Basic Plus hospital

Basic Plus Hospital will cover you for:

• Accommodation for overnight, same day and intensive care for a shared room in a public hospital. We will also pay an amount for accommodation in a private hospital or private room of a public hospital - this amount will be the minimum amount specified by applicable legislation.
• Excess option available for reduced premiums.
• Theatre and labour ward fees are not raised in a public hospital.
• 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. You have your choice of doctor/surgeon in a public or private hospital. We will cover the difference between the Medicare benefit and the MBS fee for services provided if you’re admitted to hospital.
• Access Gap Cover is when a provider chooses to participate in an arrangement us. We cover 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.
• Better Living programs to help you manage your health and wellness.
• Hospital Substitute Treatment means the possibility of receiving rehabilitation treatment or the care of a registered nurse at home.

Limited cover for private hospital accommodation: If you are admitted to a private hospital under Basic Plus Hospital cover you may only receive benefits similar to a public hospital shared room rate which can result in substantial out-of-pocket expenses.

Important note: If you have Basic Plus hospital you should be aware that it is possible that you will be placed on a waiting list even if you are admitted as a private patient.

If you are admitted into an agreement or non-agreement private hospital, benefits are payable at the minimum rate specified by law - accordingly substantial out-of-pocket expenses can be incurred.

Basic Plus Hospital will not cover you for:

• Hospital services received within policy waiting periods
• Nursing home type patient contribution, respite care or nursing home fees
• High cost, experimental or non TGA approved drugs
• Take home/discharge drugs (non-PBS drugs may be eligible for benefits from your Extras cover)
• Treatments where no Medicare benefits are available
• 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
• Labour ward fees in an agreement and non-agreement private hospital
• Ambulance transfers between hospitals (for residents in VIC, SA and NT).

Exclusions:

For treatment listed as an exclusion there is no benefit payable and you will incur significant out-of-pocket expense for these services. Please review the exclusions on this cover and always check with CBHS to treatment. The following services are excluded from this cover:

• Podiatric surgery (provided by a registered podiatric surgeon)
• Cosmetic services
• Services for which a Medicare benefit is NOT payable

Note: Basic Plus Hospital cover is not sufficient for private hospital treatment as you may incur significant out-of-pocket expenses.

Excess options available: $0, $500 or $750

You can reduce the cost of Basic Plus Hospital cover by agreeing to pay an excess of $500 or $750. This means that when you go into hospital you will pay the first $500 or $750 with respect to charges raised by the hospital. This excess is per person up to a maximum of $1,000 or $1,500 per family membership per calendar year.

* If you have a pre-existing condition, a waiting period of 12 months will apply before we will pay hospital or medical benefits towards any treatment for that condition.

** Once you have served the two-month waiting period, you can choose to upgrade your cover (once in a lifetime) and access the higher benefits for hospital psychiatric treatment associated with that cover, without serving an additional waiting period. For more details contact us on 1300 654 123 or email help@cbhs.com.au.

*** Accident means an unexpected or unforeseen event caused by an external force or object resulting in an injury to the body which requires treatment by a medical practitioner, Hospital or dentist (as the context requires) but excludes pregnancy.