Covid-19 Information

Australian Health System & Gap fees

Gap Fees

At CBHS International Health, we are more than just another health insurance provider. We want to look after you during your time in Australia as your health and wellbeing are just as important to us as they are for you. It is also important that you understand how the Australian public health system works, how it affects you and how your CBHS International Health insurance helps you navigate the system.


Why you must have Overseas Student Health Care (OSHC)

You must maintain OSHC cover as required by your student visa conditions, from the commencement to the expiry date of your visa. Also, it helps you with the cost of health care if you get sick or have an accident while you are studying in Australia.  Overseas students are not eligible for Medicare (the public health system for most Australian residents), and without access to Medicare you may have large out-of-pocket expenses. This is one area your OSHC can help you.

Your OSHC provides cover for the cost of:

Consultations
Consultations from doctors within our network available online or face-to-face.
Treatment and accommodation
Treatment and accommodation when admitted to hospital as an inpatient.
Emergency
Emergency transportation directly to hospital or on the spot treatment due to accident or emergency.
PBS
Benefits for prescription medicine listed on Pharmaceutical Benefits Scheme (PBS) Schedule.

 

Click here to see the full list or refer to the Policy Member Guide for more information and details. 

Medicare Benefits Schedule (MBS)

The Medicare Benefits Schedule (MBS) is a list of medical services for which the Australian Government will pay a Medicare rebate to provide Australian patients with financial assistance towards meeting the cost of their medical services. Since you are not eligible for MBS, this is another area your OSHC can help you. To explain it further, let’s look at seeking medical help when you are feeling unwell.

What is a GP provider?

If you feel sick with a bad cold or flu for example, or you need a general health check-up, the first person you should consult is a doctor, known in Australia as a General Practitioner (GP).

Under your OSHC, you can access a GP via:

  • Online doctor: speak to a fully qualified GP based in Australia from the comfort of your own home via your smartphone or desktop.
  • Visit any GP within our GP Network.
GP Provider

If you see any GP from the above recognised services, we will pay for the GP’s fee, up to the relevant service limit

What are gap fees?

A gap fee, also known as ‘co-payment’ is an out-of-pocket expense you have to pay when you receive medical treatment that costs more than what you can claim back from CBHS International Health. It is the difference between the MBS rebate and the fee the medical provider actually charges. For GP services, it is best to use our online doctors service or any clinics within our GP network as mentioned above. Using either of these services will attract no gap fee as we cover these costs up to the relevant service levels.

However, if you visit a doctor outside of our network or not one of our contracted online doctor services you will attract an out-of-pocket expense. It is advised to ask them how much it will cost when you book an appointment. After you have paid the doctor’s schedule fee then you will need to claim the fee back from CBHS International Health. CBHS International Health will only pay the amount covered by the Medicare Benefits Schedule (MBS). This means you could end up with significant out-of-pocket expenses.

For instance, your doctor could charge you $75 for a visit (level 2 scheduled fee). When you submit a claim to CBHS for that amount, CBHS will pay you an amount back that is determined by the Medicare Benefits Schedule (MBS). In this example, the MBS Benefit for a Level 2 consultation is $38.75. Therefore, you will have an out-of-pocket expenses of $36.25.

If you are not sure please call 1300 174 538 for our 24/7 medical, interpreter and personal assistance helpline.

Prescription Gap Fees

If you have been prescribed medicine by your doctor, you can submit a claim. You will be reimbursed up to $50 per an approved prescription item, up to $300 in a calendar year (single) or $600 (couple/family). The benefit paid will be for expenses exceeding the equivalent of the current PBS co-payment amount.

For example, if your prescription costs of $90, you will receive a benefit of $49 ($90 less the 2020 Pharmaceutical Benefits Scheme (PBS) co-payment of $41). If your prescription costs $150, you will receive a benefit of $50 (as $150 less the current PBS co-payment of $41 is higher than $50). Your maximum annual limit will remain at $300 (single) or $600 (couple/family) per calendar year.

GP Provider

Hospitals are for emergencies and booked operations

Ambulance

An emergency is any medical problem that causes extreme pain, severe blood loss, or could cause death or permanent injury if not treated quickly. An example of an emergency is having difficulty breathing, going into labour (child birth) or being hit by a car.

If you attend the hospital and it is not an emergency, you will be paying unnecessary high costs. To avoid these high costs, seek medical help from the above options under ‘What is a GP Provider?

Callcentre

you are planning surgery or an operation, or you find out suddenly you need one, contact us as soon as possible. We can advise you about the services available under your cover, which includes our contracted private hospitals.

Require further assistance?

If you require further assistance, please call the 24/7 medical, interpreter and personal assistance helpline on 1300 174 538^ and select Option 2. Anytime. Any day. 

For membership related enquiries, please contact the International Health team on the above number and press 1 or 3 between 8am-6pm (Sydney local time) Monday to Friday.

Email us: oshc@cbhscorp.com.au

^CBHS International Health may refer you to third party providers when you use the medical, interpreter and personal assistance helpline. If you decide to engage a provider, it will be on the basis that CBHS International Health will not be responsible, and you will not hold CBHS International Health responsible, for any liability that may arise from that engagement.