So you're planning a family? Congratulations! CBHS can help you work through the things you need to do, to ensure you are covered for your pregnancy.
before your baby arrives
1) Determine level of cover
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 be covered up to pre-set limits. Any daily co-payment is payable at the time of admission.
Limited Hospital & Basic Hospital
For members on Limited or Basic Hospital you will be covered for accommodation in a shared room, intensive care, theatre and labour ward fees in a Public Hospital. Any daily co-payment is payable at the time of admission. If you have Limited or Basic Hospital and wish to attend a Private Hospital you will experience significant out-of-pocket expenses.
2) Ensure all relevant waiting periods have been served
12 months waiting periods apply to pregnancy/obstetrics if you are new to private health insurance, or have upgraded to a higher level of cover.
3) Ask your doctor if they will charge under the Access Gap Scheme
Access Gap allows CBHS to pay above the schedule fee for doctors' services provided to you as an admitted patient, covering the entire doctors' fees or leaving you with significantly reduced out-of-pocket expenses. Click for more information on Access Gap.
The Access Gap scheme can be used for an obstetrician, anaesthetist, assistant surgeon and pathology.
Click to view Access Gap participating doctors who have agreed to be listed. Just because your doctor isn't on this list doesn't mean they won't participate, so don't be afraid to ask them. You might just save yourself a lot of money.
4) Ask for a written quote for the cost of your treatment
Even if your doctor charges above the Access Gap fee, you will be able to find out what out-of-pocket expenses will be incurred prior to receiving treatment.
after your baby arrives
1) Contact CBHS to add new family member to your cover
When notifying CBHS of a new addition to the family you will need to provide your baby's full name, date of birth and gender.
Family and Sole Parent Cover
If you have family or sole parent cover, all waiting periods will be waived for your baby as long as you notify CBHS within 2 calendar months of the birth.
If you have single cover, all waiting periods will be waived for your baby if you upgrade to family or sole parent cover within 2 calendar months of the birth. This upgrade must take affect from the date your baby was born.
2) Claim for expenses incurred in Hospital
If your doctor participates in Access Gap Cover
Your doctor should bill CBHS directly. If the doctor sends the bill to you, forward this to CBHS, do not take it to Medicare first - we will forward to Medicare on your behalf once we have processed our portion.
If your doctor does not participate in Access Gap Cover
Take the bills to Medicare - fill in the two-way form and Medicare will forward them to CBHS once they have processed their portion.
When is my baby an admitted patient?
Under rules set down by the Commonwealth Department of Health and Family Services, the payment of gap medical benefits is restricted to medical services provided whilst an admitted patient of a hospital.
A new born baby is classified as an admitted patient when one or more of the following criteria apply;
- The baby is admitted to an approved neo-natal intensive care facility
- The baby is the second or subsequent born in a multiple birth situation (i.e. Twins, triplets etc)
- The baby is more than 9 days old while still in hospital
If none of these criteria are met, your baby is not classified as an admitted patient for gap medical purposes and expenses can only be claimed through Medicare. (It is required that you indicate that your baby was not classified as admitted patient). You will be eligible for 85% of the schedule fee through Medicare. No further benefits are available from CBHS.
Does CBHS pay for meals?
Generally, when mother and baby are in hospital, CBHS do not pay for the partner's meals or accommodation. Although there are benefits available for Boarder Fees (accommodation only) in some hospitals for specific situations, these benefits are subject to the conditions of the contract that is in place with CBHS. Please contact CBHS for further information.
What is my Daily Co-Payment?
If you have a Daily Co-payment on your membership, you will need to pay the relevant Daily Co-payment each day that you are hospitalised up to a maximum of 6 days per person or 12 days per family per calendar year If your baby needs to be admitted to hospital, you will be required to pay the relevant Daily Co-payment unless you have reached your family maximum of 12 days.
If you have LiveLife and StepUp package cover, the daily Co-payment is waived for dependant children on your membership up to 12 years of age.
If you have Hospital 'a' Excess or Hospital 'b' Excess, you can log in to the member services area or contact CBHS to determine the excess that is payable.
Does CBHS pay for Antenatal classes?
Antenatal classes are covered on Top Extras and LiveLife package cover. The benefit payable is 70% of cost, up to a maximum of $105.00 per confinement.
To claim for antenatal classes CBHS require an official receipt showing the provider's name, qualifications, dates and cost of each class.
Can CBHS help with Lactation classes?
CBHS can help if you have Top Extras and LiveLife package cover. Lactation classes come under the midwifery benefit, which entitles you to 70% of the cost up to a maximum of $500 per confinement.
To claim for lactation classes CBHS require an official receipt showing the midwife's full name and nurse’s registration number.