FlexiSaver (Basic Plus)

You’re young and healthy, but you know that accidents happen.

That’s why you’re looking for more health options for emergencies, like accidents and broken bones. Plus, you’re all about keeping yourself in good shape, and want must-have Extras like preventative and general dental, optical and physio. You need great value in a product – every dollar is precious – and you don’t want to pay more tax than you have to. FlexiSaver is saver by name and saver by nature, as you choose which Extras you want to get benefits for. 

A man leaning towards the wall

FlexiSaver (Basic Plus) package offers more than the basics, including:

  • Dental surgery
  • Tonsils, adenoids and grommets
  • Hernia and appendix
  • Emergency ambulance services
  • Hospital Substitute Treatment and Better Living programs
  • Flexibility when using Extras – use the $700 annual limit across any selected Extras.
  • Get more than half of Extras charges back in benefits.

These are the Hospital services which are covered under your FlexiSaver (Basic Plus) policy:

Refer to the FlexiSaver (Basic Plus) product sheet to help you understand your cover and benefits.

Legend

  • /
    Plus Included
  • /
    Included
  • /
    Benefits for accommodation at MBS
  • /
    Excluded
  • /
    Restricted
  • /
    Plus Restricted
  • Emergency ambulance transport Additional services covered above the minimum requirements.
  • Accident related treatment after joining Additional services covered above the minimum requirements.
  • Tonsils, adenoids and grommets Covered in private agreement hospitals and public hospitals.
  • Joint reconstructions Covered in private agreement hospitals and public hospitals.
  • Hernia and appendix Covered in private agreement hospitals and public hospitals.
  • Dental surgery Covered in private agreement hospitals and public hospitals.
  • Bone, joint and muscle Covered in private agreement hospitals and public hospitals.
  • Brain and nervous system Covered in private agreement hospitals and public hospitals.
  • Ear, nose and throat Covered in private agreement hospitals and public hospitals.
  • Kidney and bladder Covered in private agreement hospitals and public hospitals.
  • Digestive system Covered in private agreement hospitals and public hospitals.
  • Gastrointestinal endoscopy Covered in private agreement hospitals and public hospitals.
  • Chemotherapy, radiotherapy and immunotherapy for cancer Covered in private agreement hospitals and public hospitals.
  • Skin Covered in private agreement hospitals and public hospitals.
  • Breast surgery (medically necessary) Covered in private agreement hospitals and public hospitals.
  • Diabetes management (excluding insulin pumps) Covered in private agreement hospitals and public hospitals.
  • Miscarriage and termination of pregnancy Covered in private agreement hospitals and public hospitals.
  • Gynaecology Covered in private agreement hospitals and public hospitals.
  • Male reproductive system Covered in private agreement hospitals and public hospitals.
  • Eye (not cataracts) Covered in private agreement hospitals and public hospitals.
  • Blood Covered in private agreement hospitals and public hospitals.
  • Back, neck and spine Covered in private agreement hospitals and public hospitals.
  • Implantation of hearing devices Covered in private agreement hospitals and public hospitals.
  • Dialysis for chronic kidney failure Covered in private agreement hospitals and public hospitals.
  • Insulin pumps Covered in private agreement hospitals and public hospitals.
  • Pain management Covered in private agreement hospitals and public hospitals.
  • Pain management with device Covered in private agreement hospitals and public hospitals.
  • Sleep studies Covered in private agreement hospitals and public hospitals.
  • Cataracts Covered in private agreement hospitals and public hospitals.
  • Heart and vascular system Covered in private agreement hospitals and public hospitals.
  • Lung and chest Covered in private agreement hospitals and public hospitals.
  • Plastic and reconstructive surgery (medically necessary) Covered in private agreement hospitals and public hospitals.
  • Rehabilitation Covered in private agreement hospitals and public hospitals.
  • Hospital psychiatric services Covered in private agreement hospitals and public hospitals.
  • Palliative care Covered in private agreement hospitals and public hospitals.
  • Pregnancy and birth Covered in private agreement hospitals and public hospitals.
  • Assisted reproductive services Covered in private agreement hospitals and public hospitals.
  • Joint replacements Covered in private agreement hospitals and public hospitals.
  • Weight loss surgery Covered in private agreement hospitals and public hospitals.
  • Podiatric surgery (provided by a registered podiatric surgeon) Indicates benefits for accommodation at Minimum Benefits in relevant PHI (Benefit Requirements) Rules and prostheses benefits based on items listed by the Minister of Health. No benefit for medical or theatre costs
  • Cosmetic services Exclusion (not covered)
  • Services for which a Medicare benefit is NOT payable Restricted benefits
  • Hospital Substitute Treatment Covered in private agreement hospitals and public hospitals.
  • Better Living programs Covered in private agreement hospitals and public hospitals.
  • Choice of doctor Covered in private agreement hospitals and public hospitals.
  • Access Gap Cover Covered in private agreement hospitals and public hospitals.
  • Access to Best Doctors Exclusion (not covered)
  • Gap Assist Exclusion (not covered)

FlexiSaver (Basic Plus) cover explained

Understanding Hospital cover

Here’s what you can expect to be covered for under your FlexiSaver (Basic Plus) policy:

  • Private or public hospital accommodation and services includes overnight, same day, intensive care and theatre fees. You’re covered for a private or shared room in a private or public hospital for the following services:

    • Emergency ambulance transport
    • Accident related treatment after joining
    • Tonsils, adenoids and grommets
    • Joint reconstructions
    • Hernia and appendix
    • Dental surgery
    • Bone, joint and muscle.
  • 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.
  • Emergency ambulance transport for an accident or medical emergency by your state’s approved ambulance providers.
  • Boarder accommodation up to $160 per admission, if not included in the hospital agreement.
  • 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.


    FlexiSaver (Basic 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 for 24 months after the service date.
    • Services provided in countries outside of Australia.
    • Prostheses used for excluded services.
    • 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 we do not pay benefits, and members may or will likely incur significant out-of-pocket expense for these services. Please review the exclusions on this cover and always check with CBHS to see if you are covered before receiving treatment.

    Some services are not fully covered under FlexiSaver (Basic Plus). These are called restricted services. See more under the ‘What we don’t fully cover’ tab.


    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 FlexiSaver (Basic 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 eligible for hospital benefits in a public hospital at a shared room rate. Public hospitals do not charge 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 initiatives to help you reduce the cost of your premiums.

    These include:

    • Excess
    • Age-based discounts
    • Australian Government Rebate

    Understanding excess

    FlexiSaver (Basic Plus) has a $500 excess, which you pay when you need a hospital admission. This is designed to help reduce the cost of your premiums.

    An excess is a nominated amount you agree to pay upfront to the hospital for overnight or same day admission. The $500 excess is payable once per person per calendar year, no matter how many admissions you have.

    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 forWaiting period
    Pre-existing conditions* (except for hospital psychiatric services, rehabilitation and palliative care)12 months
    Hospital psychiatric services**, rehabilitation and palliative care2 months
    Accidents***, emergency ambulance transport1 day
    All other treatments2 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.

     

    Understanding Extras cover

    FlexiSaver (Basic Plus) hospital cover will cover you for:

    • Emergency ambulance transport
    • Accident related treatment after joining
    • Tonsils, adenoids and grommets
    • Joint reconstructions
    • Hernia and appendix
    • Dental surgery
    • Bone, joint and muscle

    For the above included services you will be covered in a private or public hospital for:

    • Accommodation for overnight, same day and intensive care for private or shared room in agreement private and public hospitals
    • Medical expenses for services while admitted to hospital e.g. fees from doctors, surgeons, anaesthetists, pathology, imaging etc. Covered for services eligible for benefits from Medicare up to Medicare Benefits Schedule (MBS) fee. You have your choice of doctor/surgeon in a public and private hospital. We will cover the difference between the Medicare benefit and the MBS fee for services provided when you’re admitted to hospital.
    • Access Gap Cover is when a provider chooses to participate under an arrangement with 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
    • 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
    • Emergency ambulance transport for an accident or medical emergency by approved ambulance providers

    ^ 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).

    Restricted Benefits (Services) not fully covered:

    • The services listed below, when provided in a private hospital, are eligible for Minimum Default Benefits prescribed by private health insurance legislation. These benefits relate to hospital bed charges and are unlikely to cover the fees charged for a private hospital admission. Members may incur large out of pocket expenses for theatre fees together with the difference between the Minimum Default Benefit and the bed charge raised by the hospital.
    • 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 services
      • Palliative care services

    No benefits are payable for hospital or medical treatments for all other benefits not listed as covered or restricted (see 'Excluded services' in the product sheet for examples of services not covered).

    If you are admitted into a private hospital for restricted services, benefits are payable only at the minimum rate specified by law. These benefits may only provide a benefit similar to a public hospital shared room rate. These benefits may not be sufficient to cover admissions in a private hospital.

    FlexiSaver (Basic Plus) hospital cover will not cover you for:

    • Hospital services received within policy waiting periods
    • Nursing home type patient contribution, respite care or nursing home fees
    • Take home/discharge drugs
    • Aids not covered in hospital agreement
    • Services claimed over 24 months after the service date
    • Services provided in countries outside of Australia
    • Prostheses used for excluded services
    • 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

    $500 excess is payable on FlexiSaver (Basic Plus).

    Parts of waiting periods served within one health fund can be completed in another when a person transfers funds. If you upgrade your level of cover, waiting periods may apply to benefits not previously included within your original cover.

    An excess is a nominated amount you agree to pay upfront in respect to charges raised by a hospital for overnight or same day admission. The total excess is payable once per person per calendar year up to a maximum of twice for couples policy.

    Waiting periods apply to those who are new to private health insurance or those who already have cover with CBHS or another fund, and choose to upgrade to a higher level of cover.

    Parts of waiting periods served within one health fund can be completed in another when a person transfers funds. If you upgrade your level of cover, waiting periods may apply to benefits not previously included within your original cover.

    Hospital waiting periodCalendar month
    Pre-existing conditions* (except for hospital psychiatric services, rehabilitation and palliative care)12 months
    Hospital psychiatric services**, rehabilitation and palliative care2 months
    Accidents***, emergency ambulance transport1 day
    All Other Treatments 2 months

    * 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.

     

    Extras waiting periodCalendar months
    Preventative & general dental, physiotherapy2 months
    Prescribed optical appliances6 months

    Download the product sheet

    Refer to the FlexiSaver (Basic Plus) product sheet to help you understand your cover and benefits

    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.

     


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    Price is for single in , aged 30, with income $90,000.00 per year. Includes Australian Government Rebate on Private Health Insurance of 24.608%. Price does not include Age-based Discount and assumes no Lifetime Health Cover loading. An excess of $500.00 applies.

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          Supporting Information

          Refer to the FlexiSaver (Basic Plus) product sheet to help you understand your cover and benefits.