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If you’re off to hospital for a procedure there are some questions you should ask your specialist, Bupa, and the hospital before you receive any treatment.
Why? The answers will help determine the type of treatment you receive, as well as where and with who, which can impact how much it costs.
Take a look at our member health programs2 – including Hospital Pre-Admission and Recovery Support, Rehab Choices and the Parent and Baby Wellbeing Program.
If you have extras cover (available on eligible products), now is a great time to use it! Seeing the physio, getting mental health support or enjoying a relaxing massage can all help you prepare for hospital and make a speedy recovery3.
The Bupa Medical Gap Scheme is all about reducing the in-hospital medical costs you need to pay for treatment when you're admitted to hospital. If the doctors involved in your procedure use our scheme, you'll never pay more than $500 per doctor, or you may experience no gap.
The Bupa Medical Gap Scheme can be used in public hospitals, and private hospitals Bupa has an agreement with.
Most Bupa hospital and extras policies include uncapped emergency ambulance services4.
And, depending on your policy, you may be able to claim for non-emergency ambulance transport.
If you anticipate needing regular non-emergency ambulance transport, it may be worth considering more comprehensive Bupa ambulance cover.
Learn more about ambulance cover.
If you need to travel for essential hospital or medical treatment, we can help cover some of your travel and accommodation costs1.
The reasons for travel must meet the following conditions:
The treatment you’re receiving doesn't have to be a service we're paying benefits for, but it does need to be considered essential. We’ll need a medical referral from your doctor certifying the need for travel to process your claim.
Check your policy details in myBupa to see if you’re covered or contact us to learn more.
Parking around hospitals can be expensive.
If you can, plan your trip to hospital ahead of time and have someone drop you off.
If you've had general anaesthetic, most hospitals will require someone to collect you once you’re discharged.
Receiving care in a Bupa agreement hospital means your out-of-pocket costs are reduced.
Our ‘Find a provider’ search tool is the quickest way to check if you’ve been referred to a Bupa agreement hospital.
In most cases, we cover the following in-hospital costs at both Members First and Network (including Fixed Fee Network) hospitals, if you’re admitted for a service included in your cover5:
Member’s First hospitals are private hospitals where we guarantee no out-of-pocket charges for accommodation and theatre fees. If you need to stay overnight in a Members First hospital, you’ll also benefit5 from:
A Fixed fee hospital has similar benefits to Network hospitals, with one difference: you’ll pay a fixed fee per day to the hospital for every day you’re in hospital.
The hospital will advise you of the daily fee when you make your booking.
If you have Gold Ultimate Health Cover, Bupa will reimburse you for any fixed fee paid.
If you visit a private hospital that doesn’t have an agreement with Bupa, it's likely you'll have out-of-pocket expenses for your treatment.
The hospital will discuss any fees and charges with you before you’re admitted (this is also called informed financial consent).
As a Bupa member in a non-agreement private hospital5, if you have the appropriate cover, you can expect:
Public hospitals are funded by the Australian Government through Medicare and are run by individual state and territory governments. Medicare-entitled patients are eligible to be treated as public patients in public hospitals at no cost.
If you’re treated as a private patient in a public hospital, you can choose your own doctor (dependent on their availability). And, you may be subject to the public hospital waiting lists for available beds when admitted as a private patient.
As a Bupa member in a public hospital, you can expect to be covered5:
E.g. seeing your GP for a specialist referral, outpatient blood tests, x-rays and CT scans.
Who pays for it?
You and/or Medicare
Exclusions are things you can’t claim for because they’re not included in your cover.
Who pays for it?
You
If you have ‘restricted cover’ for a service, Bupa will pay the minimum shared room benefit set by the Australian Government.
You’ll likely have larger out-of-pocket expenses.
Who pays for it?
You and/or Medicare
If you have ‘restricted cover’ for a service, Bupa will pay a benefit equalling the Australian resident public hospital minimum shared room benefit set by the Australian Government.
It means the benefit will not fully cover the cost for your hospital accommodation, and you’ll likely have large out-of-pocket expenses.
Who pays for it?
You and/or Medicare
E.g. cosmetic surgery.
Who pays for it?
You – this isn’t covered by Medicare or private health insurance.
If you stay in hospital longer than 35 days, and your doctor has not certified that you need ongoing acute hospital care, the benefits paid by Bupa will be reduced.
Who pays for it?
You and Bupa (Bupa will pay benefits that are lower than normal hospital benefits).
Depending on your level of cover, you may need to pay an excess and/or co-payment for your hospital admission.
Who pays for it?
You, unless treatment is required due to an injury, and your cover includes accident or injury benefit. Check your policy using myBupa or contact us to learn more.
This is a daily charge billed by a small number of Network hospitals that you’re responsible for paying. The hospital should tell you about any fee when you make a booking.
Who pays for it?
You, unless you have Bupa Gold Ultimate Health Cover (in which case, either the hospital will bill Bupa directly or you can make a claim for the fixed fee paid). Contact us to learn more.
If it’s not an emergency, your ambulance transport may be covered by Bupa, depending on your level of cover.
Who pays for it?
You and/or Bupa (depending on your cover)
E.g. travel insurance, workers’ compensation.
Who pays for it?
You and/or the other source
Prescription medication, dressings and bandages provided for use outside the hospital.
Who pays for it?
You and/or Bupa (depending on your extras cover)
Some private hospitals have emergency departments. If you have been a patient in an emergency department in a private hospital, you may have to pay extra fees as these are not covered by Medicare.
Who pays for it?
You and/or Bupa (if you have overseas visitors cover (OVC) or overseas student cover (OSHC))
If you’re admitted to hospital for multiple treatments and one or more of those treatments isn’t covered on your policy, Bupa will generally only pay a benefit towards the included treatment (if you have served any applicable waiting periods and meet eligibility requirements), but not the excluded treatments.
For domestic customers, Bupa will also cover treatment as required under the legislation related to paying benefits. This includes paying benefits towards Associated Treatments for Complications, Associated Unplanned Treatments, Common Treatments, and Support Treatments.
Outside of these situations, if you receive hospital treatment during an admission to hospital that is both included and excluded, we will pay for all the included treatment and may pay any element of treatment that cannot be appropriately allocated to the excluded treatment on an ex-gratia basis. Otherwise, you will be responsible for all expenses related to the treatment which is excluded on your policy.
A waiting period is the length of time you need to wait before you can make a claim on your private health insurance and receive a benefit.
You can still access medical care even if you haven’t served the relevant waiting periods, but it may not be covered by Bupa and you may have out-of-pocket costs for the treatment.
We apply the following waiting periods to domestic hospital cover:
If you’re switching from another health insurance provider to Bupa, we’ll waive any waiting periods you’ve already served7.
To check the waiting periods for your cover, log in to myBupa or contact us.
Learn more about waiting periods for overseas student health cover.
If you have a condition that’d be considered pre-existing, you may need to wait before you can claim services related to that condition.
Learn more about pre-existing conditions.
An excess is an agreed amount you’ll pay to the hospital upon admission in exchange for paying a lower premium.
How often will you pay an excess?
If the total excess for an individual isn’t reached in a single hospital admission, the remaining balance is payable on any subsequent admission for that individual in the same calendar year.
You can check your excess amount by logging in to myBupa or contacting us.
A co-payment is an amount you’ll pay per day for any hospital admission instead of, or in addition to, an excess (depending on your level of cover).
If included in your cover, a co-payment is payable per day, for up to five days, paid per admission and applied to:
You can check if co-payment applies to you by logging in to myBupa or contacting us.
If you’re a current Bupa member and want to check what you’re covered for, you can sign in to myBupa or contact us.
Want to review or change your cover? We can help with that too (waiting periods may apply).
Thinking about getting hospital cover or switching to Bupa?
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1 Helps cover the cost of travel for essential medical or hospital treatment not available close to home, where the total return distance is 200 kilometres or more from where you live. Up to $100 per person, per trip for travel expenses and $50 per night up to $150 per person, per trip for accommodation. 2 month waiting period and eligibility criteria apply.
2 Fund and policy rules, waiting periods and program eligibility criteria apply. Without limiting these rules, any family members covered by a Bupa family policy must be: (1) at least 18 years of age and (2) named in the relevant policy, before they are eligible to access these programs and services.
3 Available on eligible products. Yearly limits, waiting periods, benefit claiming restrictions, fund and policy rules apply.
4 Bupa will cover the cost of all emergency transport and on-the-spot treatment by our recognised providers. If claimable from another source, a benefit won’t be paid by Bupa. Fund and policy rules apply.
5 Waiting periods and fund rules apply. Product excesses and co-payments apply.
6 Subject to availability and eligibility. Private room must be booked and requested at least 24 hours before admission. For every night a private room is unavailable, you’ll receive $50 back per night from the hospital. Applies to overnight admissions only. Excludes ‘nursing home type patients’, emergency care, same day stays, occasions where a private room is medically inappropriate, treatment which is excluded or restricted, and treatment for a pre-existing condition during waiting periods.
7 When switching to Bupa on an equivalent or lower level of cover within 60 days of cover end date with old health fund, provided you already served your waiting period and pending receipt of your clearance certificate. We will apply continuity once we receive it.
