At CBHS we help you manage your health challenges. We believe in offering you the services, support and tools you need to live your best life.
Our Better Living Programs are available to support eligible members towards a healthier lifestyle. Each Better Living Program is subject to its own eligibility criteria.
Contact us for more information and to confirm your eligibility for a program.
Find a provider
Welcome to the CBHS Choice Network
At CBHS, we’re passionate about helping our members enjoy healthier, happier lives. And our Choice Network plays a large role in this commitment.
Consisting of 9,000+ dental and optical providers, our Choice Network partners are committed to providing exceptional treatment to all our members. They’re also dedicated to reducing or removing the gap for Extras services on optical frames, lenses, contact lenses and preventative dental treatments.
To begin your search, simply enter ‘Dentist’ or ‘Optometrist’ in the ‘I am looking for a …' field below and select a location. If the providers that come up in your search results have our ‘Choice Network’ logo beside their name, they’re part of our network.
You can also use the search function to find a wide variety of medical specialists and other health practitioners beyond dentists and optometrists. Just make sure you check your policy or call Member Care on 1300 654 123 to confirm if your policy provides any cover for these providers.
Disclaimer: Choice Network benefits are subject to overall and available limits at time of service.
What is a ‘gap’?
A medical ‘gap’ is the difference between what a doctor charges for treatment, and what your health fund and Medicare pay for that treatment.
The Australian Government has a set range of fees for many medical treatments. These are listed on the Medicare Benefits Schedule (MBS). Medicare pays 75% of the MBS fee and your health fund pays the remaining 25%.
However, doctors are free to set their own charges, and some charge above the MBS fee. When that happens, there’s a ‘gap’ and the patient is responsible for paying that gap.
It’s important to know that medical services are charged separately from hospital accommodation and theatre fee charges.
What is Access Gap Cover?
Access Gap Cover (AGC)
is designed to reduce or eliminate the medical ‘gap’. The aim is for you to end
up with minimal, or in some cases, no out-of-pocket medical expenses when you
receive treatment as an inpatient at a private
hospital, day hospital or as a private patient in a public hospital.
If a doctor treats you under the AGC scheme, they need to send
their accounts directly to us. However, if they bill you, please send the
accounts to us before you pay them, along with a complete claim form. Please do
not take the account to Medicare. We will pay your doctor/s directly, inclusive
of Medicare and CBHS benefits. We’ll be unable to reimburse you the AGC
benefits if you pay the accounts yourself.
Always ask for a written estimate before you go into hospital
for treatment.
What isn’t covered?
It is important to note that CBHS is only
able to contribute towards doctors’ fees and AGC charges when you’re admitted
into hospital. Under law the fund cannot make any payment towards any charges
associated with seeing doctors in their rooms, or any other outpatient setting.
How to find a doctor who participates in AGC
Not all doctors take part in the AGC scheme, and those who do may not call this out on their website.
Check the search engine below to find a doctor who may participate, or who has agreed to alternative ‘no gap’ arrangements. You’ll still need to ask the doctor if they’ll treat you under our CBHS Access Gap Cover arrangement.
Your doctor might not have used AGC before, but they may consider it if you ask them. Each doctor can decide on a case-by-case basis.
Questions to ask your doctor
- Will you treat me under the CBHS Access Gap Cover arrangement?
- Will I need to pay any out-of-pocket expenses for my treatment? If so, can you give me a written estimate of how much I’ll need to pay?
- Will any of the doctors assisting with my treatment also participate in Access Gap Cover?
- Will you send the bill to CBHS directly so that they can claim my Medicare Benefit on my behalf?
Doctors who do use the scheme will usually bill CBHS directly. This includes anaesthetists, surgeons and pathologists.
How to make a claim under AGC
If your doctor is participating in AGC, they may send their accounts directly to us. However, if they bill you, please send the accounts to us, along with a completed claim form. Please do not take the accounts to Medicare. We will pay your doctor/s, inclusive of Medicare and CBHS benefits.
Doctors using Access Gap Cover will usually bill CBHS directly. CBHS claims the Medicare benefit on your behalf and pays the Medicare and Fund benefits directly to your doctor. If your doctor sends the account to you, please forward it on to CBHS, clearly identifying it is to be claimed through Access Gap Cover. CBHS won’t be able to reimburse you at the Access Gap Cover rate if you take the account directly to Medicare or pay it yourself first. If your doctor would like more details on Access Gap Cover, please offer the information at the bottom of this page.
Please note
This search facility identifies doctors who may be participating in, or intend to participate in AGC, and those who agree to alternative no gap arrangements, but please note that doctor’s can ‘opt in’ or ‘opt out’ of the program in a case-by-case basis. Be guided by the referral process initiated by your own doctor. If you have been referred to a doctor, and their name doesn’t appear in the search, ask if they would be willing to use AGC for you.
The inclusion or exclusion of doctors in this search facility is not based on any formal CBHS assessment.
The autonomous relationship between you and your doctor will not be affected in any way. CBHS does not recommend or endorse any doctors.
Doctors' details contained in this search facility are intended to help you make an informed decision when being referred to, or receiving treatment from, a doctor as an in-patient in an approved hospital or day hospital facility. Please keep in mind:
- Doctors can choose whether they will participate in AGC on a patient-by-patient basis. This decision remains solely with the doctor.
- If the doctor appears in this search facility, it does not automatically guarantee that the doctor will participate in AGC in relation to your treatment.
- Some doctors have arrangements at particular hospitals. Ask your doctor whether they will use AGC in the hospital of your choice.
- Out-of-pocket expenses may vary from patient to patient. Please ask your doctor if you will have anything to pay.
- Your doctor may not have used AGC before, so they won’t appear in this search facility. However, they may be willing to use it for you. Ask your doctor if they will participate in AGC in relation to your treatment.
- Some doctors who may not appear in this search facility may also offer services with no gap. Please check with your doctor.
Information for doctors
On behalf of our CBHS member, we invite you to participate in the Access Gap Cover (AGC) arrangement. CBHS is one of 26 health funds that participate in AGC, which is co-ordinated by the AHSA.
There are no contracts to sign, simply register with the Australian Health Services Alliance (AHSA) – this is an ‘opt in’ or ‘opt out’ arrangement.
CBHS recognises your right to exercise independent clinical judgement, so you retain complete control of patient care. The advantages for you include:
- Claims paid within 21 days (or 11 days for accounts with no claims issues)
- Payment credited directly into your nominated account, inclusive of Medicare and CBHS benefits
- Remittance is provided to you on the same day