There are rules and conditions surrounding health fund membership. Many are regulated by Commonwealth Law. Listed below are some of the key Terms and Conditions of CBHS Health Fund Limited. For more information regarding your specific Terms and Conditions, please contact the Member Care Centre on 1300 654 123.
Arrears of Membership Contributions
If your membership contributions fall in excess of 2 months in arrears, your membership will lapse. CBHS will not pay for services received during the time your membership was unpaid or after your membership lapsed.
Artificial Aids, Healthcare Appliances, Oxygen and Oxygen apparatus
Claims for Artificial Aids, Healthcare Appliances, Oxygen and Oxygen apparatus must be accompanied by a referral letter from a registered practitioner.
Benefit Payment Conditions
Benefits may not be transferred between members and/or their dependants or any other individual.
Direct payments or other benefits will only be made to the limits of a member's cover. CBHS Health Fund Limited will not pay a service provider an amount going beyond a member's cover. No payment, regardless of benefit limits will ever be higher than the receipted cost to the member.
All benefits, subject to limits and other provisions of the Rules, cannot exceed the actual cost incurred for a service and must be evidenced by an invoice or receipt. Invoices and receipts must detail the patient's full name and the provider's name and address, the service provided, and the fee charged.
All benefits are calculated and paid based on the date the service was received or the expense was incurred. For example, when visiting a physiotherapist, you incur an expense while receiving the service (which is then invoiced). For optical appliances (pairs of glasses etc), you incur an expense when you order the appliance.
In the event that CBHS Health Fund Limited regards a claim to be excessive, it will calculate the appropriate benefit according to the usual, customary and reasonable charge for the service you received.
CBHS Health Fund Limited will not pay for services you received:
- Before you joined CBHS Health Fund Limited.
- During your Waiting Periods; For services you received during a period your membership payment was in arrears.
- After your membership lapsed or was cancelled.
- While your membership was suspended.
- At the request of a third party, such as your employer or a life insurance company.
- Where the cost of the service is lower than any excess you are liable to pay.
- More than 24 months before you lodged a valid claim.
Cancelling your Membership
You may cancel your membership at any time by advising CBHS Health Fund Limited in writing. Cancellations take effect from the next due date of contributions after your request is received.
Compensation
CBHS will not pay for services you received as a result of an accident or injury for which you have the right to receive compensation, payment from a third party, such as a workers compensation, compulsory third party or public liability insurer.
Dependants
A dependant child is an unmarried child, step-child or foster child under the age of 18 years who normally resides with you. A student dependant is a dependant who is a full-time student at a school, college or university; unmarried; and between the age of 18-24 inclusive.
Emergency Ambulance Transport
If you have Hospital or Ambulance Cover, CBHS Health Fund Limited will pay the cost of ambulance services if you are transported directly to hospital or treated at the scene due to a medical emergency.
Ambulance Cover pays benefits for emergency ambulance transport only when the transportation is provided by a State Government ambulance service or an ambulance service recognised by CBHS Health Fund Limited.
Ambulance benefits are not payable for transportation to hospital for the routine management of an ongoing medical condition or transportation between hospitals.
Members residing in New South Wales or Australian Capital Territory who have Hospital Cover are entitled to ambulance transport without charge, as their hospital contributions include a Government Ambulance Levy. Emergency Ambulance transport is provided free to most Tasmanian residents. Queensland pensioner's and senior's card holders and their dependants are entitled to free ambulance cover from the Queensland government.
Entitlement to Membership
You are entitled to apply for CBHS Health Fund membership if you are a permanent resident in Australia and you are, or one of your parents is, a past or present employee of the Commonwealth Bank or its affiliated companies.
Your partner, dependants, siblings, parents or grandchildren are also eligible to join CBHS.
Liability of Members
CBHS is a company limited by guarantee, incorporated and operating in Australia, hence the liability of the members is limited. Every voting member of CBHS undertakes to contribute to the assets of CBHS, in the event of the same being wound up while still a voting member, or within one year after ceasing to be a voting member, for payment of the debts and liabilities of CBHS (contracted before ceasing to be a voting member) and of the costs, charges and expenses of winding up and for the adjustment of the rights of the contributor among themselves, such amounts as may be required, not exceeding ten dollars ($10).
Membership of more than one Health Fund
If you have hospital cover with another health fund, CBHS may move to cancel your membership.
Newborn Infants
If you have family cover, waiting periods will be waived for your newborn child if you notify CBHS within 2 calendar months of the birth.
If you have single cover, waiting periods will be waived for your newborn infant if you upgrade your level of cover to Family within 28 days of the birth of your infant. It is necessary to upgrade your cover to commence from the date of birth of your infant.
Nursing Home Type (NHT) Patients
Unless a doctor supplies documentation of special exemption, public and private hospital patients who are hospitalised continuously for a period of more than 35 days are automatically classified as NHT patients and benefits are reduced to comply with legislation. Under these circumstances, members may face out-of-pocket expenses.
Payment of your Membership Contributions
Your membership contributions can be paid directly from your salary, by bank account transfers or any other arrangement authorised by CBHS. Details are found on the Membership Application Form. For further information, contact the Member Care Centre on 1300 654 123.
Pharmaceutical Benefits (non-PBS)
The PBS is a Commonwealth Government scheme under which specified drugs are subsidised and charged at (or below) a specified level. The amount covered by the PBS varies depending on the drug. Any amount not paid for by the Government generally must be paid by the member. It is illegal for CBHS to pay a benefit for this amount unless the pharmaceutical is supplied for treatment related to admission at a contracted hospital.
CBHS Pharmaceutical Benefits are paid toward drugs requiring a prescription by law, which are prescribed by a registered medical or dental practitioner and filled by a registered pharmacist or medical practitioner.
Benefits are not payable for drugs which:
(i) are available under the Pharmaceutical Benefits Scheme in any formulation, presentation, strength, pack size with or without repeat dispensing or combination of the preceding regardless of whether of such availability is subject to the Specified Purpose, Authority Required, Pensioner Concession or Special Patient Contribution conditions of that scheme; or
(ii) were prescribed in the absence of illness or disease or for contraceptive purposes or for enhancement of sporting or employment performance; or
(iii) were supplied by a Medical Practitioner for the purposes of infertility treatment or such other circumstances as have been approved by CBHS.
Pre-existing Condition
A pre-existing condition is an illness or condition where after examining medical evidence, a medical practitioner appointed by CBHS would consider that signs or symptoms would have been in existence at any time during the six months preceding the application for membership or upgraded cover. It is not necessary for the signs or symptoms to have been diagnosed by a doctor when the member joined or upgraded their level of cover.
Providers
CBHS will pay benefits only toward services provided by qualified and registered providers.
Reimbursing CBHS
If a payment was made to you in error, CBHS is entitled, within 24 months of making the payment, to recover that amount.
If within a period of 6 months prior to cancelling your CBHS membership you receive payment for artificial aids, crowns and bridges, orthodontia, healthcare appliances, oxygen, oxygen apparatus or optical appliances, you may be required to reimburse CBHS for the amount you received.
Single and Family Membership
Single membership covers you only. Family membership covers you, your spouse and your eligible dependants.
Student Dependants
See "Dependants".
Suspensions
If a member faces hardship, plans to travel overseas for a lengthy period, or has a period of leave without pay, payment of contributions can become difficult. Under these circumstances CBHS suggest suspending membership rather than cancelling.
On reactivating a membership after suspension, a member will have to serve any outstanding waiting periods which were applied to the membership before the suspension took place. If a membership is cancelled, all waiting periods apply on rejoining.
Suspensions take effect from the next due date of contributions after your request is received.
You must fulfil certain criteria to be eligible for suspension. For further information regarding maximum suspension lengths, consecutive suspensions and eligibility for suspension, contact the Help Desk on 1300 654 123.
Time Limits on Claims
You must lodge your claim within 24 months of the date you receive a service or treatment.
Transferring to CBHS from another Health Fund
If you transfer to CBHS from an equivalent cover with another registered health benefits organisation, all waiting periods are waived. This is providing:
- you transfer to CBHS within one calendar month of cancelling membership with your previous fund;
- your commencement date with CBHS is the day following your previous fund cancellation date; you transfer to the same or a similar level of cover; and
- you have completed all relevant waiting periods with your previous fund.
If you transfer to a higher level of cover or to a level of cover that includes benefits that were not covered by your previous fund, you will be required to wait the normal periods to qualify for the new benefits. If your benefit limits have been reduced due to claims, the lower limits may also apply to your CBHS cover.
Loyalty bonuses are not transferable.
Travelling Benefits
Benefits for travelling expenses are only paid if your travel is within Australia and is necessary for you to receive essential specialist medical care that is not available where you live. Evidence from the referring doctor that travel is necessary must be provided. All claims for travelling expenses must be supported by medical certificates or other documentation from a registered medical practitioner or hospital. For further information, contact the Member Care Centre on 1300 654 123. Travelling benefits are available on Top Extras only.
Upgrading your CBHS Cover
If you upgrade your CBHS Cover, benefits are payable at the original benefit entitlement levels until you have satisfied any waiting periods. Where limits apply, benefits already paid will be taken into account.
Your Rights to Continued Membership
You have a right to continue your membership after you leave or retire from the Commonwealth Bank Group or affiliated organisation. Your dependants, partner, siblings, parents, grandparents or grandchildren also have the right to continue or take up membership.