Understanding your cover

Bupa’s OSHC provides cover for hospital and medical treatment.

What's covered
OSHC hospital cover

Hospital expenses covered

In most cases, we’ll pay for the following services when you’re in hospital, including:

Accommodation for overnight or same-day hospital stays
Operating theatre, intensive care and labour ward fees
Medication provided during your in-hospital treatment under the Pharmaceutical Benefits Scheme (PBS)
Physiotherapy, occupational therapy and dietetics and other allied health services provided in hospital
Surgically implanted prostheses up to the approved minimum benefits in the Government Prostheses List that is used as part of your surgery
Private room where available
oshc medical costs and cover

Medical expenses covered

Each doctor or specialist that treats you will charge a fee for the service they provide. This also includes most tests you may be sent to have by your doctor including pathology and radiology services.

There is a set fee for each service, called the Medicare Benefits Schedule (MBS) fee. If your doctor charges you 100% of the MBS fee then you will be fully covered for treatment in hospital and out of hospital. If your doctor charges more than 100% of the MBS fee, you'll pay the amount above the MBS fee.^
understand oshc and pharmacy cover

Outpatient pharmacy

If you're prescribed pharmacy items by a doctor, specialist or when you have visited hospital and not been admitted, you can claim back $50 per approved prescription item, up to $300 (single) or $600 (couple/family) per year.

You’ll have to pay the Pharmaceutical Benefits Schedule co-payment fee. Australian residents pay the same fee.
oshc ambulance cover by recognised providers

Emergency Ambulance Services

You can claim for emergency ambulance transportation and on-the-spot treatment by our recognised providers anywhere in Australia.

 
What's not covered
Procedures not approved by the Medical Services Advisory Committee
Procedures not recognised by Medicare
Cosmetic surgery (that is not clinically necessary and where benefits are not payable by Medicare)
Non-emergency ambulance
Assisted reproductive services
Experimental treatment
Repatriation
Respite care

Extras services such as a dental check-up, physio, podiatry consultations and chiro. Add OSHC Extras to include these services

We may not pay some or all of the costs for other services. For further information, please refer to this Important Information Guide.

Things you should know
oshc waiting periods could apply to you

Waiting periods apply

You need to be a member for a certain amount of time before claiming money back on services. This is called a waiting period.

If you have your condition before joining Bupa, this is known as a pre-existing condition and we may not be able to cover you. Or you may need to wait until you have completed your waiting period.

2 months* = Pre-existing conditions, ailments or illnesses of a psychiatric nature
12 months = Pregnancy and birth
12 months = All other pre-existing conditions, ailments or illnesses for hospital and outpatient medical services
understand what is not covered in oshc

Waiting periods don’t apply when:

Treatment is required as a result of an accident after joining Bupa
You have a condition which is defined under the Emergency Treatment section of the Important Information Guide.

Your compliant OSHC cover does not cover Extras services

To get cover for extra services like dental, physio and chiro, add Bupa OSHC Extras.

How to order a Bupa OSHC membership card

Once you know your Australian address, you can update your address in myBupa

You’ll also need to order your OSHC membership card in three easy steps:

  • Login to myBupa
  • Go to ‘Cover’ in the menu of the Home Page
  • Select ‘Order a membership card’

Please remember that this is just a snapshot of your cover. For full details on what we will and won’t help you pay for under your Bupa OSHC membership, please read your full cover description located in the box below.

* the standard 2 months waiting period for pre-existing conditions of a psychiatric nature is not enforced by Bupa until further notice.

Yearly limits, waiting periods, fund and policy rules apply.