Versatile and varied Hospital and Extras cover to suit your lifestyle

Hospital cover highlights

  • Private hospital cover for pregnancy related services
  • $70 daily co-payment helps keep premium low (co-payment does not apply to children)
  • Access Gap Cover plus $100 Gap assist which will help you with additional out-of-pocket expenses
  • Emergency Ambulance transport
  • What's covered?
  • What's partially covered
  • What's not covered
  • Waiting period
  • Co-payment
  • StepUp hospital will cover you for:

    • Accommodation for overnight, same day and intensive care for private or shared room in agreement private and public hospitals (excluding restricted services*)
    • Theatre fees and labour ward fees covered in agreement private hospitals (excluding restricted services*)
    • Medical expenses related to providers for services while admitted in hospital e.g. fees from doctors, surgeons, anaesthetists, pathology, imaging etc. Covered for all services eligible for benefits from Medicare up to Medicare Benefits Schedule (MBS) Fee. Members have their choice of doctor/surgeon in a public or 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
    • Emergency ambulance transport for an accident or medical emergency by approved ambulance providers
    • Boarder accommodation covers 100%, up to $160 per admission, if not included in hospital agreement
    • Hospital Services where a Medicare benefit is payable (excluding restricted services*)
    • Better Living programs to help you manage your health and wellness.
    • Hospital Substitute Treatment means the possibility of receiving rehabilitation treatment or the care of a registered nurse at home.

    Gap Assist#

    To further help you reduce your out-of-pocket expenses as a result of hospitalisation, StepUp also includes a medical gap benefit called Gap Assist, $100 per person per calendar year towards out-of-pocket expenses.

    # All hospital services provided in a public hospital are eligible for Minimum Default Benefits. These benefits are stipulated by the department of Health and listed in the relevant Private Health Insurance (Benefit Requirement) Rules. Some hospitals may charge above the Minimum Default Benefit for shared room accommodation. Please note that fees charged in excess of Minimum Default Benefits are an out-of-pocket expense and are not eligible for reimbursement under CBHS policies.

    *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.

  • *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.

    • major eye surgery services (corneal transplant, cataract surgery, other lens related surgery services)
    • joint replacement services (hip, knee, ankle and shoulder)
    • sterilisation and reversal of sterilisation services
    • cardiothoracic services
    • bariatric (gastric banding, sleeve gastrectomy, gastric by-pass) services
    • psychiatric services
    • rehabilitation and palliative care services
    • plastic and reconstructive surgery services
    • services for which a Medicare benefit is not payable
  • StepUp hospital cover will not cover you for

    • If a member is admitted into a private hospital for restricted services 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 private hospital
    • Hospital services received within policy waiting periods
    • Nursing home type patient contribution, respite care or nursing home fees
    • Take home/discharge drugs (non-PBS drugs may be eligible for benefits from your Extras cover)
    • Aids not covered in hospital agreement (may be eligible for benefits from your Extras cover)
    • Services claimed over 24 months after the service date
    • Services provided in countries outside of Australia
    • Prostheses used for cosmetic procedures, where no Medicare benefit is payable
    • Ambulance transfers between hospitals

    Exclusions:

    For treatment listed as an exclusion there is no benefit payable and member will incur significant out of pocket expense for these services. 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:

    • Cosmetic services
  • Waiting period:

    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, pregnancy related services 12 months
    Psychiatric, rehabilitation, palliative care, all other treatments or services 2 months
    Accidents Δ, injuries and emergency ambulance transport 1 day

    Δ Accident means an injury as a result of unintentional, unexpected actions or events that require treatment by a registered practitioner, but excludes pregnancy.

  • Co-payment:

    A daily co-payment of $70 applies to StepUp. This means that if you go into hospital you will pay $70 for every day that you are there, up to a maximum of 6 days per person or 12 days per couple/family/sole parent in a calendar year. So, if you are admitted to hospital for two days, you will pay a co-payment of $140. Co-payment does not apply for any dependant children on the policy.

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Extras cover highlights

  • A good variety of extras to suit your lifestyle

  • Cover for dental including orthodontics for the growing family

  • Generous benefits on optical, physio and chiro

  • Alternative therapies covered including remedial massage, acupuncture, naturopathy and more

     

  • Extras
  • What you get
  • Dental Dental
    1. Limited preventative dental per year (2 month waiting period)
    2. Limited general dental per year (2 month waiting period)
    3. Limited major dental on gum treatment (periodontics) and root canal treatment (endodontic) covered with up to 70% cost per service benefit (6 month waiting period)
  • Optical Prescribed Optical
    1. $250 annual limit and up to  70% cover on many types of prescription glasses and frames (6 month waiting period)
  • Therapies Therapies
    1. Physio, Chiro, Osteo, Podiatry, Dieticians covered with up to 70% cost per service benefit with various overall limit (2 month waiting period)
    2. Alternative therapies including Natural Therapies, Oriental Therapies and Massage Therapies are also covered with up to 70% cost per service benefits with an overall limit of $400 (2 month waiting period)
  • General Health General Health
    1. Blood glucose accessories, non-PBS drugs requiring a prescription by law covered with up to 70% cost per service benefits and generous annual limits (2 month waiting period applies)
  • Health Care Aids Health Care Aids
    1. When referred by a doctor and recognised by CBHS, you can get up to 70% cost per service benefit on artificial aids, blood pressure monitors, nebulisers and glucometers over a 3 year period (12 month waiting period applies)
  • Wellness Benefits Wellness Benefits
    1. A generous 90% cost per service benefit applies to health checks including breast examinations, bone density tests, skin cancer screening*, bowel/prostate cancer screening, eye screenings (2 month waiting period)
    2. We cover health management services that will help you quit smoking, as well as weight and stress management programs (2 month waiting period)
    3. We even cover Yoga, Pilates and Gym Memberships as part of a Health Management program where recommended by a GP or recognised provider (2 month waiting period
    4. *Examples of skin cancer screening include mole mapping or digital mole photography. Benefits are claimable through CBHS as long as they are not claimable from another source such as Medicare. If a member has received a benefit from Medicare they cannot claim the gap with CBHS.

*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.

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.

DENTAL
Description 70% Of the cost up to the per service benefit Overall Limit Benefit Period Waiting Period
Preventative Dental
Oral examinations (011, 012, 013) $35-$45 Unlimited Calendar year 2 Months
X-ray (022) $28
Removal of plaque (111) $41
Removal of calculus (114, 115) $65-$70
Fluoride application (121) $25
Mouthguard (151,153) $130-1$50
Fissure sealing (161) $34
General Dental
Fillings $81-$150

$350

Calendar year 2 Months
Consultation & Examinations $28-$40
X-rays $21-$60
Extraction or Surgical Dental $50-$255
Major Dental
Periodontic (gum treatment) $24-$260 $900 Calendar year 6 Months
Endodontic (root canal treatment) $7.50-$180
Inlays/Onlays/Facing/Veneers $260-$600 any five years
Dentures and implants $20-$810 any five years
Occlusal therapy $17-$260 Lifetime
Crowns and bridges $10-$720 any five years 12 Months
Orthodontia 70% $1400 Lifetime
PRESCRIBED OPTICAL
Service 70% Of the cost up to the per service benefit Overall Limit Benefit Period Waiting Period
Frames $90

$250

Calendar Year 6 Months
Single vision (pair 212) $70
Bifocal (pair) (312) $60
Trifocal (pair) (412) $90
Multifocal (pair) (512) $100
Contact lenses (852) $160
THERAPIES
Description 70% Of the cost up to the per service benefit Overall Limit Benefit Period Waiting Period
Physiotherapy (Initial/Subsequent) $61/$43 $600 ($300 sub limit per therapy) Calendar year 2 Months
Chiropractic (Initial/Subsequent) $61/$40
Osteopathy (Initial/Subsequent) $61/$35
Occupational therapy (Initial/Subsequent) $61/$35
Speech therapy (Initial/Subsequent) $95/$46
Clinical Psychology (Individual/Group sessions) $30-$140
Podiatry (excl. artificial aids: e.g. orthotics) $30-$50 $150
Dietitian $15-$75 $100
ALTERNATIVE THERAPIES
Natural therapies $33 $400 Calendar year 2 Months
Buteyko, Herbal Medicine Consultations,
Homeopathy, Naturopathy, Nutrition
Oriental therapies
Acupressure, Acupuncture
Chinese Herbal Medicine Consultation, Chinese Massage,
Kinesiology, Reflexology, Shiatsu, Traditional
Chinese Medicine Consultation
Massage therapies
Alexander Technique, Aromatherapy, Bowen Therapy
Deep Tissue Massage, Feldenkrais,
Lymphatic Drainage, Myotherapy, Remedial Massage
Rolfing, Sports Massage, Swedish Massage
Therapeutic Massage
GENERAL HEALTH
Description 70% Of the cost up to the per service benefit Overall Limit Benefit Period Waiting Period
Blood Glucose Accessories 70% $100 Calendar Year 2 Months
Non-Pharmaceutical Benefits Scheme drugs requiring a prescription by law 100% less the current government prescribed co-payment up to $75 per prescription $300
HEALTH CARE AIDS
Description 70% Of the cost up to the per service benefit Overall Limit Benefit Period Waiting Period
Artificial aids $10-$150 $150 Calendar Year (12 month waiting period) - referred by a doctor and recognised by CBHS
WELLNESS BENEFITS

90% of the cost up to the overall limit below

Service Overall Limit Benefit Period Waiting period 
Health checks  $200  Calendar year   2 months
Breast examinations (i.e. mammograms/x-rays)
Bone density tests
Skin cancer screening
Bowel/prostate cancer screening
Eye Screenings
Health management  $100  Calendar year  2 months
Quit smoking programs2
Weight management programs2
Stress management courses2
Yoga1
Pilates1
Gym membership/Personal training1 $115 ($100 sub limit on personal training) Calendar year  2 months
1 CBHS can only pay a benefit for gym membership/personal trainer/pilates /yoga where the gym/personal trainer/yoga/pilates service is provided as part of a health management program, certified by your GP or a recognised provider confirming that the gym/personal trainer/yoga/pilates program is a health management program. Approval form is available from CBHS. Please note that GP consultations are not covered by CBHS.2 Must be approved by CBHS

Other Package Covers

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. Thankyou 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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