Intermediate Extras

All category limits listed are per person.

Limit Bank periods are highlighted in the right column of the table.

	MAXIMUM PAYMENT 70% OF THE COST UP TO:	LIMIT	LIMIT BANK PERIOD (YEARS)
Essential Dental1
Periodic Examination (012)	$33	$200	1
X-Ray (022)	$23
Removal of plaque (111)	$38
Removal of calculus (114)	$60
Fluoride application (121)	$25
Mouthguard (151)	$85
Fissure sealing (161)	$27
Health Checks (Where not claimable from another source)
Mammograms	70%	$200	1
Bone density tests	70%
Skin cancer screening	70%
Bowel/prostate cancer screening	70%
CT gates scans	70%
Health Maintenance
Quit smoking programs2	70%	$100	1
Weight managements programs3	70%
Stress management courses4	70%
Gym membership5	70%	$100
Blood glucose accessoires	70%	$100
Dietician consultation	70%	$100
Essential Dental (2 MONTH WAITING PERIOD)
See ESSENTIALS above
General Dental1 (2 MONTH WAITING PERIOD)
Filling: 1 surface metallic (511)	$61	$200	1
Filling: 3 surface metallic (513)	$84
Filling: 1 surface tooth-coloured (531)	$68
Filling: 3 surface tooth-coloured (533)	$100
Consultations	$28-$40
X-rays	$19-$42
General Dental Plus1 (2 MONTH WAITING PERIOD)
Diagnostic model (071)	$24	$150	1
Enamel micro-abrasion (116)	$44
Surgical Dental1 (6 MONTH WAITING PERIOD)
Extraction of full tooth (311)6	$70	$150	1
Other surgical procedures6	$50-$205
Periodontics (gum treatment)	$60-$250	$400
Endonontics (root canal treatment)	$40-$180
Frames
Frames	$90	$250	1
Lenses
Single vision (pair)	$60
Bifocal (pair)	$60
Trifocal (pair)	$90
Multifocal (pair)	$90
Contacts
Contact lenses	$150
Physiotherapy- initial                      - subsequent	$61 $35	$250	1
Chiropractic- initial                   - subsequent	$61 $35	$250
Osteopathy- initial                   - subsequent	$61 $35
Natural Therapies (Buteyko, Herbal Medicine Consultation, Homeopathy, Naturopathy, Nutrition)	$33	$300	1
Oriental Therapies (Acupressure, Acupuncture, Chinese Herbalism Consultation, Chinese Massage, Kinesiology, Reflexology, Shiatsu, Traditional Chinese Herbalism, Traditional Chinese Medicine)	$33
Massage Therapies (Alexander Technique, Aromatherapy, Bowen Therapy, Deep Tissue, Feldenkrais Therapy, Lymphatic Drainage, Myotherapy, Remedial Massage, Rolfing, Sports Massage, Swedish Massage, Therapeutic Massage)	$33
Blood pressure monitor, nebuliser, glucometer7	70%	$300	3
Pharmaceuticals8 (non-PBS drugs requiring prescription by law). NOTE: legislation requires CBHS to deduct the current prescribed charge	Prescribed charge up to $150	$300	1

1. The application of rules for dental services and related benefit payments can be a complex matter. The most accurate way to assess benefits in advance for a specific dental procedure is to fax or email your dental quote, including item numbers and itemised costs, or call us.
2. Quit smoking programs (including nicotine replacement therapy, certain brands of patches, inhalers and gums) must be approved by CBHS and received as part of a health management program intended to prevent or ameliorate a specific health condition.
3. Weight management programs must be approved by CBHS and received as part of a health management program intended to prevent or ameliorate a specific health condition. NOTE: Benefits are not payable for meals or special food.
4. Stress management courses (including Hatha, Ashtanga, Iyengar and Bikram yoga: minimum 8 classes) must be approved by CBHS and received as part of a health management program intended to prevent or ameliorate a specific health condition.
5. Gym Membership (min. 3 months) must be approved by CBHS and received as part of a health management program intended to prevent or ameliorate a specific health condition. Per person, per calendar year.
6. 2 month waiting period applies to 'Extraction of Full Tooth' and 'Other Surgical Procedures'.
7. Where referred by a doctor and recognised by CBHS as essential to a member's health care needs.
8. Benefits for pharmaceuticals are paid per person, per calender year.

Maximum Payment
All CBHS Extras benefits are subjected to a Maximum Payment level. Generally, the Maximum Payment for an individual Extras service is 70% of the service cost up to a pre-determined maximum amount.

Example
The Maximum Payment for the service 'Extraction of a full tooth' is 70 % of the cost up to $70.

If your dentist charges you $80 for this service, you would receive a benefit payment of $56 (70% of $80 is $56).

If your dentist charges you $110 for this service, you would receive a benefit payment of $70. While 70% of $110 is $77, the Maximum Payment available for this service is $70 - the amount you would receive.

1. Where referred by a doctor and recognised by CBHS as essential to a member's health care needs.
2. Where benefits are not payable from any other source.

 This information should be read carefully and retained.