Under rules set down by the Commonwealth Department of Health and Family Services, the payment of gap medical benefits is restricted to medical services provided whilst an admitted patient of a hospital.
A new born baby is classified as an admitted patient when one or more of the following criteria apply;
- The baby is admitted to an approved neo-natal intensive care facility
- The baby is the second or subsequent born in a multiple birth situation (i.e. Twins, triplets etc)
- The baby is more than 9 days old while still in hospital
If none of these criteria are met, your baby is not classified as an admitted patient for gap medical purposes and expenses can only be claimed through Medicare. (It is required that you indicate that your baby was not classified as admitted patient). You will be eligible for 85% of the schedule fee through Medicare. No further benefits are available from CBHS.
Generally, when mother and baby are in hospital, CBHS do not pay for the partner's meals or accommodation. Although there are benefits available for Boarder Fees (accommodation only) in some hospitals for specific situations, these benefits are subject to the conditions of the contract that is in place with CBHS. Please contact CBHS for further information.
If you have a daily co-payment on your membership, you will need to pay the relevant daily co-payment each day that you are hospitalised up to a maximum of 6 days per person or 12 days per family per calendar year. If your baby needs to be admitted to hospital, you will be required to pay the relevant daily co-payment unless you have reached your family maximum of 12 days.
If you have LiveLife and StepUp package cover, the daily co-payment is waived for dependant children on your membership up to 12 years of age.
From January 1st, 2015 you will not be required to pay the relevant daily co-payment for dependant children on your membership if you have LiveLife, StepUp, Comprehensive Hospital or Limited Hospital covers. If you have Kickstart or Basic Hospital 500, the daily co-payment or excess applies for dependant children on your membership.
For further clarification on Daily Co-Payments, contact Member Care on 1300 654 123.
Pre/antenatal classes provided by a Physiotherapist are covered on Top Extras, and Prestige and LiveLife package cover. The benefit payable is 70% of cost, up to a maximum of $105.00 per confinement.
To claim for pre/antenatal classes CBHS require an official receipt showing the provider's name, qualifications, dates and cost of each class.
Pre/antenatal classes provided by a registered nurse or midwife are covered under the midwifery limit on Top Extras, and Prestige and LiveLife package cover. The benefit payable is 70% of cost, up to a maximum of $500.00 per confinement.
To claim for pre/antenatal classes provided by a registered nurse or midwife must not be claimable through Medicare. CBHS require an official receipt showing the midwife's full name and nurse’s registration number, dates and cost of each class.
CBHS can help if you have Top Extras, Prestige or LiveLife package cover. Lactation classes come under the midwifery benefit, which entitles you to 70% of the cost up to a maximum of $500 per confinement.
To claim for lactation classes the service must not be claimable through Medicare. CBHS requires an official receipt showing the midwife's full name, nurse’s registration number and date and cost of each consultation.