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Download a form

Please find below links to forms that you may need - an application form, claim forms, the Government Rebate form, a Clearance Request form, Letter of Authority, Authority of Release and more.

Accident and injury form

To assist us in promptly assessing your claim(s), please provide detailed information about the accident or injury using this form.

Download an accident and injury form (PDF, 88Kb)

Ambulance claim form

Emergency Ambulance claims need to be supported with a completed Ambulance claim form.

Download an ambulance claim form (PDF, 111Kb)

Application form

If you'd like to join Bupa, you can download and complete this form then post it to us, or join online. In order to complete either form you will need to:

  • Know which cover(s) you would like
  • Read the product information, including the terms and conditions, of the cover you have chosen and ensure that you understand the terms and conditions, including those relating to pre-existing conditions, waiting periods, restricted benefit periods or any exclusions that apply. You can view details of our products at Compare Health Covers.
  • Know the details of all persons you would like to cover
  • Be able to name the fund you are transferring from (if applicable)

 

Download an application form (PDF, 84Kb )

Authority form

This form may be used by the member to grant another person ('The authorised person') authority to access their policy. Authorised persons must be over 18 years of age.

Download an authority form (PDF, 409Kb)

Claim form

You can claim by mail or online. To claim by mail, download and print out a claim form, complete it, attach the original account(s) you received from your healthcare provider - and the original receipt(s) if you paid your provider - and post to:

GPO Box 9809
Brisbane QLD 4001

If you are making an Emergency Ambulance claim, please also complete and attach the Particulars of Ambulance Transportation (PAT) form.

Download a claim form (PDF, 50Kb)

Download an overseas visitor claim form and medical certificate (PDF, 63Kb)

Claim queries

Please remember that claims can only be paid within 2 years of the date on which the service was rendered. If you have a question about:

  • The status of your claim
  • How to fill in a claim form
  • What documents you need to attach to your claim form

Please do not hesitate to contact us.

Clearance certificate form

When transferring to Bupa from another Australian registered health fund, a clearance certificate may entitle you to continuity for services provided by and common to both funds.

Download a clearance certificate form (PDF, 156Kb)

Direct debit form

Pay by direct debit from a credit card, cheque or savings account and keep your health insurance payments up-to-date automatically. Simply complete and return the direct debit authority form or use our online payment form for your convenience.

Download a direct debit authority form (PDF, 159Kb)

Family plus form

If you have a dependant who is between the ages of 21 and 25, unmarried and not studying full-time, they can be covered on your Family or Single Parent Family membership that includes an eligible hospital cover.

Download a family plus application form (PDF, 230Kb)

Government rebate form

Complete and return this form to receive the Australian Government Rebate on private health insurance. All the people listed on the policy must be eligible for a current Medicare card.

If at any stage you wish to stop receiving the Australian Government Rebate on private health insurance as a reduced premium please notify us as soon as possible.

Download a Government rebate application form (PDF, 175Kb)

Handling your personal information form

When it comes to your health claims, it's important you're comfortable with how we handle your personal details. The following form must be read and completed by everyone on your membership aged 17 and over.

Download a handling your personal information form (PDF, 362Kb)

Living well form

Your doctor or recognised provider will need to complete a Living Well form for gym memberships, kids' swimming lessons, yoga and Pilates courses to confirm the program is medically necessary for your health or your kids' health (as the case may be).

Download a living well form (PDF, 381Kb)

Medical certificate form

Require a hospital admission and have held your current level of hospital cover for less than 12 months? You will need two Medical Certificates to be completed, one by your Doctor and one by your treating Specialist, as you may be subject to the waiting period for pre-existing conditions.

Download a medical certificate form (PDF, 105Kb)

Membership suspension form

Are you about to go on a holiday overseas? Just returned home? Fill out this form to ensure you're covered when you need to be.

Download a membership suspension form (PDF, 235Kb)

Overseas Student Health Cover suspension form

Are you an overseas student travelling overseas? Are you returning home for a period of time? Fill out this form to ensure you’re covered when you need to be.

Download an overseas student health cover suspension form (PDF, 159Kb)

Overseas visitor's cover membership suspension form

Are you about to go on a holiday overseas? Just returned home? Fill out this form to ensure you're covered when you need to be.

Download an overseas visitor's cover membership suspension form (PDF, 230Kb)

Register a foster or adopted child as a dependant application form

If you want to add a foster or adopted child to your membership, complete this application form to register them as a dependant.

Download an application form to register a foster or adopted child as a dependant (PDF, 46.7Kb)

Student dependant registration form

If you have a dependant who is between the ages of 21 and 25 years, unmarried and in full-time study, it is possible for them to remain covered until their 25th birthday. In order to register a dependant the following form must be completed.

Download a student dependant registration form (PDF, 334Kb)

Travel and accommodation expenses application form

If you have incurred any travel and accommodation expenses that can be claimed under your cover, complete this form to make a claim.

Download a travel and accommodation expenses form (PDF, 318Kb)

Unemployment benefit cover form/ Retrenchment/ Redundancy notification form

Unemployment benefit covers the payment of health insurance premiums in the event that the main income earner becomes involuntarily unemployed as a result of retrenchment or redundancy from full-time employment. Unemployment cover benefits are available on certain levels of Hospital cover. In order to apply to receive unemployment benefits, please complete and sign a Retrenchment/ Redundancy notification form. A member can still claim unemployment benefits if during this period, they undertake part-time or casual work as this is still not full-time. Conditions apply.

Download an Unemployment benefit cover form/ Retrenchment/ Redundancy notification form (PDF, 242Kb)