At CBHS we help you manage your health challenges. We believe in offering you the services, support and tools you need to live your best life.
Our Better Living Programs are available to support eligible members towards a healthier lifestyle. Each Better Living Program is subject to its own eligibility criteria.
Contact us for more information and to confirm your eligibility for a program.
HealthStarter (Basic Plus)
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Small enough to care, big enough to make a difference.
When it comes to choosing the right health care provider bigger isn’t always better. We pride ourselves on being small enough to care.
Legend
Healthstarter (Basic Plus) hospital will cover you for:
- Private or Public Hospital accommodation & services includes overnight, same day, intensive care* and theatre fees. Cover is provided for a private or shared room in a private or public hospital for the following services:
- Accident related treatment after joining^
- Tonsils, adenoids and grommets
- Joint reconstructions
- Hernia and appendix
- Dental surgery
- Bone, joint and muscle
- All other services in any hospital are eligible for restricted benefits#. Restricted benefits are payable only at the minimum rate specified by law and may only provide a benefit similar to a public hospital shared room rate. Restricted benefits may not be sufficient to cover admissions in a private hospital. Restricted services are covered for a shared room in a public hospital.
*Theatre and Labour ward fees are not charged 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 under an arrangement with 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
- 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. This applies to a member assisting with the care of another member on the same membership.
- 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.
^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).
#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.
If you are admitted to 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
HealthStarter (Basic Plus) hospital cover will not cover you for:
- 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)
- 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 (for residents in VIC, SA and NT)
Exclusions:
- Podiatric surgery (provided by a registered podiatric surgeon)
- Cosmetic services
- Services for which a Medicare benefit is NOT payable
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: $250, $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 help@cbhscorp.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.
| Extras waiting period | Calendar months |
|---|---|
| Periodontics and endodontics | 12 months |
| Prescribed optical appliances | 6 months |
| All other services | 2 months |
| Description | Overall limit |
|---|
- 3Benefit period over any 3 years.
- 5Benefit period over any 5 years.
- 7Lifetime benefit.
- 8Benefit per membership per year.
- 9Benefits are 90% of the cost up to maximum category limit.
| Preventative Dental * (2 months waiting period) | 100% of the cost up to the per service benefit below | Overall Limit | Benefit Period |
|---|---|---|---|
| Oral examinations (011, 012, 013) | $27.50-$40 | Unlimited | Calendar year |
| X-ray (022) | $23 | ||
| Removal of plaque (111) | $30 | ||
| Removal of calculus (114) | $58 | ||
| Fluoride application (121) | $22 | ||
| Mouthguard (151,153) | $62-$65 | ||
| Fissure sealing (161) | $30 |
| General Dental * (2 months waiting period) | 100% of the cost up to the per service benefit below | Overall Limit | Benefit Period |
|---|---|---|---|
| Fillings | $49-$115 | $300 | Calendar year |
| Consultation & Examinations | $28.50-$35.50 | ||
| X-rays | $20-$45 | ||
| Extraction or Surgical Dental | $50-$200 |
| Major Dental * (12 months waiting period) | 100% of the cost up to the per service benefit below | Overall Limit | Benefit Period |
|---|---|---|---|
| Periodontics (gum treatment) | $24-$190 | $375 | Calendar year |
| Endodontic (root canal treatment) | $35-$180 |
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.
| Prescribed Optical (6 months waiting period) | 100% of the cost up to the per service benefit below | Overall Limit | Benefit Period |
|---|---|---|---|
| Frames | 100% | $230 | Calendar year |
| Lenses | |||
| Contact lenses |
| Therapies (2 months waiting period) | 100% of the cost up to the per service benefit below | Overall Limit | Benefit Period |
|---|---|---|---|
| Physiotherapy (Initial/Subsequent) | $40/$30 | $250 | Calendar year |
| Chiropractic (Initial/Subsequent) | $40/$40 | ||
| Osteopathy (Initial/Subsequent) | $40/$30 | ||
| Clinical Psychology (Initial/Subsequent) | $50/$50 | $250 | |
| Dietitian (Initial/Subsequent) | $75-$42 | $100 |
| Alternative Therapies (2 months waiting period) | 100% of the cost up to the per service benefit below | Overall Limit | Benefit Period |
|---|---|---|---|
| Oriental therapies Acupressure, Acupuncture, Chinese herbal medicine consultation, Chinese massage, Traditional Chinese medicine consultation | $26 | $200 | Calendar year |
| Massage therapies Deep tissue massage, Lymphatic drainage, Myotherapy, Remedial massage, Sports massage, Swedish massage, Therapeutic massage |
| General Health (2 months waiting period) | 100% of the cost up to the per service benefit below | Overall Limit | Benefit Period |
|---|---|---|---|
| Blood Glucose Accessories | 100% | $100 | Calendar year |
| Non-Pharmaceutical Benefits Scheme drugs requiring a prescription by law | 100% less the current prescribed PBS co-payment for general patients up to $75 per prescription. | $200 |
| Wellness Benefits ^ (2 months) | Overall Limit | Benefit Period | |
|---|---|---|---|
| 90% of the cost up to the overall limit below | |||
| Health Checks | $100 | Calendar year | |
| Breast examinations (i.e. mammograms/x-rays) | |||
| Bone density tests | |||
| Skin cancer screening* | |||
| Bowel/prostate cancer screening | |||
| Eye Screenings | |||
| Health Management | $100 | Calendar year | |
| Quit smoking programs1 | |||
| Weight management programs1 | |||
| Stress management courses1 | |||
| Gym membership/Personal training2 | $115 ($100 sub limit on personal training) | Calendar year | |
* Examples of skin cancer screening include mole mapping or digital mole photography.
^ CBHS Corporate Health provides benefits towards scans, screenings and tests, where members take a pro-active way to manage their health, but only where these do not attract a benefit from Medicare. We are only able to pay a benefit for selected scans, screenings and tests when they are NOT covered by Medicare. Your GP or provider will be able to advise you if your scan, screen or test, meets Medicare’s criteria for benefits.
1 Must be approved by CBHS Corporate Health.
2 CBHS Corporate Health can only pay a benefit for gym membership/personal trainer where the gym/personal trainer service is provided as part of a health management program, certified by your GP or a recognised provider confirming that the gym/personal trainer program is a health management program. Approval form is available from CBHS Corporate Health. Please note that GP consultations are not covered by CBHS Corporate Health.
Each group of services within Extras and Package covers have 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.
Benefits which attract a 3 and 5 year period are entitled to have the benefit renewed on the same date which the service was performed respectively.
Benefits which attract a 'lifetime' period; lifetime means the period commencing on the date the member was first insured and ceases to be insured by CBHS Corporate Health (irrespective of any suspension of membership or other period without cover).
Most CBHS Corporate Health Extras benefits are subject to a Per Service Benefit. Generally, the maximum benefit for an individual Extras service is 70% of the service fee up to a Per Service Benefit within the overall category limit.
Example:
The maximum payment for the service 'extraction of a full tooth' is 70% of the cost up to the Per Service Benefit of $70.
If your dentist charges you $80 for this service, you would receive a benefit payment of $56 (70% of $80 is $56). If your dentist charges you $110 for this service, you would receive a benefit payment of $70. While 70% of $110 is $77, the Per Service benefit for this service is $70 - the amount you would receive.
Supporting Information
Refer to the HealthStarter (Basic Plus) product sheet to help you understand your cover and benefits.
Disclaimer: 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.