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Quote reference

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.





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*:


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

Features at a glance

Hospital Cover
Extras Cover
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.

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


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.

Important documents for you to read

Top Hospital (PDF)


Any medical services you receive while admitted into hospital. Any emergency department treatment is not included.

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

Additional Items:
tick icon Emergency ambulance services
tick icon Family in-hospital benefit that helps pay for in-hospital partner/family accommodation or meals
tick icon Health subscription refunds
tick icon Unemployment cover
tick icon Excess options
orange cross Co-payments
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 included 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 covered 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

  • Family In-Hospital Benefit

    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 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 is underwritten by Insurance Australia Limited ABN 11 000 016 722 AFSL 227681.

    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.
  • 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.

  • 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.

Member Exclusives

Even when you’re in great health, there are still plenty of ways to get everyday value thanks to Bupa Plus. We’ve introduced this program to give you access to an exclusive range of discounts, health tools and information to help you live a healthier, happier life. Visit



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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.

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