We're confident you'll be happy with your cover, however if you decide to cancel, we'll refund any premiums you have paid within the first 30 days of your membership commencing provided you haven't made a claim.
An excess is a set amount you pay upfront before your benefit is paid. The excess is paid each time a person on your membership is admitted into hospital, to a maximum of once per person and twice on the entire membership each calendar year unless otherwise specified.
A co-payment is an amount you agree to pay towards the cost of your daily hospital bill. A co-payment is charged per day and capped after five days for each hospital admission.
You can budget how much you'd like to pay for your monthly premium by choosing how much you want to claim back from your visits for most items at Members First providers covering dental, optical, physio and chiro. Annual maximums and waiting periods apply.
Choices is an affordable cover designed for healthy, young singles and couples, which includes the most common hospital services you’re likely to need, as well as extras including optical, physiotherapy, chiropractic and dental.
Choices includes cover for General and Major Dental, Optical, Physiotherapy, Natural Therapies and travel-related Pharmacy.
Shoulder arthroscopy & selected minor shoulder procedures
Appendicitis
Removal of tonsils and adenoids
Dental Surgery
Restricted
Minor gynaecological surgery
Restricted
Psychiatric
Restricted
Rehabilitation
Pregnancy related services (including childbirth) and assisted reproductive services
Cardiac and cardiac related services
Renal dialysis for chronic renal failure
Cataract & eye lens procedures
Hip and knee replacement including revisions
All other joint replacement including arthroplasty, revision and resurfacing procedures
Restricted
All other inpatient treatments receiving a Medicare benefit
Additional Items:
Emergency ambulance services
Special Benefits that help pay for certain in-hospital parent/ partner accommodation or meals
Laser Eye Surgery
Health Subscription refunds
Unemployment cover
Excess
Co-payments
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
Hospital costs
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
medication, dressings and other consumables
most diagnostic tests (e.g. pathology, radiology)
a surgically implanted prosthesis up to the applicable benefit on 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 this website.
Medical costs
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).
Ambulance services
On top of 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.
What's not covered
Hospital costs
Situations when you are likely not to be covered include:
during a waiting period
when specific services or treatments are excluded or restricted 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; experimental treatment and/or any treatment/procedure not approved by the Medical Services Advisory Committee (MSAC)
you will not be fully covered for hospital charges related to surgical podiatry and follow-up admissions to earlier cosmetic procedures where the follow-up procedure is recognised by Medicare
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.
Medical costs
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.
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.
Restricted Benefits
If a service is covered as a Restricted Benefit, this means you will be covered with your choice of doctor for shared room accommodation in a public hospital only.
If you go to a private hospital for a specific service which has Restricted Benefits, it is likely to result in large out-of-pocket expenses. Restricted Benefits equal the amount set by the Government as the Minister’s minimum default benefit and are generally not enough to cover accommodation costs in a private hospital.
All hospital covers have Restricted Benefits for surgical podiatry. Some hospital covers have Restricted Benefits for specific services for the duration of that cover.
Exclusions
Some covers exclude specific services. This means you will not be covered for that specified service or treatment whilst on that level of cover.
There are also other services that are either not covered or not fully covered by any of our hospital covers. Bupa only pays for services that Medicare covers. Medicare does not cover some health screening services and services that are not medically necessary. For more information please refer to ‘What’s not covered’.
Additional features
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 apply from 1st July 2011 and are indexed annually
General dental treatment includes services such as:
Your regular 6 monthly examination, scale & clean and fluoride treatment
X-rays
Mouthguards
Fillings (those done directly in the mouth – like Amalgams and white composite fillings)
Simple extractions
Surgical extractions (such as removal of impacted wisdom teeth)
Please refer to the full policy details to determine what is covered.
Benefits are only payable for services provided by dentists and dental specialists in private practice who are recognised by Bupa. Recognition of providers by Bupa is subject to change without notice. Please check with us before undergoing a course of treatment.
Major Dental
Major dental treatment includes services such as:
Periodontal treatment (treatment of gum disease)
Complex oral surgery
Root Canal Therapy (Root Treatment)
Fillings (those that have to be made outside the mouth e.g. in a laboratory or by a special machine)
Crowns and bridges
Implants
Dentures (false teeth)
Please refer to the full policy details to determine what is covered. Waiting periods may apply.
Benefits are only payable for services provided by dentists and dental specialists in private practice who are recognised by Bupa. Recognition of providers by Bupa is subject to change without notice. Please check with us before undergoing a course of treatment.
Waiting Period
General Dental -
2 months
Major Dental - 12 months
Annual Maximums
Dental has a combined annual maximum of $300 per person 1 sports mouthguard per person per calendar year
Dental Well Bonus
Your dental annual maximum increases each calendar year if you complete a preventive dental check-up every 12 months
Optical services are provided on prescription from an optometrist and include:
Frames
Prescription Lenses
Contact Lenses
Certain lens coatings
Please refer to the full policy details to determine what is covered.
Benefits are only payable for services provided by optometrists and optical dispensers in private practice who are recognised by Bupa. Recognition of providers by Bupa is subject to change without notice. Please check with us before undergoing treatment.
Waiting Period
2 months
There is a combined annual limit for all these services.
Physiotherapy involves the treatment and rehabilitation of people with movement disorders and other physical disabilities.
Please refer to the full policy details to determine what is covered.
Benefits can only be claimed for consultation and treatment by physiotherapists who are recognised by Bupa and in private practice. Some providers may not be recognised by Bupa, in which case we will not pay benefits for services they provide. Recognition of providers by Bupa is subject to change without notice. Please check with us before undergoing a course of treatment.
Chiropractic deals with the relationship between the spine and pelvis and the nervous system (which controls how they function). The bones of the spine are manipulated, based on the premise that disease is caused by interference with nerve function.
Osteopathy deals with the structure of the body and the way it functions. It uses massage and stretching techniques to improve the function where needed
Natural therapies may complement or offer alternatives to conventional medical treatment. They include therapies such as Acupuncture, Alexander Technique, Chinese Herbalism, Western Herbalism, Exercise Physiology, Feldenkrais, Naturopathy, Homoeopathy and Iridology.
“Massage” includes benefits payable for Aromatherapy, Bowen Technique, Kinesiology, Reflexology, Shiatsu and Therapeutic massage.
Please refer to the full policy details to determine what is covered.
Benefits can only be claimed for services provided by Natural Therapists who are recognised by Bupa and in private practice. Some providers may not be recognised by Bupa, in which case we will not pay benefits for services they provide. Recognition of providers by Bupa is subject to change without notice. Please check with us before undergoing a course of treatment.
Pharmacy covers you for prescription items that aren't already covered by the Government Pharmaceutical Benefits Scheme (PBS), provided its usage is approved by the Therapeutic Goods Administration (for that particular condition) and not mentioned in our exclusions list. There are some items that aren't covered by our Pharmacy benefits. They include:
over the counter items
non-prescription items
weight loss medication e.g. Duromine (some weight loss drugs are covered under the Living Well programs)
body enhancing medications e.g. anabolic steroids, and
erectile dysfunction medication
When you visit a pharmacy to get a prescription, you pay for the full amount up-front. When you make a claim, you cover the amount equal to the maximum contribution set by the Government under the PBS. We'll pay the remaining balance up to the set amount you're entitled to under your level of cover.
Psychology deals with the mind and mental processes, especially in relation to human behaviour.
Psychology services include:
Attendances (one on one)
Group attendances
Couple and Family attendances
Please refer to the full policy details to determine what is covered.
Benefits can only be claimed for services provided by Psychologists who are recognised by Bupa and in private practice. Some providers may not be recognised by Bupa, in which case we will not pay benefits for services they provide. Recognition of providers by Bupa is subject to change without notice. Please check with us before undergoing a course of treatment.
Cover for ambulance services varies dependent on the provisions of your state of residence. Please refer to the full policy details to determine what is covered.
Waiting Period
No waiting period
Singles = 1 service
Couples = 2 services
(per calendar year)
*Excludes ante and post natal physiotherapy services.
What's covered
With extras cover, you can claim benefits for those services listed on your cover and that are not claimable elsewhere (e.g. from a third party like Medicare).
For example, Medicare does not provide benefits for:
most dental examinations and treatment
most physiotherapy, occupational therapy, speech therapy, eye therapy, chiropractic services, podiatry or psychology services
acupuncture (unless part of a doctor’s consultation) or other natural therapies
glasses and contact lenses
most health aids and appliances
home nursing.
Extras cover allows you to claim benefits for extras services as long as:
the treatment is given by a private practice provider who is recognised and registered with us for benefit purposes
they meet the criteria set out in our policies and Fund Rules.
We recommend you contact us before making a booking to confirm how much you can claim and to check that your chosen provider is registered with us.
What's not covered
Extras benefits will not be payable:
during a waiting period
where a third party, including Medicare, a Government body, or an insurance company provided a benefit (except for hearing aids and breast prosthesis items)
for different services within the same service type from the same provider on the same day. For example, if you went to see an acupuncturist and then received a massage from the same provider on the same day, you cannot claim for both services
when a prescribed treatment is not fully custom made (e.g. orthotics, surgical shoes)
when a provider is not recognised by us for benefit purposes
for any treatment or service rendered outside Australia
when you have reached the maximums on your product including annual, lifetime or service limits for the service you are claiming.
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 extras cover:
initial waiting period – two months
hire, repair and maintenance of health aids and appliances; and Living Well Programs – six months
major dental, orthodontics, selected health aids and appliances – 12 months
laser eye surgery, covered only under Ultimate Health Cover - three years.
Add Pharmacy Saver
Enjoy savings on your pharmaceutical and health care purchases all year round at National Pharmacy stores. With Pharmacy Saver, you'll receive a 20% discount on a variety of health-related products.
View details >
Pharmacy saver
Add Pharmacy Saver to your extras cover and enjoy savings on your pharmaceutical and health care purchases all year
round at National Pharmacies stores. You'll get a 20% discount on a variety of health-related products.* Pharmacy
Saver is not available for prescriptions on which the Government does not allow discounts. Visit a National
Pharmacies store for more information.
* These are products designed to manage or prevent diseases, injuries or a
condition, or prescribed in connection with an episode of hospital treatment
Weekly
Member Exclusives
Member exclusives include a range of discounts and deals from specially selected partners to help you enjoy some health and wellness perks at an affordable price. Whether you're interested in fitness and sports or rest, relaxation and travel, you can choose what suits your needs from our range of partner discounts. Full terms and conditions of all offers are available in the Member Exclusives section of myBupa.
We're confident you'll be happy with your cover, however if you decide to cancel, we'll refund any premiums you have paid within the first 30 days of your membership commencing provided you haven't made a claim.
Are you sure you want to change your status?
The status you are changing, affects your application process. If you change this, you will need to reselect your health cover.
