Member forms

CBHS recognises that having access to simple and fast claiming is important to our members, which is why we have a quick and easy online eClaim system.  We also offer a range of options for submission of claims. On this page you’ll find our claim form, along with other forms such as our membership application, direct debit request and change of details forms. Please click to download the forms or right click to save the form to your computer. To learn how to digitally sign a PDF, please click here.

Accident/Injury/Condition Form

The Accident/Injury/Condition Form allows CBHS to access the member’s claim in relation to an accident, injury or condition. You’ll need to outline the nature of the injury or condition and provide other relevant details such as date of occurrence and whether the injury occurred at work.

Authority to Act Form

Transfer Certificate Request Form

Use this form to transfer your membership to CBHS from another private health insurer. This form authorises CBHS to cancel your existing membership and it facilitates a quicker transfer, as benefits can’t be paid to you until your former fund forwards a certificate of clearance to us. If you and your partner are both transferring to CBHS from separate memberships, please complete separate forms for each individual.

Changing your payment method

You can manage your account by logging into the Member Centre.

CBHS offers members a number of different options for paying premiums. As a member, you can elect to have your premiums automatically deducted from a nominated account once a month or every fortnight. Other payment options such as 3, 6 or 12 months in advance are also available.

Health Management Program Authorisation Form

Use this form to claim benefits for approved healthcare programs under CBHS Wellness Benefits. You will need to ask your health care provider to complete the relevant sections of this form.

Student Dependant Declaration Form

You can manage your account by logging into the Member Centre.

While dependants can remain on their sole parent or family cover until they are 18 (or up to 25 on Non-student Dependant covers) unmarried dependents can be covered under their parent’s or family cover until they turn 25 if they are full-time students. Use this form to confirm your child’s status as a student dependent on your cover.

Australian Government Rebate on Private Health Insurance Application Form

Use this form if you want to receive the Australian Government Rebate on Private Health Insurance as a reduction on your insurance premiums, or if you want to change your details in regard to these rebates.


Forms should be lodged directly to CHBS rather than the Department of Human Services. We will process these forms on your behalf.

Claim Form

Looking for an easier way to make claims?

You can make claims instantly with the CBHS app,  available for download on the App Store and Google Play.
You can claim online through the Member Service Centre.

Members who claim online typically receive their benefits within 1-2 working days. Most services can be claimed online and the total fee for the eClaim should be $500 or less.

Lodging a paper claim

If you need to lodge a paper claim simply follow the instructions below:

Use this claim form to make a claim for any Extras, Medical and/or Hospital services. You should read this form carefully as it contains information on important matters such as claims, additional documents to support your claim, and our privacy policy in relation to collecting your information.

Medicare Claim Form

Submit your claims to Medicare by using this form.

Medicare Two-Way Claim Form

Use this form for service providers who do not participate in Access Gap and bill you directly. This form allows Medicare to forward your claim to us for remaining benefits after they have processed your claim.

Change of Details

Members can update their details by logging into the Member Centre or calling CBHS on 1300 654 123.

Suspension Form

You can use this form to apply to suspend your cover for a fixed period of time, whether the suspension is related to financial hardship, travel or leave without pay. Find out more about suspending by calling us on 1300 654 123 or contacting us by email at ​

Contact Us

CBHS values exceptional member care as one of our service priorities. Feel free to contact us if you have any questions about any part of the claims process. Our friendly team is ready to assist you with your queries, and we invite you to connect with us by calling 1300 654 123 or sending an email at