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Accommodation for overnight and same day stays |
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Operating theatre, intensive care, ward fees |
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Medical Gap Scheme Available |
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Surgically implanted prostheses |
| In patient services included on cover: |
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Accidents sustained after joining |
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Knee arthroscopy or Meniscectomy procedures |
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Appendicitis |
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Removal of tonsils and adenoids |
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Dental Surgery |
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Minor gynaecological surgery |
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Psychiatric |
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Rehabilitation |
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Pregnancy related services (including childbirth) and assisted reproductive services |
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Cardiac and cardiac related services |
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Renal dialysis for chronic renal failure |
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Cataract & eye lens procedures |
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Hip and knee replacement (including arthroplasty, revision and resurfacing procedures) |
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All other joint replacement |
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All other inpatient treatments receiving a Medicare benefit |
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| Additional Items: |
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Emergency ambulance services |
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Special Benefits that help pay for certain in-hospital parent/ partner accommodation or meals |
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Laser Eye Surgery |
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Health Subscription refunds |
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Unemployment cover |
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Excess Options |
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Co-payments |
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Baby Books |
Waiting periods
A waiting period is the time between when you joined us, or transferred to a higher level of health cover, and when you are covered for a service or treatment on your new level of cover.
If you are a new member and receive a service or treatment during this time, you are not eligible to receive a benefit payment from us, regardless of when you submit the claim.
If you are transferring to us from another Australian health fund, once we have received confirmation of your previous membership and level of cover, you will continue to be covered for all benefit entitlements that you had on your old cover, as long as these services are offered on your new cover with us. This is referred to as continuity of cover. To receive continuity of cover, you will need to transfer to us within 60 days of leaving your old fund.
If you are an existing member, or a transferring member, and have changed to a higher level of benefit, you may be covered on your previous level of cover or on our nearest equivalent to your previous cover with your old fund.
Waiting periods apply to all levels of cover. Please refer to the full policy details to determine the waiting periods that apply to your level of cover.
The following waiting periods apply for hospital cover:
- palliative care, psychiatric and rehabilitation services – two months
- pre-existing conditions, ailments or illnesses and pregnancy related services (including childbirth) – 12 months
- all other treatments included in your cover – two months
- no waiting period for treatment you require as a result of an accident sustained after joining us
What's covered
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Hospital costs
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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
- single room where available.
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 the Member Benefits section of this website.
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Medical costs
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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).
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Ambulance services
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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.
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What's not fully covered
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Hospital costs
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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.
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Medical costs
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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.
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Inpatient vs outpatient
You are an inpatient if you are admitted into hospital for either a same-day or overnight admission.
If you are admitted as a private inpatient, you will be covered for the services listed in your chosen level of hospital cover. If you receive treatment as an outpatient (i.e. you are not admitted), in most instances you will not be covered by private health insurance. If eligible these services may be claimed from Medicare.
Minimum Benefits (MB)
No specific minimum benefits appliciable to this cover.
There are services that are not fully covered or covered at all by any of our hospital covers. For more information please refer to 'What’s not fully covered'.
Additional features
- Special Benefits
- Health subscription refund
- Unemployment Cover
- Baby Books
- Parent and Baby Wellbeing
- Gap bonus
- You may not have to pay the Medicare Levy Surcharge
Special Benefits
We'll help cover the costs of accommodation and meals for your partner, immediate family member, carer or next of kin should they need to stay in hospital with you. They will be covered for $60 per night for accommodation in hospital and up to $30 a day for hospital meals, capped at $1000 per person, per year. Hospital meals are covered when provided at a hospital cafeteria, kiosk or patient meal menu.
Health subscription refund
50% refund on a subscription to the Arthritis Foundation, Asthma Foundation and Diabetes Australia.
Unemployment Cover
If you have unemployment cover and you're involuntarily retrenched or made redundant from full-time employment, from the start of your second month of unemployment your health insurance premiums will be covered (at the same level of cover) for up to 12 months while you remain unemployed.
Unemployment cover conditions
To be eligible for unemployment cover the following conditions apply:
- If you have a family or couples membership only the main income earner is eligible.
The main income earner must:
- Have been employed for at least six months with the same company prior to your involuntary retrenchment or redundancy
- Not be a contractor or in self-employment
- Have held your health cover for 12 months before your involuntary retrenchment or redundancy
- Provide proof of your unemployment to our reasonable requirements, every three months providing you still remain unemployed
Baby Books
If you are expecting your first baby, you will receive a special gift of two free parent-friendly books - the pre-natal book "What to expect when you're expecting" when you tell us you are having a baby and "Toddler Taming" following your child's first birthday.
Parent and Baby Wellbeing
You will receive access to a range of valuable services for parents with new babies, including consultation and support, identification of depression and anxiety and follow-up support if needed. These services are provided as part of your hospital cover. It's part of our commitment to ensuring the best possible care for you and your family.
Gap bonus
Receive a $200 Gap Bonus when you join, and another $200 at the start of each calendar year per membership, to help pay for any medical gaps charged by your doctor or specialist when admitted to hospital. Plus any unused bonus amounts will accumulate.
You may not have to pay the Medicare Levy Surcharge
Covers you against paying an extra 1% tax known as the Medicare Levy Surcharge. This tax is payable by singles earning more than $80,000 or couples and families with combined taxable incomes greater than $160,000 (the family income threshold increases by $1,500 for each additional child after the first one) who do not have an appropriate level of private hospital cover. Thresholds are effective 1 July 2011 and are indexed annually.
For more Bupa packages visit the All in One Package page
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