At CBHS we help you manage your health challenges. We believe in offering you the services, support and tools you need to live your best life.
Health and Wellness Programs are available to support eligible members towards a healthier lifestyle. Each Health and Wellness Program is subject to its own eligibility criteria.
Contact us for more information and to confirm your eligibility for a program.
Key Hospital benefits
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Private hospital coverage for accidents and some common treatments
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Hernia & appendix cover
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Includes cover for joint reconstructions
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Dental surgery covered~
Hospital
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Hospital psychiatric services
Restricted Restricted benefits
Hospital treatment for the treatment and care of patients with psychiatric, mental, addiction or behavioural disorders. For example: psychoses such as schizophrenia, mood disorders such as depression, eating disorders and addiction therapy. -
Palliative care
Restricted Restricted benefits
Hospital treatment for care where the intent is primarily providing quality of life for a patient with a terminal illness, including treatment to alleviate and manage pain. -
Rehabilitation
Restricted Restricted benefits
Hospital treatment for physical rehabilitation for a patient related to surgery or illness. For example: inpatient and admitted day patient rehabilitation, stroke recovery, cardiac rehabilitation. -
Emergency ambulance transport
Included Covered in private agreement hospitals and public hospitals.
Emergency ambulance transport means an ambulance service that consists of transporting a seriously ill person to a Hospital by a State Government Ambulance Service or an ambulance service recognised by CBHS in order to receive urgently needed treatment. This includes transportation from the scene of an Accident or the scene of a medical event such as a heart attack or stroke but does not include transportation to Hospital for the routine management of an ongoing medical condition or transportation between hospitals. -
Accident related treatment and medical emergencies after joining
Included Covered in private agreement hospitals and public hospitals.
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). -
Bone, joint and muscle
Included Covered in private agreement hospitals and public hospitals.
Hospital treatment for the investigation and treatment of diseases, disorders and injuries of the musculoskeletal system. For example: carpal tunnel, fractures, hand surgery, joint fusion, bone spurs, osteomyelitis and bone cancer. Chest surgery is listed separately under Lung and chest. Spinal cord conditions are listed separately under Brain and nervous system. Spinal column conditions are listed separately under Back, neck and spine. Joint reconstructions are listed separately under Joint reconstructions. Joint replacements are listed separately under Joint replacements. Podiatric surgery performed by a registered podiatric surgeon is listed separately under Podiatric surgery (provided by a registered podiatric surgeon). Management of back pain is listed separately under Pain management. Pain management that requires a device is listed separately under Pain management with device. Chemotherapy and radiotherapy for cancer is listed separately under Chemotherapy, radiotherapy and immunotherapy for cancer. -
Dental surgery
Included Covered in private agreement hospitals and public hospitals.
Hospital treatment for surgery to the teeth and gums. For example: surgery to remove wisdom teeth, and dental implant surgery. -
Hernia and appendix
Included Covered in private agreement hospitals and public hospitals.
Hospital treatment for the investigation and treatment of a hernia or appendicitis. Digestive conditions are listed separately under Digestive system. -
Joint reconstructions
Included Covered in private agreement hospitals and public hospitals.
Hospital treatment for surgery for joint reconstructions. For example: torn tendons, rotator cuff tears and damaged ligaments. Joint replacements are listed separately under Joint replacements. Bone fractures are listed separately under Bone, joint and muscle. Procedures to the spinal column are listed separately under Back, neck and spine. Podiatric surgery performed by a registered podiatric surgeon is listed separately under Podiatric surgery (provided by a registered podiatric surgeon). -
Tonsils, adenoids and grommets
Included Covered in private agreement hospitals and public hospitals.
Hospital treatment of the tonsils, adenoids and insertion or removal of grommets. -
Ear, nose and throat
Restricted Restricted benefits
Hospital treatment for the investigation and treatment of the ear, nose, throat, middle ear, thyroid, parathyroid, larynx, lymph nodes and related areas of the head and neck. For example: damaged ear drum, sinus surgery, removal of foreign bodies, stapedectomy and throat cancer. Tonsils, adenoids and grommets are listed separately under Tonsils, adenoids and grommets. The implantation of a hearing device is listed separately under Implantation of hearing devices. Orthopaedic neck conditions are listed separately under Back, neck and spine. Sleep studies are listed separately under Sleep studies. Chemotherapy and radiotherapy for cancer is listed separately under Chemotherapy, radiotherapy and immunotherapy for cancer. -
Gastrointestinal endoscopy
Restricted Restricted benefits
Hospital treatment for the diagnosis, investigation and treatment of the internal parts of the gastrointestinal system using an endoscope. For example: colonoscopy, gastroscopy, endoscopic retrograde cholangiopancreatography (ERCP). Non-endoscopic procedures for the digestive system are listed separately under Digestive system. -
Back, neck and spine
Restricted Restricted benefits
Hospital treatment for the investigation and treatment of the back, neck and spinal column, including spinal fusion. For example: sciatica, prolapsed or herniated disc, spinal disc replacement, and spine curvature disorders such as scoliosis, kyphosis and lordosis. Joint replacements are listed separately under Joint replacements. Joint fusions are listed separately under Bone, joint and muscle. Spinal cord conditions are listed separately under Brain and nervous system. Management of back pain is listed separately under Pain management. Pain management that requires a device is listed separately under Pain management with device. Chemotherapy and radiotherapy for cancer is listed separately under Chemotherapy, radiotherapy and immunotherapy for cancer. -
Blood
Restricted Restricted benefits
Hospital treatment for the investigation and treatment of blood and blood-related conditions. For example: blood clotting disorders and bone marrow transplants. Treatment for cancers of the blood is listed separately under Chemotherapy, radiotherapy and immunotherapy for cancer. -
Brain and nervous system
Restricted Restricted benefits
Hospital treatment for the investigation and treatment of the brain, brain-related conditions, spinal cord and peripheral nervous system. For example: stroke, brain or spinal cord tumours, head injuries, epilepsy and Parkinson’s disease. Treatment of spinal column (back bone) conditions is listed separately under Back, neck and spine. Chemotherapy and radiotherapy for cancer is listed separately under Chemotherapy, radiotherapy and immunotherapy for cancer. -
Breast surgery (medically necessary)
Restricted Restricted benefits
Hospital treatment for the investigation and treatment of breast disorders and associated lymph nodes, and reconstruction and/or reduction following breast surgery or a preventative mastectomy. For example: breast lesions, breast tumours, asymmetry due to breast cancer surgery, and gynecomastia. This clinical category does not require benefits to be paid for cosmetic breast surgery that is not medically necessary. Chemotherapy and radiotherapy for cancer is listed separately under Chemotherapy, radiotherapy and immunotherapy for cancer. -
Chemotherapy, radiotherapy and immunotherapy for cancer
Restricted Restricted benefits
Hospital treatment for chemotherapy, radiotherapy and immunotherapy for the treatment of cancer or benign tumours. Surgical treatment of cancer is listed separately under each body system. -
Diabetes management (excluding insulin pumps)
Restricted Restricted benefits
Hospital treatment for the investigation and management of diabetes. For example: stabilisation of hypo- or hyper- glycaemia, contour problems due to insulin injections. Treatment for diabetes-related conditions is listed separately under each body system affected. For example, treatment for diabetes-related eye conditions is listed separately under Eye. Treatment for ulcers is listed separately under Skin. Provision and replacement of insulin pumps is listed separately under Insulin pumps. -
Digestive system
Restricted Restricted benefits
Hospital treatment for the investigation and treatment of the digestive system, including the oesophagus, stomach, gall bladder, pancreas, spleen, liver and bowel. For example: oesophageal cancer, irritable bowel syndrome, gall stones and haemorrhoids. Endoscopy is listed separately under Gastrointestinal endoscopy. Hernia and appendicectomy procedures are listed separately under Hernia and appendix. Bariatric surgery is listed separately under Weight loss surgery. Chemotherapy and radiotherapy for cancer is listed separately under Chemotherapy, radiotherapy and immunotherapy for cancer. -
Eye (not cataracts)
Restricted Restricted benefits
Hospital treatment for the investigation and treatment of the eye and the contents of the eye socket. For example: retinal detachment, tear duct conditions, eye infections and medically managed trauma to the eye. Cataract procedures are listed separately under Cataracts. Eyelid procedures are listed separately under Plastic and reconstructive surgery. Chemotherapy and radiotherapy for cancer is listed separately under Chemotherapy, radiotherapy and immunotherapy for cancer. -
Gynaecology
Restricted Restricted benefits
Hospital treatment for the investigation and treatment of the female reproductive system. For example: endometriosis, polycystic ovaries, female sterilisation and cervical cancer. Fertility treatments are listed separately under Assisted reproductive services. Pregnancy and birth-related conditions are listed separately under Pregnancy and birth. Miscarriage or termination of pregnancy is listed separately under Miscarriage and termination of pregnancy. Chemotherapy and radiotherapy for cancer is listed separately under Chemotherapy, radiotherapy and immunotherapy for cancer. -
Kidney and bladder
Restricted Restricted benefits
Hospital treatment for the investigation and treatment of the kidney, adrenal gland and bladder. For example: kidney stones, adrenal gland tumour and incontinence. Dialysis is listed separately under Dialysis for chronic kidney failure. Chemotherapy and radiotherapy for cancer is listed separately under Chemotherapy, radiotherapy and immunotherapy for cancer. -
Lung and chest
Restricted Restricted benefits
Hospital treatment for the investigation and treatment of the lungs, lung-related conditions, mediastinum and chest. For example: lung cancer, respiratory disorders such as asthma, pneumonia, and treatment of trauma to the chest. Chemotherapy and radiotherapy for cancer is listed separately under Chemotherapy, radiotherapy and immunotherapy for cancer. -
Male reproductive system
Restricted Restricted benefits
Hospital treatment for the investigation and treatment of the male reproductive system including the prostate. For example: male sterilisation, circumcision and prostate cancer. Chemotherapy and radiotherapy for cancer is listed separately under Chemotherapy, radiotherapy and immunotherapy for cancer. -
Miscarriage and termination of pregnancy
Restricted Restricted benefits
Hospital treatment for the investigation and treatment of a miscarriage or for termination of pregnancy. -
Pain management
Restricted Restricted benefits
Hospital treatment for pain management that does not require the insertion or surgical management of a device. For example: treatment of nerve pain and chest pain due to cancer by injection of a nerve block. Pain management using a device (for example an infusion pump or neurostimulator) is listed separately under Pain management with device. -
Skin
Restricted Restricted benefits
Hospital treatment for the investigation and treatment of skin, skin-related conditions and nails. The removal of foreign bodies is also included. Plastic surgery that is medically necessary and relating to the treatment of a skin-related condition is also included. For example: melanoma, minor wound repair and abscesses. Removal of excess skin due to weight loss is listed separately under Weight loss surgery. Chemotherapy and radiotherapy for cancer is listed separately under Chemotherapy, radiotherapy and immunotherapy for cancer. -
Sleep studies
Restricted Restricted benefits
Hospital treatment for the investigation of sleep patterns and anomalies. For example: sleep apnoea and snoring. -
Heart and vascular system
Restricted Restricted benefits
Hospital treatment for the investigation and treatment of the heart, heart-related conditions and vascular system. For example: heart failure and heart attack, monitoring of heart conditions, varicose veins and removal of plaque from arterial walls. Chemotherapy and radiotherapy for cancer is listed separately under Chemotherapy, radiotherapy and immunotherapy for cancer. -
Implantation of hearing devices
Restricted Restricted benefits
Hospital treatment to correct hearing loss, including implantation of a prosthetic hearing device. Stapedectomy is listed separately under Ear, nose and throat. -
Plastic and reconstructive surgery (medically necessary)
Restricted Restricted benefits
Hospital treatment which is medically necessary for the investigation and treatment of any physical deformity, whether acquired as a result of illness or accident, or congenital. For example: burns requiring a graft, cleft palate, club foot and angioma. Plastic surgery that is medically necessary relating to the treatment of a skin-related condition is listed separately under Skin. Chemotherapy and radiotherapy for cancer is listed separately under Chemotherapy, radiotherapy and immunotherapy for cancer. -
Cataracts
Restricted Restricted benefits
Hospital treatment for surgery to remove a cataract and replace with an artificial lens. -
Dialysis for chronic kidney failure
Restricted Restricted benefits
Hospital treatment for dialysis treatment for chronic kidney failure. For example: peritoneal dialysis and haemodialysis. -
Insulin pumps
Restricted Restricted benefits
Hospital treatment for the provision and replacement of insulin pumps for treatment of diabetes. -
Joint replacements
Restricted Restricted benefits
Hospital treatment for surgery for joint replacements, including revisions, resurfacing, partial replacements and removal of prostheses. For example: replacement of shoulder, wrist, finger, hip, knee, ankle, or toe joint. Joint fusions are listed separately under Bone, joint and muscle. Spinal fusions are listed separately under Back, neck and spine. Joint reconstructions are listed separately under Joint reconstructions. Podiatric surgery performed by a registered podiatric surgeon is listed separately under Podiatric surgery (provided by a registered podiatric surgeon). -
Pain management with device
Restricted Restricted benefits
Hospital treatment for the implantation, replacement or other surgical management of a device required for the treatment of pain. For example: treatment of nerve pain, back pain, and pain caused by coronary heart disease with a device (for example an infusion pump or neurostimulator). Treatment of pain that does not require a device is listed separately under Pain management. -
Assisted reproductive services
Restricted Restricted benefits
Hospital treatment for fertility treatments or procedures. For example: retrieval of eggs or sperm, In vitro Fertilisation (IVF), and Gamete Intra-fallopian Transfer (GIFT). Treatment of the female reproductive system is listed separately under Gynaecology. Pregnancy and birth-related services are listed separately under Pregnancy and birth. -
Pregnancy and birth
Restricted Restricted benefits
Hospital treatment for investigation and treatment of conditions associated with pregnancy and child birth. Treatment for the baby is covered under the clinical category relevant to their condition. For example, respiratory conditions are covered under Lung and chest. Female reproductive conditions are listed separately under Gynaecology. Fertility treatments are listed separately under Assisted reproductive services. Miscarriage and termination of pregnancy is listed separately under Miscarriage and termination of pregnancy. -
Weight loss surgery
Restricted Restricted benefits
Hospital treatment for surgery that is designed to reduce a person’s weight, remove excess skin due to weight loss and reversal of a bariatric procedure. For example: gastric banding, gastric bypass, sleeve gastrectomy.
Hospital
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Podiatric surgery (provided by a registered podiatric surgeon)
Excluded Exclusion (not covered)
Hospital treatment for the investigation and treatment of conditions affecting the foot and/or ankle, provided by a registered podiatric surgeon, but limited to cover for: - accommodation; and - the cost of a prosthesis as listed in the prostheses list set out in the Private Health Insurance (Prostheses) Rules, as in force from time to time. Note: Insurers are not required to pay for any other benefits for hospital treatment for this clinical category but may choose to do so. -
Cosmetic services
Excluded Exclusion (not covered)
Cosmetic service means an operation, procedure or treatment undertaken for the dominant purpose of improving appearance or improving psychological wellbeing. -
Services for which a Medicare benefit is NOT payable
Excluded Exclusion (not covered)
These are services that do not attract any benefits from Medicare. Examples of such services include cosmetic services, podiatric surgery and laser eye surgery.
Key Extras benefits
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Unlimited preventative dental
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General dental
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Optical
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Physio and chiro
Extras
| Description | Yearly limit per person |
|---|---|
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Unlimited |
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$230 |
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$250 |
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$100 |
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$100 |
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$200 |
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$100 |
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$100 |
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$115 (sublimit $100 for personal training) |
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$675 |
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$250 |
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$200 |
- ^ 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.
- 1 Benefit period over any 5 years
- 2 Lifetime benefit
- 3 Benefit per membership per 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 160km 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.
- 4 Benefit period over any 3 years
- # 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.
Hospital cover explained
Here’s what you can expect to be covered for under your KickStart (Basic Plus) policy:
- Agreement private or public hospital accommodation and services which includes overnight, same day, intensive care and theatre fees. You’re covered for a private or shared room in an agreement private hospital or public hospital for the following services:
- 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 admitted in hospital e.g. fees from doctors, surgeons, anaesthetists, pathology and imaging. Covered for included services eligible for benefits from Medicare up to Medicare Benefits Schedule (MBS) fee. Have your choice of doctor/surgeon in a public and private hospital. CBHS will cover the difference between the Medicare benefit and the MBS fee for services provided as an admitted patient to a hospital
- Access Gap Cover is where a provider chooses to participate under an arrangement with the fund. 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 (e.g. surgeons, anaesthetists, pathology, imaging fees etc.). Read more about Access Gap Cover.
- Surgically implanted medical devices and human tissue products to at least the minimum benefit specified in the Prescribed List of Medical Devices and Human Tissue Products 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. This applies to a member assisting with the care of another member on the same membership
- Emergency ambulance transport for an accident or medical emergency by approved ambulance providers
- Hospital services where Medicare pays a benefit (for included services only). It’s essential to check the MBS item number prior to your procedure, to confirm if the treatment falls under a category which is included in your policy.
KickStart (Basic Plus) Hospital component will not cover you for:
- No benefits are payable for hospital or medical treatment for exclusions
- 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 benefits for these under your Extras cover)
- Services you claim for 24 months after the service date
- Services provided in countries outside of Australia
- Medical devices and human tissue products used for services listed as exclusions
- Ambulance transfers between hospitals (for residents in VIC, SA and NT)
Exclusions
For treatment listed as an exclusion, CBHS does not pay a benefit. 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:
- Podiatric surgery (provided by a registered podiatric surgeon)
- Cosmetic services
- Services where a Medicare benefit is NOT payable
A note on accident-related treatment
If you require hospital treatment as a result of an accident, our accident-related treatment will supersede any exclusions you have on your cover and you’ll receive benefits as if the hospital treatment was a covered service. Please note that specific criteria apply. Refer to our Fund Rules for more details.
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 an out-of-pocket (gap) expense.
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.
Restricted services which are not fully covered under KickStart (Basic Plus)
The services listed as restricted benefits are only eligible for Minimum Benefits prescribed by private health insurance legislation. These benefits relate to hospital bed charges for a shared room in a public hospital. They are unlikely to cover the fees charged for a private room in a public hospital, or a private hospital admission. Members may incur large out-of-pocket (gap) expenses for theatre.
Understanding which services are restricted in your cover can help you plan more effectively for a hospital stay or medical treatment. Check out the Hospital services table above to see which services are restricted under the KickStart (Basic Plus) package.
This section covers a number of options which might help you reduce the cost of your premiums.
These include:
- A daily co-payment
- Age-based discount
- Australian Government Rebate on private health insurance
Understanding your daily co-payment
KickStart (Basic Plus) package includes a daily co-payment of $70 to help reduce the cost of your premiums. This means that when you’re admitted to hospital (as a day patient or overnight) you pay the daily co-payment for each day that you are in hospital up to a maximum of six days per person or 12 days per couple/family per calendar year. So, if you are admitted to hospital for two days, you will pay a co-payment of $140. The co-payment applies to all members of the policy.
Age-based discount
Age-based discount is 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. If you have an age-based discount with your current fund, we will continue to apply it when you switch to us.
Read more about the age-based discount and see what you’re eligible for.
Australian Government Rebate on private health insurance
You may be eligible for the Australian Government Rebate on private health insurance (rebate). 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 below.
| Hospital waiting periods | Calendar months |
|---|---|
| Pre-existing conditions (except for hospital psychiatric services, rehabilitation and palliative care) | 12 months |
| Pregnancy and birth | 12 months |
| Hospital psychiatric services*, rehabilitation and palliative care | 2 months |
| Accident-related treatment**, emergency ambulance transport | 1 day |
| All other treatments | 2 months |
*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.
**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.
I’m transferring from another fund or upgrading my CBHS cover
If you already have cover with another fund, and switch to CBHS, you won’t need to re-start your waiting periods if you join on an equivalent level of cover.
- 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.
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KickStart (Basic Plus)
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KickStart (Basic Plus)
Hospital cover explained
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