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).
An accident is an unforeseen event, occurring by chance and caused by an unintentional and external force or object resulting in involuntary hurt or damage to the body, which requires immediate (within 72 hours) medical advice or treatment from a registered practitioner other than the policy holder.
See 'yearly limit'.
A means tested rebate that can reduce the cost of health insurance.
A group representing and protecting the rights of registered doctors and medical students in Australia.
See the schedule of medical fees published by the Australian Medical Association (AMA).
The amount you’ll get back when you claim for a recognised service.
A loyalty feature rewarding members for continuous time on Silver, Gold & Platinum Extras. Benefits increase 2% every year, to a maximum of 10%.
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.
A complaint as defined by the Australian Complaint Handling Standard ISO AS 10002-2014 is an "expression of dissatisfaction made to or about an organisation, related to its products, services, staff or the handling of a complaint, where a response or resolution is explicitly or implicitly expected or legally required"
A person who makes a complaint about any of Bupa’s products or services.
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.
A place you are admitted for treatment (eg private hospital) when you’re admitted and discharged on the same day.
A serious and unexpected situation requiring immediate action.
If your cover has an excess, this is the amount you agree to pay for a hospital admission (which reduces your premium).
Things you can’t claim for because they’re not included in your cover.
Also called 'ancillary' cover, it's for non-hospital services that Medicare may not pay a benefit for – eg dental, optical, physio.
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.
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.
Means the Fund Rules of Bupa Australia Pty Ltd which you agree to upon taking out a health insurance policy with us. They are available at on this website at http://www.bupa.com.au/health-insurance/bupa-fund-rules-full.pdf (PDF, 1.8mb)
The amount you need to pay when your treatment costs are higher than Medicare and/or your cover allows.
Covering your costs when you’re admitted to hospital, including benefits for prosthesis and medical services provided during your hospital stay.
The written approval a provider should get from you on any out-of-pocket costs before your treatment.
You’re an inpatient when you’ve been formally admitted to hospital (does not include treatment in a hospital emergency department).
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.
The total amount you can claim on a service in your lifetime.
After your first year of membership, we increase how much you can claim for most extras services by a set percentage or amount.
Cover for medical services provided by surgeons and specialists during a hospital stay including diagnostics services such as pathology and radiology.
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.
Set benefits for specified medical services that the Government will pay for through Medicare.
Australia’s public healthcare system for all citizens and most permanent residents. It provides free or subsidised cover for certain healthcare services.
A surcharge that applies to people earning over a certain income when an appropriate level of hospital cover is not held.
A selection of offers and discounts you receive as a Bupa member.
There are both Members First Hospital providers and Members First Extras providers. Read more.
Our network of dental, optical, physiotherapy and chiropractic practitioners who provide most services at a set price to members (sometimes with no out-of-pocket costs). Read more.
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).
A low benefit payable on some hospital services that is likely to result in you having large out-of-pocket costs.
Alternative treatments that we cover, including acupuncture, naturopathy and remedial massage.
Private hospitals that Bupa has arrangements with, to make sure in most cases you’re covered for hospital costs. Read more (PDF, 300Kb).
The difference you have to pay between the Bupa benefit and what is charged by a provider.
Treatment when you're not admitted to hospital (eg emergency room treatment, specialist or GP consults).
Both extras and hospital cover.
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.
An insurance product for which a premium is paid to provide hospital cover outside of the public system and /or cover for services not covered by Medicare such as physiotherapy, optometry, general dental and podiatry services.
A doctor, hospital, healthcare professional or healthcare facility that provides a service to you (the patient).
Any treatment given to you by a provider who is recognised by Bupa (this is a provider who has met Bupa’s recognition criteria).
The maximum number of times you can use a service and receive benefits from us.
A set amount you’ll get back for treatment from a provider outside of the Members First ancillary network.
See Medicare Benefits Schedule (MBS) published by Medicare.
A dollar bonus we give you each year to help pay for any 'extras' gaps.
The maximum you can claim in a calendar year, depending on your cover. Sometimes referred to as an 'annual maximum'.
A period of time where you won’t receive any benefits from us for treatment received.
