Restricted and excluded services

CBHS Corporate Health is dedicated to providing members with some of the lowest premiums in the industry. We offer members a comprehensive range of insurance products to suit all ages and lifestyles.

To ensure fairness and to give members more choice, the products we offer vary in the benefits payable. The information on this page will help you understand the following:

  • What are restricted and excluded services
  • Which are the restricted and excluded services in your cover and how these vary depending on the hospital
  • What Medicare covers vs. what CBHS Corporate Health covers

Why you should understand Restricted and Excluded Services

Understanding which services are restricted and excluded in your cover can help you plan more effectively for a hospital stay or medical treatment. It enables you to choose the right hospital so that you can minimise your out-of-pocket expenses and be fully aware of the cost of your hospital stay.

There are three major categories of services in private health insurance: covered, restricted, or excluded. Covered services is self-explanatory and relate to what is listed as covered on your hospital cover.

Restricted Services

Restricted services are treatments or services that attract only partial benefits, which means you will only be partially covered for these items or services in a private hospital.

These services or treatments might only attract the public hospital rate or something less than full benefits. They might only be covered if you stay in a public hospital (and not a private hospital) for the treatment. As such, with restricted services you may have to pay significant out-of-pocket expenses.

Excluded Services

Excluded services are treatments or services that do not attract any benefits from CBHS Corporate Health and or Medicare. Such services may include cosmetic services, podiatric surgery and laser eye surgery. As such, with excluded services you will have to pay significant out-of-pocket expenses for hospital and medical treatment or services.

What does Medicare pay and what does CBHS Corporate Health cover?

What Medicare Pays

The Medical Benefits Schedule determines what Medicare pays (or the rebate you receive from Medicare). The Medicare Benefits Schedule (MBS) is a list of medical fees set by the Australian government that acts as a guide for rebates. These schedule fees are what the government considers to be a fair price for specific services.

You can claim 75% of the schedule fee (from Medicare) for inpatient doctor's services and a minimum of 25% of the schedule fee from CBHS Corporate Health. For doctors services provided as a non-admitted patient in a hospital, you can claim 85% of the schedule fee as a rebate. These rates apply whether you are treated in a private or public hospital.

The Schedule is a guide only, and doctors and specialists are free to charge above the Schedule amounts. This means you will need to pay the gap. All CBHS Corporate Health hospital covers provide a minimum benefit of 25% of the schedule fee for services received in private and public hospital when you are an admitted patient. 

Note also that the MBS does not cover medications; the Pharmaceutical Benefits scheme looks after subsidies for prescription medications. Medicare does not cover private patient hospital costs (this is covered by CBHS Corporate Health subject to your level of cover) or medical and hospital costs incurred outside Australia. Additionally, Medicare does not cover ambulance services and services that it considers are unnecessary. This includes surgery that is carried out for cosmetic reasons.

CBHS Corporate Health’s Benefits

The benefits that CBHS Corporate Health pays you will depend on your coverage level and your choice of hospital. To find out more, read the information below on included, excluded, and restricted services.


What are Agreement Hospitals?

CBHS Corporate Health has agreements with most private hospitals and day surgeries in Australia to keep the costs of hospitalisation lower and more predictable for members. If you stay at an agreement hospital, then depending on your level of cover, you might be covered for everything from bed fees and intensive care to coronary care fees and theatre and labour ward fees. If you choose to stay at a non-agreement hospital, you will be covered only up to pre-set limits that are set by the government and will need to pay large out-of-pocket costs.

To find out whether your hospital is an agreement hospital, use this search tool.

Restricted Services

CBHS Corporate Health offers generous hospital benefits to members under its hospital cover. 

To view details about a cover's restrictive service, please click the appropriate link below.

Three levels of hospital cover:

Contact Us

CBHS Corporate Health has made trust, reassurance and outstanding service our core values. We offer our members complete exclusivity and affordable premiums, and we’re here to support you with answering any questions you may have about restricted services under your hospital and other cover products.

To find out more, we invite you to contact our friendly support team on 1300 586 462, or send an email to