Silver Plus Hospital will cover you for:

• Accommodation for overnight, same day and intensive care for private or shared room in agreement private and public hospitals.
• Theatre 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 all 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 Corporate Health 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 Corporate Health 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 with 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 or covered under hospital agreements (excluding restricted services*).
• Hospital Substitute Treatment means the possibility of receiving rehabilitation treatment or the care of a registered nurse at home.

* Check the 'What's partially covered' for a list of the restricted services.

*Restricted Benefits (Services) not fully covered

The services listed below, when provided in a private hospital, are eligible for Minimum Default Benefits prescribed by private health insurance legislation. These benefits relate to hospital bed charges and are unlikely to cover the fees charged for a private hospital admission. Members may incur large out of pocket expenses for theatre fees together with the difference between the Minimum Default Benefit and the bed charge raised by the hospital.

The services listed below are also eligible for hospital benefits in a public hospital at a shared room rate. Public hospitals do not raise charges for theatre use.

• Hospital psychiatric services
• Podiatric surgery (provided by a registered podiatric surgeon)*
• Palliative care services

*Indicates benefits for accommodation at Minimum Benefits in relevant PHI (Benefit Requirements) Rules and prostheses benefits based on items listed by the Minister of Health. No benefit for medical or theatre costs.

Silver Plus Hospital will not cover you for:

• If member is admitted into a non-agreement private 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 non-agreement private 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 may be eligible for benefits from Extras cover).
• Aids not covered in a 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.
• Ambulance transfers between hospitals (for residents in VIC, SA and NT).

Exclusions:

For treatment listed as an exclusion there is no benefit payable and member will incur significant out of pocket expense for these services. Please review the exclusions on this cover and always check with CBHS Corporate Health to see if you are covered before receiving treatment. The following services are excluded from this cover:

• Pregnancy and birth
• Assisted reproductive services
• Joint replacements
• Weight loss surgery
• Cosmetic services
• Services for which a Medicare benefit is NOT payable

Waiting periods:

Waiting periods apply to those who are new to private health insurance or those who already have cover with CBHS Corporate Health or another fund, and choose to upgrade to a higher level of cover.

Parts of waiting periods served within one health fund can be completed in another when a person transfers funds. If you upgrade your level of cover waiting periods may apply to benefits not previously included within your original cover.

Excess

An excess is the amount you pay towards the cost of your hospital admission before any benefit is payable. By paying an excess you can reduce the cost of your hospital cover. You can choose from one of these excess options available - $0, $250, $500 or $750.

If you choose an excess, it means that when you go into hospital (same-day or overnight) you will pay the chosen excess amount directly to the hospital. The excess is only payable once per person up to a maximum of twice per couple/family membership per calendar year. Excesses do not apply to any dependant children on the policy.