for everyone (PDF) by pengxiuhui


									Health Cover
for everyone
an easy guide to CBHS
Health Cover options
as at 13 April 2007
supporting our members
to achieve optimal health outcomes

                                     table of contents
                                     Making Health Affordable                                      2
                                     Why CBHS                                                      4
                                     Giving you Choices                                            6
                                     Which package is right for me?                                8
                                     Hospital Covers                                              10
                                     Extras Cover in Detail                                       18
                                     Packaged Covers - Kickstart                                  26
                                     Important Information                                        30

                                     This brochure offers an overview of a somewhat complex field.
                                     Reading it will help you identify any areas of particular concern
                                     and will enable you to seek further clarification before making
                                     your decision to join CBHS. This brochure should be read carefully
                                     and retained.
                                     Upon joining CBHS you will receive a copy of the Health Benefit
                                     Fund Rules, these should be read carefully and retained.
    Making your health our priority                          Who can join?
                                                             To join CBHS you or one of your parents or spouse
    Making health affordable                                 (including ex-spouse) must have worked for the
                                                             Commonwealth Bank or any of its subsidiaries
    As a not-for–profit restricted health fund, CBHS         (including CommSec, CommInsure and Colonial) as a
    provides cover exclusively for current and former        permanent or contract employee on or after the date
    employees and families of the Commonwealth Bank          of the subsidiary’s affiliation with Commonwealth
    and its related companies. Created in 1951, CBHS         Bank. Even if your eligible parents or spouse were not
    covers over 140,000 Australians nation-wide with         members of CBHS, you can still join.
    flexible and highly competitive health cover.
    CBHS can offer you a range of health cover options       Whether you are single, a couple or have a
    that you can tailor to meet your needs. Offering         family, CBHS has a health cover that can offer
    quality service and fast claim turn around times, CBHS   you peace of mind.
    has your best interests at heart.
                                                             Family membership covers you if you have children
                                                             under 18 years of age or unmarried children under 25 if
                                                             they are studying full time.
                                                             If you are a dependant of someone who met the
                                                             criteria to join (even if they didn’t join) you can also
                                                             join CBHS regardless of your age or marital status.

2                                                                                                                       3
    Why CBHS?
    CBHS is a not-for-profit fund existing solely for            Fast and Simple Claiming
    the benefit of our members, an exclusive fund for            Claiming with CBHS is quick and easy. A lot of
    employees of the CBA Group, and their dependents.            providers are equipped so you can claim on the
                                                                 spot, using your membership card. On the rare
    All of this means we have our bases covered
                                                                 occasion you can’t, benefits will be paid 2-3 days
    to ensure we can effectively cover you in                    after your claim is received by post, fax or email.
    times of need.
                                                                 Competitive Benefits

    The many benefits to joining CBHS:                            Our Hospital and Extras covers provide you with a
                                                                 range of benefits with higher limits and higher
                                                                 benefits per service than many leading health funds
      Established and growing
                                                                 Extensive Hospital Agreements
      We’ve been around for more than 50 years, so you
                                                                 CBHS has agreements with nearly all of Australia’s
      know you can depend on us, and we are constantly
                                                                 licensed private hospitals and day facilities.
      evolving to meet our members’ changing needs.
      Keep the costs low                                       Join Now!
      Our management costs are about half the industry
      average, ensuring we can return more money to you        Joining CBHS is fast, easy and hassle-free. To enjoy the
      in benefits.                                             benefits of affordable health cover simply complete
                                                               the application form at the back of this brochure and
      Friendly and approachable                                return it to CBHS today!
      We provide service that is friendly and efficient. Our
                                                               Alternatively, visit our website and
      Member Care staff are never more than a phone call
                                                               join on line or contact our Member Care Centre on
      or email away, ready to assist you.
                                                               1300 654 123– it’s just too easy.
                                                               If you are transferring from another health fund we
      We have a user friendly website where you can            will arrange to cancel your previous cover, and if you
      check the progress of your claims, search for a          transfer to an equivalent cover you won’t have to re-
      service provider and update your membership              serve any waiting periods.
      details at any time.
                                                               If you have any queries contact the CBHS Member Care
                                                               Centre on 1300 654 123.

4                                                                                                                         5
    Giving you choices                                       Customise your cover
    At CBHS we aim to make your private health insurance     The level and type of cover you choose will depend on
    decision as simple as possible, offering health covers   your individual needs. Hospital, Extras and Ambulance
    tailored to suit a variety of different needs and        covers can be taken separately or combined to create
    budgets.                                                 your own customised health cover ‘package’.

    CBHS has three types of health cover,                    Alternatively, our packaged product ‘kickstart’ may be
                                                             just what you need. Listed opposite / overleaf are some
    Hospital, Extras and Ambulance.
                                                             package ideas.

    Pays benefits toward in-patient hospital services.
    Benefits, depending on the cover selected include:
       Choice of specialist / doctor
       Emergency ambulance transport
       Access Gap cover
       Prosthetic Appliances

    Pays benefits toward services not covered by Medicare.
    Benefits, depending on the cover selected, include:
       Dental work
       Prescription glasses
       Pharmaceuticals, plus many more

    Emergency Ambulance
    Pays benefits toward emergency ambulance transport
       Australia-wide protection
       Includes air, land and sea emergency transport
       Can be combined with Extras cover
    All hospital covers include ambulance cover. Ambulance
    cover can be taken by itself or combined with an
    Extras cover.

6                                                                                                                      7
    Which package is right for me?
    Over 60% of our members have chosen
    Comprehensive Hospital + Top Extras cover
                                                      Comprehensive Hospital + Top Extras
                                                      Our most popular cover, giving you peace of mind when
    Standard Comprehensive Health Cover               it comes to your health needs. You can reduce the cost of
                                                      your cover by adding an excess to your Hospital cover.

    Are you looking for a lower contribution rate?    Reduce your level of Hospital and/or Extras cover.

    where you’re at                                   cover options at a glance
                                                      Comprehensive Hospital + Intermediate Extras
    I want comprehensive hospital cover, but          Designed for those who want a high level of hospital cover,
    I’m not as interested in Extras cover.            and benefits towards the cost of a range of Extras services
                                                      You can also choose an Excess on the Hospital cover

                                                      Limited Hospital + Top Extras
    I have a family at home but we’re definitely      Lower level of hospital cover with high level of Extras
    not going to have further children.               services. You can also choose a Daily Excess on the
                                                      Hospital cover.

    The kids have grown up, and it’s time to          Comprehensive Hospital 70 or 100 + Top Extras
                                                      Gives you peace of mind with Daily Excess options that
    focus on me.                                      allow you to reduce the cost of your contributions.

                                                      Limited Hospital + Intermediate Extras
    I’m a young single or couple and don’t plan       If you are looking for a cover that suits the lifestyle and
    to have children.                                 health needs of most singles and couples without children,
                                                      this combination of products might be appropriate for you.
                                                      You can also choose an Excess on the Hospital cover.

    I’m a young fit and active person with no         Kickstart
    plans for children at the moment - I only         This package provides hospital and extras cover for
    want cover for things that might affect me!       services that fit and healthy young people are likely to need.

                                                      Ambulance Cover + Essential Extras
    I just want the basics, without hospital cover.   This combination will cover you for Emergency Ambulance
                                                      and a limited number of Extras services

8                                                                                                                      9
                                          Comprehensive Limited   Basic
                                            Hospital    Hospital Hospital

     public hospitals                                                         Hospital Covers
     Shared room
     Private Room (where available)                                           Comparison Table - The table on the left compares
     Theatre fees                                                    n/a      the benefits available under the three hospital
     Intensive Care fees                                             n/a      cover options.
     Labour ward fees                                                n/a
     agreement private hospitals and day surgeries*                           Private Hospitals
     Private Room (where available)
     Shared room                                                              CBHS has agreements with most Australian private
     Theatre fees                                                             hospitals and day hospitals. Subject to your level of
     Intensive Care fees                                                      cover, these agreements provide for accommodation
     Labour ward fees                                                         fees including bed fees, theatre and labour ward,
     services*                                                                intensive and coronary care fees when admitted as an
     Major eye surgery
                                                                              inpatient to hospital. To check if your hospital has an
     Major joint replacement                                                  agreement, please contact CBHS on 1300 654 123 or
                                                              LIMITED         visit our website
     Pregnancy & related services                           BENEFITS FOR
     Palliative care programs                            ACCOMODATION*
                                                         (shared room in a
                                                                              Should your chosen hospital not have an agreement
     Psychiatric programs
                                                           public hospital)   in place with CBHS, you will be covered up to pre-set
     Rehabilitation programs
                                                           No benefits for    limits and will incur significant out-of-pocket expenses.
     Cardiothoracic services
                                                           theatre fees or
     Reproductive surgery                                 labour ward fees
     Plastic and Reconstructive surgery
     (for medical procedures)
                                                                              Services - Non-Medicare Benefit
     Cosmetic Surgery                                                         Some services such as Surgical Podiatry, Laser
     Plastic and Reconstructive surgery                                       Eye Surgery, Cosmetic Surgery (and associated
     (Cosmetic related procedures)                                            reconstructive and plastic procedures) do not attract
     medical                                                                  a benefit from Medicare. Services that do not attract a
     Choice of Doctor                                                         benefit from Medicare will result in significant out-of-
     Access Gap cover*                                                        pocket expenses regardless of your level of cover.
     other features
     Daily Excess options*                                                    Limited Benefits
     Non-cosmetic surgically implanted
     prostheses (Government approved)                                         If your chosen cover has limited benefits for certain
     ambulance                                                                services, and you choose to go into a private hospital
                                                                              to receive any of these services, you will be faced with
     Emergency Ambulance Transport*
                                                                              significant out-of-pocket expenses including the full
     medicare levy                                                            cost of theatre or labour ward fees. It is important to
     Exemption from Medicare                                                  consider whether you may need these treatments
     Levy Surcharge (see p.34)
                                                                              before choosing a cover with limited benefits.
10                                                                                                                                        11
     Access Gap Cover                                            Daily Excess Options
     Access Gap cover aims to reduce members’ out-of-            You can reduce the cost of your Comprehensive or
     pocket expenses for doctor and specialist services          Limited Hospital cover by agreeing to pay a Daily
     received in hospital. If your doctor or specialist agrees   Excess of $70 or $100. This means that if you go into
     to bill you under the Access Gap cover scheme, you          hospital you will pay the relevant Daily Excess each day
     will enjoy reduced out-of-pocket expenses and in            that you are hospitalised up to a maximum of 6 days
     many cases you will not have to pay any out-of-pocket       per person or 12 days per family per calendar year.
     medical expenses at all.
     You can find out if your doctor has previously              Emergency Ambulance
     participated in the Access gap scheme by contacting
                                                                 This cover pays the cost of emergency ambulance
     the CBHS Member Care centre on 1300 654 123 or via
                                                                 services when transported directly to hospital or
     our website
                                                                 treated at the scene due to a medical emergency.
                                                                 Transport must be provided by ambulance services
                                                                 recognised by CBHS.
                                                                 Ambulance benefits are not payable for transportation
                                                                 to hospital for the routine management of an ongoing
                                                                 medical condition or transportation between hospitals.
                                                                 Due to variations in State government legislation,
                                                                 not all states receive the same Ambulance benefits.
                                                                 Contact CBHS for more details.

                                                                 Waiting periods and pre-existing
                                                                 Waiting periods exist to protect the fund and its
                                                                 members from unfair exploitation by individuals
                                                                 joining only when they need expensive medical care.
                                                                 Various waiting periods apply to new members and
                                                                 members upgrading their level of cover. Please see
                                                                 page 28 for detailed information on CBHS waiting
                                                                 periods and pre-existing conditions.

12                                                                                                                          13
                                                                                              TOP     INTERMEDIATE ESSENTIAL
                                                                                             EXTRAS      EXTRAS     EXTRAS

     About Extras Cover                                          essentials
                                                                 Essential Dental
     Cover yourself for day-to-day health services               Health Checks
     not covered by Medicare such as dental, optical,            Health Maintenance
     physiotherapy, gym membership and more.
     CBHS offers three levels of Extras cover making it easy     dental
     for you to find one to suit your needs and lifestyle.       General Dental
                                                                 General Dental Plus
     The table opposite indicates service categories covered.    Surgical Dental
     Information on specific limits can be found on page 18.     Major Dental

     Ambulance Cover                                             optical
                                                                 Optical Appliances
     Ambulance costs are expensive and are not covered by        (prescription)
     Medicare. CBHS Ambulance cover protects you from            wellbeing therapies
     emergency ambulance costs which can potentially
     be very high. This cover can be taken out alone, or
     combined with an Extras cover. If you have any level
     of Hospital Cover with CBHS, you are automatically
                                                                 Occupational Therapy
     covered for emergency ambulance transport and do not
                                                                 Speech Therapy
     need separate Ambulance cover
                                                                 Clinical Psychology
     CBHS pays the cost of emergency ambulance services          Podiatry
     if you are transported directly to a licensed hospital or   Audiology
     treated at the scene due to a medical emergency. This       Orthoptic Therapy
     includes transportation from the scene of an accident       alternative therapies
     or the scene of a medical event such as a heart attack or
                                                                 Natural Therapies
     stroke, but does not include transportation to hospital
                                                                 Oriental Therapies
     for the routine management of ongoing medical
                                                                 Remedial Therapies
     conditions or transfers between hospitals.
                                                                 health management
     Residents of QLD and TAS are covered by state based
                                                                 Blood pressure monitor
     ambulance schemes.                                          nebuliser, glucometer
                                                                 Artificial Aids
                                                                 Hearing Aids
                                            ambulance cover
                                                                 medical health
     Emergency Ambulance Transport                               Home Nursing
     (air, land and sea within Australia)                        Pharmaceuticals (non-PBS)

14                                                                                                                        15
     my story... (Megan, QLD)                                     Which Extras Cover is best for me?
                                                                 The table on the following pages highlights the
     After a recent visit to my dentist I was informed I had a   differences between CBHS Extras covers and will help
     gum problem and was referred to a professional I never      you decide which one is right for you. All category limits
     even knew existed called a periodontist. Naturally, one     listed are per person.
     of my first concerns was what type of expense I would
     be looking at. After logging onto the CBHS internet site    To find out if your chosen extras provider is registered
     my mind was put at ease in seeing that my Top Extras        with CBHS contact the Member Care Centre on
     cover would give me a considerable refund. I have now       1300 654 123 or visit
     been seeing my periodontist for the past four years
     and all my appointments have been covered by CBHS.          Limit bank periods are highlighted in the right column
     This really has given me peace of mind and an amazing       of the following tables. Page 30 details how the “limit
     improvement in my health. Thanks CBHS!                      bank” works.

     my story... (Terry, NSW)
     In 1997 I was involved in a very serious motor vehicle

     As a result of this MVA I sustained multiple trauma,
     third degree burns to more than 30% of my body
     and numerous fractures to my arms and legs. I spent
     14 months in hospital. The first six months at RNSH
     ( 3 months in the Intensive Care unit and 3 months in
     the Burns Unit ) and the next nine months at a private
     hospital near my home. ( Berkeley Vale Private )

     Unfortunately, ( due to NSW laws and being the
     driver deemed at fault ), I received no third party
     compensation. The costs involved in my hospitalisation
     and all the other extras I received would have been
     very substantial to say the least but thankfully to CBHS
     I didn’t have to pay anything at all.

     I am most grateful to CBHS for their very generous
     assistance in my time of need.

16                                                                                                                            17
                                                                Maximum Payment           Top       Intermediate   Essentials    Limit Bank
                                                               70% of the cost up to:    Extras         Extras       Extras     Period (years)

     essentials (2 months waiting period)
     Essential Dental
     Periodic examination (012)                                         $28
     X-Ray (022)                                                        $23
     Removal of Plaque (111)                                            $38             unlimited      $200          $150              1
     Removal of Calculus (114)                                          $50
     Fluoride application (121)                                         $22
     Mouthguard (151)                                                   $85
     Fissure sealing (161)                                              $26
     Health Checks (where not claimable from another source)
     Mammograms                                                        70%
     Bone density tests                                                70%                $200         $200          $200              1
     Skin cancer screening                                             70%
     Bowel/prostate cancer screening                                   70%
     CT gated scans                                                    70%
     Health Maintenance
     Quit smoking programs2                                            70%
     Weight loss programs3                                             70%                $100         $100          $100
     Stress management courses4                                        70%                                                             1
     Gym membership5                                                   70%                $100         $100          $100
     Blood Glucose Accessories                                         70%                $320         $100          $100
     Dietitian Consultations                                           70%                $360         $100          $100

     Essential Dental (2 months waiting period)
     See ESSENTIALS above
     General Dental1 (2 months waiting period)
     Filling: 1 surface metallic (511)                                  $54
     Filling: 3 surface metallic (513)                                  $75
     Filling: 1 surface tooth-coloured (531)                            $65             unlimited      $200          $150              1
     Filling: 3 surface tooth-coloured (533)                            $93
     Consultations                                                   $28 - $38
     X-rays                                                          $19 - $42

     CBHS Extras Cover table runs from page 18 to page 23

18                                                                                                                                          19
                                                      Maximum Payment             Top             Intermediate       Essentials        Limit Bank
                                                     70% of the cost up to:      Extras               Extras           Extras         Period (years)

     dental continued...
     General Dental Plus1 (2 month waiting period)
     Diagnostic model (071)                                   $24
     Bleaching (117)                                          $20               unlimited               $150               -                1
     Enamel micro-abrasion (116)                              $44
     Surgical Dental1 (6 month waiting period)
     Extraction of full tooth (311)6                          $63               unlimited               $150
     Other Surgical procedures6                             $50-$205                                                       -                1
     Periodontics (gum treatment)                           $57-$250                $630
     Endodontics (root canal treatment)                     $40-$180                $660
     Major Dental1 (12 month waiting period)
     Inlays/Onlays/Facings                                   $360                $1440                   -                 -
     Crowns and Bridges                                $660 per tooth                                                                       5
                                                                                 $3000                   -                 -
     Dentures and Implants                               $210-$600               $1200                   -                 -
     Orthodontia                                               -                 $2200                   -                 -
     Occlusal therapy                                  $360 per splint            $920                   -                 -

     optical (6 month waiting period)
     Frames                                                                   $130                $90               $70
     Single Vision (pair)                                                     $80                 $60               $60
     Bifocal (pair)                                                           $105                $60               $60
                                                                                           $350              $250              $180          1
     Trifocal (pair)                                                          $125                $90               $60
     Multifocal (pair)                                                        $175                $90               $60
     Contact Lenses                                                           $200                $150              $130

     wellbeing therapies (2 month waiting period)
     Physiotherapy (Initial Cons)                             $61
                                                                                    $720                $250
                       (Std Cons)                             $35
     Chiropractic      (Initial Cons)                         $61
                                                                                    $720                                  $200              1
                       (Std Cons)                             $35
     Osteopathy        (Initial Cons)                         $61
                       (Std Cons)                             $35
     Occupational Therapy                                     $35                   $720                 -                 -
     CBHS Extras Cover table runs from page 18 to page 23
20                                                                                                                                                 21
                                                              Maximum Payment            Top              Intermediate             Essentials          Limit Bank
                                                             70% of the cost up to:     Extras                Extras                 Extras           Period (years)

     wellbeing therapies continued...
     Speech therapy                                                    $40              $1850                     -                     -
     Ante natal / post natal classes                                  $105               $105                     -                     -
     Clinical Psychology                                              70%                $450                     -                     -
     Podiatry                                                         $30                $400                     -                     -
     Audiology                                                        70%                $360                     -                     -
     Orthoptic Therapy                                                70%                $450                     -                     -
     alternative therapies (2 month waiting period)
     Natural Therapies                                                $33                $450                                           -
     Oriental Therapies                                               $33                $450                  $300                     -                         1
     Remedial Therapies                                               $33                $450                                           -

     health management (12 month waiting period)
     Artificial Aids7                                                 70%               $1000                     -                     -
     Hearing Aids8                                                    70%               $1500                     -                     -                     3
     Blood pressure monitor, nebuliser, glucometer7                   70%                $500                  $300                     -

     medical health (2 month waiting period)
     Home visits by Registered Nurse                             $80 (<4 hrs)
                                                                 $120 (>4 hrs)          $2800                     -                     -
     Pharmaceuticals (non-PBS drugs requiring prescription     100% after deducting                                                                           1
     by law). NOTE: legislation requires CBHS to deduct           the prescribed        $1000                  $300                  $200
     the current government prescribed charge.                  charge up to $150

     1 The application of rules for dental services and related benefit payments       4 Stress management courses (including Hatha, Ashtanga, Ivengar and
       can be a complex matter. The most accurate way to assess benefits in              Bikram yoga: minimum 8 classes) must be approved by CBHS and
       advance for a specific dental procedure is to fax or email your dental quote,     received as part of a health management program intended to prevent or
       including item numbers and itemised costs, or call us.                            ameliorate a specific health condition.
     2 Quit smoking programs (including nicotine replacement therapy, certain          5 Gym membership (min. 3 months) must be approved by CBHS and
       brands of patches, inhalers and gums) must be approved by CBHS and                received as part of a health management program intended to prevent or
       received as part of a health management program intended to prevent or            ameliorate a specific health condition.
       ameliorate a specific health condition.                                         6 2 months waiting period applies to ‘Extraction of Full Tooth’ and ‘Other
     3 Weight loss programs must be approved by CBHS and received as part of             Surgical Procedures’
       a health management program intended to prevent or ameliorate a specific        7 Where referred by a doctor and recognised by CBHS as essential to a
       health condition. NOTE: Benefit is not payable for meals or special food.
                                                                                         member’s health care needs.
                                                                                       8 Where benefits are not payable from any other source.

     CBHS Extras Cover table runs from page 18 to page 23
22                                                                                                                                                                    23
     Packaged Covers                                             So what exactly am I covered for?
                                                                 kickstart provides benefits for the following hospital
                                                                 services in an Agreement Private Hospital;
                                                                   Injuries sustained in an accident requiring
     created specifically for                                       immediate medical treatment.
     young singles and couples.                                    Knee, hip and shoulder investigations,
                                                                   such as arthroscopy.
     We’ve carefully put together a health cover package           Knee, hip and shoulder reconstructions.
     for where you’re at now, full of the services you’ll
     “need, not the ones you won’t. The following pages            Removal of wisdom teeth.
     will give you detailed information on the services            Removal of tonsils.
     covered on kickstart.                                         Removal of appendix.
                                                                   Emergency transport in an ambulance.
     Kickstart – Hospital cover in detail                        For all other hospital treatments you will be covered
     The hospital element of kickstart covers you for costs      in a shared room of a public hospital. This means if
     if you are admitted to hospital for a range of treatments   you choose to go into a private hospital to receive
     that might affect you, less any excess that is payable.     any services other than those listed above, you will be
                                                                 faced with significant out-of-pocket expenses.

     revoc etavirp                                               Kickstart Daily Excess
     Injuries sustained in an Accident                           kickstart has a Daily Excess attached to it. This means
     Knee, hip and shoulder investigations                       that if you do have to go into hospital you will pay
     Knee, hip and shoulder reconstructions                      $70 each day that you are in there, up to a maximum
     Removal of wisdom teeth                                     of 6 days per person or 12 days for a couple. So if
                                                                 you’re admitted to hospital for two days you’ll pay
     Removal of tonsils
                                                                 an Excess of $140.
     Removal of appendix
     Emergency transport in an ambulance
                                                                 Kickstart Extras in detail
     revoc cilbup                                                Detailed kickstart Extras Benefits
                                                                 All category limits listed are per person. To find out
     All other services are covered in a shared room             if your chosen extras provider is registered with CBHS,
     of a public hospital                                        contact the Member Care Centre on 1300 654 123 or

24                                                                                                                         25
                                                                               Limit Bank                                                                           Limit Bank
                                                  Benefit         Limit                                                               Benefit          Limit
                                                                                 Period                                                                               Period

     slaitnesse                    (2 months waiting period)                                ...deunitnoc latned
     Essential Dental1                                                                      Major Dental
                                                                                            (12 months waiting period)
     Periodic examination (012)                     $25
                                                                                            Inlays / onlays / facings
     X-Ray (022)                                    $20
                                                                                            Crowns and Bridges                             No Cover for Major Dental
     Removal of Plaque (111)                        $30
                                                                                            Dentures and Implants
     Removal of Calculus (114)                      $47            $150            1
     Fluoride application (121)                    $18.50
                                                                                            Occlusal therapy
     Mouthguard (151)                               $65
     Fissure sealing (161)                          $23                                     lacitpo           (6 months waiting period)
     Health Checks                                                                          Frames
     (where not claimable from another source)      $100           $100            1                                                                 1 complete
     Health Maintenance                                                                     Lenses                                      $150           optical            1
     (inc approved yoga courses)                    $100           $100                                                                               appliance
                                                                                            Contact Lenses
     Gym membership2
     (min 3 months)                                 $100           $100                     seipareht gniebllew                            (2 months waiting period)
     Blood Glucose Accessories                      $100           $100                     Physiotherapy                                $30
     Dietitian Consultations                        $100           $100                     Chiropractic                                 $30            $250              1
     latned                                                                                 Osteopathy                                   $30
     Essential Dental                                                                       Clinical Psychology                          $50            $250
     (2 months waiting period)                          See ESSENTIALS above
     General Dental1
                                                                                            seipareht evitanretla
     (2 months waiting period)                                                              Natural Therapies                            $26
     Filling: 1 surface metallic (511)               $49                                    Oriental Therapies                           $26            $200              1
     Filling: 3 surface metallic (513)               $69                                    Remedial Therapies                           $26
     Filling: 1 surface tooth-coloured (531)       $57.50
     Filling: 3 surface tooth-coloured (533)         $85                                    *see page 30 for information on the Limit Bank Period
     Consultations                               $23 - $35.50    combined                   1 The application of rules for dental services are related benefit payments can be a
     X-rays                                      $20 - $36.50       limit                   complex matter. The most accurate way to assess benefits in advance for a specific
                                                                                            dental procedure is to fax or email your dental quote, including item numbers and
     General Dental Plus1                                       $225 year 1                 itemised costs, or call us 1300 654 123
     (2 months waiting period)                                  $450 year 2        1        2 Programs must be approved by CBHS and received as part of a health

     Diagnostic model (071)                         $22         $675 year 3                 management program intended to prevent of ameliorate a specific health
                                                                                            condition. NOTE: Benefit is not payable for meals or specific foods
     Bleaching (117)                                $20         & thereafter                3 2 months waiting periods applies to ‘Extraction of Full Tooth’ and ‘Other Surgical
     Enamel micro-abrasion (116)                   $25.50                                   Procedures’

     Surgical Dental1
     (6 months waiting period)
     Extraction of full tooth (311)                 $55
     Other surgical procedures3                  $50 - $180
     Periodontics (gum treatment)                $45 -$180
     Endodontic (root canal treatment)           $35 - $170

26                                                                                                                                                                                 27
     KickStart your dental limits                                                  sdoirep gnitiaw sartxe
     On top of the great services and benefits of kickstart,                       Crowns, bridges and orthodontia                 12 months
     we want to give you an extra reward to help you take                          Artificial aids, healthcare appliances,
                                                                                                                                   12 months
     even better care of yourself - a bonus on the amount                          oxygen apparatus and hearing aids
     you can claim for dental limits.                                              Optical                                          6 months
                                                                                   Periodontics, endodontics, facings
     For every year that you have kickstart we will increase                                                                        6 months
                                                                                   and dentures
     your combined dental limit by $225 annually, up to                            All other services                               2 months
     a maximum of $675, so you can really get value from
     your kickstart cover.
                                                                                   Pre-Existing Ailment (PEA) Waiting Period
                                                                                   All health funds can apply a special waiting period to
     Waiting periods                                                               new members of hospital covers who have pre-existing
     Waiting periods apply to all Hospital and Extras covers                       ailments. This waiting period also applies to existing
     and are listed in the table below. If you are transferring                    members who have recently upgraded their level of
     from another fund, waiting periods are waived for                             hospital cover.
     all services which are covered on your current cover,
                                                                                   If the ailment, illness or condition is considered
     providing you have already served the required CBHS
     waiting period and CBHS offers the same service.
     Benefits that are not available on your current cover                            new members must wait 12 months for any medical
     but are now available on your CBHS cover will require                            and hospital benefits;
     the appropriate waiting periods to be served.
                                                                                      members transferring or upgrading to a higher
     If transferring from another fund and your benefit                               hospital cover must wait 12 months to get the
     limits have been reduced due to claims, the lower                                higher hospital benefits. Existing members with at
     limits may also apply to your CBHS cover.                                        least 12 months membership in total across their
                                                                                      old and new cover are entitled to the lower benefits
                                                                                      on their old cover.
     sdoirep gnitiaw latipsoh
     Pre-existing ailments (see below)                               12 months     What is a pre-existing ailment?
     Pregnancy/obstetrics                                            12 months
     All other treatments                                              2 months    A pre-existing ailment is one where signs or symptoms
     Accidents, injuries and emergencies*                                  1 day
                                                                                   of your ailment, illness or condition, in the opinion of
                                                                                   a medical practitioner appointed by the health fund
                                                                                   (not your own doctor), existed at any time during the
     * As a result of unintentional, unexpected actions or events that require
     treatment by a registered practitioner. Excludes pregnancy, injuries or       six months preceding the day on which you purchased
     illnesses induced by alcohol or drug dependence and aggravation of a          your hospital insurance or upgraded to a higher level of
     pre-existing ailment.                                                         hospital cover.
28                                                                                                                                             29
     The only person authorised to decide that an ailment             Available limits are calculated using a simple “Limit
     is pre-existing is the medical practitioner appointed            Bank”.
     by CBHS. Our fund medical practitioner must,
     however, consider any information regarding signs                The “Limit Bank” works just like a bank account. When
     and symptoms provided by your treating medical                   you receive a benefit for a particular service, your “Limit
     practitioner(s).                                                 Bank” balance for that category or group of services
                                                                      reduces by the CBHS benefit amount.

     Overseas cover                                                   After the specific time period that applies to the
                                                                      category of services elapses, the amount is credited
     CBHS provides very limited coverage for treatments               back to the “Limit Bank” category. The time period
     received outside of Australia. Benefits are paid                 applies to the anniversary day of the service.
     at the equivalent NSW non-agreement level for
     accommodation and no benefits are payable                        For example, on Top Extras the physiotherapy limit is
     towards the cost of other hospital or doctors’ fees.             $720 and the time period is 1 year. If you received a
     CBHS recommends taking out travel insurance when                 benefit from CBHS of $61 for an initial physiotherapy
     travelling overseas. CBHS members can obtain a 30%               consultation, your physiotherapy limit bank balance
     discount on travel insurance through CommInsure –                decreases by $61 to $659. After one year elapses (to
     to find out more visit                          the same date the service was received) CBHS credits
                                                                      $61 to your Limit Bank.
     Limit Bank                                                       You can find out your available Limit Bank balances
                                                                      using or by contacting the Member
     Each category or group of services within CBHS Extras            Care Centre on 1300 654 123.
     covers has a limit on the amount you can claim in a
     specific time period. These limits and time periods are
     detailed in the Extras cover information section on
     page 18.

     physiotherapy                    Category Limit: $720            Limit Bank Period: 1year

     Date of Service   Claim Number   Service Description             CBHS Benefit Paid            Credit              Balance
     Balance at
     01/02/2006                                                                                                        $720.00
     02/02/2006           200012134   1 x 500 Initial Consultation         ($61.00)                                    $659.00
     05/08/2006           200423654   1 x 505 Standard Consultation        ($35.00)                                    $624.00
     02/02/2007               -       Credit of used limit                                        $61.00               $685.00
     CURRENT BALANCE (as at 03/05/2006)                                                                                $685.00
     05/08/2007                       Credit of used limit                                        $35.00

30                                                                                                                                  31
     Claiming                                                 Private Health Insurance
     You can claim your benefit in two simple, fast and       Code of Conduct
     convenient ways:
                                                              The private Health Insurance Code of Conduct is a
     1. By swiping your membership card at equipped           self-regulatory code to promote informed relationships
     service providers and paying the ‘gap’ for the           between private health insurers and consumers. As
     difference between the benefit paid and the total        a signatory to the Code of Conduct, CBHS has made
     invoice price (after discounts).                         a commitment to ensuring consumers receive the
     or                                                       correct information on private health insurance from
     2. Submit your claim by,                                 appropriately trained staff, consumer awareness of the
                                                              internal and external dispute resolution process, clear
          Commonwealth Bank internal mail                     and complete policy documentation and ensuring that
          post                                                all information between the consumer and CBHS is
          fax                                                 protected in accordance with privacy principles.
                                                              Detailed information on the Private Health
                                                              Insurance Code of Conduct can be obtained at
     Complaints Handling and Dispute                , by
                                                              contacting the Member Care Centre on 1300 654 123
     Resolution Policy                                        or visit our website on
     CBHS respects your right to make a complaint. CBHS
     recognises the value of complaints as an important       Government initiatives
     tool in monitoring and responding to customer
     expectations. To obtain a copy of the CBHS Complaints    The following Federal Government incentives are
     & Dispute Resolution Policy contact our Member Care      designed to encourage and reward private health
     Centre on 1300 654 123 or visit our website at           insurance participation.
                                                              Federal Government Rebate on
     Privacy Statement
                                                              Private Health Insurance
     CBHS respects your privacy. Protecting personal
     information is important to CBHS and is required by      The Federal Government Rebate on Private Health
     law. CBHS handles personal information in accordance     Insurance is designed to make private health insurance
     with the provisions of the Commonwealth Privacy Act      cover as affordable as possible for more Australians by
     and the National Privacy Principles under that Act. To   reducing the amount you pay for premiums by at least
     obtain a copy of the CBHS Privacy Policy contact our     30%. To be eligible for the Rebate, you have to hold a
     Member Care Centre on 1300 654 123 or visit our          valid Medicare card.
     website on
32                                                                                                                      33
     The Rebate has three levels:                              The taxable income thresholds for high income earners
                                                               are detailed below.
       30%: available if no person covered by the
       membership is aged 65 years or more;
                                                               Singles                                        $50,000
       35%: available if any person covered by the
       membership is aged 65 to 69 years; and                  Couples/families (0-1 children)              $100,000
       40%: available if any person covered by the             An extra $1,500 taxable income per additional child
       membership is aged 70 years or more.                    applies to families.
     Savings Provisions Entitlements apply to ensure that
     people remaining on a membership that have been
                                                               To avoid the 1% Medicare Levy Surcharge simply
     eligible for the 35% or 40% rebate do not have their
                                                               choose any CBHS hospital cover.
     rebate reduced to 30% when the person aged 65
     years or over leaves or cancels the membership. This      For more information on the Medicare Levy Surcharge,
     entitlement ceases if the person takes out a policy       contact the Australian Taxation Office on 13 28 61.
     that covers another person who was not on the
     original policy.
                                                               Lifetime Health Cover
     Most CBHS members claim the rebate through
                                                               Under the Federal Government’s Lifetime Health
     reduced premiums, but you can choose instead to
                                                               Cover initiative, if you take out hospital cover by 1 July
     claim it as part of your annual tax return or as a cash
                                                               following your 31st birthday and maintain it, you can
     refund from any Medicare office.
                                                               expect to pay lower premiums throughout your life
     To receive the rebate as a reduction on your premium,     compared to someone who joins a health fund when
     you need to complete the appropriate section of the       they are over 31.
     membership application at the back of this Guide.
     Please visit or contact the CBHS          For every year you delay taking out hospital
     Member Care Centre on 1300 654 123 for more               cover a 2% loading is incurred.
                                                               For example, a person turning 40 on 3 December
                                                               would have until 1 July the following year to take out
     Medicare Levy                                             hospital cover with the loading of a 39 year old (18%).
     The Medicare Levy Surcharge is an additional 1%           The maximum loading a person can be required to pay
     surcharge of taxable income imposed on higher             is 70 per cent.
     income earners who are eligible for Medicare but do
     not have an appropriate level of hospital cover with
     a health fund.

34                                                                                                                          35
     Special conditions                                          Terms & Conditions
     The following groups may have different Lifetime            There are rules and conditions surrounding
     Health cover rules:                                         health fund membership. Many are regulated by
                                                                 Commonwealth Law. For information regarding
       Migrants;                                                 the Terms and Conditions visit our website
       Australian citizens who were overseas on         or contact the CBHS Member
       1 July 2000;                                              Care Centre on 1300 654 123.

     and                                                         How to find out more
       Australian citizens who turned 31 while they
                                                                 If you would like any further information, please
       were overseas.
                                                                 contact the Member Care Centre on 1300 654 123,
     If you believe you fall into one of these groups, please    email us on or visit our website
     call the Private Health Insurance information line on       –
     1800 020 103 or CBHS for more information.
                                                                 You may also contact the Private Health Insurance
                                                                 Ombudsman on 1800 640 695 or by writing to
     Days Without Cover (DWOC)                                   Level 7, 362 Kent St, Sydney NSW 2000 for free and
                                                                 independent advice.
     Under Lifetime Health cover members are able
     to drop their cover for a cumulative period of 24
     months in their lifetime without affecting the hospital     Cooling Off Period
     contribution rate. However, after 24 cumulative
                                                                 CBHS is committed to member satisfaction and to
     months absence, their contribution will increase by 2%
                                                                 promoting informed decisions about private health
     for each additional 365 days of absence.
                                                                 insurance products and services. If you are not satisfied
     Certain periods are exempt from inclusion in these          with your health insurance for any reason you have
     days without hospital cover. They are:                      30 days from the receipt of your CBHS policy to lodge
                                                                 your request to cancel your membership and a refund,
       Periods during which you were overseas for more           providing no claims have been submitted during this
       than one year (you are treated as being overseas          period. For a copy of the Cooling Off Period policy
       during any period of return that is less than 90 days);   contact CBHS on 1300 654 123.
       Periods of suspension granted by your health fund.

36                                                                                                                           37
CBHS Health Fund Limited
ACN 087 648 717

A registered Health Benefits Organisation

Locked Bag 5014
Parramatta NSW 2124

Member Care 1300 654 123

Facsimile 02 9843 7676


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