CBHS Dictionary

Access Gap
Access Gap Cover is a medical gap cover arrangement designed to minimise or eliminate out-of-pocket expenses for medical procedures conducted in hospitals or day-surgery facilities. For more information click here.

Ambulance

See 'Emergency Ambulance'.

Benefit "Maximum Payments"

All CBHS Extras benefits are subject to a Maximum Payment level.

Generally, the Maximum Payment for an individual Extras service is 70% of the service cost up to a pre-determined maximum amount.

Example
The Maximum Payment for the service 'Extraction of a full tooth' is 70% of the cost up to $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 Maximum Payment available for this service is $70 - the amount you would receive.

1. Where referred by a doctor and recognised by CBHS as essential to a member's health care needs.
2. Where benefits are not payable from any other source.

Chiropractor
The chiropractic art focuses on adjustments to correct spinal malfunctions, called subluxations, in order to remove interference to the spinal cord and the nerves that exist between the bones of the spine. Science has found that the nerve system controls all other organs and tissues of the body, so a nerve system functioning at its best facilitates the body's ability to cope with disability and disease.

Chiropractors focus on the nerve system (the brain and spinal cord) which manages the body's vast chemical interactions to help ensure proper function. The brain sends messages through the spinal cord across a huge network of spinal nerves to deliver information to every cell, organ and system of the body. This information system coordinates the myriad chemical reactions that dictate how well you sleep, how food is digested, your ability to concentrate, physical coordination, the capabilities of the immune system and all aspects of body function.

When bones of the spine become misaligned or move out of their normal position, they can distort the flow of information from the brain to the body. Without the proper information from the nerve system, the body cannot function to its full potential. That's why chiropractors gently correct these misalignments - to correct interference to the nerve system and the body's ability to control and coordinate its many functions.

Information provided by Chiropractic Association of Australia

Clearance Certificate
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:

• Level of cover
• Lifetime Health Cover age
• Days Without Cover
• Persons covered

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.

Code of Conduct
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:

• Work towards improving the standards of practice and service in the private health insurance industry.
• Provide information to members in plain language.
• Promote better informed decisions about private health insurance products and services by:
  • Ensuring that policy documentation is full and complete.
  • Providing clear explanations on the contents of the policy documentation upon request.
  • Ensuring that staff providing information in health insurance are appropriately trained.
• Ensure that information exchanged between CBHS and its members is protected in accordance with privacy principles.
• Provide information to members on their rights and obligations under their policy with CBHS, including information on the code of conduct.
• Ensure all members are aware of the internal and external dispute resolution process.

Cooling Off Period
Under the Code of Conduct CBHS will allow any members 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.

Cosmetic Surgery
Cosmetic procedures do not have a Medicare Benefit Schedule (MBS) item number and therefore any benefits paid by CBHS will be minimal.

Admission to either an agreement or non-agreement hospital will receive limited benefits for the accommodation and nil benefits for theatre, medical fees and prostheses (if required for the procedure).

There are some MBS item numbers with a description which can be performed for either a cosmetic or medical reason (e.g. breast reduction). CBHS requires a medical report from the treating surgeon to ascertain the type of procedure to determine benefits payable.

Daily Excess
Members can elect to pay a lower contribution for their Comprehensive or Limited Hospital Cover by agreeing to pay a set amount per day they are hospitalised.

CBHS covers have two Daily Excess option - $70 or $100. This means that if a member is admitted to a hospital (including day hospitals), they will need to pay the relevant Daily Excess each day they are hospitalised up to a maximum of 6 days per person or 12 days per family per calendar year.

Days With Out Cover (DWOC)
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:

• Periods during which you are overseas for more than one year (you will still be treated as being overseas during any period of return that lasts fewer than 90 days).
• Periods of suspension granted by a health fund.

Dependent
There are two categories of dependant members:
1. Dependant Member
2. Dependant Child

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.

Eligibility Groups
Access to CBHS is restricted to current or former employees/contractors of the Commonwealth Bank Group, as well their partner, dependants, siblings, parents and grandchildren.

The Commonwealth Bank Group means the Commonwealth Bank of Australia and its subsidiary companies.

Emergency Ambulance - State Rules

Western Australia 
CBHS Hospital and Ambulance Covers provide for emergency ambulance transport to a hospital, including transportation from the scene of an accident or the scene of a medical event, but does not include transportation to hospital for the routine management of an ongoing medical condition or transportation between hospitals.

Residents aged over 65 are entitled to free or subsidised ambulance services.

Queensland
QLD residents pay ambulance subscription through their electricity bills which covers them for Ambulance services Australia wide.

Tasmania
Tasmanian residents pay ambulance subscription through their resident taxes and receive reciprocal arrangements with all states except South Australia and Queensland. If ambulance services are required in these States, Tasmanian residents will be billed for these costs.

New South Wales and Australian Capital Territory
CBHS Hospital and Ambulance Covers provide for full ambulance transport within New South Wales and Australian Capital Territory.

In all other States, New South Wales and Australian Capital Territory residents will receive emergency ambulance transport to a hospital, including transportation from the scene of an accident or the scene of a medical event, but does not include transportation to hospital for the routine management of an ongoing medical condition or transportation between hospitals.

Victoria and South Australia 
CBHS Hospital and Ambulance Covers provide for emergency ambulance transport to a hospital, including transportation from the scene of an accident or the scene of a medical event, but does not include transportation to hospital for the routine management of an ongoing medical condition or transportation between hospitals.

Government Rebate
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 Rebate has three levels:

• 30% if no person covered by the membership is aged 65 years or more; 
• 35% if any person covered by the membership is aged 65 to 69 years; and
• 40% if any person covered by the membership is aged 70 years or more.

For further details click here.

In-patient  
You are classified as an 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.

Lifetime Health Cover
Lifetime Health Cover is a Federal Government initiative that rewards people for taking out Hospital Cover at an early age and maintaining that cover throughout their lifetime. For further details click here.

Limit Bank
The Limit Bank works just like a bank account. When you receive a benefit for a particular service, your Limit Bank 'balance' for that category or group of services reduces by the CBHS benefit amount.

After the specific time period that applies to the category of services elapses, the amount is credited back to the Limit Bank. The time period applies to the anniversary day of the service.

Example
On Top Extras the physiotherapy limit is $720 and the time period is one year. If you received a benefit from CBHS of $61 for an initial physiotherapy consultation, your physiotherapy limit bank balance decreases by $61 to $659. After one year elapses (to the same date the service was received) CBHS credits $61 to your Limit Bank.

Limited Services
You can elect to pay a lower contribution for your private health insurance in return for agreeing to be covered for lesser benefits.

If you select a Hospital Cover with limited benefits for certain services and choose to go into a private hospital to receive any of these services, you will be faced with significant out-of-pocket expenses, including the full cost of theatre or labour ward fees, intensive care units and coronary care units.

For more information on Limited Services, click here.

Medical Benefit Schedule (MBS)
The Government sets a schedule of medical fees - called the Medicare Benefits Schedule - based on a fair price and how much Australia can afford to pay for the total health system. Whether people are a member of a health fund or a private patient paying for all your own costs, the Government provides a rebate on nearly all medical fees. This rebate is currently 75% of the MBS fee for in-hospital medical fees and 85% of the MBS fee for medical fees incurred out of hospital.

Medicare Levy Surcharge
The Medicare Levy Surcharge is an additional 1% surcharge of taxable income imposed on people who are considered high income earners, and do not have an appropriate level of hospital cover. Click here for more information on the Medicare Levy Surcharge.

Medicare Safety Net
If you need to see a doctor or have tests regularly you may end up with high medical costs which are not claimable through CBHS. The Medicare Safety Net is designed to help you when you need it most. Once you reach a safety net threshold, visits to the doctor or having tests may cost less.
For more information click here. 

"Gap"
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.

Gap Assist
A medical gap benefit to assist with any out-of-pocket expenses which may incur as a result of a hospitalisation. LiveLife Package Cover offers a Gap Assist benefit of $200 per person, per calendar year and Step Up Package Cover offers a Gap Assist benefit of  $100 per person, per calendar year.

Norfolk Island
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:

• Hospitalisation costs on Norfolk Island are covered as if the treatment occurred in Australia.
• Hospitalisation costs for Norfolk Island members who come to Australia for hospitalisation are covered under the Hospital Purchaser Provider Agreement (HPPA).
• For non-HPPA hospital, minister default applies.
• Norfolk Island member who hold a current Medicare card are entitled to the 25% medical and Access Gap Cover benefits.
• Norfolk Island members who do not hold a current Medicare card cannot claim the 25% medical benefits or Access gap Cover benefits.
• Is transported to an Australian Hospital (not a New Zealand Hospital)
• The provider of the services is a recognised Emergency Ambulance provider by CBHS (e.g. not defence force plane etc)

Outpatient
An outpatient is as individual who comes to a hospital or clinic for medical care but does not need to be admitted.

Osteopathy
Osteopathy is a drug free form of manual medicine.  It treats the body's musculoskeletal components (joints, muscles and spine) through gentle hands-on techniques, such as soft tissue stretching and massage, deep tactile pressure, and the mobilisation of joints.

The lifestyle of the average working Australian is becoming busier, but more sedentary.  The combination of sitting at a computer during the week and then playing weekend sport, while a positive step towards healthy exercise, can make you more prone to injury.
     
The work environment can be a source of many health complaints, such as lower back, neck or shoulder pain, headaches, and repetitive strain injury (RSI). Participating in social or competitive sport can also put strain on the body, especially if you sustain injuries to the knees, feet or arms.

For further information on Osteopathy, or to find your nearest Osteopath, please visit the Australian Osteopathic Association's website www.osteopathic.com.au or call 1800 4 OSTEO (1800 4 67836)

Private Health Insurance Act 2007 
The Private Health Insurance Act 2007 was introduced in April 2007 and replaces the National Health Act 1953.

All funds are governed by this legislation.

Private Health Insurance Ombudsman (PHIO)
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.

Contact Details
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
Email: info@phio.org.au

Physiotherapist
A physiotherapist is an expert in human movement who applies diagnostic skills and clinical reasoning to understand a patient's condition and help improve movement and physical independence.

Physiotherapists educate patients about managing their condition, and advise ways to prevent pain and injury. Often, they will design a personal exercise program that suits the body's specific needs and lifestyle.

Physiotherapists use a wide range of drug free techniques to relieve pain, restore function and movement, and prevent further problems, including:

• Joint mobilisation and manipulation
• Therapeutic exercise and stretches
• Electrophysical agents (such as hot packs, ice and ultrasound)
• Soft tissue massage
• Breathing exercises and techniques

Generally, you don't need to see a doctor before visiting a physiotherapist. Medicare rebates may be available for some people with certain chronic conditions and complex care needs (up to five physiotherapy services per year) on referral from their GP.

Pre-existing Ailment
A Pre-existing Ailment is an illness or condition, the signs or symptoms of which, in the opinion of a medical practitioner appointed by CBHS, existed at any time during the six months prior to the member joining a hospital table or upgrading to a higher level of cover.

This means the sign or symptom of the pre-existing illness, ailment 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.

Reflexology
Reflexology is based on the principle that certain parts of the body reflect the whole.

Reflex points, which relate to all parts of the body, can be found in the feet, hands and ears. These points respond to pressure, stimulating the body's own natural healing process. The body starts progressively clearing blockages, re-establishing energy flows and balancing itself, resulting in better health. There are many different styles and approaches used in reflexology, however the basic principle is constant. Subtle yet powerful, reflexology is becoming increasingly popular in the world of complementary therapies.

Regular reflexology has many beneficial and lasting effects. Some are of a more general nature, balancing and restoring systems for better function, and some are quite specific, addressing the client's particular conditions.

To find out more about reflexology, visit www.reflexology.org.au, or speak to your GP.

Information provided by the Reflexology Association of Australia.

Waiting Periods
CBHS waiting periods apply across a range of services. The waiting period is the time you have to wait after you join CBHS before you can claim for a particular service.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. Such waiting periods aim to protect the fund and its members from unfair exploitation by individuals joining when they need expensive medical care. Months referred to in the table below are calendar months. For more information on waiting periods click here.