing to active fund switching as a likely driver of GMHBA’s growth, though the insurer has not publicly broken down where its new members came from.
The federal government approved a 4.41% average premium increase from April 1, 2026 – the highest since 2017, according to the Department of Health, Disability and Ageing. Behind that average sits a wide range: individual fund increases ran from 1.98% at the low end to 5.98% at the top. GMHBA held its increase to 1.98% – the market floor – for the fourth consecutive year.
Members Health Fund Alliance, the peak body for not-for-profit and member-owned funds, reported its member funds averaged 3.62% for 2026, against 5.12% for the three largest for-profit insurers. GMHBA’s figure sits more than 1.6 percentage points below even that.
For a broker advising a client currently sitting with a fund at the higher end of the 2026 range, this is not a one-year anomaly. It is a four-year pattern.
GMHBA paid $425 million in hospital and medical claims and $119 million in ancillary claims in 2025-26, totalling $544 million. That covered more than 130,600 hospital admissions and close to 71,000 surgeries.
Board chair Claire Higgins framed the results around member value during a period of sustained economic pressure. “The true measure of our success is the value we deliver to members when they need us most. These outcomes, combined with our record membership growth, reflect the trust members place in us and our unwavering focus on affordable products, quality care, and exceptional service,” she said.
GMHBA attributed part of its growth to two new Extras products launched in 2026 – GMHBA SmartCare and Frank Bundables – alongside ongoing investment in technology and digital capability.
CEO Jarrod Coysh pointed to the fund’s model spanning both insurance and direct care delivery. “Sustainable growth is the outcome of creating genuine value for members. We have invested heavily in making our products more competitive, expanding access to healthcare services, and providing more personalised support throughout our members’ health journeys. As a not-for-profit organisation, every decision we make is guided by our purpose of improving the health and wellbeing of our members and communities,” he said.
The fund delivered more than 131,000 occasions of care across its network in 2025-26, including 59,652 GP appointments, 53,651 eye care interactions, 11,151 dental consultations, and 6,935 physiotherapy consultations.
As of March 31, 2026, 12,790,111 people – representing 45.8% of the Australian population – held hospital treatment cover.
In the 12 months to September 2025, insurers paid out more than $26.7 billion in health, medical, and extras benefits, with hospital treatment rising 6% to $20 billion and general treatment up 5% to $6.7 billion, per the Department of Health.
Participation has grown, but the Department of Health, Disability and Ageing noted that the hospital benefits ratio was 85.5% in 2024-25, unchanged from the previous financial year and below pre-pandemic levels of around 90%. Insurers had previously indicated that the ratio could approach 87% for 2024-25, but that increase did not materialise.
Members Health Fund Alliance reported its funds operate on net margins of 2.6%, compared to approximately 7% for the major for-profit funds – a structural difference that directly affects each fund's annual pricing room.
The Ombudsman’s consistent finding is that members who move are largely moving between funds, not out of PHI altogether. The market is in motion. The question for brokers is whether their clients are on the right side of a pricing gap that has now held for four years.
A client at 5.98% is paying three times the annual rate of increase of a client at 1.98%. Compounded over four years, that is a meaningful premium difference – one that a structured benchmarking conversation at renewal could address.
GMHBA’s result reflects a broader structural divide between fund types that widens with each premium round. Brokers who understand that divide are better positioned to have the conversation before their clients go looking for it themselves.
