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Budget Family

 
30-DAY COOLING OFF PERIOD
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30-day cooling off period

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.

Payment

Excess:

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Excess

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.

Extras Paid Back*:

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Extras Paid Back

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.

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Includes:

  • Hospital $0.0
  • Extras $0.0
  • Pharmacy Saver (weekly) $0.45

Features at a glance

Hospital Cover
      BASIC
Extras Cover
      BASIC
back on extras*
Price is based on cover for: Family00 years old, StateChange
Assumes no Lifetime Health Cover loading and [rebate] government rebate included. Price may vary if details change.
*For most items at Members First providers, covering general dental, physio, chiro and podiatry services. Annual maximums, waiting periods and fund rules apply.

Are you eligible for the Government Rebate?

Are you registered with Medicare?

Have you held continuous hospital cover since July 1, 2000your 31st birthday? help

When did you last begin continuous health cover

Is your partner registered with Medicare?

Has your partner held continuous hospital cover since July 1, 2000their 31st birthday? help

When did your partner last begin continuous health cover

Apply the Australian Government Rebate (30%) to reduce cover costs?

Do you or your partner hold any of these concession cards? help

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About this cover

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The following information explains what is included and what is not included. We will pay for all services included on your cover as listed below. You also have the option of lowering your premium by paying an excess. Remember that you could incur out-of-pocket costs for some of these items.

An affordable package to help with your family’s well being when you are finished having kids. With Budget Family, you'll enjoy affordable extras and hospital cover that includes full cardiac.

View Extras Cover

Important documents for you to read

Hospital

Offer

Key features

purple separator

Great family cover from Bupa:

  • Gap free optical
  • $100 yearly top-up bonus
  • Guaranteed single room at Members First hospitals

PLUS additional benefits for kids:

  • No hospital excess
  • Gap free general dental1
  • Gap free physio2

Any medical services you receive after you’re admitted into hospital. This includes medical services you receive from the hospital after you’ve been discharged but not services from your GP. Any emergency department treatment is not included.

For inpatient services included on cover:
tick image Accommodation for overnight and same day stays
tick image Operating theatre, intensive care, ward fees
tick image Bupa Medical Gap Scheme available
tick image Surgically implanted prostheses
tick image Accidents sustained after joining
tick image Knee arthroscopy or meniscectomy procedures
tick image Appendicitis
tick image Removal of tonsils and adenoids
tick image Dental Surgery
tick image Minor gynaecological surgery
minimum benefits Psychiatric services
tick image Rehabilitation services
minimum benefits Pregnancy (childbirth)
minimum benefits Assisted reproductive services (IVF)
tick image Cardiac and cardiac related services
minimum benefits Renal dialysis for chronic renal failure
minimum benefits Cataract and eye lens procedures
minimum benefits Hip and knee replacement (including arthroplasty, revisions and resurfacing procedures)
tick image Palliative care
tick image All other joint replacements
tick image Gastric banding and obesity related services
tick image Abdominoplasty and lipectomy
tick image All other inpatient treatments receiving a Medicare benefit

Additional Items:
tick image Emergency ambulance services
cross image Family in-hospital benefit that helps pay for in-hospital partner/family accommodation or meals
cross image Health Subscription refunds
cross image Unemployment cover
tick image Excess Options
cross image Co-payments
tick image No excess for kids
How to read our table:
green tick Included orange cross Not included Not included

Not included/Exclusions

If you require treatment for a specific procedure or service that is excluded under your level of cover you will not receive any benefits towards your hospital and medical costs and you may have significant out-of-pocket costs.

If a service is not covered by Medicare there will be no benefit payable from your hospital cover so you should always check with us to see if you’re covered before receiving treatment. For more information please refer to ‘What is not included’.

minimum benefits Minimum Benefits Minimum Benefits

Minimum Benefits

For services paid at minimum benefits in a private hospital we will pay minimum shared room benefits, and you will have your choice of doctor. These benefits would not be adequate to cover all hospital costs and are likely to result in large out-of-pocket expenses.

For services paid at minimum benefits in a public hospital, we will pay minimum shared room benefits and you will have your choice of doctor. If these benefits are less than the public hospital charges, you will have out-of-pocket expenses to pay.

Help on definitions Definitions help

Definitions help

Click here to view our online glossary.


How hospital cover works

The information below is general information which applies to all our hospital products – not just yours. It includes descriptions that may not be relevant to your product (for example, if your product does not include an excess, the description of an “excess” and how it works is not relevant to you). Read this information together with the list above to understand how your product works.

What we will pay for

We’ll help pay for hospital costs in private and public hospitals. We’ll also help pay the medical costs for in-patient services.

Hospital costs


Hospital costs are charges that are incurred as part of your treatment in hospital. Some common hospital costs include:

  • accommodation for overnight or same-day stays
  • operating theatre, intensive care and labour ward fees
  • supplied pharmaceuticals approved by the Pharmaceutical Benefits Scheme
  • physiotherapy, occupational therapy, speech therapy and other allied health services
  • surgically implanted prostheses up to the approved benefits in the Government’s Prostheses List
  • private room where available.

What happens if I am treated in a private hospital that Bupa has an agreement with?

Once you have served any waiting periods for your product, we will pay for medical treatment provided when you are a patient in private hospitals that Bupa has an agreement with, if it is included in your cover.

A small number of these hospitals may charge a fixed daily fee, which you must pay. This fee is capped at a maximum number of days for overnight stays. The hospital 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.

At Members First Day Hospitals, you have the added benefit of no medical gaps in addition to being covered for hospital costs, provided the treatment is recognised by Medicare and there are no exclusions on your level of cover.#

# Not available in NT. Any co-payment or excess related to your level of cover will still apply.

We recommend you call us first before making a booking to confirm that your chosen hospital gives certainty of full cover. We can also discuss any excess or co-payment that might apply to your level of cover. You can find out if a hospital has an agreement with us by checking the Find a Healthcare Provider section of this website.

Can I choose to be treated as a private patient in a public hospital or at a private hospital that Bupa does not have an agreement with?

If you elect to be treated as a private patient in a public hospital or are admitted to a private hospital that Bupa does not have an agreement with, you are covered as set out below for any treatment recognised by Medicare unless it is excluded or restricted under your cover.

In these circumstances, you are likely to incur out-of-pocket expenses for your hospital costs.

What happens if I choose a private hospital that Bupa doesn’t have an agreement with?

If you are admitted to a private hospital that Bupa does not have an agreement with, we will pay shared room minimum benefits and benefits for prostheses up to the benefit in the Government Prostheses List. This will apply for any treatment recognised by Medicare, unless it is excluded or restricted under your cover. These benefits will only partially cover the full cost and you will have significant out-of-pocket expenses.

It is important to note that you will be responsible for the cost of your stay and may be charged directly for your hospital accommodation, doctor’s services (including any diagnostic tests), surgically implanted prostheses (such as artificial hips) and personal expenses such as TV hire and telephone calls. Some of these hospitals bill Bupa directly for the limited benefits we pay. Please also refer to the Medical Costs section below.

What happens if I choose to be a private patient in a public hospital?

As a private patient in a public hospital you are entitled to choose your doctor, if they are available. However, it is important to understand that you may still be subject to public hospital waiting lists.

Depending on your illness or condition, this may be the same doctor who would have been allocated to you by the hospital as a public patient. Additionally, whether a doctor provides treatment at a public hospital, or performs a particular procedure in a public hospital, is outside of Bupa’s control.

If you elect to be treated as a private patient in a public hospital, we will pay minimum benefits for shared room accommodation as set by the Australian Government. Depending on your level of cover, if you choose to stay in a private room, Bupa may pay an additional fixed benefit towards the cost of your stay. If this benefit is less than the hospital charge, the hospital should let you know what out-of-pocket expenses you will have to pay. Bupa also pays benefits for prostheses up to the benefit in the Government Prostheses List.

The above applies for any treatment recognised by Medicare unless it is excluded or restricted under your cover. It is important to note that in public hospitals, private rooms are generally allocated to people who medically need them.

As a private patient in a public hospital you will also be responsible for personal expenses such as TV hire and telephone calls together with any Medical Gaps your doctor/surgeon charges above the Medicare Benefit Scheme and prostheses charges above the benefit in the Government Prostheses List.

Medical costs


These are the fees charged by a doctor, surgeon, anaesthetist or other specialist for any treatment given when you are in 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.

How benefit is calculated

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%.

Bupa Medical Gap Scheme

The Bupa Medical Gap Scheme is an arrangement Bupa has with some medical specialists/doctors such as an anaesthetist to help minimise the amount you’ll need to pay for your medical costs in hospital.

No Gap

If you see a “No Gap” doctor that uses the Bupa Medical Gap Scheme you won’t have to pay any medical costs as your medical specialist or doctor will bill Bupa directly. Check with them that they will use this for your upcoming admission upfront.

Known Gap

If you see a ‘Known Gap’ doctor that uses the Bupa Medical Gap Scheme with you, you will need to pay up to $500 towards your medical costs.

Without the Gap Scheme

If your doctor is not using the gap scheme, Medicare will pay 75% and Bupa will pay 25% of the MBS fee. Any charge above that will be your gap.

Your choice of network

We are partnered with Genesis Heart Care, a network of cardiologists across VIC, QLD, SA and WA that focus on providing quality, evidence based cardiology services. When you see a cardiologist from Genesis Heart Care you will have certainty of no out-of-pocket expenses for your in-hospital cardiologist treatment. You’ll also be provided with information and advice so you can make informed decisions about your treatment and lifestyle.

What we won't pay for

Hospital costs


Situations when you will not be covered include:

  • when you have not been admitted into a hospital and are treated as an outpatient (eg emergency room treatment, outpatient ante-natal consultations with an obstetrician)
  • during a waiting period
  • when a service is excluded from your cover
  • when a service is included as a minimum benefit and you are admitted to a private hospital, you will not be covered above the minimum benefit
  • for the fixed fee charged by a fixed fee hospital or a hospital that has a fixed fee service
  • for psychiatric and rehabilitation day programs, at a hospital Bupa does not have an agreement with
  • 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 related to surgical podiatry (including the fees charged by the podiatric surgeon); cosmetic surgery where not clinically necessary; respite care; experimental treatment and/or any treatment/procedure not approved by the Medical Services Advisory Committee (MSAC)
  • personal expenses such as: pay TV, internet access, 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) 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 (eg chiropractors, dieticians or psychologists)
  • where compensation, damages or benefits may be claimed by another source (eg workers compensation)
  • for any amount charged by a public or non-agreement hospital which is not covered by us or which is above the benefit that we pay
  • for any treatment or service provided outside Australia
  • for some non-PBS, high cost drugs
  • for pharmacy items not opened at the point of leaving the hospital.

Medical costs


We will not pay for medical treatment where a third party is already required to pay for that treatment. This includes where Medicare, workers compensation, transport accident or other types of insurance pay for some reason. There are also rules about what we are allowed to pay as a health insurer that we must abide by. We are not able to pay for medical treatment by a GP, for example or emergency room treatment even if it is in a hospital.

Doctors set their own fees for medical treatment. We pay for medical treatment up to an amount based on Medicare requirements. That is, Medicare pay part and we pay part of the Doctor’s fee up to a Medicare specified amount. We will not pay any part of a Doctor’s fee charged that is above the Medicare specified fee unless your medical specialist/doctor participates in our Medical Gap Scheme. To ensure peace of mind: ask your doctor about their fees and whether they participate in and use our Medical Gap Scheme before your medical treatment.  Remember to ask your doctor about fees for other practitioners that may be involved in your medical treatment, such as the anaesthetist and assistant surgeons as they each charge separately.

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.

Waiting periods


A waiting period is a set amount of time during which you will not receive a benefit from us for a service or treatment included on your policy. You can switch from another health insurer to us and we will generally recognise any waiting periods that you have served on your old policy. We call this "portability" Different waiting periods apply for different services.

The following waiting periods apply for hospital cover:

  • palliative care, psychiatric and rehabilitation services – two months
  • pre-existing conditions, ailments or illnesses and pregnancy (including childbirth) – 12 months
  • all other treatments included in your cover – two months.

Inpatient vs outpatient

You are an inpatient when you are admitted to hospital. We will pay for treatment included in your chosen product once the hospital admits you. You are not an inpatient if you only receive treatment in a hospital emergency department.

You are an outpatient if you go to hospital to receive treatment but the hospital does not admit you (for example, you only undergo pathology tests or radiology services at the hospital and go home). You may be able to make a claim from Medicare to pay for those types of services as some of them are eligible for Medicare rebates.

When to contact us

If you have been a Bupa member for less than 12 months on your current hospital cover, it is important to contact us before you are admitted to hospital to find out whether the pre-existing condition waiting period applies to you. We need about five working days to make the pre-existing condition assessment, subject to the timely receipt of information from your treating medical practitioner/s. Make sure you allow for this timeframe when you agree to a hospital admission date. If you proceed with the admission without confirming benefit entitlements and we (the health fund) subsequently determine your condition to be pre-existing, you will be required to pay all hospital charges and medical charges not covered by Medicare.

Planning for a baby

If you are thinking about starting a family we recommend that you contact us to check whether your current level of cover includes pregnancy in advance. This is because a 12-month waiting period applies to pregnancy (including childbirth) and assisted reproductive services.

No waiting periods will apply to the newborn provided they have been added to the appropriate family hospital cover within two months of their birth.

Additional features

You may not have to pay the Medicare Levy Surcharge

Covers you against paying an additional levy known as the Medicare Levy Surcharge. This levy is tiered according to your level of income and whether you hold an appropriate level of private hospital cover. The income levels and surcharges are: singles earning more than $90,000 (1%), $105,000 (1.25%) and more than $140,000 (1.5%) or couples and families with combined taxable incomes greater than $180,000## (1%), $210,000# (1.25%) and $280,000# (1.5%).
#Family income thresholds increase by $1,500 for each additional child after the first child. Thresholds are effective 1 July 2014 and are indexed annually.

You should ask your tax adviser for more information or visit the Australian Taxation Office website.


For more Hospital Cover packages visit the Hospital Cover page

Find more Bupa health insurance by Life Stage: Singles Health Insurance, Couples Health Insurance, Family Health Insurance, Single Parents Health Insurance

Health Insurance Comparison, compare health insurance by Life Stage

Extras

Get more back at Members First providers

At Members First providers, you will get at least 60% back on most items, covering general dental, physio and chiro services. At Non-Members First providers, you will get back a fixed amount depending on the service. These Non-Members First providers may charge higher fees than the fixed amount so you may need to pay to cover the ‘gap’.

Services
See our glossary for help on definitions.

Waiting Periods

Annual Maximums

Per person, per calendar year

green tickGeneral Dental General Dental

General Dental

General dental treatment includes services such as:

  • Your regular 6 monthly examination, scale and 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.

2 months

$700

1 We cover the cost of your kids' General Dental services until they turn 25. This means you'll benefit from no out of pocket costs on your kids' general dental services at Members First providers. Limits and conditions apply please contact us for details. 

green tickMajor Dental Major Dental

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 eg 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.

12 months

$600

green tickOrthodontics Orthodontics

Orthodontics

Orthodontic treatment includes the use of devices like “braces” to change the position of teeth and the jaws.

Please refer to the full policy details to determine what is covered. Waiting periods may apply. Some levels of cover only include orthodontics if treatment is required as a result of an accident after joining.

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.

12 months

$400

 

Lifetime Limit: $1300

green tickOptical Optical

Optical

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.

2 months

Members First $260

Non-Members First $180

green tickPhysiotherapy Physiotherapy

Physiotherapy

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.

2 months

$450

2 We cover the cost of your kids' physiotherapy services until they turn 25. This means you'll benefit from no out-of-pocket costs for most of your kids' physiotherapy sessions at Members First providers. Limits and conditions apply please contact us for details.

green tickChiropractic and Osteopathy Chiropractic and Osteopathy

Chiropractic and Osteopathy

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.

Please refer to the full policy details to determine what is covered. Benefits can only be claimed for consultation and treatment by chiropractors and osteopaths 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.

2 months

$350 per person

$500 per membership

green tickNatural Therapies Natural Therapies

Natural Therapy

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 Remedial 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.

2 months

$300

A sub-limit of $100 per person per calendar year applies for massage.

green tickLiving Well Living Well

Living Well

Our Living Well benefit helps you reach your goals by covering some of the costs for health–related programs including: gym memberships, yoga, Pilates, nicotine replacement therapy and weight management programs. However, please remember – gym memberships, yoga and Pilates require your doctor or recognised provider to complete a Living Well form to confirm the program is medically necessary.

Please refer to the full policy details to determine what is covered.

6 months

$100

green tickPharmacy Pharmacy

Pharmacy

Your extras pharmacy entitlement covers you for prescription only items that are not supplied under the PBS (Pharmaceutical Benefits Scheme); are TGA (Therapeutic Goods Administration) approved; are prescribed by a registered medical practitioner; supplied by a Bupa recognised, registered pharmacist; and not otherwise excluded by Bupa.

When in hospital, if you are treated with drugs that are not PBS approved, you may not be fully covered and the hospital may charge you for all or part of the cost. You should be advised by the hospital of any charges before treatment.

There are some additional items that are not covered by our pharmacy benefit and these include:

  • Over the counter or non-prescription items
  • Compounded items
  • Weight loss medication (some weight loss medications are covered under the Living Well Programs)
  • Body enhancing medications (eg anabolic steroids).

Pharmacy in-hospital

When you make a claim, we will deduct a pharmacy co-payment and pay the remaining balance up to the set amount under your chosen level of cover.

2 months

$400

green tickDietary Dietary

Dietary

Dietetics is the promotion of health and treatment of disease through diet.

Please refer to the full policy details to determine what is covered.

Benefits can only be claimed for services provided by Dietitians 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.

2 months

$200

green tickPsychology Psychology

Psychology

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.

2 months

$200

green tickPodiatry (excludes orthotics) Podiatry

Podiatry

Podiatry is the prevention, diagnosis, treatment and rehabilitation of conditions of the feet and lower limbs.

Podiatry services include:

  • Attendances
  • Biomechanical analysis

Please note: Benefits for Orthotics if payable, are paid under Health Appliances.

Please refer to the full policy details to determine what is covered.

Benefits can only be claimed for services provided by Podiatrists 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.

2 months

$200

green tickSpeech Therapy Speech Therapy

Speech Therapy

Speech therapy is the assessment and treatment of people who have a communication disability. Communication disabilities are the result of problems with speech, using and understanding language, voice, fluency, hearing, or reading and writing.

Please refer to the full policy details to determine what is covered.

Benefits can only be claimed for consultation and treatment by speech 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.

2 months

$200

green tickHealth Aids and Appliances Health Aids and Appliances

Health Aids and Appliances

Includes a range of health related items that people suffering with various medical conditions may use to assist them in leading a relatively normal life.

Health appliances include:

  • Asthma pumps
  • Blood glucose monitors
  • INR Blood testing devices (eg Coaguchek)
  • Compression garments
  • Surgical stockings
  • CPAP and BPAP devices
  • TENS machines
  • Hearing Aids
  • Braces and Splints

Please refer to the full policy details to determine what is covered. Benefits payable are subject to eligibility.

Benefits are not claimable when a prescribed treatment is not custom made (eg orthotics, braces and splints, surgical shoes). Health appliances must be purchased from a Fund-recognised provider. Call us if you would like any additional information on other criteria that applies to claiming health aids and appliances.

12 months

$600 combined annual maximum. Limits per item apply.

Defined Appliances include TENS Machines, blood pressure monitors, insoles, orthopaedic and corrective footware, pressure garments, braces, artificial limbs. Limits apply per item. CPAP Devices subject to eligibility.

To receive benefits for health aids and appliances you'll need to visit a recognised provider. You will also need to meet the eligibility criteria, provide proof of purchase and a clinical referral where required.

Benefits are not claimable when a prescribed treatment is not custom made (eg. orthotics, surgical shoes). Call us if you would like any additional information on other criteria that applies to claiming health aids and appliances.

A benefit is also payable for the hire, repair and maintenance of health appliances. Restrictions and sub-limits apply. Benefits are not payable in the first 12 months after purchasing an item, within 12 months following the repair, or on items where hire and repair is deemed inappropriate.

Contact us for a full list of health aids and appliances that may be payable and for details of the limits that apply per item.

green tickTop Up Bonus Top Up Bonus

Top Up Bonus

Each calendar year you can receive a Top-Up Bonus which helps cover any out of pocket expenses for the extras services in your cover.

 

Top Up Bonus

Top up bonuses are per membership per calendar year. Bonuses do not accumulate at the end of the year.

$100 per membership

green tickEmergency Ambulance Services Emergency ambulance services

Emergency ambulance services

Cover for ambulance services varies depending on the provisions of your state of residence. Please refer to the full policy details to determine what is covered.

No waiting period

2 services (per calendar year)

What we will pay for

Once you have served any applicable waiting periods you can claim benefits for those services included on your cover and that are not claimable elsewhere (eg 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 we won't pay for

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 (eg 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 and when you are covered for a service or treatment. If you 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. Different waiting periods apply for different services.

If you’re changing from another Australian health fund to Bupa, you’ll 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’ll need to transfer to us within 60 days of leaving your old fund.

If you are an existing member and you change your health cover, you may need to wait before you can access your new benefits. Where your new level of cover is higher than what you previously held, the lower level of benefit applies.

Waiting periods apply to services as listed below. Please refer to the full policy details to determine the specific services that are covered under your level of cover, including the associated waiting periods for those services.

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, root fillings, orthodontics, selected health aids and appliances – 12 months.

Add Pharmacy Saver

Enjoy savings on your pharmaceutical and health care purchases all year round at National Pharmacies 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

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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.

 

Payment

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30-DAY COOLING OFF PERIOD

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. 

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Government Rebate
?

The Government offers all Australian residents who are entitled to Medicare benefits an income-tested rebate on their private health insurance.

The government now income tests the rebate on private health insurance. One way you can save up-front is to claim the rebate as a reduction on your premium, would you like to do that now?

For individuals earning $90000 ($180000 for families*) or under
*This increases by $1,500 per child after the first child
If at any stage you wish to nominate a new income tier or stop receiving the Australian Government Rebate as a reduced premium, you must notify your health fund as soon as possible.