Members FAQs

Who is eligible to join CBHS?

Anyone who works or has worked for the Commonwealth Bank Group (CBA Group) including parents, partner, siblings, dependants or grandparents.

Even if you don’t work for the CBA Group anymore, you and your immediate family are still eligible to join, and always will be.

See full eligibility details here.

What do I have to do if I leave the CBA Group?

When you leave the CBA Group, you can still stay with us or re-join. Please contact us when you know your last day at CBA so we can update your details.

Do I need to re-serve waiting periods when I join CBHS?

If you transfer from equivalent cover with another Australian health fund (as confirmed by your Transfer Certificate) and have served all the waiting periods with your previous fund, you won’t have to re-serve waiting periods with us. This is also if you join CBHS within one calendar month of leaving the old fund. Waiting periods may apply if you choose to upgrade to a higher level of cover or if you suspend your cover. Read more on waiting periods.

What are my payment options?

You can pay by direct debit, invoice or CBA and Bankwest salary deductions either fortnightly, monthly, quarterly, or annually. We no longer accept billing in arrears.

You can also pay by credit card, BPoint and BPAY for memberships paid 3, 6 or 12 months in advance. We don’t accept regular payments via credit cards.

Who can be covered by my Couple or Family policy?

We do not discriminate.

Family

Up to two parents and their children can be covered by a Family or Sole Parent policy regardless of whether your family has one dad and one mum, one dad, one mum, two dads or two mums.

Our Family and Sole Parent policies can cover parents and their adopted children, and foster parents (including grandparents, aunts and uncles etc.) who have children in their legal care. For children to be included on a Family or Sole Parent policy, it’s important that guardianship be recognised by a Federal or State Government agency such as Medicare or one of the state-based family/community services agencies. We may ask for evidence of this guardianship.

Children are covered by your Family or Sole Parent policy until they turn 18 (or 31 if they are still studying full-time). If you have children aged 18 or over who aren’t studying, you’re welcome to upgrade to our non-student dependant cover, which they can stay on until they turn 31, regardless of their studying status.

For cover for other extended family members, check out our eligibility rules.

Couple

A ‘Couple’ membership means a membership that includes two people − the policy holder and their partner. You don’t need to be married. 

1300 654 123 or email help@cbhs.com.au.

What is a student dependant?

A child of a policy holder, provided the child does not have a partner, is at least 18 but under 31, and is a full-time student at a school, college, or university, or a first or second year apprentice.

What is a non-student dependant?

A child of a policy holder, provided the child does not have a partner, is at least 18 but under 31, and is not a full-time student at a school, college or university, or a first or second year apprentice.

Do I have to pay an excess / co-payment for my dependants?

We waive co-payments for any dependent children on your membership for the following covers:

• Comprehensive Hospital 70 (Gold)
• Comprehensive Hospital 100 (Gold)
• Comprehensive Hospital $750 Excess (Gold)
• Limited Hospital 70 (Bronze Plus)
• Limited Hospital 100 (Bronze Plus)
• LiveLife (Gold)
• StepUp (Bronze Plus)

If you hold any other cover, all child dependants will have to pay the excess or co-payment for hospital admission if applicable.

If you have Hospital A Excess (Gold) or Hospital B Excess (Bronze Plus), you can log in to the Member Centre or contact us to determine the excess payable.

How do I request a new membership card?

You can do this online via the CBHS Member Centre or via our smartphone app.

How can I obtain my tax statement?

You can download your tax statements from the Member Centre.

Login to the CBHS Member Centre

• From the menu select Tax Statement
• Click on the Tax Statement you wish to view
• Your Tax Statement will then be displayed in PDF format

How much will I have to pay in taxes, rebates and levies?

We recommend you consult your accountant or the Australia Tax Office (ATO) to determine your obligations and impacts from taxes, rebates and levies. We can provide general information on the Australian Government Rebate for private health insurance, and period of coverage, but we can’t provide advice or recommendations for personal tax impacts.

How can I update my contact and address details?

You can update your contact and address details online via the CBHS Member Centre.

My product is ‘closed’, what does this mean?

We continuously review our products. If a product becomes ‘closed’, no new members can purchase this policy but existing members that currently have the policy can remain on this cover. Call us on 1300 654 123 for details of your product and to check if it still meets your needs.

What can I claim for?

What you’re eligible to claim for depends on your level of cover. Briefly, these are some of the categories that our products may cover:

• Dental, optical, physiotherapy and chiropractic services
• Artificial aids and healthcare appliances
• Hospital psychiatric services, rehabilitation and palliative care
• Hospital cover ranging from Basic Plus to Gold
• In-vitro fertilisation treatment
• Surgical podiatry, surgical dental, gym memberships and health management services.

Find out more

Can I claim for treatment, services or goods received overseas?

No. Under the CBHS Health Benefit Fund Rules and the Private Health Insurance (Accreditation) Rules 2008, benefits for treatments, goods and services listed under Extras covers are payable only if the provider is a CBHS Recognised Provider and meets the Private Health Insurance (Accreditation) Rules 2008.

Overseas providers don’t meet these criteria.

What are the additional requirements for making a claim for health management services?

If you’re claiming for health management services such as gym memberships and personal training, you’ll need to have your GP, specialist, or allied health service provider complete a Health Management Program (HMP) Authorisation Form. The, simply provide this to us when submitting your claim.  Download an HMP form here.

How do I calculate my claims benefit?

We automatically calculate your claims benefit for you when you lodge a claim at your provider’s practice or when you lodge a claim online. If you claim through your provider, you’ll receive the benefit as a deduction in your out-of-pocket expenses. Your claims benefit will be based on the allowable claims percentage or per service limit and overall limit for the category and applicable benefit period.

You can also use the Online Benefit Quote tool that is available after logging in the Member Centre.

What is the CBHS Choice Network?

This is a group of providers who are committed to reducing or removing the gap for Extras services on selected preventative dental and optical frames, lenses and contact lenses.

Find a CBHS Choice Network provider

Why does CBHS only allow same day claiming for electronic claims?

We only allow same day claiming for electronic claims to protect our members. 98% of claims are made on the spot in real-time, but with the other 2%, we have found elements of irregularity in backdated claims.

What if I don’t have my membership card with me at the time of treatment?

You will have to pay for the treatment then lodge a claim with us either online, via our smartphone app or by email or post.

• Log in to claim online
• Download a claim form

Why do I need a doctor’s referral for certain claims?

We sometimes need a referral from your medical practitioner to confirm that the product you’re claiming is medically required.

What types of services do I need a referral for?

We need a referral from your medical practitioner for artificial aids, health care appliances, contraceptives and some pharmacy items in certain circumstances.

How long will my referral last?

Artificial aids and health care appliances – three years

• Contraceptives – 12 months

How can I claim on travel and accommodation?

We pay benefits towards travel and accommodation if you need essential medical or dental treatment that is not available within a 160km round trip from your home. Benefits are only paid for the member receiving treatment.

Essential medical treatment means:

• You have been referred for the treatment by a registered medical practitioner; and
• You have given us a medical certificate from the registered medical practitioner, which states that the treatment is essential.

We also require the following:

A medical certificate from the medical practitioner/a copy of the doctor’s invoice as confirmation you have attended the practice/clinic

• A copy of the receipt from the hotel, motel, etc. (for accommodation only)
• A completed and signed CBHS claim form.

Do I need to send the original receipts?

No. We accept scanned or duplicate receipts.

Why won't my doctor participate in the Access Gap Cover scheme?

It is up to your doctor to decide whether they will charge you at the Access Gap Cover rate. Even if the doctor has participated in this scheme before, it does not guarantee that they will participate in Access Gap Cover for your treatment. Doctors are free to choose whether they will participate in Access Gap Cover on a patient-by-patient basis, and this decision remains solely with the doctor.

What kind of things might I have to pay for while in hospital?

Some additional services may not be covered by CBHS. Examples include:

• Telephone use
• Newspapers
• Boarder fees
• Meals for partner
• Pharmaceuticals
• Physiotherapy

If you need any of these services, please contact Member Care on 1300 654 123 to find out if they are covered at your hospital.

Am I classified as an inpatient if I’m having chemotherapy every day?

You will be covered for daily chemotherapy if you have Hospital cover and the hospital where you receive treatment has an agreement with us and admits you as a day patient.

What am I covered for in the emergency ward of a private hospital?

We only pay benefits towards services you receive as an inpatient. That means you are admitted to hospital. If you attend a private hospital emergency ward and incur costs as an outpatient (i.e. you are not admitted to hospital), you will not be able to claim these costs through CBHS.

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.

You don’t need to pay the relevant daily co-payment for dependants on your membership if you have LiveLife (Gold)*, StepUp (Bronze Plus), or Comprehensive Hospital (Gold). If you have KickStart (Basic Plus), Basic Plus Hospital 500 or Basic Plus Hospital 750 the daily co-payment or excess applies for dependants on your membership.

For more details on daily co-payments, contact Member Care on 1300 654 123.

^{*LiveLife(Gold) is a closed product and no longer available for new sales and transfers.}

Co-payment

Members can lower the contribution rates for their Comprehensive Hospital (Gold) or Limited Hospital (Bronze Plus) cover by electing to pay a daily co-payment.

There are two daily co-payment options - $70 or $100. This means that if you are admitted to a hospital (including day surgeries), you will need to pay the relevant daily co-payment for each day you are hospitalised, up to a maximum of 6 days per person or 12 days per family per calendar year.

StepUp (Bronze Plus) includes a $70 daily co-payment as a standard inclusion. On StepUp (Bronze Plus) package cover, we will waive the daily co-payment for dependant children on your membership.

You can also reduce the cost of your Comprehensive Hospital (Gold) cover by agreeing to pay an excess of $750 and Basic Plus Hospital cover by agreeing to pay an excess of $500 or $750.

For more information, please visit our hospital comparison page.

Do I have to pay my excess/co-payment for a day procedure?

Yes.

What is a pre-existing ailment?

A pre-existing ailment is one where signs or symptoms of your ailment, illness or condition, in the opinion of a medical practitioner appointed by the health fund (not your own doctor), existed at any time during the six months preceding the day on which you purchased your Hospital cover or upgraded to a higher level of Hospital cover. The only person authorised to decide that an ailment is pre-existing is the medical practitioner appointed by CBHS. Our medical practitioner must, however, consider any information regarding signs and symptoms provided by your treating medical practitioner(s).

Am I covered for all prostheses?

You are covered to the minimum benefit specified in the prosthesis list issued under Private Health Insurance legislation.

Why do you want me to provide a medical report for my planned hospitalisation?

When you join or upgrade, there’s a 12-month waiting period for pre-existing ailments. We may ask you to provide a medical report so our medical advisor can assess if the condition is pre-existing.

The doctor you first consulted for the condition should complete the report.  Download the Certificate for Medical Practitioner.

Am I covered for a minor medical procedure in my doctor's rooms?

An example of a minor medical procedure could be the removal of a small cancerous spot. The doctor could perform this procedure in a sterile room and raise a specific fee for the use of the room.

This type of service is considered a non-admitted theatre fee. Benefits towards this specific fee are available under Top Extras, Prestige (Gold) and LiveLife (Gold) package covers. Benefits are 70% of the cost up to a limit defined for your cover.

Please note that the bill for doctor services is payable by Medicare only.

Can I receive benefits towards home nursing after hospitalisation?

Sometimes, home nursing is provided by a hospital after you have been discharged. We can pay for this under your Hospital cover as part of your admission costs.

If the above doesn’t apply, and you have Top Extras, LiveLife (Gold) or Prestige (Gold) packaged cover, you may receive benefits towards home nursing by a registered nurse.

Why does CBHS pay ambulance claims differently depending on which state the service has been provided?

Each State Government has different arrangements that determine how ambulance claims are paid. That’s why we pay claims based on the state in which the service was provided.

• NSW & ACT residents – receive full ambulance cover with CBHS. If you hold CBHS Ambulance cover only, we will pay towards emergency transport only.
• QLD residents – a subscription is paid through the electricity bill, which covers ambulance services Australia wide.
• NT, SA, VIC & WA residents – receive emergency ambulance cover with CBHS if Hospital cover or Ambulance cover is held.
• TAS residents – a subscription is paid through resident taxes if the services are performed in ACT, NT, NSW, TAS, VIC or WA. If the service is provided in QLD or SA, emergency ambulance services are covered if you hold CBHS Hospital cover or Ambulance cover.

Are IVF treatments covered by CBHS?

We don’t pay benefits for drugs used in IVF treatment under the pharmaceutical entitlement in Extras cover. However, we do pay benefits towards inpatient IVF treatment in a contracted private hospital if your current Hospital cover includes assisted reproductive services.

When is my baby an admitted patient?

Under Department of Health rules, the payment of gap medical benefits is restricted to medical services provided while an admitted patient of a hospital.

A newborn 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 (e.g. twins or triplets)
• The baby is more than nine 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 you can only claim expenses through Medicare. (You have to indicate that your baby was not classified as an 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, we don’t pay for the partner's meals or accommodation. There are benefits available for boarder fees (accommodation only) in some hospitals for specific situations, but these benefits are subject to the conditions of the contract in place with CBHS. Please contact Member Care for further information.

Does my baby need to pay a co-payment?

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.

We will waive the co-payment for any dependants on the following covers only:

• Comprehensive Hospital (Gold) 70 & 100
• Comprehensive Hospital $750 Excess (Gold)
• Limited Hospital (Bronze Plus) 70 & 100
• LiveLife (Gold)
• StepUp (Bronze Plus).

Does CBHS pay for antenatal classes?

Antenatal classes are covered on Top Extras, LiveLife (Gold) and Prestige (Gold) package cover. The benefit payable is 70% of cost, up to a maximum of $105.00 per confinement.

To claim for antenatal classes, we require an official receipt showing the provider's name, qualifications, dates and the cost of each class.

Can CBHS help with lactation classes?

CBHS can help if you have Top Extras, LiveLife (Gold) and Prestige (Gold) 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, we require an official receipt showing the midwife's full name and nurse’s registration number.

Why doesn’t CBHS pay benefits towards home birthing?

We don’t pay benefits towards a midwife performing home birthing because midwives can’t obtain insurance to cover this service.

What types of medical conditions qualify for Best Doctors?

Best Doctors provides services for a wide range of medical conditions. They include everything from back pain and sports injuries to chronic diseases and life-threatening illnesses. Best Doctors does not provide emergency services. Best Doctors has introduced a new service called Mental Health Navigator. Learn more about all Best Doctors services.

Do I have to travel or collect my own medical records?

No, you make a confidential call to Best Doctors and they handle everything for you. As all your contact with Best Doctors will be over the phone or online, you do not need to travel, visit doctors’ offices or contact your doctor(s) to obtain records, images or other information related to your medical case.

Does Best Doctors share information about my case?

Best Doctors is 100% confidential. They will not tell us about your call or its contents. The Best Doctors expert’s report is shared with your treating doctor(s) and with CBHS only with your written consent.

Who are the doctors Best Doctors uses?

Best Doctors physicians include the world’s top medical specialists. They are selected by other doctors through a comprehensive review process. Best Doctors surveys doctors to find out which doctors they trust most. Every doctor in the survey is asked, “If you or a loved one needed a doctor in a certain specialty, who would you choose?” Doctors cannot pay to be included on the Best Doctors list or nominate themselves for consideration.

Do I have to follow Best Doctors’ recommendations?

No. You remain in full control of your healthcare decision-making. The information you receive from Best Doctors is intended to help you make informed decisions regarding your diagnosis and/or treatment plan, and only you can decide whether you want to share the report with your treating doctor or not. Best Doctors will not share your report with your doctor unless you authorise it.

How will Best Doctors work with my treating doctor?

Best Doctors shares its expert’s findings with you first — and only with you. Then Best Doctors will share the expert’s report with your treating doctor once they have received your authorisation. They will not share the report without your consent. The goal of Best Doctors is to provide useful information so that you and your doctor can make more informed decisions together regarding your treatment.

Most doctors find that collaboration with other experts is very helpful, especially in complex situations. Best Doctors enables doctors to collaborate in a new way.

Isn’t asking for a second opinion from Best Doctors insulting to my doctor?

Not at all. Treating doctors who have worked with Best Doctors appreciate having access to respected experts in their field of practice. They also gain access to information regarding innovative diagnostic and treatment protocols that might not be available yet in their local communities.

How will Best Doctors maintain my privacy?

Best Doctors complies with all relevant state and national laws and regulations related to patient privacy. Unless required by law, your specific name and medical information will NOT be shared with anyone, including CBHS or treating doctor, without your written consent. On occasion, de-identified information may be used to help improve the Best Doctors program.

How do I know if I’m eligible for Best Doctors?

Best Doctors is available to the CBHS Prestige (Gold) and Premium Package members.