What does Medicare pay and what does CBHS Corporate Health cover?
What Medicare Pays
The Medical Benefits Schedule determines what Medicare pays (or the rebate you receive from Medicare). The Medicare Benefits Schedule (MBS) is a list of medical fees set by the Australian government that acts as a guide for rebates. These schedule fees are what the government considers to be a fair price for specific services.
You can claim 75% of the schedule fee (from Medicare) for inpatient doctor's services and a minimum of 25% of the schedule fee from CBHS Corporate Health. For doctors services provided as a non-admitted patient in a hospital, you can claim 85% of the schedule fee as a rebate. These rates apply whether you are treated in a private or public hospital.
The Schedule is a guide only, and doctors and specialists are free to charge above the Schedule amounts. This means you will need to pay the gap. All CBHS Corporate Health hospital covers provide a minimum benefit of 25% of the schedule fee for services received in private and public hospital when you are an admitted patient.
Note also that the MBS does not cover medications; the Pharmaceutical Benefits scheme looks after subsidies for prescription medications. Medicare does not cover private patient hospital costs (this is covered by CBHS Corporate Health subject to your level of cover) or medical and hospital costs incurred outside Australia. Additionally, Medicare does not cover ambulance services and services that it considers are unnecessary. This includes surgery that is carried out for cosmetic reasons.
CBHS Corporate Health’s Benefits
The benefits that CBHS Corporate Health pays you will depend on your coverage level and your choice of hospital. To find out more, read the information below on included, excluded, and restricted services.