We’re a small fund, backed by a big not-for-profit.
We may be new but we’re already scoring some of the highest customer satisfaction rates in the industry. Affordable premiums, award-winning Hospital cover and an extensive range of health and wellness benefits – what’s not to like?
Entry Hospital (Basic Plus) will cover you for:
- Accommodation for overnight, same day and intensive care for a shared room in a public hospital. We will also pay an amount for accommodation in a private hospital or private room of a public hospital - this amount will be the minimum amount specified by applicable legislation.
- Excess option available for reduced premiums.
- Theatre and labour ward fees are not raised in a public hospital.
- 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. You have your choice of doctor/surgeon in a public or private hospital. We will cover the difference between the Medicare benefit and the MBS fee for services provided if you’re admitted to hospital.
- Access Gap Cover is when a provider chooses to participate in an arrangement us. We cover 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.
- Emergency ambulance transport for an accident or medical emergency by approved ambulance providers.
- 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.
If you are admitted into an agreement or non-agreement private hospital, benefits are payable at the minimum rate specified by law - accordingly substantial out of pocket expenses can be incurred.
Entry Hospital (Basic Plus) will not cover you for:
- Hospital services received within policy waiting periods
- Nursing home type patient contribution, respite care or nursing home fees
- High cost, experimental or non TGA approved drugs
- Take home/discharge drugs (non-PBS drugs may be eligible for benefits from your Extras cover)
- Treatments where no Medicare benefits are available
- 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
- Labour ward fees in an agreement and non-agreement private hospital
- Ambulance transfers between hospitals (for residents in VIC, SA and NT).
For treatment listed as an exclusion there is no benefit payable and you will incur significant out of pocket expense for these services. Please review the exclusions on this cover and always check with CBHS Corporate Health to see if you are covered before receiving treatment.
The following services are excluded from this cover:
- Podiatric surgery (provided by a registered podiatric surgeon)
- Cosmetic services
- Services for which a Medicare benefit is NOT payable
Note: Basic Plus Hospital cover is not sufficient for private hospital treatment as you may incur significant out-of-pocket expenses.
An excess is the amount you pay towards the cost of your hospital admission before any benefit is payable. By paying an excess you can reduce the cost of your hospital cover. Excess levels included: $500 or $750.
When you go into hospital (same-day or overnight) you will pay the chosen excess amount directly to the hospital. The excess is only payable once per person up to a maximum of twice per couple/family membership per calendar year. Excesses apply to all members on the policy.
Waiting periods apply if you are new to private health insurance or if you already have cover with us or another fund, and you choose to upgrade to a higher level of cover.
Parts of waiting periods served within one health fund can be completed in another when you transfer funds. If you upgrade your level of cover, waiting periods may apply to benefits not previously included within your original cover.
|Hospital waiting periods||Calendar months|
|Pre-existing conditions* (except for hospital psychiatric services, rehabilitation and palliative care)||12 months|
|Pregnancy and birth||12 months|
|Hospital psychiatric services**, rehabilitation and palliative care||2 months|
|Accidents***, emergency ambulance transport||1 day|
|All other treatments||2 months|
*If you have 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.
**Once you have served the two-month waiting period, you can choose to upgrade your 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 586 462 or email firstname.lastname@example.org.
***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.
Refer to the Entry Hospital (Basic Plus) product sheet to help you understand your cover and benefits.
Disclaimer: Members with Entry level Basic Plus hospital should be aware that it is possible that you will be placed on a waiting list even if you are admitted as a private patient.