Product Brochure MARCH

Transcription

1 Product Brochure MARCH

2 1 Contact us CBHS Health Fund Limited ABN A Registered Private Health Insurer Call CBHS Member Care Monday to Friday, 7.00am 7.00pm (AEST) Go to cbhs.com.au 24 hours, 7 days a week Post to CBHS Health Fund Limited Locked Bag 5014 Parramatta NSW 2124 Contents Who is CBHS? 3 Who can join? 3 Why join? 4 2 Level 5, 79 George Street, Parramatta, NSW, 2150 Fax to to help@cbhs.com.au What are the cover options? 5 Like us at facebook.com/cbhshealthfund Packaged Covers 7 Package comparisons (Hospital) 9 Package comparisons (Extras) 11 Maximum claimable amounts (Extras, Packages) 13 Hospital Covers 15 Comparison of Hospital Covers 17 Ambulance Cover 19 Benefits of Hospital Cover 20 Understanding Hospital Cover 21 Extras Covers 23 Comparison of Extras Covers 25 Maximum claimable amounts (Extras Cover) 27 Benefits of Extras Cover 29 CBHS Wellness Benefit 29 CBHS Choice Network 29 Understanding Extras Cover 31 Government incentives 32 Additional information 33

3 3 Who is CBHS? CBHS takes pride in delivering high-quality health insurance that offers peace of mind at every life stage. CBHS was set up in 1951 as a shared, not for profit cooperative after the Commonwealth Bank decided it wanted to provide its employees with access to affordable health insurance. We have now been serving past and current employees and their families for over 60 years. Why join? CBHS is a not for profit health fund run solely for the benefit of our members. We pride ourselves on our ability to provide our members with the best service, exceptional value and competitive products that offer better benefits. CBHS is not just for when you are sick, we provide information and benefits to help keep you healthy. 4 Who can join? CBHS is a restricted health fund which means we can only offer cover to certain eligible people. To be eligible you must be a current (or former) employee, contractor or franchisee of a CBA Group company or a member of their immediate or extended family. Immediate family (sibling, parent, partner, former partner, child or dependent) can join CBHS with their own membership which can also include their partner and/or children. Extended family (partner of a sibling, niece or nephew of the employee or grandchild) are eligible to join with singles cover only. If you leave the CBA Group you are still eligible to remain a member or join CBHS. Not sure if you are eligible to join? Call our friendly Member Care team and find out more. Primary eligibility Current and former employees, contractors and franchisees of CBA Group Companies. Joining the CBHS family means you can: Be a member of Roy Morgan s Private Health Insurer of the Year for 2014 and 2012! Utilise our Choice Network of preferred providers Access an array of wellness programs and member benefits Enjoy exclusive member discounts Claim online 24 hours a day Have confidence with a 30-day cooling off period on all new policies Switching from another fund is easy, just tell us the fund name and policy details - we ll take care of the rest! Member discounts When you become a CBHS member you gain access to a wide range of exclusive discounts. You can find a full list of providers and discounts at: cbhs.com.au/memberdiscounts Immediate family of a Primary Eligible person Including partner, ex-partners, parents, siblings and children Extended family of a Primary Eligible Person Grandchildren, niece or nephew can join on singles cover only. 2014

4 5 What are the cover options? Choose a Package Cover By choosing a Package Cover, you receive both hospital and extras cover along with an array of benefits which are only available as part of our Package Covers. Hospital Cover Provides benefits towards admitted hospital services. See pages for inclusions on each cover. comprehensive hospital For complete peace of mind in case the unexpected arises. 6 Hospital Extras active hospital A high-level of cover with exclusions for a small number of procedures to match your life stage. Our highest level of cover for Hospital and Extras giving you ultimate peace of mind. limited hospital For a sense of security but without things you are less likely to need. A mid-level cover including pregnancy services and a broad range of extras for a growing family. basic hospital Provides treatment as a private patient in a shared room of a public hospital. Extras Cover Provides benefits towards services not usually covered by Medicare like dental, optical, physiotherapy, chiropractic and alternative therapies. See pages for details. An affordable cover for the fit and healthy. For singles, couples and young families. top extras Wide range of services and benefits for security and peace of mind. An entry level cover for the young and healthy single or couple looking to take up their own first cover. intermediate extras essential extras Provides benefits for popular general services and treatments. Essential services for those who maintain a healthy lifestyle. OR We offer a flexible solution allowing you to pick a hospital and extras cover from Page 6 to match your life stage. Mix n Match?? Other covers We offer several other cover types for specific purposes. Ambulance Only Provides cover for ambulance costs including treatments at the scene arising from medical emergencies. See page 19 for details. Travel Insurance CBHS partners with Allianz to provide travel insurance to members and their families. Visit for more information.

5 7 8 CBHS has made choosing your health cover even easier, by packaging our Hospital and Extras Covers. Hospital Cover Level Extras Cover Level Prestige CBHS premium level of cover, offering an extensive range of hospital and medical services, and generous extras benefits plus more. No co-payment or excess The option to keep a non-student dependant up to the age of 25 Access to Best Doctors and other Wellness Benefits Highest extras benefits including unlimited preventative and general dental Access Gap Cover (with participating doctors) plus $200 Gap Assist which will help you with additional out-of-pocket medical expenses Emergency ambulance transport Hospital Cover Level Extras Cover Level KickStart An affordable package cover for the fit and healthy, because accidents do happen! Get covered for the things you may need like dental and optical, without the things you don t, like pregnancy. $70 daily co-payment A great range of extras benefits Wellness benefits for health management Access Gap Cover (with participating doctors) Emergency ambulance transport Package Cover StepUp A mid-level cover which includes pregnancy services and extras to suit a young or growing family. FlexiSaver An entry level package covering only selected hospital and extras services, while excluding things you may not need at this stage of life. Hospital Cover Level Extras Cover Level Pregnancy related services $70 daily co-payment (does not apply for dependant children on the policy) Access Gap Cover (with participating doctors) plus $100 Gap Assist which will help you with additional out-of-pocket medical expenses Cover for dental, optical, physio, chiro and other therapies Emergency ambulance transport Hospital Cover Level Extras Cover Level $500 excess on hospital admission helps keep premiums low Flexibility in using extras overall limit Gives 55% of the provider charges back in benefits Access Gap Cover (with participating doctors) Emergency ambulance transport For more information on coverage, see pages 9-14 for full comparisons.

6 9 Package comparisons (Hospital) Prestige StepUp KickStart FlexiSaver 10 Daily co-payment Nil $70 $70 - Excess $500 Emergency ambulance transport (See page 19 for details) Gap Assist (See page 20 for details) $200 $ Non-student dependant option Access to Best Doctors (See page 20 for details) Example hospital procedures at participating private hospitals Accident related treatment after joining (relevant to level of cover) Removal of wisdom teeth, tonsils, adenoids, appendix Investigation, repair or reconstruction of bones and tissues of a knee, hip or shoulder Removal of kidney stones & gall stones R Colonoscopies, gastroscopies R Cancer treatment (e.g. radiotherapy, chemotherapy) R Brain surgery R Back surgery (e.g. spinal fusion, discectomy) R Cochlear implant surgery & bone anchored hearing devices R Insulin pump procedures R Renal dialysis R Major eye surgery (including cataract surgery, glaucoma surgery and corneal grafts/transplants) R R Hip & knee joint replacement R R Other joint replacement R R Pregnancy related services R Assisted reproductive services (e.g. IVF, GIFT) R Sterilisation and reversal of sterilisation R R Cardiothoracic services (heart and lung related) R R Bariatric services all including revision and reversal procedures (e.g. gastric banding, sleeve gastrectomy) R R Psychiatric services R R R Rehabilitation services R R R Palliative care services R R R Plastic and reconstructive surgery services R R Cosmetic services Other services for which a Medicare benefit is NOT payable R R R All other inpatient services where a Medicare benefit is payable R - Covered in private agreement hospitals and public hospitals R - Restricted benefit - Exclusion (Not covered) Please see page for further information about Hospital Cover and waiting periods.

7 11 Package comparisons (Extras) Overall Limits and Benefit Period Each service (or group of services) has an overall limit on the amount that you claim per person within each benefit period. The benefit period is the period in which the overall limit may be used. Most benefit periods are per unless stated, below. Dental Waiting Periods Prestige StepUp KickStart FlexiSaver Benefit Period Preventative dental 2 months Unlimited Unlimited Unlimited $700 General dental 2 months Unlimited $350 combined limit Major dental $675 Periodontic (gum treatment) $700 - Endodontic (root canal treatment) $700 - Inlays/onlays/facings/veneers 6 months $1, $900 Dentures and implants $1, any 5 years Occlusal therapy $ lifetime Crowns and bridges $3, any 5 years 12 months Orthodontia $3,200 $1, lifetime Optical Sublimit of $150 Prescribed optical appliances 6 months $450 $250 $230 combined with dental Therapies Physiotherapy $900 Combined with dental Chiropractic $250 - $1,000 Osteopathy $600 - ($300 sublimit Occupational therapy $800 per therapy) - - Speech therapy $1, Clinical psychology $500 $250-2 months Ante natal/post natal physiotherapy $105 Combined with Physiotherapy - - Hypnotherapy $ Podiatry (excl. artificial aids: e.g. orthotics) $400 $ Audiology $ Eye therapy $ Dietitian $360 $100 $100 - Alternative therapies Natural therapies - Buteyko, Herbal Medicine Consultations, Homeopathy, Naturopathy, Nutrition Oriental therapies - Acupressure, Acupuncture, Chinese Herbal Medicine Consultation, Chinese Massage, Kinesiology, Reflexology, Shiatsu, Traditional Chinese Medicine Consultation Massage therapies - Alexander Technique, Aromatherapy, Bowen Therapy, Deep Tissue Massage, Feldenkrais, Lymphatic Drainage, Myotherapy, Remedial Massage, Rolfing, Sports Massage, Swedish Massage, Therapeutic Massage General health Blood glucose accessories 2 months $1,000 $320 $400 $100 $200 $ Non-pharmaceutical benefits scheme drugs requiring a prescription by law. 2 months (100% less the current government prescribed co-payment up to the maximum claimable benefit.) $1,000 $300 $200 - Health care aids (referred by a doctor and recognised by CBHS) Artificial aids $1,500 $ Hearing aids 12 months $2, any 3 years Blood pressure monitor, nebuliser, glucometer $ CBHS will not pay a benefit in respect of a service that was rendered to a member if the services can be claimable from any other source

8 13 Maximum claimable amounts 14 Packaged Extras Covers Prestige StepUp KickStart FlexiSaver Prestige StepUp KickStart FlexiSaver Benefit Percentage CBHS pays this percent of the total cost up to the maximum claimable amount per service and up to the overall limit in each benefit period. 70% 70% 100% # Item Description Dental Preventative dental 011 Examination $45 $45 $ X-ray $28 $28 $ Removal of calculus - first visit $65 $65 $ Fluoride $25 $25 $20 General dental 322 Surgical removal of a tooth $177 $170 $ Surgical removal of a tooth (including bone) $195 $195 $ Surgical removal of a tooth (including bone and tooth division) $250 $250 $200 55% of cost up to the annual combined limit 55% of cost up to the annual combined limit 55% of cost up to the annual combined limit 531 Adhesive restoration (filling), 1 surface posterior tooth $90 $90 $ Adhesive restoration (filling) 2 surfaces posterior tooth $110 $110 $ Adhesive restoration (filling) 3 surfaces posterior tooth $135 $135 $110 Major dental 222 Root planing - per tooth $30 $30 $ Complete chemo mechanical preparation of root canal one canal $136 $136 $ Complete chemo mechanical preparation of root canal each additional canal $85 $85 $ Root canal obturation - one canal $145 $145 $ Root canal obturation - each additional canal $65 $65 $ Veneer - direct $260 $ Veneer - indirect $600 $ Full crown - non metallic - indirect $720 $ Bridge - direct - per pontic $380 $ Bridge - indirect - per pontic $680 $ Complete maxillary denture $480 $ Complete mandibular denture $500 $ Complete maxillary and mandibular denture $750 $ Passive removable appliance - per arch $3,200 $1, Maxillary expansion appliance $3,200 $1, Complete course of orthodontic treatment $3,200 $1, Occlusal splint $260 $ Optical 110 Frames $140 $ Single vision lens pair $130 $ Bifocal lens pair $140 $ Trifocal lens pair $150 $ Multifocal lens pair $210 $ Contact lenses $220 $ % of cost for one complete optical appliance up to the annual limit 55% of cost up to the annual sub limit Benefit Percentage CBHS pays this percent of the total cost up to the maximum claimable amount per service and up to the overall limit in each benefit period. 70% 70% 100% 55% of cost up to the annual combined limit Item Description Therapies Physiotherapy (initial/subsequent) $61 / $43 $61 / $43 $40 / $30 55% of cost up to the annual combined limit Chiropractic (initial/subsequent) $61 / $40 $61 / $40 $40 / $30 - Osteopathy (initial/subsequent) $61 / $35 $61 / $35 $40 / $30 - Occupational therapy (initial/subsequent) $61 / $35 $61 / $ Speech therapy (initial/subsequent) $95 / $46 $95 / $ Clinical psychology (initial/subsequent) $140 / $80 $140 / $80 $50 - Ante natal/post natal physiotherapy 70% 70% - - Hypnotherapy $ Podiatry (excl. artificial aids: e.g. orthotics) (standard consult) $30 $ Audiology $ Eye therapy $ Dietitian (initial/subsequent) $75 / $42 $75 / $42 $75 / $42 - Alternative therapies Natural therapies - Buteyko, Herbal Medicine Consultations, Homeopathy, Naturopathy, Nutrition Oriental therapies - Acupressure, Acupuncture, Chinese Herbal Medicine Consultation, Chinese Massage, Kinesiology, Reflexology, Shiatsu, Traditional Chinese Medicine Consultation Massage therapies - Alexander Technique, Aromatherapy, Bowen Therapy, Deep Tissue Massage, Feldenkrais, Lymphatic Drainage, Myotherapy, Remedial Massage, Rolfing, Sports Massage, Swedish Massage, Therapeutic Massage General health $33 $33 $26 - $33 $33 $26 - $33 $33 $26 - Blood glucose accessories 70% 70% 70% - Non-pharmaceutical benefits scheme drugs requiring a prescription by law. (100% less the current government prescribed co-payment up to the maximum claimable benefit.) $150 $75 $75 - Health care aids (referred by a doctor and recognised by CBHS) Artificial aids $10 - $1,500 $10 - $ Hearing aids 70% Blood pressure monitor, nebuliser, glucometer 70% - - -

9 15 As every member s lifestyle and situation is different, our selection of hospital and extras cover allows you to select a combination to suit your individual needs. Hospital Cover Level Hospital Cover Level Hospital Cover Level Hospital Cover Level comprehensive hospital Our highest level of hospital cover to provide you with peace of mind in case the unexpected arises. Cover as an admitted patient for all treatments covered by Medicare Daily co-payment option for reduced premiums (co-payment does not apply for dependent children on the policy) Access Gap Cover (with participating doctors) Emergency ambulance transport Access to private hospitals (for non-restricted services) active hospital A high-level of cover with exclusions for a small number of procedures to match your life stage. Covers a wide range of private hospital treatments Includes Cardiothoracic services Access Gap Cover (with participating doctors) $100 co-payment which does not apply for dependent children on the policy Emergency ambulance transport limited hospital Designed to cover most eventualities with some restricted benefits on services and treatments for things you are less likely to need. Daily co-payment option for reduced premiums (co-payment does not apply for dependent children on the policy) Access Gap Cover (with participating doctors) Emergency ambulance transport Access to private hospitals (for non-restricted services) basic hospital A basic-level of hospital cover to give you the choice of your own doctor or specialist when receiving treatment as a private patient in a shared room of a public hospital. Excess option for reduced premiums Choice of doctor or specialist Access Gap Cover (with participating doctors) Emergency ambulance transport 16 Hospital For a full comparison of hospital covers, please see page 17. For explanations, please see pages

10 Comparison of Hospital Covers 17 comprehensive hospital active hospital limited hospital Daily co-payment Nil, $70, $100 $100 Nil, $70, $100 - Excess Nil, $500 Emergency ambulance transport Non-student dependant option Example hospital procedures at participating private hospitals Accident related treatment after joining (relevant to level of cover) R Removal of wisdom teeth, tonsils, adenoids, appendix R Investigation, repair or reconstruction of bones and tissues of a knee, hip or shoulder R Removal of kidney stones & gall stones R Colonoscopies, gastroscopies R Cancer treatment (e.g. radiotherapy, chemotherapy) R Brain surgery R Back surgery (e.g. spinal fusion, discectomy) R Cochlear implant surgery & bone anchored hearing devices R Insulin pump procedures R Renal dialysis R Major eye surgery (including cataract surgery, glaucoma surgery and corneal grafts/transplants) R R Hip & knee joint replacement R R Other joint replacement R R Pregnancy related services R R Assisted reproductive services (e.g. IVF, GIFT) R R Cardiothoracic services (heart and lung related) R R Bariatric services all including revision and reversal procedures (e.g. gastric banding, sleeve gastrectomy) R R Psychiatric services R R R Rehabilitation services R R Palliative care services R R R Sterilisation and reversal of sterilisation R R Plastic and reconstructive surgery services R R Cosmetic services Other services for which a Medicare benefit is NOT payable R R R All other inpatient services where a Medicare benefit is payable R basic hospital 18 - Covered in private agreement hospitals and public hospitals R - Restricted benefit - Exclusion (Not covered) Please see page for further information about Hospital Cover and waiting periods.

11 19 Benefits of Hospital Cover Chronic Disease Management Program If you suffer from a chronic disease, it can impact every aspect of your life. CBHS offers a series of telephone based Chronic Disease Management Programs aimed at providing education and support to better understand your situation. Trained professionals will assist you with medication management, identifying risk factors, provide guidelines for maintenance of your health and ultimately, help you improve your quality of life. Daily co-payment options^ You can reduce the cost of your Comprehensive or Limited Hospital cover by agreeing to pay a daily copayment for a maximum of 6 days per person or 12 days per family, per. See table below. Excesses An excess is a nominated amount you agree to pay upfront in respect to charges raised by a hospital for overnight or same day admission. 20 Ambulance Cover Ambulance costs are expensive and are not covered by Medicare. CBHS Ambulance Cover protects you from emergency ambulance costs. You are automatically covered for emergency ambulance transport (air, land and sea within Australia) if you have any level of Hospital cover with CBHS. Ambulance cover pays the cost of emergency ambulance services if you are transported directly to a hospital or treated at the scene, due to a medical emergency. Transport must be provided by a State Government ambulance service or a private ambulance service recognised by CBHS (e.g. Royal Flying Doctors Service). This includes transportation from the scene of an accident or the scene of a medical event such as a heart attack or stroke, but does not include transportation to hospital for the routine management of ongoing medical conditions or transfers between hospitals. If you require cover for non-emergency services please contact your state ambulance scheme for further information. You can take Ambulance Cover as a stand-alone option. *Residents of QLD and TAS are covered by state based Ambulance schemes For more information visit our website cbhs.com.au or wellness@cbhs.com.au. Hospital Substitute Treatment This program is aimed at reducing the time you spend in hospital, often cutting it out altogether. It allows you to receive specialised treatment from a private nurse, physiotherapist and occupational therapist in the comfort of your own home. This program is available at no cost to CBHS members who hold an appropriate level of hospital cover or package product and the medical services to be provided are an appropriate substitute for treatment that would be fully covered in a hospital under that product. Access Gap Cover Many people admitted to hospital as private patients can find themselves faced with out-of-pocket expenses or gaps. CBHS has arrangements with some doctors that are designed to minimise or eliminate out-of-pocket expenses altogether. Members have access to these arrangements on all Hospital levels of cover. Go to cbhs.com.au/ agcsearch for more information on AGC or to search for AGC participating doctors. Exclusive benefits for Packaged Covers Exclusive to Prestige Package members, the international program Best Doctors provides access to leading medical minds from around the world. The Best Doctors network has more than 53,000 experts in over 450 specialties and subspecialties and is designed to complement the care you receive from your own doctor. The total excess is payable once per person per up to a maximum of twice for a couple, family or sole parent policy. FlexiSaver package cover has a fixed $500 excess, while for Basic Hospital cover you can choose $500 excess to reduce the cost. Cover Comprehensive Hospital^ Active Hospital^ Limited Hospital^ Basic Hospital Prestige StepUp^ KickStart FlexiSaver Co-payment or Excess Nil, $70 or $100 co-payment $100 co-payment Nil, $70 or $100 co-payment Nil or $500 excess Nil $70 co-payment $70 co-payment $500 excess ^ Daily co-payment does not apply to dependent children on Comprehensive Hospital, Active Hospital, Limited Hospital or StepUp Package Gap Assist To further help you reduce your out-of-pocket expenses from hospitalisation, Prestige and StepUp include a Gap Assist benefit of $200 for Prestige and $100 for StepUp per person per. Cover Gap Assist Amount Prestige $200 StepUp $100

12 21 Understanding Hospital Cover Agreement private hospitals CBHS holds agreements with an extensive range of Australian private hospitals and day surgeries. These agreements ensure hospital fees including bed fees, theatre and labour ward fees, intensive and coronary care fees are covered when admitted as a patient to hospital (subject to your level of cover). For charges incurred in a non-agreement hospital members may only receive benefits similar to a public hospital shared room rate. To check if your hospital holds an agreement, visit our website cbhs.com.au/hospitalsearch and we strongly recommend you contact us on to confirm your benefit entitlement prior to receiving hospital treatment. Members who choose a non-agreement hospital may incur out-of-pocket expenses for hospital related services irrespective of their level of cover. Public Hospitals All CBHS hospital covers provide benefits for certain treatments with your choice of doctor in a public hospital. No benefits are payable if the service or treatment is an exclusion. Admitted hospital medical services* CBHS will pay up to 25% of the Medicare Benefit Schedule (MBS) fee, while Medicare pays the other 75%. If charges are more than the MBS fee, then a gap payment arises. Services that do not attract a benefit from Medicare will be subject to restricted benefits only or excluded (depending on level of cover) resulting in significant out-of-pocket expenses for both hospital and medical services. Inclusions, exclusions and restrictions In the hospital cover comparison tables (pages 9, 10, 17 and 18), there are three types of markings showing whether each category is included, excluded or restricted: R Inclusion. Means that they are fully covered in private hospitals with which CBHS has an agreement Exclusion. Shows a service or procedure category which is not covered by this policy. There is no benefit payable and you will incur significant out of pocket expense for these services. Please review the exclusions and check with us to see if you are covered before receiving treatment. Restricted. A restricted benefit is one which CBHS pays a benefit for services which are performed in a public hospital with the doctor of the member s choice. If the member chooses to go to a private hospital to receive these services, CBHS will pay only the Minimum Default Rate for accommodation specified by the law and they will be faced with significant out-of-pocket expenses. In a private hospital, the member will be liable to pay the full cost of theatre or labour ward fees, intensive care units and coronary care units. Hospital Waiting Periods Waiting periods apply to those who are new to private health insurance or choose to upgrade to a higher level of cover. If you choose to transfer your policy to CBHS any waiting periods already served at your previous fund can be honoured. Upgrading your level of cover may cause additional waiting periods to apply. Pre-existing conditions, pregnancy related services (Definitions on page 33). Psychiatric, rehabilitation, palliative care, all other treatments or services. Accidents 1, injuries and emergencies, emergency ambulance transport. 12 months 2 months 1 day What s covered? Depending on the level of cover: Accommodation for overnight, same day and intensive care for private or shared room in agreement private and public hospitals Theatre and labour ward fees covered in agreement private hospitals (excluding restricted services) Medical expenses related to providers for services while admitted in hospital e.g. fees from doctors, surgeons, anaesthetists, pathology, imaging etc. Covered for services eligible for benefits from Medicare up to Medicare Benefits Schedule (MBS) fee. Members have their choice of doctor/surgeon in a public and private hospital. CBHS will cover the difference between the Medicare benefit and the MBS fee for services provided as an admitted patient to a hospital Access Gap Cover is where a provider chooses to participate under an arrangement with the fund. CBHS covers up to 100% of an agreed amount in excess of the MBS fee which reduces or eliminates your out-of-pocket medical expenses (i.e. surgeons, anaesthetists, pathology, imaging fees etc.) Surgically implanted prostheses to at least the minimum benefit specified in the prosthesis list issued under Private Health Insurance legislation Pharmacy covers most drugs related to the reason for your admission in agreement private hospitals Boarder accommodation covers 100%, up to $160 per admission, if not included in hospital agreement Emergency ambulance transport for an accident or medical emergency by approved ambulance providers Hospital Services where a Medicare benefit is payable (excluding restricted services) Chronic Disease Management Programs information available under the membership/ services and benefits tab at Hospital Substitute Treatment information available under the membership/services and benefits tab at What s not covered? Depending on the level of cover: No benefits are payable for hospital or medical treatment and associated costs for excluded services If member is admitted into a private hospital for restricted services or into a non-agreement hospital, benefits are payable only at the minimum rate specified by law. These benefits may only provide a benefit similar to a public hospital shared room rate. These benefits may not be sufficient to cover admissions in a private hospital or a non-agreement hospital. Hospital services received within policy waiting periods Nursing home type patient contribution, respite care or nursing home fees Take home/discharge drugs (non-pbs drugs may be eligible for benefits from Extras cover) Aids not covered in hospital agreement (may be eligible for benefits from Extras cover) Services claimed over 24 months after the service date Services provided in countries outside of Australia Prostheses used for cosmetic procedures, where no Medicare benefit is payable or for excluded services Ambulance transfers between hospitals Fees raised by public hospitals that exceed Minimum Default Benefits set by the Department of Health for shared room accommodation CBHS benefits vary depending on the level of cover and services covered. Please refer to the individual product sheet or call us and check before getting treatment or going to hospital. 22 * A member will incur substantial out of pocket expenses if they are not entitled to Medicare Benefits (i.e Non-Australian Residents). 1 Accident means an injury as a result of unintentional, unexpected actions or events that require treatment by a registered practioner, but excludes pregnancy

13 23 Extras cover provides benefits towards services like dental, optical, physio, chiro and alternative therapies. 24 Extras Cover Level top extras Designed for members who want to be covered for an extensive range of extras services Generous per service benefits on a wide range of services Unlimited preventative and general dental High overall limits on major dental, optical, physio, chiro and therapies Cover for hearing aids and other health care aids and appliances Wellness benefits for health management Extras Cover Level intermediate extras Allows you to be covered for a wide range of popular extras required for day-to-day health management Benefits for preventative and general dental Benefits towards optical, physio, chiro and some therapies Wellness benefits for health management Extras Extras Cover Level essential extras Helps you maintain a healthy lifestyle at an affordable level of cover Benefits for preventative dental Basic benefits towards general dental, optical, physio and chiro Wellness benefits for health management For comparisons of Extras Covers, see page 25. For benefits and explanations, see pages

14 25 Comparison of Extras Covers Overall Limits and Benefit Period Each service (or group of services) has an overall limit on the amount that you claim per person within each benefit period. The benefit period is the period in which the overall limit may be used. Most benefit periods are per unless stated, below. Dental CBHS will not pay a benefit in respect of a service that was rendered to a member if the services can be claimable from any other source Waiting Periods Top Intermediate Essential Benefit Period Preventative dental 2 months Unlimited $230 $210 General dental 2 months Unlimited $500 $170 Major dental Periodontic (gum treatment) $630 - $400 Endodontic (root canal treatment) $660 - Inlays/onlays/facings/veneers 6 months $1, Dentures and implants $1, any 5 years Occlusal therapy $ lifetime Crowns and bridges 12 months $3,000 $700 - any 5 years Orthodontia $2, lifetime Optical Prescribed optical appliances 6 months $375 $250 $200 Therapies Physiotherapy $720 $300 Chiropractic $720 $200 $250 Osteopathy $720 Occupational therapy $720 - Speech therapy $1, Clinical psychology $450-2 months Ante natal/post natal physiotherapy $105 - Hypnotherapy $ Podiatry (excl. artificial aids: e.g. orthotics) $400 $250 - Audiology $ Eye therapy $ Dietitian $360 $100 $100 Alternative therapies Natural therapies - Buteyko, Herbal Medicine Consultations, Homeopathy, Naturopathy, Nutrition $450 Oriental therapies - Acupressure, Acupuncture, Chinese Herbal Medicine Consultation, Chinese Massage, Kinesiology, Reflexology, Shiatsu, Traditional Chinese Medicine Consultation 2 months $450 Massage therapies - Alexander Technique, Aromatherapy, Bowen Therapy, Deep Tissue Massage, Feldenkrais, Lymphatic Drainage, Myotherapy, Remedial Massage, Rolfing, Sports Massage, Swedish Massage, Therapeutic Massage $450 General health $300 $200 Blood glucose accessories $320 $100 $100 Non-pharmaceutical benefits scheme drugs requiring a prescription by law. 2 months (100% less the current government prescribed co-payment up to the maximum claimable benefit.) $1,000 $300 $200 Health care aids (referred by a doctor and recognised by CBHS) Artificial aids $1,000 $350 - Hearing aids 12 months $1, Blood pressure monitor, nebuliser, glucometer $500 $300 - any 3 years 26

15 27 Maximum claimable amounts Mix n Match Extras Covers Top Extras Intermediate Extras Essential Extras Top Extras Intermediate Extras Essential Extras 28 Benefit Percentage CBHS pays this percent of the total cost up to the maximum claimable amount per service and up to the overall limit in 70% 70% 70% each benefit period. # Item Description Dental Preventative dental 011 Examination $45 $45 $ X-ray $28 $28 $ Removal of calculus - first visit $65 $65 $ Fluoride $25 $25 $25 General dental 322 Surgical removal of a tooth $177 $177 $ Surgical removal of a tooth (including bone) $195 $195 $ Surgical removal of a tooth (including bone and tooth division) $250 $250 $ Adhesive restoration (filling), 1 surface posterior tooth $90 $90 $ Adhesive restoration (filling) 2 surfaces posterior tooth $110 $110 $ Adhesive restoration (filling) 3 surfaces posterior tooth $135 $135 $135 Major dental 222 Root planing - per tooth $30 $ Complete chemo mechanical preparation of root canal one canal $136 $ Complete chemo mechanical preparation of root canal each additional canal $85 $ Root canal obturation - one canal $145 $ Root canal obturation - each additional canal $65 $ Veneer - direct $ Veneer - indirect $ Full crown - non metallic - indirect $720 $ Bridge - direct - per pontic $380 $ Bridge - indirect - per pontic $680 $ Complete maxillary denture $ Complete mandibular denture $ Complete maxillary and mandibular denture $ Passive removable appliance - per arch $2, Maxillary expansion appliance $2, Complete course of orthodontic treatment $2, Occlusal splint $ Optical 110 Frames $140 $90 $ Single vision lens pair $130 $70 $ Bifocal lens pair $140 $60 $ Trifocal lens pair $150 $90 $ Multifocal lens pair $210 $100 $ Contact lenses $220 $160 $140 Benefit Percentage CBHS pays this percent of the total cost up to the maximum claimable amount per service and up to the overall limit in each benefit period. 70% 70% 70% Item Description Therapies Physiotherapy (initial/subsequent) $61 / $43 $61 / $43 $61 / $43 Chiropractic (initial/subsequent) $61 / $40 $61 / $40 $61 / $40 Osteopathy (initial/subsequent) $61 / $35 $61 / $35 $61 / $35 Occupational therapy (initial/subsequent) $61 / $ Speech therapy (initial/subsequent) $95 / $ Clinical psychology (initial/subsequent) $140 / $ Ante natal/post natal physiotherapy 70% - - Hypnotherapy $ Podiatry (excl. artificial aids: e.g. orthotics) (standard consult) $30 $30 - Audiology $ Eye therapy $ Dietitian (initial/subsequent) $75 / $42 $75 / $42 $75 / $42 Alternative therapies Natural therapies - Buteyko, Herbal Medicine Consultations, Homeopathy, Naturopathy, Nutrition Oriental therapies - Acupressure, Acupuncture, Chinese Herbal Medicine Consultation, Chinese Massage, Kinesiology, Reflexology, Shiatsu, Traditional Chinese Medicine Consultation Massage therapies - Alexander Technique, Aromatherapy, Bowen Therapy, Deep Tissue Massage, Feldenkrais, Lymphatic Drainage, Myotherapy, Remedial Massage, Rolfing, Sports Massage, Swedish Massage, Therapeutic Massage General health $33 $33 $33 $33 $33 $33 $33 $33 $33 Blood glucose accessories 70% 70% 70% Non-pharmaceutical benefits scheme drugs requiring a prescription by law. (100% less the current government prescribed co-payment up to the maximum claimable benefit.) Health care aids (referred by a doctor and recognised by CBHS) $75 $75 $75 Artificial aids $10 - $1,000 $10 - $350 - Hearing aids 70% - - Blood pressure monitor, nebuliser, glucometer 70% 70% -

16 29 Benefits of Extras Cover 30 CBHS Wellness Benefit is a program to assist members in managing their health and wellbeing. These unique benefits are available to all members holding extras cover and each of our packaged covers excluding FlexiSaver. CBHS Wellness Benefit covers you for a variety of health checks and programs designed to assist you in better managing your health and wellbeing. Health Checks CHBS provides eligible members with 90% of the cost of a variety of health checks (when the service is not eligible for a Medicare benefit) up to the annual limit depending on the level of cover (see below for limits). Health checks included are: Breast examinations Bone density test Skin cancer screening Bowel/prostate cancer screening Eye screenings Health Management A series of programs are available for eligible members who can receive a benefit of up to 90% of the cost up to the annual limit on these programs: Quit smoking programs 1 Weight management programs 1 Stress management courses 1 Yoga 2 Pilates 2 Gym membership 2 Personal training 2 Wellness benefits Prestige KickStart All other Extras and Packaged covers (excluding FlexiSaver) Health Checks $300 $100 $200 Health Management $200 $100 $100 Gym Membership or Personal Training $230 (sublimit $200 for personal training) $115 (sublimit $100 for personal training) $115 (sublimit $100 for personal training) 1 Must be approved by CBHS 2 CBHS can only pay a benefit for gym membership/personal trainer/pilates/yoga where the gym/personal trainer/yoga/pilates service is provided as part of a health management program, certified by your GP or a recognised provider confirming that the gym/personal trainer/yoga/pilates program is a health management program. Approval form is available from the CBHS website. Please note that GP consultations are not covered by CBHS. The CBHS Choice Network is a group of over 3,000 dental and optical providers who are committed to providing exceptional treatment to our members while reducing or removing the gap for Extras services on selected preventative dental treatments, optical frames, lenses and contact lenses. For more information about the CBHS Choice Network and to find a provider, visit cbhs.com.au/choicenetwork Recognised providers In addition to our choice network, we pay benefits for services provided by recognised providers in accordance with the CBHS Health Benefit Rund Rules and the applicable Government regulations. Various types of providers are deemed to be recognised providers based on the services which they offer. For more information about this criteria, please visit cbhs.com.au/recognisedproviders Exclusive benefits for Prestige Package and Top Extras Home visits by registered nurse A benefit exclusively for our Prestige package and Top Extras members, where an in home visit is required by a registered nurse, CBHS will pay a benefit of 70% of the cost up to $80 for less than four hours and up to $120 for more than four hours. An annual benefit limit applies of $2,800 per person. Travel and accommodation Another exclusive benefit for our Prestige Package and Top Extras members, to help offset the cost of traveling long distances to medical appointments. Eligible members can receive a benefit of 50% of the cost for accommodation (single room rate), airfare, train, bus or 15c per kilometre for car travel up to the annual limit of $ Travel is only payable for a patient who requires essential medical and dental treatment, where it is not available at a facility within a 160km round trip of the member s home. In order to claim travel a patient must be visiting a specialist and will require a referral letter. Excludes Ronald McDonald house.

17 31 Understanding Extras Cover CBHS Extras benefits are based on a percentage benefit of the providers fee up to a CBHS limit per service capped by a sub-limit or overall limit. Extras cover Prestige and StepUp; Top, Intermediate and Essential KickStart FlexiSaver Benefit Percent 70% of the cost up the maximum claimable amount per service 100% of the cost up the maximum claimable amount per service 55% of the cost up to the annual combined limit Working out Extras benefits When you make a claim on Extras cover, you receive a percentage (refer to the table on pages and for the benefit percent for each product) of the total cost of each particular item you claim up to the maximum claimable amount per service (see pages and for details of maximum claimable amounts). To make a claim, the item must also be included in your cover and you must not have exceed your overall limit in the benefit period. 70% service fee = $42 which is more than the per service benefit ($36) CBHS Benefit payable = $36 Dentist Fee $60 FlexiSaver 55% of service fee = $33 CBHS Benefit payable = $33 Government incentives The Australian Government Rebate on private health insurance All Australians eligible for Medicare have access to the Australian Government Rebate on private health insurance, which is a subsidy on the cost of private health insurance. This rebate is income tested against a person s level of assessable income for tax purposes, with the rebate being paid by the Australian Government, directly to the health fund. From 1 April 2014, contribution to an individual s private health insurance rebate is indexed annually by the lesser of the Consumer Price Index (CPI) or the actual average increase in the premium charged by insurers. If you are eligible for the rebate this change effectively means that the rebate percentage you receive today is going to be reduced every year that the average increase of premiums for all insurers is higher than the CPI. If you are not eligible for rebate this change does not affect you. Your rebate percentage is calculated based on your income level and your age. Please visit the Government website to see the latest rebate details: Medicare Levy Surcharge The Medicare Levy Surcharge is charged to individual high-income earners who do not have an appropriate level of private hospital cover. To avoid the Medicare Levy Surcharge, simply choose any CBHS hospital or package cover. For more information on the Medicare Levy Surcharge, contact the Australian Taxation Office on Lifetime Health Cover loading On the 1st July following your 31st birthday, for every year you delay taking out hospital cover, the government adds a 2% loading. This loading continues to increase each year you are without cover. For people who are currently paying a Lifetime Health Cover Loading, it will be removed after 10 years of continuous paid hospital cover. Further details on the Lifetime Health Cover Loading can be found at: 32 Dentist Fee $40 70% service fee = $28 which is less than the per service benefit ($36) FlexiSaver 55% of service fee = $22 CBHS Benefit payable = $28 CBHS Benefit payable = $22 Benefit period Each item (or group of items) where a benefit is payable by CBHS on Extras and Package covers has a overall limit and a benefit period in which that limit can be used. In most cases, the limits are per person, per, however some services renew each 3- or 5-years or once in the lifetime of the cover. Benefits which attract any 3 or 5-year period are renewed on the same date which the service was performed respectively. Extras waiting periods (calendar months) Crowns, bridges, orthodontia, artificial aids, healthcare appliances, oxygen apparatus and hearing aids Prescribed optical appliances, periodontics, endodontics, facings, occlusal therapy, implants and dentures All other services 12 months 6 months 2 months

18 33 Additional information 34 Pre-existing conditions If a member has a pre-existing condition, a waiting period of 12 months will apply before we will pay hospital or medical benefits towards any treatment for that condition. A pre-existing condition is defined as an ailment, illness, or condition where the signs or symptoms existed at any time in the period of 6 months ending on the day on which the person became insured by a policy. It is the opinion of the CBHS appointed doctor that determines whether the signs or symptoms were in existence that doctor, however, will have regard to any information provided by the member s doctor. Members must also wait for 12 months to be covered for pre-existing conditions where they upgrade their cover. Complaints handling and dispute resolution policy CBHS respects your right to make a complaint and recognises the value of complaints as an important tool in monitoring and responding to customer expectations. To obtain a copy of the CBHS Complaints and Dispute Resolution Policy visit our website or contact our Member Care team on Private Health Insurance Ombudsman You may also contact the Private Health Insurance Ombudsman by: Phone (free call anywhere in Australia, mobile charges may apply) info@phio.gov.au Post Private Health Insurance Ombudsman Office of the Commonwealth Ombudsman GPO Box 442 Canberra ACT 2601 Private health insurance code of conduct The Private Health Insurance Code of Conduct is a self-regulatory code to promote informed relationships between private health insurers and consumers. As a signatory to the Code of Conduct, CBHS has made a commitment to ensuring: Consumers receive the correct information on private health insurance from appropriately trained staff Consumer awareness of the internal and external dispute resolution process Clear and complete policy documentation Ensuring that all information between the consumer and CBHS is protected in accordance with privacy principles. Detailed information on the Private Health Insurance Code of Conduct can be obtained at privatehealth.com.au/codeofconduct, by visiting our website or by contacting Member Care on Cooling off period If you are not satisfied with your health insurance for any reason, you have 30 days from the receipt of your CBHS policy to cancel your membership and receive a refund provided you have not made a claim or have no pending claims. Health benefit fund rules There are rules and conditions surrounding membership of CBHS. Many are regulated by Commonwealth law. For information regarding the Health Benefit Fund Rules visit cbhs.com.au. Privacy Statement CBHS respects your privacy. Protecting personal information is important to CBHS and is required by law. CBHS handles personal information in accordance with the provisions of the Commonwealth Privacy Act 19 and the National Privacy Principles under that Act. To obtain a copy of the CBHS Privacy Policy visit our website cbhs.com.au or contact Member Care on This brochure offers an overview of complex information. 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 in conjunction with the CBHS Health Benefit Fund Rules before joining. A copy of the Health Benefit Fund Rules can be downloaded from cbhs.com.au. This information should be read carefully and retained. The information contained in this brochure is true and correct at the time of printing - 1 March 2016.

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