A mid-level package cover with the same benefits as Limited Hospital and Intermediate Extras plus more…

• Limited Hospital plus pregnancy related services
• $70 daily co-payment excluding children under 13 years of age
• Access Gap Cover plus $100 Gap assist which will help you with additional out-of-pocket expenses
• Emergency Ambulance transport

hospital component

what’s covered?

StepUp 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 and labour ward 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

• Pharmacy covers most drugs related to the reason for your admission in agreement private hospitals

• 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)
•  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?

StepUp hospital cover will not cover you for:

• If a 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

A daily co-payment of $70 applies to StepUp. This means that if you go into hospital you will pay $70 for every day that you are there, up to a maximum of 6 days per person or 12 days per family in a calendar year. With StepUp, no co-payment is payable for dependant children under the age of 13.

extras component

 dental

  prescribed optical appliances

therapies

alternative therapies

general health

health care aids

(2 month waiting period)

¹ CBHS can only pay a benefit for gym membership/personal trainer/pilates /yoga where the gym/ personal trainer/yoga/pilates service is provided as part of a health management program, certified by your GP or a recognised provider confirming that the gym/personal trainer/yoga/pilates program is a health management program. Approval form is available from CBHS. Please note that GP consultations are not covered by CBHS.

² Must be approved by CBHS

* A benefit is not payable in respect of a service that was rendered to a Member if the services can be claimable from any other source

Benefit Period

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.

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.

Per Service Benefit

Most CBHS Extras benefits are subject to a Per Service Benefit. Generally, the maximum benefit for an individual Extras service is 70% of the service fee up to a Per Service Benefit within the overall category limit.

Example
The maximum payment for the service 'extraction of a full tooth' is 70% of the cost up to the Per Service Benefit of $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 Per Service benefit for this service is $70 - the amount you would receive.

Download StepUp 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.