At CBHS we aim to provide you with as much information about your health cover as possible. Here we have provided some useful claiming information to use as a guide. If you do not find the answer you are looking for, you are most welcome to call our Member Care Centre to find out more.
information on claiming for some services.
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.
Psychiatric, Rehabilitation and Palliative Care
- Private Hospital: Psychiatric, rehabilitation and palliative care is a very complex area, and benefits paid by CBHS will depend on the contract in place with the hospital.
If your hospital has an agreement in place with CBHS and you have served all appropriate waiting periods, your initial admission will be covered. Be aware that the length of stay and the quantity of services (for example electric shock treatment, same day program and half day programs) may be limited. Your hospital should inform you if you will have out-of-pocket expenses
If your chosen hospital is not contracted with CBHS you will receive limited benefits and will face significant out-of-pocket expenses.
- Public Hospital: If you have Comprehensive Hospital cover you will be covered for all accommodation and associated costs for your admission.
Limited Hospital and Basic Hospital
- Private Hospital: If you have Limited Hospital or Basic Hospital cover and are admitted to a private hospital for palliative care, psychiatric or rehabilitation treatment, you will receive limited benefits, and will have significant out-of-pocket expenses.
- Public Hospital: If you have served all appropriate waiting periods you will be covered for all accommodation in a shared room and associated costs for your admission.
Under all CBHS Hospital Covers, payment for drugs and other supplies prescribed at the time of discharge from a public or private hospital are your responsibility.
Any excess is payable at the time of admission.
In Vitro Fertilisation (IVF)
If you joined or upgraded a Hospital Cover in the last 12 months, waiting periods - including those for Pre-existing Conditions may apply for IVF treatment. Please contact CBHS for details before commencing treatment if you are considering IVF.
If you have Comprehensive Hospital cover and your chosen hospital is contracted with CBHS, you will be covered for all accommodation, intensive care, theatre and labour ward fees. If your chosen hospital is not contracted with CBHS you will receive limited benefits but will have significant out-of-pocket expenses. Any excess on your cover is payable at the time of admission.
Limited Hospital and Basic Hospital
Members with Limited Hospital or Basic Hospital cover will be covered for accommodation in a shared room and intensive care, and theatre and labour ward fees in a public hospital. Any excess is payable at the time of admission. If you wish to attend a private hospital, you will experience significant out-of-pocket expenses.
If you require cosmetic or plastic surgery, please contact CBHS before admission to hospital to determine the benefit paid towards your treatment and accommodation.
Please contact CBHS for information relating to benefits for surgical podiatry. Before contacting CBHS please ensure that you know whether the treatment will be performed by a 'surgical podiatrist' or an 'orthopaedic surgeon' as this will affect the benefits paid.
Surgical Dental (performed in hospital)
Please contact CBHS for information relating to benefits for surgical dental. Your level of Extras Cover will affect the benefits you receive for surgeon costs. It is important that you know the dental item numbers and the hospital or day surgery where you will be receiving the treatment before contacting CBHS.
Nursing Home Type patient (NHT)
Unless a doctor supplies documentation of special exemption, public or private hospital patients who are hospitalised continuously for a period of more than 35 days are automatically classified as NHT patients. In such cases benefits are reduced to comply with legislation and members may face out-of-pocket expenses. Please contact CBHS for more information relating to NHT patients.
Some services such as surgical podiatry, laser eye surgery, plastic and reconstructive surgery for cosmetic purposes, do not attract a benefit from Medicare. Such services will result in significant out-of-pocket expenses regardless of your level of cover.
For any alternative health claims you must submit an official receipt from the provider, detailing the persons name who received the service, the type of consultation, the provider's name, address, phone number, name of association and registration number.
Gym Membership, Personal Training, Yoga & Pilates
Under CBHS Wellness Benefits, members can claim towards the above services when the services are received as part of a Health Management Program designed to improve or reduce a specific health or medical condition.
Health Management services that require an Authorisation form:
- Gym membership
- Personal training
A completed Health Management Program (HMP) Authorisation Form must be completed by your GP, Specialist or Allied Health service provider when submitting your claim. CBHS accepts a maximum program duration up to 5 years after which, a new HMP Authorisation form is required.
Am I covered as an admitted patient for Chemotherapy on a daily basis?
You will be covered for chemotherapy received on a daily basis as long as the hospital you are receiving the treatment from has an agreement with CBHS, and admits you as a day patient. If you have an excess, this will apply to your hospital admission.
Am I covered for a minor medical procedure in my doctor's room?
An example of a minor medical procedure could be the removal of a small cancerous spot where the doctor may perform this procedure in a sterile room and raises a specific fee.
Benefits towards this specific fee are available under Top Extras and LiveLife package cover. Benefits are 70% of the cost up to a maximum of $160. This type of service is considered a non-admitted theatre fee.
Can I receive benefits towards home nursing after hospitalisation?
In some instances home nursing is provided by the hospital after you have been discharged and is payable by CBHS under your hospital cover as part of your admission costs.
Alternatively if the above does not apply and you have Top Extras or LiveLife package cover, you will receive benefits towards home nursing by a registered nurse.
Am I covered for prostheses?
To at least the minimum benefit specified in the prosthesis list issued under Private Health Insurance legislation.
When does CBHS require a medical report for a planned hospitalisation?
If you have joined or upgraded your level of hospital cover within the last 12 months, you may be subject to waiting periods for pre-existing conditions. You need to provide a medical report so our medical advisor can assess whether or not the condition is covered.
The report must be completed by the first doctor consulted for this condition. Download the Certificate for Medical Practitioner.