Here’s what you can expect to be covered for under your Starter Basic Plus Hospital policy:

• Accommodation for overnight, same day and intensive care for private or shared room in agreement private and public hospitals
• Theatre fees covered in agreement private hospitals for included services
• Medical expenses related to providers for services while admitted in hospital e.g. fees from doctors, surgeons, anaesthetists, pathology and imaging. Covered for included services eligible for benefits from Medicare up to Medicare Benefits Schedule (MBS) fee. Have your choice of doctor/surgeon in a public and 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 (e.g. surgeons, anaesthetists, pathology and imaging fees). Read more about Access Gap Cover.
• Surgically implanted medical devices and human tissue products to at least the minimum benefit specified in the Prescribed List of Medical Devices and Human Tissue Products issued under Private Health Insurance legislation
• Pharmacy covers most drugs related to the reason for your admission in agreement private hospitals
• Boarder accommodation covers 100%, up to $160 per admission, if not included in hospital agreement. This applies to a member assisting with the care of another member on the same membership
• Emergency ambulance transport for an accident or medical emergency by approved ambulance providers
• Hospital services where a Medicare benefit is payable (for included services only). It’s essential to check the MBS item number prior to your procedure, to confirm if the treatment falls under a category which is included in your policy.

• No benefits are payable for hospital or medical treatment for exclusions
• If you’re admitted into a non-agreement private hospital, benefits are payable only at the minimum rate specified by law. The benefit might be similar to a public hospital shared room rate. These benefits may not be sufficient to cover admissions in a non-agreement 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 Extras cover)
• Aids not covered in hospital agreement (may be eligible for benefits from Extras cover)
• Services claimed over 24 months after the service date
• Services provided in countries outside of Australia
• Medical devices and human tissue products used for cosmetic procedures, where a Medicare benefit is not payable
• Ambulance transfers between hospitals (for residents in VIC, SA and NT)

Exclusions:

For treatment listed as an exclusion, CBHS does not pay a benefit. Please review the exclusions on this cover and always check with CBHS to see if you are covered before receiving treatment. The following services are excluded from this cover:

• Back, neck and spine
• Blood
• Brain and nervous system
• Breast surgery (medically necessary)
• Chemotherapy, radiotherapy and immunotherapy for cancer
• Diabetes management (excluding insulin pumps)
• Digestive system
• Eye (not cataracts)
• Gynaecology
• Kidney and bladder
• Lung and chest
• Male reproductive system
• Miscarriage and termination of pregnancy
• Pain management
• Skin
• Sleep studies
• Heart and vascular system
• Implantation of hearing devices
• Plastic and reconstructive surgery (medically necessary)
• Podiatric surgery (provided by a registered podiatric surgeon)
• Cataracts
• Dialysis for chronic kidney failure
• Insulin pumps
• Joint replacements
• Pain management with device
• Assisted reproductive services
• Pregnancy and birth
• Weight loss surgery
• Cosmetic services
• Services for which a Medicare benefit is NOT payable

A note on accident-related treatment

If you require hospital treatment as a result of an accident, our accident-related treatment will supersede any exclusions you have on your cover and you’ll receive benefits as if the hospital treatment was a covered service. Please note that specific criteria apply. Refer to our Fund Rules for more details.  

Non-agreement private hospital rates

If you’re admitted into a non-agreement private hospital, CBHS will only pay benefits at the minimum rate specified by law. These benefits may be similar to a public hospital shared room rate. This may not be enough to cover your admissions in a non-agreement private hospital, and that means you would be liable for an out-of-pocket (gap) expense.

Before going to hospital, it’s best to check to see whether CBHS has an agreement with that hospital. We can help you to locate CBHS agreement hospitals in your area.

Restricted services which are not fully covered under Starter Basic Plus Hospital

The services listed below as restricted benefits are only eligible for Minimum Benefits prescribed by private health insurance legislation. These benefits relate to accommodation only and are generally similar to hospital bed charges for a shared room in a public hospital. They are unlikely to cover the fees charged for a private room in a public hospital, or private hospital accommodation. Theatre fees are not covered and members may incur large out-of-pocket (gap) expenses.

• Hospital psychiatric services
• Palliative care
• Rehabilitation
  

Understanding which services are restricted in your cover can help you plan more effectively for a hospital stay or medical treatment.

This section covers a number of options which might help you reduce the cost of your premiums.

These include:

• An excess
• Age-based discount
• Australian Government Rebate on private health insurance

An excess

Starter Basic Plus Hospital cover has a $750 excess. An excess helps you reduce the cost of your Hospital premiums, and is an amount you pay towards the cost of your hospital admission before CBHS pays a benefit.

When you’re admitted to hospital (same-day or overnight) you will pay the excess amount directly to the hospital. You only pay the excess once per person up to a maximum of twice per couple/family membership per calendar year. For Starter Basic Plus, the excess applies to all members on the policy including dependants.

Age-based discount

An age-based discount is an Australian Government initiative designed to help make Hospital cover more affordable for young Australians. If you’re aged between 18 and 29, you are eligible for a discount of up to 10% off your premiums. CBHS is proud to be a fund which supports age-based discounts − it’s not mandatory for funds to make this discount available. If you have an age-based discount with your current fund, we will continue to apply it when you switch to us.

Read more about age-based discounts and see what you’re eligible for.

Australian Government Rebate on private health insurance

You may be eligible for the Australian Government Rebate on private health insurance (rebate). The percentage of rebate is determined depending on your age and income. Most people choose to claim this rebate as a reduction in their premiums. You can also choose to claim it as a tax offset when you lodge your annual tax return.

See if you’re eligible for the rebate.

We get that one of the most important questions you have about your cover is “When can I start using it?” Waiting periods are designed to make health insurance fair for all.

I’m new to health insurance

Waiting periods apply to all those who are new to private health insurance. These are set out in the table bellow.

*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.

**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.

I’m transferring from another fund or upgrading my CBHS cover
If you already have cover with another fund, and choose to switch to CBHS, you won’t need to re-start your waiting periods if you join on an equivalent level of cover.

• If you served part of your waiting periods within one health fund, you can complete these with CBHS
• If you upgrade your level of cover, waiting periods will apply to benefits not previously included within your original cover.

Learn more about waiting periods

Each service we pay a benefit on has an overall limit, sometimes an annual, multi-year or lifetime benefit period and a waiting period.

Once you’ve become a CBHS member and served the relevant waiting period, you can claim benefits on services covered under your policy.

Waiting periods are designed to keep health insurance fair for all members in a fund.

What can I claim for?

If your chosen Extras cover includes them, you can claim for the following services. Check our product sheets to see the details on what each cover includes.

• Chiropractic
• Dental
• Dietary services
• Health care aids
• Occupational therapy
• Optical
• Osteopathy services
• Pharmaceuticals
• Physiotherapy
• Podiatry
• Psychology
• Speech therapy
• Wellness benefits for a variety of health checks and programs designed to assist you in better managing your health and wellbeing e.g gym membership, skin cancer screening, bone density screening and breast examinations.

If you’re planning to claim for a treatment or service under Extras, make sure you’re using a recognised provider.  We can only pay benefits if you use a recognised provider.

How is my claims benefit calculated?

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 the cost of the service. Your benefit will be based on the maximum claimable amount per service up to the overall limit left available under your chosen Extras cover (see the product sheet).

You can also find out your benefit using the Online Benefit Quote tool in the Member Centre.

How long does it take CBHS to pay Extras claims?

If your service provider has HICAPS or iSOFT facilities, all you need to do is give them your membership card and the benefit will be automatically deducted from the total service fee. If you’re visiting one of our Choice Network providers, you may not have any out-of-pocket expenses to pay.

Members who claim online typically receive their benefits within 1 – 2 business days. Once you have lodged your eClaim, you will receive an email confirmation. Once your claim has been assessed, you will receive a benefit remittance confirming your claim benefit.  

What is the CBHS Choice Network?

This is a group of over 9,000 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 near you.

When do my benefits renew?

Most benefits for services are based on per person per calendar year, unless otherwise stated in the product sheet. They will renew on 1 January.

For services with a ‘three year’ or ‘five year’ period attached, the benefit will renew on the same date which you received the service in three or five years respectively.

For services which attract a ‘lifetime’ benefit period, the benefit limits only useable once only.

What do I need to 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. Then, simply provide this to us when submitting your claim. 

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 can I claim on travel and accommodation?

Under Top Extras cover, 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. We only pay benefits for the member receiving treatment.

Essential medical treatment means:

• Your registered medical practitioner has referred you for the treatment; and
• You have 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 treatment location you travelled to e.g. the medical practitioner/a copy of the doctor’s invoice
• 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?