Premium Package (Gold)

• 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, radiologists, pathology, imaging etc. Covered for all services eligible for benefits from Medicare up to the Medicare Benefits Schedule (MBS) fee. Members have their choice of doctor/surgeon in a public or 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 the Private Health Insurance legislation

• Pharmacy covers most drugs related to the reason for your admission in an agreement private hospital

• 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^*)

• Better Living programs to help you manage your health and wellness.

• Hospital Substitute Treatment means the possibility of receiving rehabilitation treatment or the care of a registered nurse at home.

Gap Assist

To further help you reduce your out-of-pocket expenses as a result of hospitalisation, Premium Package (Gold) also includes a medical gap benefit called Gap Assist, $200 per person per calendar year towards out-of-pocket expenses.

The services listed below, when provided in a private hospital, are eligible for Minimum Default Benefits prescribed by the 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:

• Podiatric surgery¹ (provided by a registered podiatric surgeon)

^* A benefit is not payable in respect of a service that was rendered to a Member if the services can be claimable from any other source. ¹ 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.

• If a 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 drugs may be eligible for benefits from your Extras cover)
• Aids not covered in hospital agreement (may be eligible for benefits from your 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).

• Cosmetic services
• Services for which a Medicare benefit is NOT payable