Unless otherwise specified with private hospital cover, you can choose to be treated as a private patient in either a public or a private hospital. With us you are fully covered as a private patient in most Members First and Network hospitals, and all public hospitals across Australia. A small number of hospitals may charge a fixed daily fee, capped at a maximum number of days per stay. These hospitals should inform you of this fee when you make a booking. This fee is in addition to any excess or co-payment you may have as part of your hospital cover.

When admitted to hospital, in most cases you will be covered for all in-hospital charges when provided as part of your in-hospital treatment including:

• accommodation for overnight or same-day stays
• operating theatre, intensive care and labour ward fees
• supplied pharmaceuticals approved by the Pharmaceutical Benefits Scheme
• allied services including physiotherapy, occupational therapy and dietetics
• dressings and other consumables
• pathology and radiology diagnostic tests performed in hospital by Bupa contracted providers
• surgically implanted prostheses up to the approved benefits in the Government’s Prostheses List

We recommend you call us first before making a booking to confirm that your hospital of choice gives you certainty of full cover. We can also discuss any excess or co-payment that may be applicable to your level of cover. You can find out if a hospital has an agreement with us by checking this website.

These are the fees charged by a doctor, surgeon, anaesthetist or other specialist for any treatment given to you in hospital. Private health insurance provides you with the choice of your own doctor, and you decide whether you will go to a public or a private hospital that your doctor attends. You may also have more choice as to when you are admitted to hospital.

You are covered for:

• the cost of these medical treatments up to the Medicare Benefit Schedule (MBS) fee.

The MBS fee is the amount set by the Federal Government for each medical service covered by Medicare. You must be eligible for Medicare in order to be covered up to the MBS fee. If you choose to be treated as a private patient in a hospital (public or private), Medicare will cover you for 75% of the MBS fee for associated medical costs and we will cover the remaining 25%. If your specialist charges more than the MBS fee there will be a ‘gap’ for you to pay. However, the Bupa Medical Gap Scheme can help eliminate or reduce the gap for you if your doctor/s choose to use it.

At Members First day facilities, not only will you be fully covered for the facility accommodation and theatre fees but there are no out-of-pocket expenses for medical treatments (e.g. your specialist’s fees).

Included in your cover, you will receive cover for recognised emergency only ambulance transport or on-the-spot treatment. This is capped at one service for a single membership and two services for couple, single parent and family memberships each calendar year.

An emergency is an unplanned event where you need immediate medical treatment. Benefits are only available for emergency or casualty transportation where, in the opinion of a medical officer, a customer requires immediate medical treatment in circumstances where there is serious threat to the customer's life or health.

Benefits are not payable for:

• Transportation from a hospital to your home;
• Transportation from a hospital to a nursing home;
• Transportation from a hospital to another hospital (where the customer has been admitted to the transferring (first) hospital; or
• Transportation from the person's home, a nursing home or hospital for ongoing medical treatment, e.g. chemotherapy, dialysis.

If you do not have an ambulance subscription with your state ambulance service and need to make a claim for emergency ambulance services covered on top of your cover, please complete and return to us the Patient Ambulance Transportation form.

Situations when you are likely not to be covered include:

• during a waiting period
• when specific services or treatments are paid at minimum benefits or excluded from your level of cover
• when you are treated at a non-agreement hospital you will not be fully covered
• for the fixed fee charged by a fixed fee hospital
• when you have not been admitted into a hospital and are treated as an outpatient (e.g. emergency room treatment, outpatient ante-natal consultations with an obstetrician prior to child birth)
• hospital treatment provided by a practitioner not authorised by a hospital to provide that treatment
• hospital treatment for which Medicare pays no benefit, including: medical costs in relation to surgical podiatry (including the fees charged by the podiatric surgeon); most cosmetic surgery; respite care; experimental treatment and/or any treatment/procedure not approved by the Medical Services Advisory Committee (MSAC)
• personal expenses such as: pay TV, non-local phone calls, newspapers, boarder fees, meals ordered for your visitors, hairdressing and any other personal expenses charged to you unless included in your cover
• if you are in hospital for more than 35 days and you have been classified as a ‘nursing home type’ patient. In this situation you may receive limited benefits and be required to make a personal contribution towards the cost of your care
• for pharmacy items not opened at the point of leaving the hospital
• if you choose to use your own allied health provider rather than the hospital’s practitioner for services that form part of your in-hospital treatment (e.g. chiropractors, dieticians or psychologists)
• where compensation, damages or benefits may be claimed by another source (e.g. workers compensation)
• any treatment or service rendered outside Australia
• some non-PBS, high cost drugs.

You will not be covered for:

• medical services for surgical procedures performed by a dentist, surgical podiatrist, or any other practitioner or service that is not eligible for a rebate through Medicare.