A mid–level package cover designed for those who are active and healthy, but still want the security of more extras benefits and hospital services.
- $100 Gap Assist benefit towards medical expenses
- Private hospital cover with some restricted services
- $70 daily excess
- No excess for children under 12 years of age
- Labour ward fees & pregnancy related services
- Wellness benefits for health management
- Emergency ambulance transport
hospital component
what’s covered?
StepUp hospital cover will cover you for:
- Accommodation – Overnight, Same Day, Intensive Care & Special Care Nursery
- Theatre & Labour ward
- Medical expenses – anaesthetists, specialists, surgeons, radiologists, pathology and imaging whilst admitted in hospital
- Surgically implanted prothesis (government approved)*
For the following services in a private hospital:
- Accidents
- Knee, hip and shoulder investigations
- Knee, hip and shoulder reconstructions
- Removal of wisdom teeth
- Removal of tonsil & adenoides
- Removal of appendix
- Pregnancy and related services
All other services (with a Medicare item number) are eligible only for restricted benefits. Restricted benefits are payable only at the minimum rate specified by law. Restricted benefits may only be similar to a public hospital shared room rate. This means if you choose to go into a private hospital to receive any services other than those listed above, you may be faced with significant out-of-pocket expenses.
what’s not covered?
StepUp hospital cover will not cover you for:
* Medicare benefit is generally not payable for a cosmetic procedure which is not medically necessary
extras component
dental
|
Description
|
70% of the cost up to the per service benefit below
|
Overall Limit
|
Limit Bank
|
|
Preventative Dental (2 month waiting period)
|
|
Oral Examinations (011, 012, 013)
|
$28-$40
|
UNLIMITED |
1
|
|
X-Ray (022)
|
$23
|
|
Removal of plaque (111)
|
$38.25
|
|
Removal of calculus (114,115)
|
$60
|
|
Fluoride application (121)
|
$25
|
|
Mouthguard (151,153)
|
$85-$87
|
|
Fissure sealing (161)
|
$27
|
| General Dental (2 month waiting period) |
|
Fillings
|
$61-$112
|
$350
|
1
|
|
Consultations & examinations
|
$28-$40
|
|
X-rays
|
$21-$42
|
|
Extractions or surgical dental
|
$50-$255
|
| General Dental (6 month waiting period) |
|
Periodontic (gum treatment)
|
$57-$250
|
$900
|
1
|
|
Endodontic (root canal treatment)
|
$7.50-$180
|
|
Inlays/Onlays/Facing
|
$360
|
5
|
|
Dentures and Implants
|
$20-$810
|
|
Occlusal Therapy
|
$17-$260
|
LIFE
|
| General Dental (12 month waiting period) |
|
|
Crowns and Bridges
|
$10-$680
|
5 |
|
Orthodontia
|
70%
|
$1400
|
LIFE
|
prescribed optical appliances
|
Description
|
70% of the cost up to the per service benefit below
|
Overall Limit
|
Limit Bank
|
|
Frames (6 month waiting period)
|
$250
|
1
|
|
Frames
|
$90
|
|
Lenses (6 month waiting period)
|
|
Single Vision (pair)
|
$60
|
|
Bifocal (pair)
|
$60
|
|
Trifocal Vision (pair)
|
$90
|
|
Multifocal (pair)
|
$90
|
|
Contact Lenses (6 month waiting period)
|
|
Contact Lenses
|
$150
|
therapies
|
Description
|
70% of the cost up to the per service benefit below
|
Overall Limit
|
Limit Bank
|
|
Therapies (2 month waiting period)
|
| Physiotherapy (Initial/Subsequent) |
$61/$35
|
$600 ($300 sublimit per therapy)
|
1 |
| Chiropractic (Initial/Subsequent) |
$61/$35
|
| Osteopathy (Initial/Subsequent) |
$61/$35
|
| Occupational Therapy (Initial/Subsequent) |
$61/$35 |
| Speech Therapy (Initial/Subsequent) |
$80/$40 |
| Clinical Psychology (Individual/Group sessions) |
$30-$140 |
|
Podiatry (excl. artificial aids: e.g. orthotics)
|
$30-$50
|
$150
|
|
Dietician
|
$15-$65
|
$100 |
alternative therapies
|
Description
|
70% of the cost up to the per service benefit below
|
Overall Limit
|
Limit Bank
|
|
Alternative Therapies (2 month waiting period)
|
Natural Therapies
Buteyko, Herbal Medicine Consultations, Homeopathy, Naturopathy, Nutrition |
$33
|
$400
|
1
|
Oriental Therapies
Acupressure, Acupuncture, Chinese Herbal Medicine Consultation, Chinese Massage, Kinesiology, Reflexology, Shiatsu, Traditional Chinese Medicine Consultation |
Massage Therapies
Alexander Technique, Aromatherapy, Bowen Therapy, Deep Tissue Massage, Feldenkrais, Lymphatic Drainage, Myotherapy, Remedial Massage, Rolfing, Sports Massage, Swedish Massage, Therapeutic Massage |
general health
|
Description
|
Per Service Benefit
|
Overall Limit
|
Limit Bank
|
|
General Health (2 month waiting period)
|
| Blood Glucose Accessories |
70%
|
$100
|
1
|
| Non-Pharmaceutical Benefits Scheme drugs requiring a prescription by law |
100% less the current government prescribed co-payment up to $150 per prescription |
$300 |
PER CALENDAR YEAR |
health care aids
|
Description
|
70% of the cost up to the per service benefit below
|
Overall Limit
|
Limit Bank
|
|
Health Care Aids (12 month waiting period) - where referred by a doctor and recognised by CBHS
|
| Artificial Aids |
70%
|
$150
|
1
|
(2 month waiting period)
|
Description
|
90% of the cost up to the overall limit below
|
Limit Bank
|
|
Health Checks (where not claimable from Medicare)
|
Breast examinations (e.g. mammograms/x-rays)
Bone density tests
Skin cancer screening
Bowel/prostate cancer screening
Eye Screenings |
$200 |
1
|
|
Health Management
|
Quit smoking programs2
Weight management programs2
Stress management courses2
First aid course/first aid kits^ |
$100 |
1 |
| Yoga1 |
| Pilates1 |
| Gym membership/Personal training1 |
$100 |
PER CALENDAR YEAR |
^Benefits on first aid courses and kits are only payable when provided by recognised CBHS providers. First aid course must be completed for benefits to be applicable to the first aid kit. Excludes replacement first aid items.
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
Limit Bank
Each group of services within Extras covers has an overall limit on the amount you can claim in a specific time period. This is called the Limit Bank.
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 PDF
Download CBHS Contribution Rates Brochure
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.