Prestige (Gold)

Our highest level of coverage, including Extras, in one comprehensive package
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70 years with a singular mission. Members for life.
Everything we do centres around achieving that goal.

    Legend

    Prestige (Gold) hospital cover will cover you for:

    • Accommodation for overnight, same day and intensive care covered for private or shared room in agreement private and public# hospitals
    • Theatre and labour ward fees covered in agreement private hospitals (excluding restricted services*)
    • Medical expenses related to providers for services while admitted in hospital e.g. fees from doctors, surgeons, anaesthetists, radiologists, pathology, imaging etc. Covered for all services eligible for benefits from Medicare up to Medicare Benefits Schedule (MBS) fee. You can choose your 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
    • 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
    • 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 means the possibility of receiving rehabilitation treatment or the care of a registered nurse at home.

    Gap Assist

    To further help you reduce your out-of-pocket expenses as a result of hospitalisation, Prestige also includes a medical gap benefit called Gap Assist, $200 per person per calendar year towards out-of-pocket expenses.

    # 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 for services that can be claimed from any other source.

    What's partially covered

    * 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.

    • Podiatric surgery (provided by a registered podiatric surgeon)1
    • Services for which a Medicare benefit is NOT payable

    1 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.

    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.

    Prestige (Gold) 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 (non-PBS drugs may be eligible for benefits from your Extras cover).
    • Aids not covered in hospital agreement (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 members will 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. The following services are excluded from this cover:

    • Cosmetic services
    There is no Co-payment or Excess payable for hospital admission on Prestige (Gold).

    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
    Crowns and bridges, orthodontia, artificial aids, healthcare appliances, oxygen apparatus and hearing aids12 months
    Prescribed optical appliances, periodontics, endodontics, inlays, onlays, facings, veneers, occlusal therapy, dentures and implants6 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 per year (2 month waiting period)
    • Unlimited general dental per year (2 month waiting period)Major dental with up to 100% cover and generous overall limits (6 or 12 month waiting period depending on procedures)
    PREVENTATIVE DENTAL
    Description100% of the cost up to the per service benefitOverall LimitBenefit PeriodWaiting Period
    Oral examinations (011, 012, 013)$35-$45UnlimitedCalendar year2 Months
    X-ray (022)$28
    Removal of plaque (111)$41
    Removal of calculus (114, 115)$65-$70
    Fluoride application (121)$25
    Mouthguard (151,153)$130-1$50
    Fissure sealing (161)$34
    GENERAL DENTAL
    Description100% of the cost up to the per service benefitOverall LimitBenefit PeriodWaiting Period
    Fillings$81-$150UnlimitedCalendar year2 Months
    Consultation & Examinations$28-$40
    X-rays$21-$60
    Extraction or Surgical Dental$50-$255
    MAJOR DENTAL
    Description100% of the cost up to the per service benefitOverall LimitBenefit PeriodWaiting Period
    Periodontics (gum treatment)$24-$260$700Calendar year6 Months
    Endodontic (root canal treatment)$7.50-$180$700Calendar year6 Months
    Inlays/Onlays/Facing/Veneers$260-$600$1440Any 5 years6 Months
    Dentures & Implants$20-810$1500Any 5 years6 Months
    Occlusal therapy$17-$260$920Lifetime6 Months
    Orthodontia100%$3200Lifetime12 Months
    Crowns and Bridges$10-$720$3500Any 5 years12 Months

    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.

    • $450 annual limit and up to 100% cover on many types of prescription glasses and frames (6 month waiting period)
    Service100% of the cost up to the per service benefitOverall LimitBenefit PeriodWaiting Period
    Frames$140

    $450

    Calendar Year6 Months
    Single vision (pair 212)$130
    Bifocal (pair) (312)$140
    Trifocal (pair) (412)$150
    Multifocal (pair) (512)$210
    Contact lenses (852)$220
    • Physio, physiology services,chiro, osteo, hypnotherapy, occupational therapy, speech therapy, clinical psychology, ante natal/post natal physio, podiatry, audiology, eye therapy, dietitians and exercise physiology all covered with up to 100% cost per service benefit (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 at $1000 (2 month waiting period)
    THERAPIES
    Description100% of the cost up to the per service benefitOverall LimitBenefit PeriodWaiting Period
    Physiotherapy (Initial/Subsequent)$61/$43$900Calendar year2 Months
    Chiropractic (Initial/Subsequent)$61/$40$1000
    Osteopathy (Initial/Subsequent)$61/$35
    Hypnotherapy$80$360
    Occupational Therapy (Initial/Subsequent)$61/$35$800
    Speech Therapy (Initial/Subsequent)$95/$46$1850
    Clinical Psychology (Initial/Subsequent)$140/$80$500
    Ante natal/Post natal physiotherapy100%$105
    Podiatry (excl. artificial aids: e.g. orthotics)$30-$50$400
    Audiology$60$360
    Eye Therapy$60$455
    Dietitian (Initial/Subsequent)$75/$42$360
    Exercise Physiology (initial/subsequent)$35-$35$360
    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$33$1000 Calendar year 2 Months
    Massage Therapies - Deep Tissue Massage, Lymphatic Drainage, Myotherapy, Remedial Massage, Sports Massage, Swedish Massage, Therapeutic Massage
    • Blood glucose accessories, nurse visits at home, non-PBS drugs requiring a prescription by law, and travel with accommodation all covered with up to 100% cost per service benefits and generous annual limits (2 month waiting period and some other conditions apply)
    Description100% of the cost up to the per service benefitOverall LimitBenefit PeriodWaiting Period
    Blood Glucose Accessories100%$320Calendar Year2 Months
    Home visits by Registered Nurse$120 (>4 hrs) $80 (<4 hrs)$2800
    Non-Pharmaceutical Benefits Scheme drugs requiring a prescription by law100% less the current prescribed PBS co-payment for general patients up to $150 per prescription$1000
    Travel & accommodation+100% of the cost for accommodation (shared room rate) airfare, train, bus or 15c per kilometre for car$500Per Membership per calendar year
    + Travel is only payable for a patient who requires essential medical and dental treatment, where it is not available at a facility within a 160 km round trip of the member's home. In order to claim travel a patient must be visiting a specialist and will require a referral letter. Excludes Ronald McDonald house.
    • When referred by a doctor and recognised by CBHS, you can get 100% cost per service benefit up to certain limits in any 3 year period (12 month waiting period applies)
    Description100% of the cost up to the per service benefitOverall LimitBenefit PeriodWaiting Period
    Artificial aids$10-$1500$1500Any 3 years(12 month waiting period) -
    Hearing aids100%$2200
    Blood pressure monitor, Nebuliser, Glucometer100%$500

    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 100% 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)

    100% of the cost up to the overall limit below:

    DescriptionOverall LimitBenefit PeriodWaiting Period
    HEALTH CHECKS
    $300Calendar year2 months
    Breast examinations (i.e. mammograms/x-rays)
    Bone density tests
    Skin cancer screening
    Bowel/prostate cancer screening
    Eye Screenings
    HEALTH MANAGEMENT $200 Calendar year
    Quit smoking programs2
    Weight management programs2
    Stress management courses2
    Gym membership/Personal training1$230 ($200 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 Prestige (Gold) 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.