FlexiSaver (Basic Plus)

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

• 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.