Limited Hospital (Bronze Plus)

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.

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.