Here’s a guide to assist you in understanding the meaning of the terminology used by CBHS.
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Access Gap Cover is a gap cover arrangement designed to minimise or eliminate out-of-pocket expenses for medical procedures.....
You are classified as an admitted patient (in-patient) when you have been admitted to a hospital as a registered bed patient and are receiving services under the direction of a physician.
Western Australia, South Australia, Victoria and Northern Territory
Hospital Covers pay the cost of emergency ambulance services when transported directly to hospital or treated at the scene due to a medical emergency. Transport must be provided by ambulance services recognised by CBHS.
Ambulance benefits are not payable for transportation to hospital for the routine management of an ongoing medical condition or transportation between hospitals.
New South Wales and Australian Capital Territory
Part of your hospital contribution is a levy charged by your State or Territory government. This entitles you to full ambulance cover within your State and emergency ambulance cover in all other States or Territories. If you receive a bill for ambulance services please forward it to CBHS for payment.
Queensland and Tasmania
Most ambulance services received within your state are provided by your State government and you should not receive a bill for these services. If you receive ambulance services outside your State, the same conditions apply as for Western Australia, South Australia, Victoria and Northern Territory.
Each group of services within Extras and Package covers have an overall limit on the amount you can claim. Most limits are based on per person per calendar year entitlement, unless otherwise stated in our Extras table.
Benefits which attract any 3 or 5 year period are entitled to have the benefit renewed on the same date which the service was performed respectively.
Private health insurance consumers have the right to transfer between different insurers without re-serving waiting periods. When a consumer transfers to a new health insurer, a clearance certificate is required in order to confirm the previous level of cover held and whether or not the Lifetime Health Cover loading should apply.
Details provided on the clearance certificate include:
From 1 April 2007, new legislation required health insurers to send clearance certificates upon request within 14 days. If PHIO receives a complaint from a member who has not received a clearance certificate within the 14 day time frame, the matter will be classified as a Level-3 Complaint (dispute) and an immediate response requested.
Members can lower contribution rates for their Comprehensive or Limited Hospital cover by electing to pay a daily co-payment.
There are two daily co-payment options - $70 or $100. This means that if you are admitted to a hospital (including day surgeries), you will need to pay the relevant daily co-payment for each day you are hospitalised, up to a maximum of 6 days per person or 12 days per family per calendar year.
All CBHS package covers include a $70 daily co-payment as a standard inclusion. Exclusive to LiveLife and StepUp package covers, we will waive the daily co-payment for dependant children on your membership up to 12 years of age.
The Private Health Insurance Code of Conduct is a self-regulatory code to promote informed relationships between private health insurers and consumers. As a signatory to the Code of Conduct, CBHS has made a commitment to:
Under the Code of Conduct CBHS will allow any member who has not yet made a claim, to cancel their membership and receive a full refund of any contributions paid within a period of 30 days from the commencement date of their policy.
Under Lifetime Health Cover, you can be without Hospital Cover for a cumulative total of 1094 days in your lifetime without incurring any additional loadings.
Once you have been absent for 1095 days, an additional 2% loading will be applied to your hospital cover premium.
For each additional 365 days you will incur a further 2% loading. DWOC are applied to each person over 30 on the membership and will transfer with you to another fund.
The permitted days for which you can drop their hospital cover without incurring a loading are:
There are two categories of dependant members:
Dependant Member is an adult on the membership who is not the Principal Member and not a Dependant Child. (i.e. spouse, defacto)
Dependant Child is a person who is:
(a) a child of the Member or a child for whom the Member is legally responsible for the day-to-day care of and is under the age of 18; or
(b) a dependent of the Member, is under the age of 25 and is a full-time student at a school, college or university, and does not have a partner.
Access to CBHS is restricted to current or former employees of the Commonwealth Bank Group, as well their partners, dependants, siblings, parents and grandchildren.
The Commonwealth Bank Group means the Commonwealth Bank of Australia and its subsidiary companies.
The Federal Government Rebate on Private Health Insurance is designed to make private health insurance cover as affordable as possible for more Australians by reducing the amount you pay for premiums by at least 30%
To be eligible for the Rebate, you have to hold a valid Medicare card.
The 'medical gap' is the difference between the doctor's fee for services provided in hospital and the combined Medicare benefit and health insurance benefit. The patient must pay this amount, unless the specialist has participated in the CBHS Access Gap scheme. You may also need to make a payment for non-medical hospital services, consultations in a specialist's rooms, or ancillary services.
The Federal Government Rebate on Private Health Insurance is designed to make private health insurance cover as affordable as possible for more Australians by reducing the amount you pay for premiums by at least 30%. To be eligible for the Rebate, you have to hold a valid Medicare card.
Members residing in Norfolk Island are entitled to identical benefits to those available to CBHS members in Australia. CBHS benefits to members residing on Norfolk Island are as follows:
The provider of the services is a recognised Emergency Ambulance provider by CBHS (e.g. not defence force plane etc)
A non-admitted patient (or outpatient) is an individual who comes to a hospital or clinic for medical care but does not need to be admitted.
A pre-existing condition is an illness or condition, the signs or symptoms of which, in the opinion of a medical adviser appointed by CBHS, existed at any time during the six months prior to the member joining a hospital cover or upgrading to a higher level of cover.
This means the sign or symptom of the pre-existing illness or condition should have been reasonably apparent or reasonably evident to the contributor or there must be something that would have been apparent to a reasonable GP on a routine external examination if the contributor had been examined.
The Private Health Insurance Ombudsman provides an independent service to help consumers with health insurance problems and enquiries.
The Ombudsman can deal with complaints from health funds, private hospitals or medical practitioners. Complaints must be about a health insurance arrangement.
PHIO also manages the website www.privatehealth.gov.au where members can find out about private health insurance and search for and compare selected features for all private health insurance products offered in Australia.
Private Health Insurance Ombudsman
Level 7, 362 Kent Street
Sydney NSW 2000
Complaints Hotline: 1800 640 695 (free call anywhere in Australia)
Telephone: (02) 8235 8777
Facsimile: (02) 8235 8778
CBHS waiting periods apply across a range of services and treatments. The waiting period is the time you have to wait after you join CBHS before you can claim for a particular service or treatment.
Waiting periods apply to those who are new to private health insurance or upgrade to a higher level of cover. Parts of waiting periods served within one health fund can be completed in another when a person transfers funds.
Last updated: 22-Dec-2011 09:58:46 AM