In order to bring you the best possible user experience, this site uses Javascript. If you are seeing this message, it is likely that the Javascript option in your browser is disabled. For optimal viewing of this site, please ensure that Javascript is enabled for your browser.

Glossary

Please refer to the Important Information (PDF, 339Kb) and our Fund Rules (PDF 179Kb) for more information and to see how these definitions may apply to you.

Overseas Visitors can find more information http://www.bupa.com.au/visitors-info or in our overseas visitors rules (PDF, 511Kb).

A | B | C | D | E | F | G | H | I | J | K | L | M | N | O | P | Q | R | S | T | U | V | W | X | Y | Z

A

Accident

An unexpected event that leaves you with an injury that needs urgent medical attention.

Annual maximum

See 'yearly limit'.

Australian Government Rebate on private health insurance

A means tested rebate that can reduce the cost of health insurance.

Australian Medical Association (AMA)

A group representing and protecting the rights of registered doctors and medical students in Australia.

AMA fee

See the schedule of medical fees published by the Australian Medical Association (AMA).

B

Benefit

The amount you’ll get back when you claim for a recognised service.

Benefit Bonus

A loyalty feature rewarding members for continuous time on Silver, Gold & Platinum Extras. Benefits increase 2% every year, to a maximum of 10%.

Bupa Medical Gap Scheme

An arrangement between Bupa and medical providers giving you certainty of what you will pay. It can help reduce or eliminate your out-of-pocket medical costs. The provider bills us directly and if there is a gap, the provider will ask you for payment. Read more.

C

Co-payment

If your cover has a co-payment, this is the amount you agree to pay each day towards the cost of your hospital stay, for up to five days.

D

Day surgery/facility

A place you are admitted for treatment (eg private hospital) when you’re admitted and discharged on the same day.

E

Emergency

A serious and unexpected situation requiring immediate action.

Excess

If your cover has an excess, this is the amount you agree to pay for a hospital admission (which reduces your premium).

Exclusions

Things you can’t claim for because they’re not included in your cover.

Extras cover

Also called 'ancillary' cover, it's for non-hospital services that Medicare may not pay a benefit for – eg dental, optical, physio.

F

Family in-hospital benefit

A benefit to help cover meals and accommodation (provided by and in the hospital) for a relative or carer when they need to stay in hospital with you.

Fixed fee

A daily fee a small number of Network hospitals will charge, which you’ll have to pay. It’s different (and in addition) to a co-payment or excess.

G

Gap

The amount you need to pay when your treatment costs are higher than Medicare and/or your cover allows.

H

Hospital cover

Covering your costs when you’re admitted to hospital, including benefits for prosthesis and medical services provided during your hospital stay.

I

Informed Financial Consent

The written approval a provider should get from you on any out-of-pocket costs before your treatment.

Inpatient

You’re an inpatient when you’ve been formally admitted to hospital (does not include treatment in a hospital emergency department).

L

Lifetime Health Cover (LHC)

Lifetime Health Cover loading is paid when you don’t take out hospital cover before 1 July following your 31st birthday – it goes up 2% a year, to a maximum of 70%. Any loading that applies will be removed after you’ve held hospital cover continuously for 10 years.

Lifetime limit

The total amount you can claim on a service in your lifetime.

Loyalty maximums

After your first year of membership, we increase how much you can claim for most extras services by a set percentage or amount.

M

Medical cover

Cover for medical services provided by surgeons and specialists during a hospital stay including diagnostics services such as pathology and radiology.

Medical gap bonus

A dollar bonus available on Ultimate Health Cover & Ultimate Corporate Health Cover that we give you each year, accumulating to help pay for any in-hospital medical gaps.

Medicare Benefits Schedule (MBS)

Set benefits for specified medical services that the Government will pay for through Medicare.

Medicare

Australia’s public healthcare system for all citizens and most permanent residents. It provides free or subsidised cover for certain healthcare services.

Medicare Levy Surcharge (MLS)

A surcharge that applies to people earning over a certain income when an appropriate level of hospital cover is not held.

Member Exclusives

A selection of offers and discounts you receive as a Bupa member.

Members First

There are both Members First Hospital providers and Members First Extras providers. Read more.

Members First - Extras

Our network of dental, optical, physiotherapy and chiropractic practioners who provide most services at a set price to members (sometimes with no out-of-pocket costs). Read more.

Members First – Hospitals & Day Facilities

Private hospitals that Bupa has arrangements with to provide treatment for members with some additional benefits like the private room offer and maternity care package (where applicable).

Members First day facilities are private hospitals that guarantee you will have no hospital or medical out of pocket costs (apart from any co-payment or excess). Read more (PDF, 300Kb).

Minimum benefit

A low benefit payable on some hospital services that is likely to result in you having large out-of-pocket costs.

N

Natural therapies

Alternative treatments that we cover, including acupuncture, naturopathy and remedial massage.

Network hospitals

Private hospitals that Bupa has arrangements with, to make sure in most cases you’re covered for hospital costs. Read more (PDF, 300Kb).

O

Out-of-pocket

The difference you have to pay between the Bupa benefit and what is charged by a provider.

Out-patient

Treatment when you're not admitted to hospital (eg emergency room treatment, specialist or GP consults).

P

Packaged cover

Both extras and hospital cover.

Pre-existing conditions

Any ailment, illness or condition that you had signs or symptoms of during the six months before you took out or upgraded health cover with us.

Provider

A doctor, hospital, healthcare professional or healthcare facility that provides a service to you (the patient).

S

Service

Any treatment given to you by a provider who is recognised by Bupa (this is a provider who has met Bupa’s recognition criteria).

Service limit

The maximum number of times you can use a service and receive benefits from us.

Set benefits

A set amount you’ll get back for treatment from a provider outside of the Members First ancillary network.

Schedule fee

See Medicare Benefits Schedule (MBS) published by Medicare.

T

Top-up bonus

A dollar bonus we give you each year to help pay for any 'extras' gaps.

Y

Yearly limit

The maximum you can claim in a calendar year, depending on your cover. Sometimes referred to as an 'annual maximum'.

W

Waiting periods

A period of time where you won’t receive any benefits from us for treatment received.

Not a Bupa member?
FIND THE RIGHT COVER
My current status
Single
Couple
Family
Single parent
My date of birth
I live in

The government now income tests the rebate on private health insurance. One way you can save up-front is to claim the rebate as a reduction on your premium, would you like to do that now?
help text
The Government offers all Australian residents who are entitled to Medicare benefits an income-tested rebate on their private health insurance.
Join hospital and extras by 30 November and get up to $200 worth of New Balance vouchers