A hospital cover designed for those seeking a sense of security, with some restricted benefits on services and treatments on things you are less likely to need, like pregnancy.
- Daily co-payment option for reduced premiums
- Access gap cover
- Emergency ambulance transport
- Access to private hospitals
what’s covered?
Limited hospital cover will cover you for:
- Accommodation for overnight, same day and intensive care for private or shared room in agreement private and public hospitals (excluding restricted services*)
- Theatre fees covered in agreement private hospitals (excluding restricted services*)
- Medical expenses related to providers for services while admitted in hospital e.g. fees from doctors, surgeons, anaesthetists, pathology, imaging etc. Covered for all services eligible for benefits from Medicare up to Medicare Benefits Schedule (MBS) Fee. Members have their choice of doctor/surgeon in a public or private hospital. CBHS will cover the difference between the Medicare benefit and the MBS fee for services provided as an admitted patient to a hospital
- Access Gap Cover is where a provider chooses to participate under an arrangement with the fund. CBHS covers up to 100% of an agreed amount in excess of the MBS fee which reduces or eliminates your out-of-pocket medical expenses (i.e. surgeons, anaesthetists, pathology, imaging fees etc)
- Surgically implanted prostheses to at least the minimum benefit specified in the prosthesis list issued under Private Health Insurance legislation
- Emergency ambulance transport for an accident or medical emergency by approved ambulance providers
- Boarder accommodation covers 100%, up to $160 per admission, if not included in hospital agreement
- Hospital Services where a Medicare benefit is payable (excluding restricted services*)
*Restricted Benefits (Services) not fully covered
The services listed below, when provided in a private hospital, are eligible for Minimum Default Benefits prescribed by private health insurance legislation. These benefits relate to hospital bed charges and are unlikely to cover the fees charged for a private hospital admission. Members may incur large out of pocket expenses for theatre fees together with the difference between the Minimum Default Benefit and the bed charge raised by the hospital.
The services listed below are also eligible for hospital benefits in a public hospital at a shared room rate. Public hospitals do not raise charges for theatre use.
- Major eye surgery services (corneal transplant, cataract surgery, other lens related surgery services)
- Joint replacement services (hip, knee, ankle and shoulder)
- Pregnancy related services
- Assisted reproductive services (e.g. IVF)
- Sterilisation and reversal of sterilisation services
- Cardiothoracic services
- Bariatric (gastric banding, sleeve gastrectomy, gastric by-pass) services
- Psychiatric services
- Rehabilitation and palliative care services
- Plastic and reconstructive surgery services
- Services for which a Medicare benefit is not payable
what’s not covered?
Limited hospital cover will not cover you for:
- If member is admitted into a private hospital for restricted services benefits are payable only at the minimum rate specified by law. These benefits may only provide a benefit similar to a public hospital shared room rate. These benefits may not be sufficient to cover admissions in a private hospital
- Hospital services received within policy waiting periods
- Nursing home type patient contribution, respite care or nursing home fees
- Take home/discharge drugs (non-PBS drugs may be eligible for benefits from your Extras cover)
- Aids not covered in hospital agreement (may be eligible for benefits from your Extras cover)
- Services claimed over 24 months after the service date
- Services provided in countries outside of Australia
- Prostheses used for cosmetic procedures, where no Medicare benefit is payable
- Ambulance transfers between hospitals
Download Limited Hospital Product Sheet
When deciding if this product is right for you, please refer to the CBHS Health Benefit Fund Rules. This information should be read carefully and retained.
related links
