Top Extras Boost

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.