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.
Premium Package (Gold) hospital cover will cover you for:
- Accommodation for overnight, same day and intensive care covered for private or shared room in agreement private and public# hospitals
- Theatre 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, radiologists, pathology, imaging etc. Covered for all services eligible for benefits from Medicare up to Medicare Benefits Schedule (MBS) fee. You can choose your 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
- 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
- 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.
#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 for services that can be claimed from any other source.
What's partially covered
*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.
- Podiatric surgery (provided by a registered podiatric surgeon)1
- Services for which a Medicare benefit is NOT payable
1Indicates benefits for accommodation at Minimum Benefits in relevant PHI (Benefit Requirements) Rules and prostheses benefits based on items listed by the Minister of Health. No benefit for medical or theatre costs.
If a member is admitted into a non-agreement private hospital, 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.
Premium Package (Gold) hospital cover will not cover you for:
- 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 (for residents in VIC, SA and NT).
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 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.
|Extras waiting period||Calendar months|
|Periodontics, endodontics, inlays, onlays, facings, veneers, occlusal therapy, dentures, implants, crowns, bridges, orthodontia, artificial aids, healthcare appliances, oxygen apparatus and hearing aids||12 months|
|Prescribed optical appliances||6 months|
|All other services||2 months|
|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)||$35-$45||Unlimited||Calendar year|
|Removal of plaque (111)||$41|
|Removal of calculus (114,115)||$65-$70|
|Fluoride application (121)||$25|
|Fissure sealing (161)||$34|
|General Dental * (2 months waiting period)|
|Consultation & Examinations||$28-$40|
|Extraction or Surgical Dental||$50-$255|
|Major Dental * (12 months waiting period)|
|Periodontics (gum treatment)||$24-$260||$700||Calendar year|
|Endodontic (root canal treatment)||$7.50-$180||$700|
|Inlays/Onlays/Facing/Veneers||$260-$600||$1440||Any 5 years|
|Dentures & Implants||$20-$810||$1500|
|Crowns and Bridges||$10-$720||$3500|
* 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.
(6 months waiting period)
|100% of the cost up to the per service benefit below||Overall Limit||Benefit Period|
|Single vision (pair 212)||$130|
|Bifocal (pair) (312)||$140|
|Trifocal (pair) (412)||$150|
|Multifocal (pair) (512)||$210|
|Contact lenses (852)||$220|
(2 months waiting period)
|100% of the cost up to the per service benefit below||Overall Limit||Benefit Period|
|Physiotherapy (Initial/Subsequent)||$61/$43||$900||Calendar year|
|Occupational Therapy (Initial/Subsequent)||$61/$35||$800|
|Speech Therapy (Initial/Subsequent)||$95/$46||$1850|
|Clinical Psychology (Initial/Subsequent)||$140/$80||$500|
|Ante natal/Post natal physiotherapy||100%||$105|
|Podiatry (excl. artificial aids: e.g. orthotics)||$30-$50||$400|
|Exercise Physiology (Initial/Subsequent)||$35/$35||$360|
(2 months waiting period)
|Oriental therapies||$33||$1000||Calendar year|
|Acupressure, Acupuncture, Chinese Herbal Medicine Consultation, Chinese Massage, Traditional Chinese Medicine Consultation|
|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%||$320||Calendar year|
|Home visits by Registered Nurse||$120 (>4 hrs) |
$80 (<4 hrs)
|Non-Pharmaceutical Benefits Scheme drugs requiring a prescription by law||100% less the current prescribed PBS co-payment for general patients up to $150 per prescription||$1000|
|Travel & accommodation+||100% of the cost for accommodation (shared room rate) airfare, train, bus or 15c per kilometre for car||$500||Per Membership per calendar year|
+ Travel is only payable for a patient who requires essential medical and dental treatment, where it is not available at a facility within a 160 km round trip of the member's home. In order to claim travel a patient must be visiting a specialist and will require a referral letter. Excludes Ronald McDonald house.
|Health Care Aids (12 months waiting period)||100% of the cost up to the per service benefit below||Overall Limit||Benefit Period|
|Artificial aids||$10-$1500||$1500||Any 3 years|
|Blood pressure monitor, Nebuliser, Glucometer||100%||$500|
|Wellness Benefits ^|
|Overall Limit||Benefit Period|
|100% of the cost up to the overall limit below|
|Health Checks||$300||Calendar year|
|Breast examinations (i.e. mammograms/x-rays)|
|Bone density tests|
|Skin cancer screening*|
|Bowel/prostate cancer screening|
|Health Management||$200||Calendar year|
|Quit smoking programs1|
|Weight management programs1|
|Stress management courses1|
|Gym membership/Personal training2||$230 ($200 sub limit on personal training)|
* 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.
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.
Refer to the Premium Package (Gold) 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.