Hospital cover highlights

  • Cover for accident related treatments and medical emergencies including surgery for broken bones
  • Private hospital cover for some most common procedures like removal of wisdom teeth, tonsils, adenoids and appendix
  • Emergency ambulance transport – only 1 day waiting period
  • What's covered?
  • What's not covered
  • Waiting periods
  • Excess
  • FlexiSaver (Basic Plus) hospital cover will cover you for:

    • Emergency ambulance transport
    • Accident related treatment after joining
    • Tonsils, adenoids and grommets
    • Joint reconstructions
    • Hernia and appendix
    • Dental surgery
    • Bone, joint and muscle

    For the above included services you will be covered in a private or public hospital for:

    • Accommodation for overnight, same day and intensive care for private or shared room in agreement private and public hospitals
    • Medical expenses for services while admitted in hospital e.g. fees from doctors, surgeons, anaesthetists, pathology, imaging etc. Covered for services eligible for benefits from Medicare up to Medicare Benefits Schedule (MBS) fee. Members have their 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 (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

    ^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).

    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.

    • Hospital psychiatric services
    • Rehabilitation services
    • Palliative care services
  • FlexiSaver (Basic Plus) hospital cover will not cover you for

    • No benefits are payable for hospital or medical treatments for all other benefits not listed as covered or restricted (see 'Excluded services' in the product sheet for examples of services not covered).
    • If member is admitted into a non-agreement private hospital for services covered by this product, 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 non-agreement private hospital
    • Hospital services received within policy waiting periods
    • Nursing home type patient contribution, respite care or nursing home fees
    • Take home/discharge drugs
    • Aids not covered in hospital agreement
    • Services claimed over 24 months after the service date
    • Services provided in countries outside of Australia
    • Prostheses used for excluded services
    • Ambulance transfers between hospitals (for residents in VIC, SA and NT)
    • Fees raised by public hospitals that exceed Minimum Default Benefits set by the Department of Health for shared room accommodation
  • Waiting periods:

    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 period Calendar month
    Pre-existing conditions* (except for hospital psychiatric services, rehabilitation and palliative care) 12 months
    Hospital psychiatric services**, rehabilitation and palliative care 2 months
    Accidents***, emergency ambulance transport 1 day
    All other treatments 2 months

     

    * If a member has 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.

    ** Note that upon serving the two month waiting period, members can choose to upgrade their 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 by sending an email to 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.

  • Excess:

    $500 excess is payable on FlexiSaver (Basic Plus).

    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.

    An excess is a nominated amount you agree to pay upfront in respect to charges raised by a hospital for overnight or same day admission. The total excess is payable once per person per calendar year up to a maximum of twice for couples policy.

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Extra cover highlights

  • Flexibility to use the available overall limit for any of the included service (except for optical)
  • Get more than half of the provider charges back in benefits
  • Cover for selected extras including preventative dental, general dental, optical and physio
  • Per person overall limit which renews every calendar year
Description Waiting period Per service benefit Overall limit Benefit period
Preventative dental (e.g. oral examinations, x-ray, scale and clean, mouthguards) 2 month 55% of the cost of service $700 (sublimit of $150 for optical) Calendar Year
General dental (e.g. fillings, extractions or surgical dental)
Optical (e.g. frames, prescription lens, contact lens) 6 month
Physiotherapy 2 month

* A benefit is not payable in respect of a service that was rendered to a Member if the services can be claimable from any other source.

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.

Each group of services within Extras and Packages cover has an overall limit on the amount you can claim. Most limits are based on per person per calendar year, unless otherwise stated in our Extras table.

Other Package Covers

  • CBHS Prestige (Gold)

    Prestige
    (Gold)

    Prestige (Gold) is a premium level of cover with top of the range hospital cover and very generous limits on Extras. Plus, access to Best Doctors services.

  • CBHS StepUp (Bronze Plus)

    StepUp
    (Bronze Plus)

    A mid-level package cover ideal for those planning a family. Hospital cover includes pregnancy services, while Extras includes more than the basics.

  • CBHS KickStart (Basic Plus)

    KickStart
    (Basic Plus)

    Affordable package cover for the fit and healthy covering the things you want, like dental and optical, without the services you don’t need.

What Our Members Think

I joined as a CBHS member in 1978. Through many health events and challenges CBHS has always been there for me and my family. Their exceptional service over this time has always been appreciated.

- Jenny J

What Our Members Think

I've not long joined CBHS from another fund, but so far I've been impressed by the super helpful and friendly staff, the higher claim limits and rebates at a very competitive premium, and how easy it is to lodge manual claims through the app. Thanks CBHS - you've won me over! 😃

- Jessica B

What Our Members Think

What I love about CBHS is their customer service - friendly staff and always ready to help and email you the information you ask about. Keep up the great work!!!

- Linda S

What Our Members Think

I love CBHS as its so so easy to lodge a claim and whenever i need a question answered friendly consultant is one phone call away. The phone back option instead of waiting is brilliant!

- Rachel N

What Our Members Think

I have been with CBHS since I began at CBA 15 years ago...Now I have three beautiful children, one who has a disability. Our top extras cover has been really essential for his early intervention. I do love the ease of claiming online.

- Annette E

What Our Members Think

I am relatively new to CBHS and am loving it already. I worked for a CBA subsidiary a long time ago but was still eligible to join. So much better that the for-profit funds - our premium is only a little more and we pay a lower co-contribution and get great benefits. I am loving the massage rebate for my partner and gym rebate for me!

- David G

What Our Members Think

I'm extremely happy with CBHS! I have been a customer for about six years. I think the price is reasonable. And i would refer you to my family and friends any day. Thank you CBHS!!!

- Karen W

What Our Members Think

Love CBHS as I never have to doubt that they've got my back when I need it. Been through other insurers who have limited options or limits, yet cost the same or more.

- Mark F

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