Most Australian taxpayers pay an annual Medicare Levy on their taxable income each year. This helps fund Medicare, the public healthcare system that provides free or subsidised cover for certain healthcare services to Australian citizens and permanent residents. On top of this, if you do not have private health insurance you may be charged the Medicare Levy Surcharge (MLS) of between 1%-1.5% if you earn above a certain income. The base income threshold (under which you are not liable to pay the MLS) is $90,000 for singles and $180,000 for families.

It’s important that you contact us when you arrive in Australia so we can activate your cover, update your local contact details and send your membership card/s.

Many Australians who take out Private Health Insurance cover can claim a rebate to help contribute towards the cost of their premiums. The rebate is income tested and applies to domestic hospital and ancillary (Extras) products. The rebate does not apply to OVHC. You could be eligible for the rebate if you have Medicare and an Australian domestic product such as Extras. For more information about the Australian Government Private Health Insurance rebate you can visit www.privatehealth.gov.au or the Australian Taxation Office at www.ato.gov.au

The Pharmaceutical Benefits Scheme (PBS) is an Australian Government program that subsidises some prescription medicines to make them more affordable for residents. Generally, overseas visitors to Australia are not eligible for subsidised prescription medication under the PBS. Overseas visitors from countries with which Australia has a Reciprocal Health Care Agreement (RHCA) are also eligible to access the PBS.

For members who hold Overseas Worker Mid Hospital and Medical or Overseas Worker Top Hospital and Medical cover, there is a benefit. For selected pharmaceutical items (including discharge medication), you will receive a benefit up to $75, calculated as follows: the receipted cost of the prescription less a co-payment equivalent to the current prescribed Pharmaceutical Benefits Scheme (PBS) co-payment for general patients.

A pre-existing condition is an illness or medical condition, the signs or symptoms of which existed at any time in the period of six months before the person became insured under an OSHC or OVHC policy. This is determined by a medical advisor appointed by CBHS International Health and takes into consideration any information provided by the member’s Health Care Provider.

Australia has RHCAs with the following countries:

• United Kingdom
• New Zealand
• Italy
• Belgium
• Malta
• Netherlands
• Sweden
• Finland
• Norway
• Slovenia
• Republic of Ireland

Residents from these countries are entitled to Reciprocal Medicare for medically necessary treatment while in Australia.

Exclusions are services that are not covered under your policy. You can seek services for the exclusions but CBHS International Health will not pay any benefits. Examples of exclusions under our health cover are:

• Non-admitted hospital psychiatric services
• Assisted reproductive services
• Cosmetic surgery
• Stem cell, bone marrow and organ transplant
• Other services for which a Medicare benefit is not payable.

You’ll have to pay a gap fee if the amount the medical provider charges is more than the benefit you’re entitled to under your cover. You’ll need to pay the gap fee yourself – you won’t be able to claim that amount. For example, if you have a standard consultation with a doctor and charged the MBS fee of $37.05, your policy would pay 100% and you would have no gap. If the doctor charged $50 then your policy would pay $37.05 (equal to the MBS benefit) and you would have to pay $12.95 which is the ‘gap’ between the benefit your policy pays and the cost of the service.

Sometimes you must wait for a period of time before you’re able to claim benefits for services under your CBHS International Health cover – this is called a waiting period. The following waiting periods apply to our policies:

• Accidents, emergency ambulance transport: 1 day
• All other treatments (including pre-existing conditions relating to hospital psychiatric services, rehabilitation and palliative care): 2 months
• Product upgrades – waiting periods must be served for services that were not available on your previous product: 2 months for outpatient services (not including pregnancy related services) and 12 months for pre-existing medical conditions, pregnancy, birth and terminations.
• Pre-existing medical conditions: 12 months
• Pregnancy-related services, including miscarriage and termination: 12 months 

The public healthcare system is run by the government and is called Medicare. Medicare covers things such as:

• Treatment by a doctor or general practitioner (also called GPs)
• Treatment by a specialist
• Prescription medication
• Treatment in a public hospital

If you are entitled to Medicare and have a Medicare card you will receive benefit to help pay for these services. If you are not entitled to Medicare, then your OVHC can help pay for these services.

These are medical services you receive in the emergency department of a hospital, but you have not been formally admitted to hospital.

For example, if you consulted with a hospital doctor, had a blood test or x-ray while you were in the emergency department of a hospital, but had not been formally admitted into hospital, this is known as outpatient services.

The formal hospital admission process usually includes you being given a hospital wristband and allocated a hospital bed in a hospital ward (rather than the emergency department). This only happens when you’ve been assessed and meet certain criteria. If you meet the hospital criteria for admission, it is because your doctor has decided you need to stay in hospital (at least overnight) - or you've had pre-planned day surgery/procedure (such as a colonoscopy) and need to be admitted for inpatient care.

If you have not been formally admitted to hospital for an overnight stay when you went to the Hospital emergency department or attended day surgery, your medical treatment you received is outpatient services.

This is medical treatment you receive once you have been formally admitted to hospital.

The formal hospital admission process usually includes you being given a hospital wristband and allocated a hospital bed in a hospital ward (rather than the emergency department). This only happens when you’ve been assessed and meet certain criteria. If you meet the hospital criteria for admission, it is because your doctor has decided you need to stay in hospital (at least overnight) - or you've had pre-planned day surgery/procedure (such as a colonoscopy) and need to be admitted for inpatient care.

Inpatient services include pre-planned hospital admissions for day surgery or a medical procedure (for example colonoscopy). This is where you have day surgery or a medical procedure done, then later the same day you go home. Day surgery or medical procedures can be considered inpatient medical treatment if you need inpatient care, even if you don't need to stay overnight at the hospital.

Overseas workers and visitors are generally not eligible for Medicare; the public health system for Australian residents and citizens. If you need medical attention while you’re in Australia and you don’t have health cover, it can be very expensive, to be treated in either the public or the private healthcare system.

Accidents happen and people get sick. Your CBHS International Health cover makes sure you’re covered if you have an accident or illness while you’re in Australia. Make sure you understand what your chosen policy covers you for.

 

What is Medicare?

Medicare is the Australian Government’s public healthcare system. Medicare covers things such as:

• Treatment by a doctor or general practitioner (also called GPs)
• Treatment by a specialist
• Certain prescription medication
• Treatment in a public hospital

If you're entitled to Medicare and have a Medicare card, you will receive benefits to help pay for these services. If you're not entitled to Medicare, then your OVHC can help pay for these services.

As most overseas visitors or workers are not eligible for Medicare (our publicly funded healthcare for residents and citizens), getting an appropriate level of health cover is a requirement for a range of work and visitors visas. Some visa subclasses must purchase and provide proof of acceptable OVHC when applying for their visa and maintain cover for the entire time they are in Australia.

Depending on the type of cover you buy, your OVHC will keep you protected against some of the costs of medical treatment if you get sick or have an accident. Some treatments can cost thousands of dollars!

Yes. If your visa application is refused or cancelled, you will need to provide CBHS International Health with a copy of any correspondence you receive from the Department of Home Affairs (previously known as Department of Immigration and Border Protection (DIBP)) refusing or cancelling your visa. CBHS International Health may be required to report policy cancellation to the Department of Home Affairs.

If you come from a country that has a RHCA with Australia, and your taxable income reaches the MLS threshold, then you may have to pay the MLS. This could mean that you will need to pay an additional 1% - 1.5% in tax unless you have appropriate private hospital cover. To find out more about the MLS and tax, you should seek independent tax advice or visit the Australian Taxation Office at www.ato.gov.au

Medicare: www.humanservices.gov.au/customer/dhs/medicare

Private Health Insurance: www.privatehealth.gov.au

If you have taken out your OVHC cover prior to your arrival in Australia, and paid one month’s premium, CBHS International Health may apply an administration fee equal to one month’s premium contribution.

If you have paid more than one month’s premium, CBHS International Health will retain an administration fee equal to one month’s premium contribution and will refund the balance of the premium paid.

If you are already in Australia and withdraw or cancel the policy within 30 days of the start date of the policy, CBHS International Health will retain an administration fee equal to one month’s premium contribution.

Reciprocal Health Care Agreements (RHCAs) vary from country to country, so it’s important to understand what you are and aren’t covered for before deciding on health insurance. Even if you’re entitled to reciprocal benefits, Medicare does not cover you for everything and without health insurance you will need to pay for these services. The list below gives examples of services that are NOT covered under RHCA.

• Ambulance
• Dental care
• Elective treatment
• Funerals
• Medical evacuation to your home country
• Paramedical services, for example blood tests
• Treatment and accommodation in private hospitals, or as a private patient in a public hospital
• Treatment that is not immediately necessary.

If we do not have your bank account details on file, we will attempt to contact you by email twice over a period of 60 days to request your bank account details. If we do not receive a response from you within 60 days, we will hold the amount of the refund (less an administration fee), pending contact from you. We'll keep your details on file for seven years after cancelling your membership, and you may contact us to claim your refund at any point during this time.

• OVHC administration fee is $50 (AUD). 

If you don’t have an Australian bank account, we can process the refund via foreign transfer less the bank’s foreign transaction fee of $37.00 (AUD). If the refund amount due is less than $50 (AUD), foreign transfer is not an option. In this case, CBHS International will apply the refund as an administration fee.

• OVHC administration fee is $50 (AUD).