KickStart (Basic Plus)

You’re fit and healthy, so you want cover for Extras services you’ll need like dental and optical and you want the security of basic hospital services because accidents do happen!
Kickstart

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70 years with a singular mission. Members for life.
Everything we do centres around achieving that goal.

    Legend

    KickStart (Basic Plus) hospital will cover you for:

    • Private or Public Hospital accommodation & services includes overnight, same day, intensive care* and theatre fees. Cover is provided for a private or shared room in a private or public hospital for the following services:
      1. Accident related treatment after joining^
      2. Tonsils, adenoids and grommets
      3. Joint reconstructions
      4. Hernia and appendix
      5. Dental surgery
      6. Bone, joint and muscle
    • All other services in any hospital are eligible for restricted benefits#. Restricted benefits are payable only at the minimum rate specified by law and may only provide a benefit similar to a public hospital shared room rate. Restricted benefits may not be sufficient to cover admissions in a private hospital. Restricted services are covered for a shared room in a public hospital.

    * Theatre and Labour ward fees are not charged in a public hospital

    • Medical expenses related to providers for services while admitted in hospital e.g. fees from doctors, surgeons, anaesthetists, pathology, imaging etc. Covered for all services eligible for benefits from Medicare up to Medicare Benefits Schedule (MBS) Fee. You have your choice of doctor/surgeon in a public or private hospital. We will cover the difference between the Medicare benefit and the MBS fee for services provided if 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
    • Emergency ambulance transport for an accident or medical emergency by approved ambulance providers
    • Better Living programs to help you manage your health and wellness.
    • Hospital Substitute Treatment means the possibility of receiving rehabilitation treatment or the care of a registered nurse at home.

    ^ 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).

    # All hospital services provided in a public hospital are eligible for Minimum Default Benefits. These benefits are stipulated by the department of Health and listed in the relevant Private Health Insurance (Benefit Requirement) Rules. Some hospitals may charge above the Minimum Default Benefit for shared room accommodation. Please note that fees charged in excess of Minimum Default Benefits are an out-of-pocket expense and are not eligible for reimbursement under CBHS policies.

    * A benefit is not payable in respect of a service that was rendered to a Member if the services can be claimable from any other source.

    If a member is 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.

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

    • Nursing home type patient contribution, respite care or nursing home fees
    • Take home/discharge drugs (non-PBS drugs may be eligible for benefits from your Extras cover)
    • Services claimed 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)

    Exclusions:

    For treatment listed as an exclusion there is no benefit payable and you will incur significant out of pocket expense for these services. Please review the exclusions on this cover and always check with us to see if you are covered before receiving treatment. The following services are excluded from this cover:

    • Podiatric surgery (provided by a registered podiatric surgeon)
    • Cosmetic services
    • Services for which a Medicare benefit is NOT payable

    Co-payment:

    A daily co-payment of $70 applies to KickStart (Basic Plus). This means that if you go into hospital you will pay $70 for every day that you are there, up to a maximum of 6 days per person or 12 days per couple/family/sole parent in a calendar year. So, if you are admitted to hospital for two days, you will pay a co-payment of $140. Co-payment does not apply for any dependant children on the 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
    Pregnancy and birth12 months
    Hospital psychiatric services**, rehabilitation and palliative care2 months
    Accidents***, emergency ambulance transport1 day
    All Other Treatments2 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
    Prescribed optical appliances, periodontics, endodontics 6 months
    All other services2 months
    Description Overall limit
    Legend
    • 3Benefit period over any 3 years.
    • 5Benefit period over any 5 years.
    • 7Lifetime benefit.
    • 8Benefit per membership per year.
    • 9Benefits are 90% of the cost up to maximum category limit.
    • Unlimited preventative dental care (2 month waiting period)
    • Limited general dental (2 month waiting period)
    • Limited major dental (6 month waiting period)
    PREVENTATIVE DENTAL
    Description100% of the cost up to the per service benefitOverall LimitBenefit PeriodWaiting Period
    Oral examinations (011, 012, 013)$27.50-$40UnlimitedCalendar year2 Months
    X-ray (022)$23
    Removal of plaque (111)$30
    Removal of calculus (114,115)$42-$55
    Fluoride application (121)$20
    Mouthguard (151,153)$62-$65
    Fissure sealing (161)$30
    GENERAL DENTAL
    Description100% of the cost up to the per service benefitOverall LimitBenefit PeriodWaiting Period
    Fillings$49-$115

    $675

    Calendar year2 Months
    Consultation & Examinations$28.50-$35.50
    X-rays$20-$45
    Extraction or Surgical Dental$50-$200
    MAJOR DENTAL6 Months
    Periodontics (gum treatment)$24-$190
    Endodontic (root canal treatment)$35-$180

    Benefits are not payable for Do-It-Yourself (DIY) dentistry including whitening kits, aligners and occlusal splints. Please contact us to confirm whether a benefit is payable.

    • Frames, lenses and contact lenses covered up to the maximum claimable benefit per service
    Service100% of the cost up to the per service benefitOverall LimitBenefit PeriodWaiting Period
    Frames100%

    $230

    Calendar Year6 Months
    Lenses
    Contact lenses
    • Physio, chiro, osteo, clinical psychology and dietitians covered with up to the maximum claimable benefit per service (2 month waiting period)
    • Alternative therapies including oriental therapies and massage therapies are also covered with up to 100% cost per service benefits with an overall limit of $200 (2 month waiting period)
    THERAPIES
    Description100% of the cost up to the per service benefitOverall LimitBenefit PeriodWaiting Period
    Physiotherapy (Initial/Subsequent)$40/$30$250Calendar year2 Months
    Chiropractic (Initial/Subsequent)$40/$40
    Osteopathy (Initial/Subsequent)$40/$30
    Clinical Psychology (Initial/Subsequent)$50/$50$250
    Dietitian (Initial/Subsequent)$75/$42$100
    ALTERNATIVE THERAPIES
    Description100% of the cost up to the per service benefitOverall LimitBenefit PeriodWaiting Period
    Oriental Therapies - Acupressure, Acupuncture, Chinese Herbal Medicine Consultation, Chinese Massage, Traditional Chinese Medicine Consultation$26$200Calendar year2 Months
    Massage Therapies - Deep Tissue Massage, Lymphatic Drainage, Myotherapy, Remedial Massage, Sports Massage, Swedish Massage, Therapeutic Massage
    • Blood glucose accessories and non-pharmaceutical benefits scheme drugs requiring a prescription by law up to the maximum claimable benefit per service (2 month waiting period and referred to by a CBHS recognised doctor)
    Description100% of the cost up to the per service benefitOverall LimitBenefit PeriodWaiting Period
    Blood Glucose Accessories100%$100Calendar Year2 Months
    Non-Pharmaceutical Benefits Scheme drugs requiring a prescription by law100% less the current prescribed PBS co-payment for general patients up to $75 per prescription$200

    CBHS Wellness Benefits cover you for a variety of health checks and programs designed to assist you in better managing your health and wellbeing.

    • A generous 90% cost per service benefit applies to health checks including breast examinations, bone density tests, skin cancer screening+, bowel/prostate cancer screening, eye screenings (2 month waiting period)
    • We cover health management services that will help you quit smoking, as well as weight and stress management programs (2 month waiting period)
    • We even cover gym memberships as part of a Health Management program where recommended by a GP or recognised provider (2 month waiting period)

    90% of the cost up to the overall limit below:

    HEALTH CHECKS
    DescriptionOverall LimitBenefit PeriodWaiting Period
    Breast examinations (i.e. mammograms/x-rays)$100Calendar year2 months
    Bone density tests
    Skin cancer screening
    Bowel/prostate cancer screening
    Eye Screenings
    HEALTH MANAGEMENT
    DescriptionOverall LimitBenefit PeriodWaiting Period
    Quit smoking programs2 $100 Calendar year2 months
    Weight management programs2
    Stress management courses2
    Gym membership/Personal training1$115 ($100 sub limit on personal training)

    1 CBHS can only pay a benefit for gym membership/personal trainer/ where the gym/personal trainer service is provided as part of a health management program, certified by your GP or a recognised provider confirming that the gym/personal trainer program is a health management program. Approval form is available from CBHS. Please note that GP consultations are not covered by CBHS.
    2 Must be approved by CBHS.
    + Examples of skin cancer screening include mole mapping or digital mole photography.

    CBHS provides benefits towards scans, screenings and tests, where members take a pro-active way to manage their health, but only where these do not attract a benefit from Medicare. We are only able to pay a benefit for selected scans, screenings and tests when they are NOT covered by Medicare. Your GP or provider will be able to advise you if your scan, screen or test, meets Medicare’s criteria for benefits.

    Supporting Information

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

    From
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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 25.059%. Price does not include Age-based Discount and assumes no Lifetime Health Cover loading. A co-payment of $70.00 applies.