Changes to our fund rules

The below changes will become effective from 1 January 2016 unless noted below.


Changes to suspension rules

  • Removal of leave without pay suspension type
    A member will continue to be allowed to suspend for travel or financial hardship, however suspensions for ‘leave without pay’ will no longer be available.
  • Minimum periods before suspensions
    You will have to have been a member with CBHS for at least 12 months, and be up to date in contribution payments, in order to apply for a suspension for any reason.
  • Minimum periods between suspensions for travel
    After a ‘suspension for travel’, a member will be required to reactivate their membership for a minimum of six months before another period of ‘suspension for travel’ will be approved.
  • Maximum period of suspension for financial hardship
    We are changing the maximum period for which you can suspend your membership for financial hardship to a maximum of two years. Periods of suspension approved by CBHS will continue not to count towards any Lifetime Health Cover (LHC) loading obligation.
  • New conditions while on suspension
    When you reactivate your membership from suspension, we will continue to waive the waiting periods which you have already served prior to suspension. However, if a new medical condition arises during the period in which the membership is suspended, it will be deemed a pre-existing condition and a waiting period of 12 months will apply upon reactivation of the membership (except psychiatric services, rehabilitation services and palliative care services which will have a 2 month waiting period).

New definitions
With the evolution of health practices and technology, we encounter new and more frequently used terms that may be used during your treatment. We have added some definitions for these terms which seek to make it as clear as possible under which circumstances certain services are covered and when they are not covered.

Exclusion for all cosmetic services
Some of our Hospital Covers have restricted benefits on some non-therapeutic cosmetic services. CBHS will no longer allow claims for non-therapeutic cosmetic services that do not attract a benefit from Medicare.
This change applies to all Hospital Covers from 1 February 2016.

Reducing conflicts of interest
We have introduced a new rule to reduce the potential for conflicts of interest in the provision of goods and services by our recognised providers. This rule means CBHS will no longer approve claims made by a member who is: also the provider; employed by the provider; or is in the provider’s immediate family.

If you would like to download a copy of the current rules (as at 1 December 2015) please click here. Please note that the above changes will be applied to this CBHS Health Benefit Fund Rules on 1 January 2016 and 1 February 2016 per the date for each change specified above.

If you would prefer to receive a hardcopy of the rules, you can request this by emailing help@cbhs.com.au.