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 is a restricted service
  • Which are the restricted services in your cover and how these vary depending on the hospital
  • What Medicare covers vs. what CBHS covers

Why you should understand Restricted Services

Understanding which services are restricted 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.

Restricted Services

There are three major categories of services in private health insurance: included, restricted, or excluded. Restricted services are treatments or services that attract only partial benefits, which means you will only be partially covered for these items or services.

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) as a private patient for the treatment. As such, with restricted services you may have to pay significant out-of-pocket expenses.

What does Medicare pay and what does CBHS 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 100% of the schedule fee (from Medicare) for inpatient GP services. For non-GP services provided outside a hospital, you can claim 85% of the schedule fee as a rebate. In a private hospital, Medicare refunds 75% of the schedule fee. In public hospitals you are not charged for care and treatment.

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 amount unless your cover level provides benefits for the gap. Most CBHS covers provide benefits for 25% of the schedule fee for services received in private and public hospital when you are an admitted patient. For Livelife (Gold) and CBHS Prestige (Gold) products an additional $200 can be claimed under the Gap Assist benefit.

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 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 only.

CBHS' Benefits

The benefits that CBHS 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 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 offers generous hospital benefits to members under its packaged cover and hospital cover. 

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

Hospital cover:

Packaged cover:

Do you need more information?

CBHS’s claims support service is just one of the areas in which we deliver exceptional member care. If you have any questions about online claiming or submitting claims, contact us directly on 1300 654 123 or email