Fund Product Template
Fund Name: CBHS Health Fund Ltd
Postal Address: Locked Bag 5014
Parramatta NSW 2124
Telephone: 1300 654 123
Facsimile: (02) 9843-7676
(02) 9843-7677
Email: [email protected]
Chief Executive Officer: Mr Paul Gladman
Claims Enquiries: 1300 654 123
Membership Enquires: 1300 654 123
Patient Eligibility Checks: www.cbhs.com.au
HELPER is an online service for hospitals to perform patient eligibility checks. If you do not have a password please call our Member Care Centre on 1300 654 123 and ask to be transferred to the Data and Technical Team to begin the registration process. Registration is effective immediately.
Table: Hospital 'a,' Comprehensive, Overseas Visitors Cover and CBHS Prestige
Description: Private Hospital covers
Comprehensive, Overseas Visitors Cover and CBHS Prestige
Excess: Nil
Co-payment: Nil
Hospital 'a' Excess cover Excess:
$350 per person for an overnight hospital admission up to a maximum of $700 for a family membership per calendar year
Co-payment:
A Co-payment of $100 per day is payable for every Hospital service as an Admitted Patient that does not include an overnight stay. This is an uncapped amount and is payable on every occasion by the member.
Comprehensive 100 or Comprehensive 70 hospital cover
Co-payment: $100 or $70 per day of hospitalisation per Calendar Year
(maximum of 6 days per person or 12 days per family).
Table: Hospital 'b' & Limited
Description:
Hospital 'b' Excess hospital cover Excess:
$350 per person for an overnight hospital admission up to a maximum of $700 for a family membership per calendar year
Co-payment:
A Co-payment of $100 per day is payable for every Hospital service as an Admitted Patient that does not include an overnight stay. This is an uncapped amount and is payable on every occasion by the member.
Limited 100 or Limited 70 hospital cover
Co-payment: $100 or $70 per day of hospitalisation per Calendar Year
(maximum of 6 days per person or 12 days per family).
Table: Basic Hospital
Description: This level of cover receives Minimum Benefits in a private
hospital as specified in PHI Benefit Requirement Rules.
Excess/Co-payment: Nil
Table: Basic Hospital 500
Description: This level of cover receives Minimum Benefits in a private
hospital as specified in PHI Benefit Requirement Rules. Private Hospital cover (with Minimum Benefits in a private hospital for some treatments) see attached for more
Excess: $500.00 per person with a maximum of $1000 per family per
calendar year.
Table: LiveLife Description:
Co-payment
$70 per day of hospitalisation per Calendar Year (maximum of 6 days per person or 12 days per family) applies to all Members covered by the membership. This co-payment is waived for children under 13 years.
Table: StepUp
Description:
Co-payment:
$70 per day of hospitalisation per Calendar Year (maximum of 6 days per person or 12 days per family) applies to all Members covered by the membership. This co-payment is waived for children under 13 years.
Table: Kickstart Hospital
Description:
Co-payment: $70 per day of hospitalisation per Calendar Year (maximum
of 6 days per person or 12 days per couple)
Table: Global Mobility Basic Hospital Cover
Description:
No Benefit shall be payable for treatment received by a Member in a Private Hospital (including a private day surgery facility). The Benefit payable for treatment received in a Public Hospital shall be the Minimum Default Benefit for that treatment.
Excess/Co-payment: Nil
Aug-14
Private Hospital cover
Private Hospital cover (with Minimum Benefits in a private hospital for some treatments) see attached for more
details
Nil for CBHS Prestige, Comprehensive Hospital and Overseas Visitors Cover
The services listed below are also eligible for hospital benefits in a public hospital at a shared room rate.
- cosmetic surgery
- podiatric surgery
- laser eye surgery
- other services for which a Medicare benefit is not payable
Aug-14
LiveLife
Hospital 'a' Excess hospital cover
Excess -$350 per person for an overnight hospital admission up to a maximum of $700 for a family membership per calendar year
Comprehensive 100 or Comprehensive 70 Hospital cover
For compensable services where liability has been accepted by another party, please direct claim to relevant party.
$100 or $70 per day of hospitalisation per Calendar Year (maximum of 6 days per person or 12 days per family).
Co-payment - $100 per day is payable for every Hospital service as an Admitted Patient that does not include an overnight stay. This is an uncapped amount and is payable
on every occasion by the Member.
CBHS Prestige, LiveLife, Comprehensive Hospital, Overseas Visitors Cover & Hospital a Excess
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.
Hospital admissions for Compensation, Accidents or Injuries MUST have the relevant form completed on admission and sent to CBHS with the hospital claim.
Excess/Co-payments
$70 per day of hospitalisation per Calendar Year (maximum of 6 days per person or 12 days per family). This co-payment is waived for children under 13 years.
All other hospital services receive benefits up to the amount listed in the Hospital Purchaser-Provider Agreement. (Hospital Contract)
Claims Subject to a COMPENSABLE Injury
Joint Replacement Services
Major Eye Surgery Services Sterilisation & Reversal of Sterilisation Services Bariatric Services
hip, knee, ankle, shoulder and other joint
replacements
corneal transplant, cataract surgery, other lens related
gastric banding, sleeve gastrectomy, gastric by-pass
45000 45224 45469 45515 45566 45639 45713 38200 38315 38449 38503 38637 38763 48918 42653 37616 14215 45003 45227 45471 45518 45568 45641 45714 38203 38318 38450 38504 38640 38766 48921 42656 37619 30511 45006 45230 45472 45519 45569 45644 45716 38206 38321 38452 38505 38643 38800 48924 42659 37622 30512 45009 45233 45474 45520 45570 45645 45720 38209 38324 38453 38506 38647 38803 49115 42662 37623 30514 45012 45236 45475 45522 45572 45646 45723 38212 38327 38455 38507 38650 38806 49209 42665 31441 45015 45239 45477 45524 45575 45647 45726 38213 38330 38456 38508 38653 38809 49318 42698 35687 31569 45018 45240 45478 45527 45578 45650 45729 38215 38350 38457 38509 38654 38812 49319 42701 35688 31572 45019 45400 45480 45528 45581 45652 45731 38218 38353 38458 38512 38656 49321 42702 35691 31575 45020 45403 45481 45530 45584 45653 45732 38220 38356 38460 38515 38670 43852 49324 42703 31578 45021 45406 45483 45533 45585 45656 45735 38222 38358 38462 38518 38673 49327 42704 35694 31581 45024 45409 45484 45536 45586 45659 45738 38225 38359 38464 38677 43900 49330 42707 35697 31584 45025 45412 45485 45539 45587 45660 45741 38228 38362 38466 38550 38680 43903 49333 42710 35700 31587 45026 45415 45486 45542 45588 45661 45744 38231 38365 38468 38553 38700 43906 49339 42713 31590 45027 45418 45487 45543 45590 45662 45747 38234 38368 38469 38556 38703 43909 49342 42716 and associated 45030 45419 45488 45544 45593 45665 45752 38237 38371 38470 38559 38706 43912 49345 procedure items 45033 45421 45489 45545 45596 45668 45753 38240 38384 38473 38562 38709 43915 49518 ie. 30393 etc 45035 45424 45490 45546 45597 45669 45754 38241 38387 38475 38565 38712 49519 45036 45427 45491 45548 45599 45671 45755 38243 38390 38477 38568 38715 15360 49521 45039 45430 45492 45551 45602 45674 45758 38246 38393 38478 38571 38718 15363 49524 45042 45433 45493 45552 45605 45675 45761 38256 38480 38572 38721 15541 49527 45045 45436 45494 45553 45608 45676 45767 38270 38415 38481 38577 38724 49530 45048 45439 45496 45554 45611 45677 45770 38272 38418 38483 38588 38727 49533 45051 45442 45497 45555 45614 45680 45773 38275 38421 38485 38730 49715 45054 45445 45498 45556 45617 45683 45776 38285 38424 38487 38600 38733 45200 45448 45499 45557 45620 45686 45779 38286 38427 38488 38603 38736 50218 (see note 2) 45203 45451 45500 45558 45623 45689 45782 38287 38430 38489 38609 38739 45206 45460 45501 45559 45624 45692 45785 38290 38436 38490 38612 38742 49554 (see note 3) 45207 45461 45502 45560 45625 45695 45788 38293 38438 38493 38613 38745 45209 45462 45503 45561 45626 45698 45791 38300 38440 38496 38615 38748 45212 45464 45504 45562 45629 45701 45794 38303 38441 38497 38618 38751 45215 45465 45505 45563 45632 45704 45797 38306 38446 38498 38621 38754 45218 45466 45506 45564 45635 45707 38309 38447 38500 38624 38757 45221 45468 45512 45565 45638 45710 38312 38448 38501 38627 38760 Aug-14
All other hospital services receive benefits up to the amount listed in the Hospital Purchaser-Provider Agreement. (Hospital Contract) Services associated with total hip
replacement
Services associated with joint replacement If performed within 12 months of end of pregnancy or if performed with item numbers 45564, 45565, 45530 or 30165
Ministers Default Rate
49554 50218 Plastic and Reconstructive Surgery items (see
Item
3 2 1 Note
Clinical notes required - see Note 1 including medical admissions
Psychiatric, Rehabilitation or Palliative Care Services & services for which
there is no Medicare Benefit Schedule Fee payable Claims Subject to a COMPENSABLE Injury
Claims for undetermined compensable services should be accompanied with a completed
Hospital admissions for Compensation, Accidents or Injuries MUST have the relevant form completed on admission and sent to CBHS with the hospital claim.
MINIMUM DEFAULT BENEFITS as specified in the relevant Schedule of the Private Health Insurance (Benefit Requirement) Rules
Cardiothoracic services
$70 per day of hospitalisation per Calendar Year (maximum of 6 days per person) applies to all Members covered by the membership. This does not apply to a Dependent under the age of 13 years old.
StepUp
Co-payments
For compensable services where liability has been accepted by another party, please direct claim to relevant party.
Plastic & Reconstruction Surgery Services
MINIMUM DEFAULT BENEFITS as specified in the relevant Schedule of the Private Health Insurance (Benefit Requirement) Rules
When the procedure is for a revision of a total hip replacement where only part of the original total hip is required - ie the tibia or
the femur and is not a pre-existing condition Where required for treatment of cancer, requires an arthrodesis
and is not a pre-existing condition
Services associated with trauma, burn, cancer or other accidental mutilation that was not present at the time this level of cover was
taken Explanation of Notes
Hospital 'b' Excess
$350 per person for an overnight hospital admission up to a maximum of $700 for a family membership per calendar year
Limited 100 or Limited
Co-payments - $100 or $70 per day of hospitalisation per Calendar Year (maximum of 6 days per person or 12 days per family).
Joint Replacement Services Assisted Reproductive Services Major Eye Surgery Services Sterilisation & Reversal of
Sterilisation Services Bariatric Services
hip, knee, ankle, shoulder and other joint replacements
corneal transplant, cataract surgery, other lens related surgery services
gastric banding, sleeve gastrectomy, gastric by-pass
45000 45224 45469 45515 45566 45639 45713 38200 38315 38449 38503 38637 38763 16401 16612 48918 13200 42653 37616 14215 45003 45227 45471 45518 45568 45641 45714 38203 38318 38450 38504 38640 38766 16404 16615 48921 13201 42656 37619 30511 45006 45230 45472 45519 45569 45644 45716 38206 38321 38452 38505 38643 38800 16406 16618 48924 13202 42659 37622 30512 45009 45233 45474 45520 45570 45645 45720 38209 38324 38453 38506 38647 38803 49115 13203 42662 37623 30514 45012 45236 45475 45522 45572 45646 45723 38212 38327 38455 38507 38650 38806 16500 16621 49209 13206 42665 31441 45015 45239 45477 45524 45575 45647 45726 38213 38330 38456 38508 38653 38809 16501 16624 49318 13209 42698 35687 31569 45018 45240 45478 45527 45578 45650 45729 38215 38350 38457 38509 38654 38812 16502 16627 49319 13212 42701 35688 31572 45019 45400 45480 45528 45581 45652 45731 38218 38353 38458 38512 38656 16504 16633 49321 13215 42702 35691 31575 45020 45403 45481 45530 45584 45653 45732 38220 38356 38460 38515 38670 43852 16505 16636 49324 13218 42703 31578 45021 45406 45483 45533 45585 45656 45735 38222 38358 38462 38518 38673 16508 49327 13221 42704 35694 31581 45024 45409 45484 45536 45586 45659 45738 38225 38359 38464 38677 43900 16509 35643 49330 13251 42707 35697 31584 45025 45412 45485 45539 45587 45660 45741 38228 38362 38466 38550 38680 43903 16511 35674 49333 42710 35700 31587 45026 45415 45486 45542 45588 45661 45744 38231 38365 38468 38553 38700 43906 16512 35676 49339 37605 42713 31590 45027 45418 45487 45543 45590 45662 45747 38234 38368 38469 38556 38703 43909 16514 35677 49342 37606 42716 and associated 45030 45419 45488 45544 45593 45665 45752 38237 38371 38470 38559 38706 43912 16515 35678 49345 procedure items
45033 45421 45489 45545 45596 45668 45753 38240 38384 38473 38562 38709 43915 16518 49518 13290 (see note 4) ie. 30393 etc
45035 45424 45490 45546 45597 45669 45754 38241 38387 38475 38565 38712 16519 82105 49519 13292 (see note 4) 45036 45427 45491 45548 45599 45671 45755 38243 38390 38477 38568 38715 15360 16520 82110 49521 45039 45430 45492 45551 45602 45674 45758 38246 38393 38478 38571 38718 15363 16522 82120 49524 45042 45433 45493 45552 45605 45675 45761 38256 38480 38572 38721 15541 16525 82125 49527 45045 45436 45494 45553 45608 45676 45767 38270 38415 38481 38577 38724 16527 82130 49530 45048 45439 45496 45554 45611 45677 45770 38272 38418 38483 38588 38727 16528 82135 49533 45051 45442 45497 45555 45614 45680 45773 38275 38421 38485 38730 16564 49715 45054 45445 45498 45556 45617 45683 45776 38285 38424 38487 38600 38733 16567 45200 45448 45499 45557 45620 45686 45779 38286 38427 38488 38603 38736 16570 50218 (see note 2) 45203 45451 45500 45558 45623 45689 45782 38287 38430 38489 38609 38739 16571 45206 45460 45501 45559 45624 45692 45785 38290 38436 38490 38612 38742 16573 49554 (see note 3) 45207 45461 45502 45560 45625 45695 45788 38293 38438 38493 38613 38745 16590 45209 45462 45503 45561 45626 45698 45791 38300 38440 38496 38615 38748 16591 45212 45464 45504 45562 45629 45701 45794 38303 38441 38497 38618 38751 16600 45215 45465 45505 45563 45632 45704 45797 38306 38446 38498 38621 38754 16603 45218 45466 45506 45564 45635 45707 38309 38447 38500 38624 38757 16606 45221 45468 45512 45565 45638 45710 38312 38448 38501 38627 38760 16609 Aug-14
All other hospital services receive benefits up to the amount listed in the Hospital Purchaser-Provider Agreement. (Hospital Contract)
4 13290, 13292 Analysis and Storage where not associated with assisted reproduction
Services associated with Assisted Reproduction 2 50218 Where required for treatment of cancer, requires
an arthrodesis and is not a pre-existing condition
Services associated with joint replacement
3 49554
When the procedure is for a revision of a total hip replacement where only part of the original total hip is required - ie the tibia or the femur and is not
a pre-existing condition
Services associated with total hip replacement
Item Full Contract Rate - clinical notes required for all
services listed below Ministers Default Rate
1
Plastic and Reconstructive Surgery items (see
above)
Services associated with trauma, burn, cancer or other accidental mutilation that was not present
at the time this level of cover was taken
If performed within 12 months of end of pregnancy or if performed with item numbers 45564, 45565,
45530 or 30165
Note
Claims Subject to a COMPENSABLE Injury
Claims for undetermined compensable services should be accompanied with a completed Accident/Injury/Illness form.
Hospital admissions for Compensation, Accidents or Injuries MUST have the relevant form completed on admission and sent to CBHS with the hospital claim.
MINIMUM DEFAULT BENEFITS as specified in the relevant Schedule of the Private Health Insurance (Benefit Requirement) Rules
Explanation of Notes
Restricted Benefits (Services) not fully covered
Clinical notes required - see Note 1 including medical admissions
The services listed below are also eligible for hospital benefits in a public hospital at a shared room rate.
MINIMUM DEFAULT BENEFITS as specified in the relevant Schedule of the Private Health Insurance (Benefit Requirement) Rules
including medical admissions
Psychiatric, Rehabilitation or Palliative Care Services & services for which there is no
Medicare Benefit Schedule Fee payable
For compensable services where liability has been accepted by another party, please direct claim to relevant party.
Limited Hospital & Hospital b Excess
Plastic & Reconstruction Surgery Services Cardiothoracic services Pregnancy Related Services
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.
Hip
30571 41788 D001 47003 47468 47048 47054 49503 30572 41789 D002 - see note 1 47006 47540 47051 47057 49506 30574 41792 D003 - see note 1 47009 48906 47492 47060 49536 30394 41793 D015 - see note 1 47012 48909 47495 47534 49539 41796 D042 47015 48930 47498 47537 49542 41797 D043 - see note 1 47411 48933 47501 47543 49551 41800 D051 - see note 1 47414 48945 47504 47546 49557 41801 D052 - see note 1 47417 48948 47507 47549 49558 41804 47420 48951 47510 47552 49559 47423 48954 47519 47555 49560 47426 48957 47522 47558 49561 47429 48960 47525 47579 49562 47432 47540 47582 49563 47435 49360 47585 49564 47438 49363 47588 49566 47441 49366 47591 49569Aug-14
Claims Subject to a COMPENSABLE Injury
Claims for compensable services should be accompanied with a completed Accident/Injury/Illness form.
Hospital admissions for Compensation, Accidents or Injuries MUST have the relevant form completed on admission and sent to
KickStart
Shoulder
Knee
Explanation of Notes
Note 1: dental extractions covered for wisdom teeth only (tooth ID 18, 28, 38 & 48)
$70 per day of hospitalisation per Calendar Year (maximum of 6 days per person or 12 days per couple)
Please note that any MBS Items NOT LISTED below or any Cosmetic Surgery, Surgical Podiatry, Laser Eye Surgery and all other procedures that have NO MBS item number receive 'Minimum Benefits' only according to the Schedule of the Private Health Insurance Benefit Requirements Rules for accommodation in a Private Hospital. Benefits for Prostheses are payable for
non-cosmetic surgically implanted items that are Government approved up to the minimum amount specified by legislation.
The following MBS item numbers below ARE covered in a Private Hospital or Day Hospital that has a Hospital Agreement
Investigations, Repairs and Reconstructions Removal of
Basic Hospital
Excess/Co-payment - Nil
Basic Hospital 500
Co-payment - Nil
Excess - $500.00 per person per admission with a maximum of $1000 per family per calendar year.
Aug-14
All services when provided in a private or public 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.
Fees raised by public hospitals that exceed Minimum Default Benefits set by the Department of Health and Ageing for shared room accommodation will be the member's out of pocket expense. Hospitals should provide patients with an estimate of fees in order for the patient to make an informed decision.
Basic Hospital
Hospital admissions for Compensation, Accidents or Injuries MUST have the relevant form completed on admission and sent to CBHS with the hospital claim.
For compensable services where liability has been accepted by another party, please direct claim to relevant party.
Claims Subject to a COMPENSABLE Injury
Excess/Co-payment - Nil
Aug-14
Global Mobility Basic Hospital Cover
No Benefit shall be payable for treatment received by a Member in a Private Hospital (including a private day surgery facility).
The Benefit payable for treatment received in a Public Hospital shall be the Minimum Default Benefit (Minister's Default Benefit) for that treatment.
