What does Medicare pay and what does CBHS cover?
What Medicare Pays
The Medical Benefits Schedule determines what Medicare pays (or the rebate you receive from Medicare). The Medicare Benefits Schedule (MBS) is a list of medical fees set by the Australian government that acts as a guide for rebates. These schedule fees are what the government considers to be a fair price for specific services.
You can claim 100% of the schedule fee (from Medicare) for inpatient GP services. For non-GP services provided outside a hospital, you can claim 85% of the schedule fee as a rebate. In a private hospital, Medicare refunds 75% of the schedule fee. In public hospitals you are not charged for care and treatment.
The Schedule is a guide only, and doctors and specialists are free to charge above the Schedule amounts. This means you will need to pay the gap amount unless your cover level provides benefits for the gap. Most CBHS covers provide benefits for 25% of the schedule fee for services received in private and public hospital when you are an admitted patient. For Livelife and CBHS Prestige products an additional $200 can be claimed under the Gap Assist benefit.
Note also that the MBS does not cover medications; the Pharmaceutical Benefits scheme looks after subsidies for prescription medications. Medicare does not cover private patient hospital costs (this is covered by CBHS subject to your level of cover) or medical and hospital costs incurred outside Australia. Additionally, Medicare does not cover ambulance services and services that it considers are unnecessary. This includes surgery that is carried out for cosmetic reasons only.
The benefits that CBHS pays you will depend on your coverage level and your choice of hospital. To find out more, read the information below on included, excluded, and restricted services.