Platinum Extras health insurance

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 benifit. 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

When you, your partner or your family take out our hospital cover, extras cover or packaged cover, you will receive capped cover for recognised emergency ambulance transport and on-the-spot treatment.

An emergency is when there is reason to believe that the patient’s life may be in danger or the patient should be attended to without undue delay.

Transportation means a journey from the place where immediate medical treatment is sought to the casualty department of a receiving hospital.

Emergency ambulance transportation is defined as air or road transportation by a Recognised Ambulance Provider of an unplanned and of a non-routine nature for the purpose of providing immediate medical attention to a person.

Whether the transportation is deemed an emergency is determined by the paramedic and usually recorded on the account.

Benefits are not payable for:

• transportation from a hospital to your home
• transportation from a hospital to a nursing home
• transportation from a hospital to another hospital where the customer has been admitted to the transferring (first) hospital
• transportation from the person’s home, a nursing home or hospital for ongoing medical treatment, (eg chemotherapy, dialysis).

We recommend that you take out an ambulance subscription with your recognised State Ambulance Provider if it’s available in your state (VIC, SA, NT and rural postcodes in WA). We will only provide ambulance benefits, in accordance with your level of cover, when you do not hold a subscription with an ambulance provider and a state ambulance scheme does not provide cover.

NSW and ACT members: If you reside in New South Wales or the Australian Capital Territory and you have hospital cover, you pay an ambulance levy as part of your premium. This entitles you to free emergency ambulance transport under the State Government ambulance transport schemes.When you receive an account for ambulance transport, simply send it to us and we’ll endorse it for you to send back to the appropriate ambulance transport scheme.

QLD and TAS members: If you reside in Queensland or Tasmania, you are covered under your state service scheme.

VIC, SA, WA and NT members: If you reside in Victoria, South Australia, Western Australia or the Northern Territory you will receive cover for recognised emergency ambulance transport and on-the-spot treatment from us.This is as long as you don’t have an ambulance subscription with your state ambulance service or cover through a state-based arrangement.

Most state schemes cover their respective residents within their state of residence only. However, some states have entered into reciprocal agreements that allow you to be covered for ambulance services when you travel outside your state of residence. You should check with your state ambulance provider for when these reciprocal arrangements apply and the level of cover offered.

If you fall outside your state-based arrangement (including any reciprocal agreement) and are not covered for emergency ambulance services, you will be covered by Bupa up to the annual cap, as long as your level of cover contains ambulance cover and the services are provided by a recognised provider.