Benefits review 2015 faqs

1. What is the date of effect?

All benefits will take effect from 1 January 2015. This means that any services incurred on and after this date will follow the reviewed benefits.

2. What is a Benefit increase or decrease?

A monetary limit increase or decrease either for individual services or the overall limits for particular category claimable by our Members.

3. Will I be affected by the Benefit review?

If your membership includes any products listed in the summary of changes below your limits or product features will change accordingly for those products.

  • Waiving of co-payments for children dependants on Comprehensive and Limited Hospital products, Livelife and StepUp package products
  • Non-pharmaceutical benefits scheme (PBS) benefits reduced from $150 to $75 per service on Top, Intermediate and Essential Extras products, and StepUp, KickStart and Overseas Visitor package products
  • Removal of benefits for dental item 141 (oral hygiene instructions) from Top, Intermediate and Essential Extras products, and Prestige, Livelife, StepUp, KickStart, and Overseas Visitor packaged products
  • Preventative dental overall limit has increased from $200 to $230 for Intermediate Extras
  • Preventative dental overall limit has increased from $180 to $210 for Essential Extra

4. How were the Benefit changes selected?

CBHS reviewed various factors in detail to determine which benefits and by what amount will experience increases.

The review takes into consideration both Extras and Hospital covers, Member feedback received, historical claiming experiences and those services where our Members may have incidents of high out of pocket expenses.

5. Why are you not increasing Benefits as much as in previous years?

Our medical and hospital costs continue to escalate, placing increased pressure on our ability to continue delivering the value and service for which we have become widely acknowledged. To ensure that we stay competitive, each year CBHS reviews its product benefits in terms of both frequency of use and total cost.

This year’s review confirms that our benefits continue to be highly competitive overall. We have identified some benefits which warranted improvement while there were others which have either been inappropriately used, or which carry a total cost which is disproportionate to the number of members utilising the benefit.

Any product change is implemented solely to ensure that our products remain both relevant to your needs and that they continue to represent exceptional value.

6. Why are only selected Benefits getting increases or decreases, and why only on selected products

At CBHS we continually strive to ensure that we give back to our Members at every possible opportunity. The review balances feedback from individuals as well as potential trends and impacts to all members.

We also ensure that our benefits and products remain competitive, sustainable and in the best interest of all members.

7. Why are you waiving co-payments for children dependants on Comprehensive and Limited Hospital products, and Livelife and StepUp package products?

We’re family and we know the distress that a child being hospitalised can cause to a family. Waiving the co-payment to children is our way to make things simpler and to support you and your family even more during difficult times.

8. Why are you reducing the non-pharmaceutical benefits scheme (PBS) benefits from $150 to $75 on Top, Intermediate and Essential Extras products, and StepUp, KickStart and Overseas Visitor package products?

Our analysis showed that most members were not using the full service limit. CBHS benefits of $75 will still be higher than the major funds.

On Extra’s cover CBHS pays benefits of up to $150 per prescription for non-pharmaceutical benefit scheme drugs. Moving forward this benefit will be reduced to $75 per service. $75 is also higher than the cost of most prescriptions. There is no change to your current overall yearly limits for this service.

9. What is dental item 141 (oral hygiene instructions) and why are you reducing this benefit?

Advice on how to maintain healthy teeth should form part of a routine dental check-up. Some dentists have been charging our members for this service as a separate charge. To discourage separate charges, we will pay nil benefits for dental item 141 (oral hygiene instructions) on all Extras cover.

The 2012 Australian Dental Association (ADA) survey highlighted that 42% of dentists provide this service at no charge. This service is defined by the ADA as “Instruction in techniques for the removal of bacterial plaque. Advice of appropriate toothpaste and medicaments may be included.”

10. Why are you increasing the overall dental limit for Essential and Intermediate?

CBHS believes that preventative dental services are of the utmost importance. We are constantly reviewing the costs incurred by members against our limits and as a result of this analysis we are increasing the limits as per below:

  • The current overall limit for preventative dental on Intermediate Extras is $200. Moving forward this will increase to $230 for each calendar year.
  • The current overall limit for preventative dental on Essential Extras is $180. Moving forward this will increase to $210 for each calendar year.