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Bupa Health Insurance When Does My Cover Begin

How long after joining does my insurance cover begin?

A waiting period starts from the date you take out your health insurance or upgrade your cover. If a treatment has a waiting period, you won't be covered during that time. If you’ve upgraded your cover, during a waiting period, you’ll still be able to access the benefit you had on your lower level of cover, but will have to serve the waiting period before having access to the higher benefit.

Different waiting periods apply for different services.

Some things, like emergency ambulance transport or treatment received as a result of an accident occurring after joining will not attract a waiting period and you will be covered from day one.

There are different waiting periods for different medical conditions and treatments.

The following waiting periods apply for hospital cover:

No waiting period
Accidents sustained after joining

  • No waiting period applies to a service you need due to an accident sustained after joining. Benefits for these services are paid according to your level of cover (no benefit applies for an excluded service). Check your product sheet for what’s included in your cover.
  • For how we define an accident, please click here.

2 months

  • Initial waiting period, palliative care, psychiatric and rehabilitation services.
  • Assisted reproductive services (eg IVF).
  • Generally the circumstances in which assisted reproductive services are required are due to an underlying pre-existing condition. Therefore, in most instances, a 12 month pre-existing waiting period applies before you can receive benefits for these services.
  • All other treatments included in your cover other than accidents.

12 months

  • Pregnancy (including childbirth).
  • Pre-existing conditions, ailments or Illness.
  • Laser eye surgery (where related to a pre-existing condition) covered under Ultimate Health Cover and Ultimate Corporate Health Cover.

A pre-existing condition is any condition, ailment or illness that you had signs or symptoms of during the six months before you joined or upgraded to a higher level of cover with us. It is not necessary that you or your doctor knew what your condition was or that the condition had been diagnosed.

If you knew you weren’t well, or had signs of a condition that a doctor would have detected (if you had seen one) during the six months prior to joining or upgrading, then the condition would be classed as pre-existing.

A doctor appointed by us decides whether your condition is pre-existing, not you or your doctor. The appointed doctor must consider your treating doctor’s opinion on the signs and symptoms of your condition, but is not bound to agree with them.

The following waiting periods apply for Extras cover:

  • Initial waiting period – 2 months.
  • Hire, repair of health aids and appliances; and Health Management Programs – 6 months.
  • Major dental, orthodontics, selected health aids and appliances – 12 months.

 

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