CBHS Health Fund Ltd. (02) (general fax line) (02) (provider relations direct)

Transcription

1 Fund Product Template Fund Name: CBHS Health Fund Ltd Postal Address: Locked Bag 5014 Parramatta NSW 2124 Telephone: Facsimile: (02) (general fax line) (02) (provider relations direct) Chief Executive Officer: Mr Keith Stockall Claims Enquiries: Membership Enquires: Patient Eligibility Checks: Patients eligibility checks via fax available to hospitals who do not have access to the internet ONLY. HELPER is an online service for hospitals to perform patient eligibility checks. If you do not have a password please call our Member Care Centre on and ask to be transferred to Provider Relations to begin the registration process. Registration is effective immediately. Excess: Overnight: Same Day: Hospital 'a' & Comprehensive Private Hospital cover Hospital 'a' Excess cover $350 per person up to a maximum of $700 for couple/family for overnight accommodation only - per calendar year. $100/ person for every day only admission with no yearly maximum - effective 1 October Comprehensive 100 or Comprehensive 70 hospital cover $100 or $70 each day up to a maximum of 6 days per person or 12 days per couple/family - per calendar year

2 Hospital 'b' & Limited Private Hospital cover (with benefit restrictions for some treatments) see attached for more details Excess: Overnight: Same Day: Hospital 'b' Excess hospital cover $350/ person up to a maximum of $700 for couple/family for overnight accommodation only per calendar year. $100/ person for every day only admission with no yearly maximum - effective 1 October Limited 100 or Limited 70 hospital cover $100 or $70 each day up to a maximum of 6 days per person or 12 days per couple/family - per calendar year. Hospital 'c' & Basic Hospital Public Hospital cover nil LiveLife Private Hospital cover $70 each day up to a maximum of 6 days per person or 12 days per couple/family - per calendar year. $70 excess is waived for children under 12 years of age. StepUp p Private Hospital cover (with benefit restrictions for some treatments - see attached for more details. $70 each day up to a maximum of 6 days per person or 12 days per couple/family - per calendar year. $70 excess is waived for children under 12 years of age. Kickstart Hospital Private Hospital cover (with benefit restrictions for some treatments - see attached for more details. $70 each day up to a maximum of 6 days per person or 12 days per couple - per calendar year. Overseas Visitors cover Private Hospital cover for overseas visitors nil

3 LiveLife, Comprehensive, Overseas Visitors Cover & Hospital a Hospital 'a' Excess hospital cover $350/ person up to a maximum of $700 for couple/family for overnight accommodation only per calendar year. $100/ person for every day only admission with no yearly maximum - effective 1 October Comprehensive 100 or Comprehensive 70 Hospital cover $100 or $70 each day up to a maximum of 6 days per person or 12 days per membership policy per calendar year LiveLife $70 each day up to a maximum of 6 days per person or 12 days per couple/family per calendar year. $70 excess is waived for children under 12 years of age. For all services that have an MBS item number, benefits are payable in Private Hospitals or Day Hospitals that have a Hospital Agreement with CBHS. Benefits for Prostheses are payable for non-cosmetic items that are Government approved. Cosmetic Surgery, Surgical Podiatry, Laser Eye Surgery, Reversal of Sterilisation and all other procedures that have no MBS item number will attract the "Minimum Benefits" according to the relevant Schedule of the Private Health Insurance Benefit Requirements Rules for accommodation. No benefit is paid towards the cost of theatre charges raised for these services. Benefits for Prostheses are payable for non-cosmetic surgically implanted items that are Government approved. UNDETERMINED COMPENSABLE CLAIMS Claims for undertermined compensable services should be accompanied with a completed Accident/Injury/Illness form. For compensable services where liability has been accepted by another party, please direct claim to relevant party.

4 Limited Hospital & Hospital b Hospital 'b' Excess hospital cover $350/ person up to a maximum of $700 for couple/family for overnight accommodation only per calendar year. $100/ person for every day only admission with no yearly maximum - effective 1 October Limited 100 or Limited 70 Hospital cover $100 or $70 each day up to a maximum of 6 days per person or 12 days per membership policy per calendar year The following Services receive "Minimum Benefits" only according to the relevant Schedule of the Private Health Insurance Benefit Requirements Rules for accommodation. Benefits for Prostheses are payable for non-cosmetic surgically implanted items that are Government approved. For all other services not mentioned below, are covered in accordance with the Hospital Agreement with CBHS Plastic & Reconstruction Surgery required - see notes 3, 4, 5 & 6 Clinical notes Cardiothoracic Pregnancy and Related Services Explanation of Notes Note 3 Clinical notes re required to determine whether the procedure is being performed as a result of a trauma, burn or cancer and is not a pre existing ailment. Note 4 Clinical notes required -Minimum Benefits if performed within 12 months of end of pregnancy, or if performed with item numbers 45564, or Note 5 Clinical notes required - Minimum Benefits if performed with item numbers 45564, or Note 6 Clinical notes required - Minimum Benefits if performed with item numbers 45564, 45565, or

5 Limited Hospital & Hospital b Hospital 'b' Excess hospital cover $350/ person up to a maximum of $700 for couple/family for overnight accommodation only per calendar year. $100/ person for every day only admission with no yearly maximum - effective 1 October Limited 100 or Limited 70 Hospital cover $100 or $70 each day up to a maximum of 6 days per person or 12 days per membership policy per calendar year The following Services receive "Minimum Benefits" only according to the relevant Schedule of the Private Health Insurance Benefit Requirements Rules for accommodation. Benefits for Prostheses are payable for non-cosmetic surgically implanted items that are Government approved. For all other services not mentioned below, are covered in accordance with the Hospital Agreement with CBHS Major Joint Replacement Reproductive Surgery & Assisted Reproduction Major Eye Surgery Sterilisation Gastric Banding Surgery Psychiatric Treatment, Rehabilitation, Palliative Care & services with no MBS item number and associated procedure items (see note 2) ie etc (see note 2) (see note 2) (see note 1) (see note 1) UNDETERMINED COMPENSABLE CLAIMS For compensable services Claims for undertermined compensable services should be accompanied with a completed Accident/Injury/Illness form. "Minimum Benefits" only according to the Schedule of the Private Health Insurance Benefit Requirements Rules (see note 7) Explanation of Notes Note 1 Clinical notes are (see note 8) Note 2 Clinical notes are required - Minimum Benefits only if this procedure is associated with a sterilisation procedure. Note 7 Clinical notes required - covered in accordance with the Hospital Agreement with CBHS where treatment using item is required for cancer and requires an arthrodesis and is not a pre-existing condition. Note 8 Clinical notes required - covered in accordance with the Hospital Agreement with CBHS when the procedure is for a revision of a total hip replacement where only part of the original total hip, is required - ie the tibia or the femur and is not a pre-existing condition.

6 Basic Hospital & Hospital c Basic Hospital & Hospital c All inpatient services that have MBS item number are limited to "Minimum Benefits" according to the Schedule of the Private Health Insurance Benefit Requirements Rules for accommodation in a Private Hospital. No benefits are payable for theatre costs raised for any services. Benefits for Prostheses are payable for non-cosmetic surgically implanted items that are Government approved. UNDETERMINED COMPENSABLE CLAIMS - claims for undertermined compensable services should be accompanied with a completed Accident/Injury/Illness form. For compensable services where liability has been accepted by another party, please direct claim to relevant party.

7 StepUp $70 each day up to a maximum of 6 days per person or 12 days per couple/family - per calendar year. $70 excess is waived for children under 12 years of age. Please note that any MBS Items NOT LISTED below or any Cosmetic Surgery, Surgical Podiatry, Laser Eye Surgery, Reversal of Sterilisation and all other procedures that have NO MBS item number receive 'Minimum Benefits' only according to the Schedule of the Private Health Insurance Benefit Requirements Rules for accommodation in a Private Hospital. Benefits for Prostheses are payable for noncosmetic surgically implanted items that are Government approved. The following MBS item numbers below ARE covered in Private Hospital or Day Hospitals that has a Hospital Agreement with CBHS. Investigations and Repairs Joint Reconstructions Appendix Tonsils Wisdom Teeth Pregnancy and Related Services D D D UNDETERMINED COMPENSABLE CLAIMS Claims for undertermined compensable services should be accompanied with a completed Accident/Injury/Illness form. For compensable services where liability has been accepted by another party, please direct claim to relevant party.

8 kickstart $70 each day up to a maximum of 6 days per person or 12 days per couple - per calendar year. Please note that any MBS Items NOT LISTED below or any Cosmetic Surgery, Surgical Podiatry, Laser Eye Surgery, Reversal of Sterilisation and all other procedures that have NO MBS item number receive 'Minimum Benefits' only according to the Schedule of the Private Health Insurance Benefit Requirements Rules for accommodation in a Private Hospital. Benefits for Prostheses are payable for non-cosmetic surgically implanted items that are Government approved. The following MBS item numbers below ARE covered in Private Hospital or Day Hospitals that has a Hospital Agreement with CBHS. Investigations and Repairs Joint Reconstructions Appendix Tonsils Wisdom Teeth D D D UNDETERMINED COMPENSABLE CLAIMS Claims for undertermined compensable services should be accompanied with a completed Accident/Injury/Illness form. For compensable services where liability has been accepted by another party, please direct claim to relevant party.

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