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CBHS Members Health Fund Hospital Cover

Choose from 4 levels of hospital cover with CBHS Members Health Fund

CBHS looks out for the health of more than 80,000 employees of Commonwealth Bank and their family members. First established in 1951, CBHS brings to the table commercial professionalism while still being a not-for-profit members fund.

CBHS is a restricted health fund, meaning that only current and former employees of the Commonwealth Bank Group and their families are eligible to join.

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CBHS hospital plans

All CBHS hospital plans include emergency ambulance cover and they allow you to access the CBHS disease management programs, to help you self-manage chronic conditions and to avoid what might be unnecessary expenses or hospital admissions.

All plans, even Basic cover, also include cover for at-home treatments from specialists to help reduce the chance of a hospital-acquired infection and they provide a range of other at-home treatments and services for a better quality of life in the face of illness.

Basic hospital cover gives you the benefit of being a private patient in a public hospital. You also have access to Gap Cover for predictable, plannable expenses.

This plan includes cover for:

  • Overnight, shared room accommodation in a public hospital (as well the minimum amount of cover for accommodation in a private hospital or a private room in a public hospital).
  • Public hospital theatre and labour ward fees.
  • Medical expenses related to providers, for example, surgeons, anaesthetists and other specialists, for services covered under the Medicare Benefits Schedule (MBS) performed in hospital.

This is a cost-effective plan that covers you for private hospital treatment. It includes cover for all the essentials, with restrictions on services that you’re less likely to need.

This plan includes cover for:

  • Overnight, same day and intensive care accommodation in a private or shared room at a public or private hospital.
  • Private hospital theatre fees.
  • Medical expenses related to provider or specialist fees.
  • Drugs required for treatment in a private hospital.
  • Accommodation for a friend or family member if someone needs to stay with you.
  • All services covered under the MBS, performed in hospital, excluding any specific restrictions.

Restricted or excluded treatments include:

  • Major eye surgery
  • Joint replacements
  • Pregnancy-related services
  • Fertility treatments or reversals
  • Cardiothoracic services
  • Bariatric weight-loss procedures (gastric banding, sleeve gastrectomy and gastric bypass)
  • Psychiatric services
  • Rehabilitation and palliative care services
  • Plastic and reconstructive surgery services
  • Services not covered by Medicare
  • Cosmetic services

Active hospital cover gives you access a wider range of treatments and is for people who want more security or have greater health needs.

This plan includes cover for:

  • Overnight, same day and intensive care accommodation in a private or shared room at a public or private hospital.
  • Private hospital theatre fees.
  • Medical expenses related to provider or specialist fees.
  • Accommodation for a friend or family member if someone needs to stay with you.
  • All services covered under the MBS, performed in hospital, excluding any specific restrictions.

Restricted or excluded treatments include:

  • All joint replacements
  • Pregnancy-related services
  • Assisted reproductive services such as IVF
  • Bariatric weight-loss procedures (gastric banding, sleeve gastrectomy and gastric bypass)
  • Services not covered by Medicare
  • Cosmetic services

This is the highest level of hospital cover from CBHS, covering a wide range of essential and non-essential procedures to ensure you and your family are protected.

This plan includes cover for:

  • Overnight, same day and intensive care accommodation in a private or shared room at a public or private hospital.
  • Theatre and labour ward fees in a private hospital.
  • Medical expenses related to provider or specialist fees.
  • Pharmaceutical cover.
  • All services covered under the MBS, performed in hospital, excluding any specific restrictions.

Restricted or excluded treatments include:

  • Podiatric surgery
  • Laser eye surgery
  • Services not covered by Medicare
  • Purely cosmetic procedures

Are there any other benefits?

The CBHS disease management programs and at-home hospital cover, available with all plans, are exceptional benefits that are difficult to find elsewhere without paying significantly more.

Also, as a restricted members health fund, CBHS can deliver a higher quality of cover at a lower cost than you might find elsewhere. As a publicly run not-for-profit organisation, CBHS is a transparent health fund where you as a member you can have a say and receive annual reports.

Meanwhile, a range of CBHS support groups deliver an invaluable benefit to you and your family and to top it off, CBHS membership also comes with a range of discounts on eyewear, contact lenses and more.


Excesses, waiting periods and exclusions

Firstly, it’s important to remember that you will only be thoroughly covered in an agreed-upon private hospital. When attending a non-agreement private or public hospital, you are only covered up to the minimum MBS amount and you may be left with out-of-pocket expenses.

You should also be aware of potential excess or co-payment expenses. These are optional ways to reduce your premium payments:

  • Excess: The Basic plan gives you the option of selecting a $0 excess to avoid unwanted expenses, or a $500 excess to reduce premiums. If you choose $500, this means you’ll need to pay the first $500 of hospital costs before CBHS starts covering it. The excess is per person, up to a maximum of $1,000 per membership, per year.
  • Co-payment: The other hospital plans give you the option of choosing a co-payment instead of an excess. The Limited and Comprehensive plans give you a choice of a $70 or $100 co-payment, while the Active plan is set at $100. This is a set daily amount that you must pay for every day you are hospitalised. It’s payable up to six times per person, per year, or up to 12 times per family.

The waiting periods are:

  • 1 day for ambulance transport cover
  • 12 months for pregnancy-related services or pre-existing conditions
  • 2 months for everything else covered by the plan

Excluded services include:

  • Hospital services provided within the policy waiting periods
  • Nursing home or respite care fees
  • High cost, experimental or non-TGA approved drugs
  • Take-home drugs or certain types of health aids (though these may be covered with an Extras plan)
  • Services claimed more than 24 months after the service date
  • Services provided in countries outside of Australia
  • Ambulance transfers between hospitals

How to claim with CBHS

  • As a non-admitted patient: This is when you are not actually staying in hospital, but are either visiting for blood testing, x-rays or other services, or are examined but discharged straight away. Here, you must submit your claim directly to Medicare only, unless you see an Access Gap Cover doctor.
  • As an admitted patient: Hospitals will bill CBHS directly, but you will need to pay any co-payment or excess directly to the hospital where applicable.
  • For admitted patient medical services: Medicare will pay 75% of the MBS cost, while CBHS will pay the other 25%. If the charges are more than the MBS amount, a gap payment will arise. To reduce, cap or eliminate gap expenses, you can get a list of participating Access Gap Cover doctors and practitioners from CBHS. These doctors will bill CBHS directly and you should not submit these claims to Medicare first.

Andrew Munro

Andrew writes for finder.com.au, comparing products, writing guides, sniffing out deals and looking for new ways to help people get the most out of their money.

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