Silver Visitors will cover you for:

• Accommodation for overnight, same day and intensive care for private or shared room in agreement private hospitals and public hospitals. If an excess option (see Excess section) has been selected, the excess will apply.
• Theatre fees covered in agreement private hospitals except for restricted services or exclusions.
• Supplied pharmaceuticals approved by the Pharmaceutical Benefits Scheme (PBS) and provided as part of your in-hospital treatment.
• Boarder accommodation covers 100%, up to $160 per admission, if not included in hospital agreement.
• Emergency ambulance services when transported directly to a hospital or treated at the scene due to an accident or medical emergency. Transport must be provided by a State Government ambulance service or a private ambulance service recognised by CBHS Corporate Health (such as Royal Flying Doctor Service).
  
  Residents of WA holding a Hospital or Package product are also eligible to claim a benefit for non-emergency ambulance transport services up to a maximum of $5,000 per person per calendar year.
• Hospital Services where a Medicare benefit would apply to the service if the service had been provided to the holder of a valid Medicare card.
• Medical expenses related to providers e.g. fees from doctors, surgeons, anaesthetists, pathology, imaging etc. Covered for all services eligible for benefits from Medicare up to 100% of the Medicare Benefits Schedule (MBS) fee, where Medicare benefit would apply to the service if the service had been provided to the holder of a valid Medicare card. This applies to services you receive as an admitted or non-admitted hospital patient.
• Access Gap Cover is where a provider chooses to participate under an arrangement with the fund. CBHS Corporate Health covers up to 100% of an agreed amount in excess of the MBS fee which reduces or eliminates your out-of-pocket expenses (i.e. surgeons, anaesthetists, pathology, imaging fees etc). Benefits are limited to those where a Medicare benefit would apply to the service if the service had been provided to the holder of a valid Medicare card.
• Surgically implanted prostheses to at least the minimum benefit specified in the prostheses list under Private Health Insurance legislation.
• Repatriation The benefit is for one one-way repatriation, per membership, per calendar year, up to a maximum of $10,000 if the member becomes terminally ill or suffers a life altering injury, including the return of mortal remains.
• Pharmacy Selected pharmacy items including discharge medications. 100% benefit up to $75 per script. Maximum overall limit of $300 per person per calendar year.

* Check the 'What's partially covered' for a list of the restricted services.

*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.

• Pregnancy related services
• Bariatric services - all including revision and reversal procedures (e.g. gastric banding, sleeve gastrectomy)
• Rehabilitation services
• Psychiatric services
• Palliative care services

Silver Visitors will not cover you for:

• 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.
• Hospital services received within policy waiting periods (see Waiting Periods section).
• Nursing home type patient contribution, respite care or nursing home fees.
• Non PBS, high cost drugs.
• Aids not covered in hospital agreement (may be eligible for benefits from 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 had the service been provided to the holder of a valid Medicare card.
• Ambulance transfers between hospitals (for residents in VIC, SA and NT).

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 Corporate Health to see if you are covered before receiving treatment. The following services are excluded from this cover:

• Non-admitted psychiatric and psychology services.
• Stem cells, bone marrow transplants.
• Organ transplants.
• Assisted reproductive services (e.g. IVF, GIFT)
• Cosmetic services
• Other services for which Medicare benefit is NOT payable

Waiting periods:

Waiting period is the time when the member is not covered for a service or treatment after starting or joining the membership. You will receive benefits listed on your level of cover once you have served the appropriate waiting periods.

Hospital waiting periods	Calendar months
Pre-existing conditions, pregnancy related services	12 months
All other treatments (including pre-existing conditions relating to psychiatric, rehabilitation and palliative care)	2 months
Accidents, emergency ambulance transport	1 day

 

Excess

Silver Visitors has an excess of $500. This means that when you go into hospital you will pay the first $500 in respect to charges raised by the hospital. This excess is per person (including dependants) up to a maximum of $1000 per family membership per calendar year. Excesses apply to both day and overnight stays.