Key Hospital benefits
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Joint reconstructions
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Ear, nose and throat
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Dental surgery, insulin pumps, dialysis, and back, neck and spine treatment.
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Hospital Substitute Treatment and Better Living programs
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Make your premiums more affordable with an optional $70 or $100 co-payment
Hospital
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Emergency ambulance transport
Plus Included Additional services covered above the minimum requirements.
Emergency ambulance transport means an ambulance service that consists of transporting a seriously ill person to a Hospital by a State Government Ambulance Service or an ambulance service recognised by CBHS in order to receive urgently needed treatment. This includes transportation from the scene of an Accident or the scene of a medical event such as a heart attack or stroke but does not include transportation to Hospital for the routine management of an ongoing medical condition or transportation between hospitals. -
Accident related treatment after joining
Plus Included Additional services covered above the minimum requirements.
Accident related treatment means treatment provided in relation to an Accident that occurs after a Member joins the Fund and the Member provides documented evidence of seeking treatment from a Health Care Provider within 7 days of the Accident occurring. If Hospital Treatment is required, the Member must be admitted to a Hospital within 180 days of the Accident occurring. Any additional Hospital Treatment (after the initial 180 days) will be paid as per the level of Benefits payable on the Member’s chosen level of cover (if applicable). -
Tonsils, adenoids and grommets
Included Covered in private agreement hospitals and public hospitals.
Hospital treatment of the tonsils, adenoids and insertion or removal of grommets. -
Joint reconstructions
Included Covered in private agreement hospitals and public hospitals.
Hospital treatment for surgery for joint reconstructions. For example: torn tendons, rotator cuff tears and damaged ligaments. Joint replacements are listed separately under Joint replacements. Bone fractures are listed separately under Bone, joint and muscle. Procedures to the spinal column are listed separately under Back, neck and spine. Podiatric surgery performed by a registered podiatric surgeon is listed separately under Podiatric surgery (provided by a registered podiatric surgeon). -
Hernia and appendix
Included Covered in private agreement hospitals and public hospitals.
Hospital treatment for the investigation and treatment of a hernia or appendicitis. Digestive conditions are listed separately under Digestive system. -
Dental surgery
Plus Included Additional services covered above the minimum requirements.
Hospital treatment for surgery to the teeth and gums. For example: surgery to remove wisdom teeth, and dental implant surgery. -
Bone, joint and muscle
Included Covered in private agreement hospitals and public hospitals.
Hospital treatment for the investigation and treatment of diseases, disorders and injuries of the musculoskeletal system. For example: carpal tunnel, fractures, hand surgery, joint fusion, bone spurs, osteomyelitis and bone cancer. Chest surgery is listed separately under Lung and chest. Spinal cord conditions are listed separately under Brain and nervous system. Spinal column conditions are listed separately under Back, neck and spine. Joint reconstructions are listed separately under Joint reconstructions. Joint replacements are listed separately under Joint replacements. Podiatric surgery performed by a registered podiatric surgeon is listed separately under Podiatric surgery (provided by a registered podiatric surgeon). Management of back pain is listed separately under Pain management. Pain management that requires a device is listed separately under Pain management with device. Chemotherapy and radiotherapy for cancer is listed separately under Chemotherapy, radiotherapy and immunotherapy for cancer. -
Brain and nervous system
Included Covered in private agreement hospitals and public hospitals.
Hospital treatment for the investigation and treatment of the brain, brain-related conditions, spinal cord and peripheral nervous system. For example: stroke, brain or spinal cord tumours, head injuries, epilepsy and Parkinson’s disease. Treatment of spinal column (back bone) conditions is listed separately under Back, neck and spine. Chemotherapy and radiotherapy for cancer is listed separately under Chemotherapy, radiotherapy and immunotherapy for cancer. -
Ear, nose and throat
Included Covered in private agreement hospitals and public hospitals.
Hospital treatment for the investigation and treatment of the ear, nose, throat, middle ear, thyroid, parathyroid, larynx, lymph nodes and related areas of the head and neck. For example: damaged ear drum, sinus surgery, removal of foreign bodies, stapedectomy and throat cancer. Tonsils, adenoids and grommets are listed separately under Tonsils, adenoids and grommets. The implantation of a hearing device is listed separately under Implantation of hearing devices. Orthopaedic neck conditions are listed separately under Back, neck and spine. Sleep studies are listed separately under Sleep studies. Chemotherapy and radiotherapy for cancer is listed separately under Chemotherapy, radiotherapy and immunotherapy for cancer. -
Kidney and bladder
Included Covered in private agreement hospitals and public hospitals.
Hospital treatment for the investigation and treatment of the kidney, adrenal gland and bladder. For example: kidney stones, adrenal gland tumour and incontinence. Dialysis is listed separately under Dialysis for chronic kidney failure. Chemotherapy and radiotherapy for cancer is listed separately under Chemotherapy, radiotherapy and immunotherapy for cancer. -
Digestive system
Included Covered in private agreement hospitals and public hospitals.
Hospital treatment for the investigation and treatment of the digestive system, including the oesophagus, stomach, gall bladder, pancreas, spleen, liver and bowel. For example: oesophageal cancer, irritable bowel syndrome, gall stones and haemorrhoids. Endoscopy is listed separately under Gastrointestinal endoscopy. Hernia and appendicectomy procedures are listed separately under Hernia and appendix. Bariatric surgery is listed separately under Weight loss surgery. Chemotherapy and radiotherapy for cancer is listed separately under Chemotherapy, radiotherapy and immunotherapy for cancer. -
Gastrointestinal endoscopy
Included Covered in private agreement hospitals and public hospitals.
Hospital treatment for the diagnosis, investigation and treatment of the internal parts of the gastrointestinal system using an endoscope. For example: colonoscopy, gastroscopy, endoscopic retrograde cholangiopancreatography (ERCP). Non-endoscopic procedures for the digestive system are listed separately under Digestive system. -
Chemotherapy, radiotherapy and immunotherapy for cancer
Included Covered in private agreement hospitals and public hospitals.
Hospital treatment for chemotherapy, radiotherapy and immunotherapy for the treatment of cancer or benign tumours. Surgical treatment of cancer is listed separately under each body system. -
Skin
Included Covered in private agreement hospitals and public hospitals.
Hospital treatment for the investigation and treatment of skin, skin-related conditions and nails. The removal of foreign bodies is also included. Plastic surgery that is medically necessary and relating to the treatment of a skin-related condition is also included. For example: melanoma, minor wound repair and abscesses. Removal of excess skin due to weight loss is listed separately under Weight loss surgery. Chemotherapy and radiotherapy for cancer is listed separately under Chemotherapy, radiotherapy and immunotherapy for cancer. -
Breast surgery (medically necessary)
Included Covered in private agreement hospitals and public hospitals.
Hospital treatment for the investigation and treatment of breast disorders and associated lymph nodes, and reconstruction and/or reduction following breast surgery or a preventative mastectomy. For example: breast lesions, breast tumours, asymmetry due to breast cancer surgery, and gynecomastia. This clinical category does not require benefits to be paid for cosmetic breast surgery that is not medically necessary. Chemotherapy and radiotherapy for cancer is listed separately under Chemotherapy, radiotherapy and immunotherapy for cancer. -
Diabetes management (excluding insulin pumps)
Included Covered in private agreement hospitals and public hospitals.
Hospital treatment for the investigation and management of diabetes. For example: stabilisation of hypo- or hyper- glycaemia, contour problems due to insulin injections. Treatment for diabetes-related conditions is listed separately under each body system affected. For example, treatment for diabetes-related eye conditions is listed separately under Eye. Treatment for ulcers is listed separately under Skin. Provision and replacement of insulin pumps is listed separately under Insulin pumps. -
Miscarriage and termination of pregnancy
Included Covered in private agreement hospitals and public hospitals.
Hospital treatment for the investigation and treatment of a miscarriage or for termination of pregnancy. -
Gynaecology
Included Covered in private agreement hospitals and public hospitals.
Hospital treatment for the investigation and treatment of the female reproductive system. For example: endometriosis, polycystic ovaries, female sterilisation and cervical cancer. Fertility treatments are listed separately under Assisted reproductive services. Pregnancy and birth-related conditions are listed separately under Pregnancy and birth. Miscarriage or termination of pregnancy is listed separately under Miscarriage and termination of pregnancy. Chemotherapy and radiotherapy for cancer is listed separately under Chemotherapy, radiotherapy and immunotherapy for cancer. -
Male reproductive system
Included Covered in private agreement hospitals and public hospitals.
Hospital treatment for the investigation and treatment of the male reproductive system including the prostate. For example: male sterilisation, circumcision and prostate cancer. Chemotherapy and radiotherapy for cancer is listed separately under Chemotherapy, radiotherapy and immunotherapy for cancer. -
Eye (not cataracts)
Included Covered in private agreement hospitals and public hospitals.
Hospital treatment for the investigation and treatment of the eye and the contents of the eye socket. For example: retinal detachment, tear duct conditions, eye infections and medically managed trauma to the eye. Cataract procedures are listed separately under Cataracts. Eyelid procedures are listed separately under Plastic and reconstructive surgery. Chemotherapy and radiotherapy for cancer is listed separately under Chemotherapy, radiotherapy and immunotherapy for cancer. -
Blood
Plus Included Additional services covered above the minimum requirements.
Hospital treatment for the investigation and treatment of blood and blood-related conditions. For example: blood clotting disorders and bone marrow transplants. Treatment for cancers of the blood is listed separately under Chemotherapy, radiotherapy and immunotherapy for cancer. -
Back, neck and spine
Plus Included Additional services covered above the minimum requirements.
Hospital treatment for the investigation and treatment of the back, neck and spinal column, including spinal fusion. For example: sciatica, prolapsed or herniated disc, spinal disc replacement, and spine curvature disorders such as scoliosis, kyphosis and lordosis. Joint replacements are listed separately under Joint replacements. Joint fusions are listed separately under Bone, joint and muscle. Spinal cord conditions are listed separately under Brain and nervous system. Management of back pain is listed separately under Pain management. Pain management that requires a device is listed separately under Pain management with device. Chemotherapy and radiotherapy for cancer is listed separately under Chemotherapy, radiotherapy and immunotherapy for cancer. -
Implantation of hearing devices
Plus Included Additional services covered above the minimum requirements.
Hospital treatment to correct hearing loss, including implantation of a prosthetic hearing device. Stapedectomy is listed separately under Ear, nose and throat. -
Dialysis for chronic kidney failure
Plus Included Additional services covered above the minimum requirements.
Hospital treatment for dialysis treatment for chronic kidney failure. For example: peritoneal dialysis and haemodialysis. -
Insulin pumps
Plus Included Additional services covered above the minimum requirements.
Hospital treatment for the provision and replacement of insulin pumps for treatment of diabetes. -
Pain management
Included Covered in private agreement hospitals and public hospitals.
Hospital treatment for pain management that does not require the insertion or surgical management of a device. For example: treatment of nerve pain and chest pain due to cancer by injection of a nerve block. Pain management using a device (for example an infusion pump or neurostimulator) is listed separately under Pain management with device. -
Pain management with device
Plus Included Additional services covered above the minimum requirements.
Hospital treatment for the implantation, replacement or other surgical management of a device required for the treatment of pain. For example: treatment of nerve pain, back pain, and pain caused by coronary heart disease with a device (for example an infusion pump or neurostimulator). Treatment of pain that does not require a device is listed separately under Pain management. -
Sleep studies
Plus Included Additional services covered above the minimum requirements.
Hospital treatment for the investigation of sleep patterns and anomalies. For example: sleep apnoea and snoring. -
Rehabilitation
Restricted Restricted benefits
Hospital treatment for physical rehabilitation for a patient related to surgery or illness. For example: inpatient and admitted day patient rehabilitation, stroke recovery, cardiac rehabilitation. -
Hospital psychiatric services
Restricted Restricted benefits
Hospital treatment for the treatment and care of patients with psychiatric, mental, addiction or behavioural disorders. For example: psychoses such as schizophrenia, mood disorders such as depression, eating disorders and addiction therapy. -
Palliative care
Restricted Restricted benefits
Hospital treatment for care where the intent is primarily providing quality of life for a patient with a terminal illness, including treatment to alleviate and manage pain. -
Hospital Substitute Treatment
Included
This program is aimed at reducing the time you spend in hospital, often cutting it out altogether. Care is delivered in the comfort of our own home by health care professionals. -
Better Living programs
Included
The Better Living Programs help you take control of your health by providing tailored guidance, advice and practical solutions from health care professionals -
Choice of doctor
Included
You can choose your doctor and when you’re treated with private Hospital cover. -
Access Gap Cover
Included
(AGC) is a billing scheme that aims to reduce or eliminate out-of-pocket expenses to members for doctor and specialist services received in hospital.
Hospital
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Cataracts
Excluded Exclusion (not covered)
Hospital treatment for surgery to remove a cataract and replace with an artificial lens. -
Heart and vascular system
Excluded Exclusion (not covered)
Hospital treatment for the investigation and treatment of the heart, heart-related conditions and vascular system. For example: heart failure and heart attack, monitoring of heart conditions, varicose veins and removal of plaque from arterial walls. Chemotherapy and radiotherapy for cancer is listed separately under Chemotherapy, radiotherapy and immunotherapy for cancer. -
Lung and chest
Excluded Exclusion (not covered)
Hospital treatment for the investigation and treatment of the lungs, lung-related conditions, mediastinum and chest. For example: lung cancer, respiratory disorders such as asthma, pneumonia, and treatment of trauma to the chest. Chemotherapy and radiotherapy for cancer is listed separately under Chemotherapy, radiotherapy and immunotherapy for cancer. -
Plastic and reconstructive surgery (medically necessary)
Excluded Exclusion (not covered)
Hospital treatment which is medically necessary for the investigation and treatment of any physical deformity, whether acquired as a result of illness or accident, or congenital. For example: burns requiring a graft, cleft palate, club foot and angioma. Plastic surgery that is medically necessary relating to the treatment of a skin-related condition is listed separately under Skin. Chemotherapy and radiotherapy for cancer is listed separately under Chemotherapy, radiotherapy and immunotherapy for cancer. -
Pregnancy and birth
Excluded Exclusion (not covered)
Hospital treatment for investigation and treatment of conditions associated with pregnancy and child birth. Treatment for the baby is covered under the clinical category relevant to their condition. For example, respiratory conditions are covered under Lung and chest. Female reproductive conditions are listed separately under Gynaecology. Fertility treatments are listed separately under Assisted reproductive services. Miscarriage and termination of pregnancy is listed separately under Miscarriage and termination of pregnancy. -
Assisted reproductive services
Excluded Exclusion (not covered)
Hospital treatment for fertility treatments or procedures. For example: retrieval of eggs or sperm, In vitro Fertilisation (IVF), and Gamete Intra-fallopian Transfer (GIFT). Treatment of the female reproductive system is listed separately under Gynaecology. Pregnancy and birth-related services are listed separately under Pregnancy and birth. -
Joint replacements
Excluded Exclusion (not covered)
Hospital treatment for surgery for joint replacements, including revisions, resurfacing, partial replacements and removal of prostheses. For example: replacement of shoulder, wrist, finger, hip, knee, ankle, or toe joint, spinal disc replacement. Joint fusions are listed separately under Bone, joint and muscle. Spinal fusions are listed separately under Back, neck and spine. Joint reconstructions are listed separately under Joint reconstructions. Podiatric surgery performed by a registered podiatric surgeon is listed separately under Podiatric surgery (provided by a registered podiatric surgeon). -
Weight loss surgery
Excluded Exclusion (not covered)
Hospital treatment for surgery that is designed to reduce a person’s weight, remove excess skin due to weight loss and reversal of a bariatric procedure. For example: gastric banding, gastric bypass, sleeve gastrectomy. -
Podiatric surgery (provided by a registered podiatric surgeon)
Excluded Exclusion (not covered)
Hospital treatment for the investigation and treatment of conditions affecting the foot and/or ankle, provided by a registered podiatric surgeon, but limited to cover for: - accommodation; and - the cost of a prosthesis as listed in the prostheses list set out in the Private Health Insurance (Prostheses) Rules, as in force from time to time. Note: Insurers are not required to pay for any other benefits for hospital treatment for this clinical category but may choose to do so. -
Cosmetic services
Excluded Exclusion (not covered)
Cosmetic service means an operation, procedure or treatment undertaken for the dominant purpose of improving appearance or improving psychological wellbeing. -
Services for which a Medicare benefit is NOT payable
Excluded Exclusion (not covered)
These are services that do not attract any benefits from Medicare. Examples of such services include cosmetic services, podiatric surgery and laser eye surgery. -
Access to Best Doctors
Excluded Exclusion (not covered)
Best Doctors is available for members on Prestige (Gold) only. Best Doctors offer specialist medical advice that assists members experiencing a medical condition by providing access to a unique global network of 50,000 leading medical specialists. -
Gap Assist
Excluded Exclusion (not covered)
A medical gap benefit to assist with any out-of-pocket expenses which may incur as a result of a hospitalisation. CBHS Prestige (Gold) offers a Gap Assist benefit of $200 per person, per calendar year and the StepUp (Bronze Plus) Package Cover offers a Gap Assist benefit of $100 per person, per calendar year.
We have three levels of Extras cover. Find one that fits with your lifestyle and budget.
Add extras to this coverHospital cover explained
Here’s what you can expect to be covered for under your Limited Hospital (Bronze Plus) policy:
- Accommodation for overnight, same day and intensive care in a private or shared room in agreement private and public hospitals (excluding restricted services – see ‘What we don’t fully cover’).
- Theatre fees covered in agreement private hospitals (excluding restricted services – see ‘What we don’t fully cover’).
- Medical expenses related to providers for services while you’re a hospital inpatient. You’re covered for all services that Medicare pays benefits for, and CBHS will cover the difference between the Medicare benefit and the Medicare Benefits Schedule (MBS) fee for services provided as an admitted patient to a hospital. Examples include fees from doctors, surgeons, anaesthetists, pathology, imaging etc. You can choose your doctor/surgeon in a public or private hospital.
- Access Gap Cover with providers (e.g. doctor or surgeon) who choose to participate in CBHS’ Access Gap Cover scheme. The amount over and above the MBS fee is known as a ‘gap’. 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 (i.e. surgeons, anaesthetists, pathology, imaging fees etc).
- Surgically implanted prostheses which are on the Australian Government’s Prostheses List are covered to at least the specified minimum benefit. Medical prostheses include heart valve stents, joint replacement devices, and pacemakers.
- Pharmacy benefit covers most drugs related to the reason for your admission in agreement with private hospitals.
- Boarder accommodation covers 100%, up to $160 per admission, if not already included in the hospital agreement. This is for a support person to stay overnight with you if the hospital allows.
- Emergency ambulance transport for an accident or medical emergency by your state’s approved ambulance providers.
- Hospital services where a Medicare benefit is payable (excluding restricted services*)
- Better Living programs to help you manage your health and wellness.
- Hospital Substitute Treatment to help get you back into your own bed earlier. There is no extra charge if the services are an appropriate substitute for treatment that would have been fully covered in hospital.
Limited Hospital (Bronze Plus) will not cover you for:
- Hospital services you receive before you have served waiting periods.
- Nursing home type patient contribution, respite care or nursing home fees.
- Take home/discharge drugs (for non-PBS drugs, you may be eligible for benefits under your Extras cover).
- Healthcare aids e.g. walkers not covered in a hospital agreement (you may be able to claim benefits for these under your Extras cover).
- Services you claim 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.
- Ambulance transfers between hospitals (for residents in VIC, SA and NT).
- Fees raised by public hospitals that exceed Minimum Default Benefits set by the Department of Health for shared room accommodation.
Exclusions:
For treatment listed as an exclusion there is no benefit payable and members may or will likely incur significant out-of-pocket expenses for these services. 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:
- Cataracts
- Heart and vascular system
- Lung and chest
- Plastic and reconstructive surgery (medically necessary)
- Pregnancy and birth
- Assisted reproductive services
- Joint replacements
- Weight loss surgery
- Podiatric surgery (provided by a registered podiatric surgeon)
- Cosmetic services
- Services for which Medicare does not pay a benefit
- Fees raised by public hospitals that exceed Minimum Default Benefits set by the Department of Health for shared room accommodation.
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 a gap.
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.
Some services are not fully covered under Limited Hospital (Bronze Plus). These are called restricted services.
The services below, when provided in a private hospital, are only eligible for the minimum benefits set out by law. These benefits relate to hospital bed charges and are unlikely to cover the private hospital admission fees. That means there may be a large out-of-pocket (gap) expense for both the bed charge and any theatre fees.
The services listed below are also eligible for hospital benefits in a public hospital at a shared room rate. Public hospitals do not raise charges for theatre use.
- Hospital psychiatric services
- Rehabilitation
- Palliative care services
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:
- Co-payment
- Age-based discounts
- Australian Government Rebate
How a co-payment works
You can reduce the cost of your Limited Hospital (Bronze Plus) cover premiums by agreeing to a daily co-payment of $70 or $100. Of course, you can also opt to have cover without a co-payment option.
Taking a co-payment means that when you go into hospital, you pay the daily co-payment for each day that you are in hospital up to a maximum of six (6) days per person or 12 days per family per calendar year.
We don’t charge a co-payment for any dependent children on your policy.
Age-based discounts
Age-based discounts are 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.
Read more about age-based discounts and see what you’re eligible for.
Australian Government Rebate
The Australian Government Rebate on private health insurance (Rebate) is a means-tested Rebate which you may be eligible for. 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.
| Cover for | Waiting period |
|---|---|
| Pre-existing conditions* (except for hospital psychiatric services, rehabilitation and palliative care) | 12 months |
| Hospital psychiatric services**, rehabilitation and palliative care | 2 months |
| Accidents***, emergency ambulance transport | 1 day |
| All other treatments | 2 months |
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 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.
* 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.
Will 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 chosen hospital.
Am I classified as an inpatient if I’m having chemotherapy every day?
You will be covered for daily chemotherapy if you have an appropriate level of Hospital cover, and your hospital 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 as an outpatient (i.e. you are not admitted to hospital), you will not be able to claim any costs through CBHS.
What is a daily co-payment?
A co-payment is a daily amount that you contribute for each night you stay in hospital. This might be capped depending on your product. 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 six days per person or 12 days per family per calendar year.
Do I have to pay my excess/co-payment for a day procedure?
Yes.
Do I have to pay an excess/co-payment for my dependants?
We waive excess/co-payments for any dependant children on your membership for the following covers:
- Comprehensive Hospital 70 (Gold)
- Comprehensive Hospital 100 (Gold)
- Comprehensive Hospital $750 Excess (Gold)
- Active Hospital 100 (Silver Plus)
- Limited Hospital 70 (Bronze Plus)
- Limited Hospital 100 (Bronze Plus)
- LiveLife (Gold)
- StepUp (Bronze Plus)
If you hold any other cover, you will have to pay the excess or co-payment for child dependants for hospital admission if applicable.
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. A GP who performs this procedure at their clinic might charge a specific fee for this.
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 CBHS doesn’t pay for any outpatient doctor services. You can claim these from Medicare only.
Can I receive benefits towards home nursing after a hospital stay?
Sometimes, the hospital will provide home nursing as a hospital substitute treatment program after you have left the hospital. 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 state?
Each State Government has different arrangements that determine how ambulance claims are paid. That’s why we pay claims based on the relevant state.
- 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 pay a subscription through their electricity bill, which covers ambulance services Australia-wide.
- NT, SA, VIC & WA residents receive emergency ambulance cover with CBHS if you hold Hospital cover or Ambulance cover.
- TAS residents pay a subscription through resident taxes for services which take place in ACT, NT, NSW, TAS, VIC or WA. CBHS will cover emergency ambulance services provided in QLD or SA if you hold CBHS Hospital cover or Ambulance cover.