FLEXtras 4 Standard 50
Cover benefits:
- Tailor your extras cover to suit your needs
- Guaranteed percentage back at recognised providers on selected services, up to yearly limits+++
- Unlimited Emergency Ambulance Services^^^
- Flexibility to swap a service you haven't claimed on during the calendar year. If you’ve already made a claim on the service you wish to change, you’ll need to wait until January 1 of the next year; this is when your limits reset.β
- If you have selected General Dental as one of your service selections and visit a Members First Ultimate provider, you can get:
- 100% back on up to two 6-monthly check-up and cleans every year, claimable outside of yearly limits**
- 100% back on general fillings, up to yearly limits~~
+++Waiting periods, benefit claiming restrictions, fund and policy rules apply.
** You can receive 100% back on dental check-up and cleans (select dental items only) once every 6 months at Members First Ultimate Providers. Waiting periods, benefit claiming restrictions, policy and fund rules apply. Excludes orthodontics and in-hospital treatments. Available on all eligible extras products which includes General Dental (excluding FLEXtras and Your Choice Extras 60 where general dental is not included). If you choose or require any additional dental services, any health insurance benefits will also be subject to your yearly limits.
^^^ Cover for uncapped emergency ambulance transport or on-the-spot treatment by our recognised providers in each state of Australia. If claimable from another source, a benefit won’t be paid by Bupa. Waiting period, fund and policy rules apply.
~~ You can receive 100% back on direct restorations or fillings (select dental items only), up to yearly limits, at Members First Ultimate Providers. Waiting periods, benefit claiming restrictions, policy and fund rules apply. Benefits are payable up to yearly limits or on available remaining limits in relation to your product. Some out of pocket costs may apply if a claim exceeds your yearly limits. Excludes Orthodontics and in-hospital treatments. Available on all eligible extras products which includes General Dental (excluding Simple Start – Basic Plus, OSHC Extras, FLEXtras and Your Choice Extras 60 where General Dental is not included). If you choose or require any additional dental services, an out-of-pocket cost may apply.
β You'll have the flexibility to swap services if your needs change. If you haven't made a claim for a given service within the calendar year, you can swap it for another service. If you've already made a claim on a service you'd like to change, you'll need to wait until your limits reset on 1 January to make any changes. These selections and any changes apply to everyone covered by your membership. Yearly limits, waiting periods, benefit claiming restrictions, fund and policy rules apply.
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 (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.
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.
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 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 you 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 benefit. Where your new level of cover is higher than what you previously held, the lower level of benefits applies.
Waiting periods apply to services as listed below. Please refer to the fully 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 Health Management extras service - six months
- major dental, root fillings, orthodontics, selected health aids and appliances - 12 months
- emergency ambulance transport or on-the-spot treatment – one day
Emergency ambulance is for an unplanned event where you’ve been injured or you have a medical emergency where your life may be at risk, or where you need medical treatment right away. The ambulance provider will confirm whether the transport or medical treatment was an emergency.
Non-emergency ambulance is for situations when you need an ambulance but don’t need treatment right away. Non-emergency ambulance cover is not included as part of Bupa’s hospital and extras covers.
For example:
- Transport from a hospital to your home or nursing home.
- Transport to a hospital, your home or nursing home for ongoing treatment, like dialysis or chemotherapy.
- Where you’re admitted to one hospital and need to be taken to another.
Unlimited emergency ambulance services Australia-wide is included in most of our hospital and extras covers. That means we will pay 100% of the charges for emergency ambulance transportation and on-the-spot treatment by our recognised providers. A one-day waiting period applies.
If you can claim for an ambulance service with another provider, Bupa won’t pay a benefit. This includes state government ambulance subscriptions, or where the state government covers ambulance transport.
Find out more about ambulance cover in your state.
Recognised ambulance providers
Bupa will only pay benefits towards ambulance services when they are provided by any of the following providers:
- ACT Ambulance Service
- Ambulance Service of NSW
- Ambulance Victoria
- Queensland Ambulance Service
- South Australia Ambulance Service
- St John Ambulance Service NT
- St John Ambulance Service WA
- Tasmanian Ambulance Service.
* Private room not covered for minimum benefit services or exclusions. At Bupa agreement hospitals only, room availability and eligibility criteria apply.
~ Subject to availability and eligibility. Private room must be booked and requested at least 24hrs 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 or where a private room is medically inappropriate.
^ Must select general dental, waiting periods, policy and fund rules apply. Limits also apply to how often you can get a service, based on usual clinical practice. For example, we'll generally only pay for a scale and clean once every six months.
^^ Waiting periods, yearly limits, fund and policy rules apply. Limits also apply to how often you can get a service, based on usual clinical practice. For example, we'll generally only pay for a scale and clean once every six months.
+ Waiting periods, fund and policy rules apply. Child dependants only. Excludes orthodontics and hospital treatments.