Medicare Benefit Schedule

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 OVHC and OSHC can help you.

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 OVHC (excluding OVHC Base Hospital) and 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 Choice Network.

If you see any GP from the above recognised services, we will pay for the GP’s fee, up to the relevant service limit. OVHC members may incur a $10 out-of-pocket fee.

What are gap fees?

A gap fee, also known as ‘co-payment’, is an out-of-pocket expense you must 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 charges. For GP services, it is best to use our online doctors service or any clinics within our  Choice Network. Using either of these services will attract no gap fee as we cover these costs up to the relevant service levels. OVHC members may incur a $10 out-of-pocket fee.

However, if you visit a doctor that is not part of our network, you may have an out-of-pocket expense. We recommend that when you book the appointment, ask them how much it will cost. Once you have paid the bill, you can submit the claim to CBHS International Health. We will pay the amount listed on the Medicare Benefits Schedule (MBS). This means you could have 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 $39.10*. Therefore, you will have an out-of-pocket expense of $35.90.

If you are not sure please call our 24/7 medical, interpreter and personal assistance helplines:

Students: 1300 174 538^{^}
Workers: 1300 174 537^{^}

*Correct as of 1 January 2022. MBS rates are updated annually.

Prescription Gap Fees

OSHC

If you have been prescribed medicine by your doctor, you can submit a claim. You will be reimbursed up to $50 per 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 2022 Pharmaceutical Benefits Scheme (PBS) co-payment of $41.50). If your prescription costs $150, you will receive a benefit of $50 (as $150 less the current PBS co-payment of $41.50 is higher than $50). Your maximum annual limit will remain at $300 (single) or $600 (couple/family) per calendar year.

OVHC

You will receive a benefit of up to $75, calculated as follows: the receipted cost of the prescription for selected pharmaceutical items (including discharge medication) less a co-payment equivalent to the current prescribed Pharmaceutical Benefits Scheme (PBS) co-payment for general patients.

• Overseas Worker Base Hospital: Not covered
• Overseas Worker Mid Hospital: $300 per person per calendar year
• Overseas Worker Top Hospital: $600 per person per calendar year