Premium Package (Gold)

Premium Package (Gold) is our highest level of combined cover, offering an extensive range of hospital services and generous extras benefits to help you get the most out of life.

Hospital cover highlights

  • Access Gap Cover plus $200 Gap Assist which will help you with additional out-of-pocket medical expenses
  • Access to Best Doctors

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 the Medicare Benefits Schedule (MBS) fee. Members have their choice of doctor/surgeon in a public or private hospital. CBHS Corporate Health will cover the difference between the Medicare benefit and the MBS fee for services provided as an admitted patient to a hospital
  • 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 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 the Private Health Insurance legislation
  • Pharmacy covers most drugs related to the reason for your admission in an agreement private hospital
  • 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*)

Gap Assist

To further help you reduce your out-of-pocket expenses as a result of hospitalisation, Premium Package (Gold) also includes a medical gap benefit called Gap Assist, $200 per person per calendar year towards out-of-pocket expenses.


# 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 Corporate Health 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.

Restricted Benefits* (Services) not fully covered

The services listed below, when provided in a private hospital, are eligible for Minimum Default Benefits prescribed by the 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 surgery1 (provided by a registered podiatric surgeon)

* 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. 1 Indicates 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.

Premium Package (Gold) hospital cover 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
  • 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).

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:

  • Cosmetic services
  • Services for which a Medicare benefit is NOT payable

Waiting periods

Waiting periods apply to those who are new to private health insurance or those who already have cover with CBHS Corporate Health or another fund, and choose to upgrade to a higher level of cover.

Parts of waiting periods served within one health fund can be completed in another when a person transfers funds. If you upgrade your level of cover, waiting periods may apply to benefits not previously included within your original cover.

Hospital waiting period Calendar month
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 a member has 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.

** Note that upon serving the two month waiting period, members can choose to upgrade their 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 by sending an email to 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.

Extra cover highlights

  • High benefits for optical, physio, chiro and other therapies
  • Unlimited preventative and general dental
  • Extensive cover for massage / alternative therapies with an overall limit of $1000
  • Covers health care aids including hearing aids and other artificial aids

Benefits

Dental

  • 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
    X-ray (022) $28
    Removal of plaque (111) $41
    Removal of calculus (114,115) $65-$70
    Fluoride application (121) $25
    Mouthguard (151,153) $130-$150
    Fissure sealing (161) $34
    General Dental (2 months waiting period)
    Fillings $81-$150 Unlimited Calendar year
    Consultation & Examinations $28-$40
    X-rays $21-$60
    Extraction or Surgical Dental $50-$255
    Major Dental (6 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
    Occlusal therapy $17-$260 $920 Lifetime
    Major Dental (12 months waiting period)
    Orthodontia 100% $3200 Lifetime
    Crowns and Bridges $10-$720 $3500 Any 5 years

Prescribed optical

  • Prescribed Optical
    (6 months waiting period)
    100% of the cost up to the per service benefit below Overall Limit Benefit Period
    Frames $140 $450 Calendar year
    Single vision (pair 212) $130
    Bifocal (pair) (312) $140
    Trifocal (pair) (412) $150
    Multifocal (pair) (512) $210
    Contact lenses (852) $220

Therapies

  • Therapies
    (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
    Chiropractic (Initial/Subsequent) $61/$40 $1000
    Osteopathy (Initial/Subsequent) $61/$35
    Physiology Services (Initial/Subsequent) $35 $360
    Hypnotherapy $80 $360
    Occupational Therapy (Initial/Subsequent) $61/$35 $800
    Speech Therapy (Initial/Subsequent) $95/$46 $1850
    Clinical Psychology $30-$140 $500
    Ante natal/Post natal physiotherapy 100% $105
    Podiatry (excl. artificial aids: e.g. orthotics) $30-$50 $400
    Audiology $60 $360
    Eye Therapy $60 $455
    Dietitian $15-$75 $360
    Alternative Therapies
    (2 months waiting period)
    Oriental therapies $33 $1000 Calendar year
    Acupressure, Acupuncture
    Chinese Herbal Medicine Consultation, Chinese Massage,
    Traditional Chinese Medicine Consultation
    Massage therapies
    Deep Tissue Massage
    Lymphatic Drainage, Myotherapy, Remedial Massage
    Sports Massage, Swedish Massage
    Therapeutic Massage

General Health

  • 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)
    $2800
    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

  • 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
    Hearing aids
    100%
    $2200
    Blood pressure monitor, Nebuliser, Glucometer
    100%
    $500

Wellness Benefits

  • Wellness Benefits
    (2 months)
    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
    Eye Screenings
    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. 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.


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.

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.

Benefit Period

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).

Per Service Benefit

Extras per service benefits for Premium Package (Gold) are based on 100% of the cost the provider charges you, up to a maximum claimable amount (the set benefit per service) which is capped by an overall limit.

Extras Waiting Period

Extras waiting period Calendar months
Crowns and bridges, orthodontia, artificial aids, healthcare appliances, oxygen apparatus and hearing aids 12 months
Prescribed optical appliances, periodontics, endodontics, inlays/onlays, facings, dentures and implants 6 months
All other services 2 months

Download Premium Package (Gold) Product Sheet

When deciding if this product is right for you, please refer to the CBHS Corporate Health Benefit Fund Rules. This information should be read carefully and retained.