The information below is general information which applies to all our hospital products - not just yours. It includes descriptions that may not be relevant to your product (for example, if your product does not include an excess, the description of an “excess” and how it works is not relevant to you). Read this information together with the list above to understand how your product works.

There have been some changes to our Network Hospitals please see our Network Hospital PDF  or visit 'Find a Provider'. Bupa has worked hard to put transitional arrangements in place, which means there will be no impact to hospital costs for our members until 1 October 2022, and in some cases, until August 2023. For all updates regarding Ramsay Health Care please see our 'Bupa and Ramsay Negotiations' webpage.

You are an inpatient when you are admitted to hospital. We will pay for treatment included in your chosen product once the hospital admits you. You are not an inpatient if you only receive treatment in a hospital emergency department.

You are an outpatient if you go to hospital to receive treatment but the hospital does not admit you (for example, you only undergo pathology tests or radiology services at the hospital and go home) or If you go to a doctor or specialist in private practice anywhere in Australia.

Your OSHC covers you for 100% of the Medicare Benefits Schedule (MBS) fee for services provided by doctors including surgeons, anaesthetists, pathologists or radiologists while in hospital and also as an outpatient, when you are treated by a doctor or specialist in private practice

On top of your hospital cover you will receive cover for uncapped emergency ambulance transportation services or on-the spot treatment anywhere in Australia with a Bupa recognised provider. Emergency ambulance services will be covered only where the service is medically necessary for admission to hospital or for any condition that requires on-the-spot Emergency Treatment. You’re not covered for non-emergency transportation from a hospital to your home, a nursing home or another hospital.

If you need to make a claim for emergency ambulance services covered on your OSHC, please complete and return to us the Particulars of Ambulance Transportation form.

Recognised Ambulance Providers

Bupa will only pay benefits towards ambulance services when they are provided by any of the following recognised 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.

Hospital costs are charges that are incurred as part of your treatment in hospital. Some common hospital costs include:

• accommodation for overnight or same-day stays
• operating theatre, intensive care and labour ward fees
• supplied pharmaceuticals approved by the Pharmaceutical Benefits Scheme
• physiotherapy, occupational therapy, speech therapy and other allied health services
• surgically implanted prostheses up to the approved benefits in the Government’s Prostheses List
• private room where available.
• reimbursement on emergency department fees charged at any private or public hospital including administration fees if admitted into hospital (or in all circumstances depending on your level of cover)

What happens if I am treated in a private hospital that Bupa has an agreement with?

Once you have served any waiting periods for your product, we will pay for medical treatment provided when you are a patient in private hospitals that Bupa has an agreement with, if it is included in your cover.
A small number of these hospitals may charge a fixed daily fee, which you must pay. This fee is capped at a maximum number of days for overnight stays. The hospital should inform you of this fee when you make a booking. This fee is in addition to any excess or co-payment you may have as part of your hospital cover.

At Members First Day Hospitals, you have the added benefit of no medical gaps in addition to being covered for hospital costs, provided the treatment is recognised by Medicare and there are no exclusions on your level of cover.^#

Any co-payment or excess related to your level of cover will still apply. We recommend you call us first before making a booking to confirm that your chosen hospital gives certainty of full cover. We can also discuss any excess or co-payment that might apply to your level of cover. You can find out if a hospital has an agreement with us by checking the find a healthcare provider section of this website.

^#Not available in NT.

Can I choose to be treated as a private patient in a public hospital or at a private hospital that Bupa does not have an agreement with?

If you elect to be treated as a private patient in a public hospital or are admitted to a private hospital that Bupa does not have an agreement with, you are covered as set out below for any treatment recognised by Medicare unless it is excluded or restricted under your cover.

In these circumstances, you are likely to incur out-of-pocket expenses for your hospital costs.

What happens if I choose a private hospital that Bupa doesn’t have an agreement with?

If you are admitted to these hospitals for any treatment recognised by Medicare that is included in your cover:

• You will have restricted cover for your hospital costs. At these hospitals, this means that you are likely to have large out of pocket costs.
• You will still be covered for prostheses up to the amount listed on the Government Prostheses List.

How do I pay these costs?

It is important to note that you will be responsible for the cost of your stay and may be charged directly for your hospital accommodation, doctor’s services (including any diagnostic tests), surgically implanted prostheses (such as artificial hips) and personal expenses such as TV hire and telephone calls. Some of these hospitals bill Bupa directly for the limited benefits we pay. Please check the medical costs section to understand how you’re covered for medical costs, like specialists’ fees.

What happens if I choose to be a private patient in a public hospital?

What we pay for:

If you are admitted to these hospitals for any treatment recognised by Medicare that is included in your cover:

• You will have restricted cover for your hospital costs, which means that we will pay minimum benefits for shared room accommodation as set by the Australian Government. This will usually cover you for a shared room, but you may still have an amount to pay yourself.
• Depending on your level of cover, if you choose to stay in a private room, Bupa may pay an additional fixed amount towards the cost of your stay. If this amount is less than what the hospital charges you, the hospital should let you know what you will have to pay yourself.
• You will still be covered for prostheses up to the amount listed on the Government Prostheses List. If your specialist charges more than this amount, you will need to pay it yourself.

For what medical costs (like specialist’s fees) we pay for, check the medical costs section.

Other costs I might have to pay myself

As a private patient in a public hospital you will also be responsible for personal expenses such as TV hire and telephone calls together with any Medical Gaps your doctor/surgeon charges.

Will I get a private room?

It is important to note that in public hospitals, private rooms are generally allocated to people who medically need them.

What does this mean for my choice of doctor?

As a private patient in a public hospital you are entitled to choose your doctor, if they are available. Depending on your illness or condition, this may be the same doctor who would have been allocated to you by the hospital as a public patient. Additionally, whether a doctor provides treatment at a public hospital, or performs a particular procedure in a public hospital, is outside of Bupa's control.

What does this mean for when I can get treatment?

At a public hospital, even if you are treated as a private patient - it is important to understand that you may still be subject to public hospital waiting lists.

Inpatient medical costs

These are the fees charged by your doctor, surgeon, anaesthetist or other specialist for any treatment given to you when you are admitted to a hospital as an inpatient. This includes most inpatient diagnostic tests recognised by Medicare as medically necessary (e.g. pathology, radiology). We cover you for 100% of the Medicare Benefits Schedule (MBS). This is the amount determined by the Australian Government for a specific service for Australian residents. If your doctor or specialist charges more than the MBS Fee there will be a ‘gap’ for you to pay.
To find out the Medicare Benefit Schedule (MBS) fee visit mbsonline.gov.au.

Bupa Medical Gap Scheme

The Bupa Medical Gap Scheme is designed to remove or reduce the costs you pay for your treatment in hospital. Where a doctor chooses to use the Scheme for your treatment, they agree to only charge up to a certain fee. Bupa then pays a much higher amount than we normally would to help cover the extra cost. If a doctor uses the no-gap option, Bupa covers all of the extra charges, so you pay nothing for that doctor’s medical fees. Otherwise, for each doctor choosing to use the Gap Scheme, the most you’ll pay is up to $500 out-of-pocket on medical costs. Each doctor involved in your treatment can choose to use the Bupa Medical Gap Scheme for your admission in a Public Hospital, or a Private Hospital with which Bupa has an agreement.

See www.bupa.com.au/medicalgapscheme for more.

Emergency Department Fees

You'll receive reimbursement on emergency department fees at any private or public hospital including administration fees even if not admitted to hospital

Outpatient medical costs

This is cover for any treatment you receive where you are not admitted into hospital in Australia from a doctor or specialist in private practice (including diagnostic services such as radiology and pathology). We will cover you for up to 100% of the Medicare Benefits Schedule Fee (MBS Fee) for outpatient services. The MBS Fee is the amount determined by the Australian Government for a specific service for Australian residents. If your doctor or specialist charges more than the MBS Fee there will be a gap for you to pay.
To find out the Medicare Benefit Schedule (MBS) fee visit mbsonline.gov.au.

Outpatient pharmacy benefit

You can also receive benefits on selected pharmacy items prescribed as an outpatient or by a doctor or specialist. Please check your product summary to determine the benefits and co-payment that apply. This is provided the pharmacy items usage is approved by the Therapeutic Goods Administration (TGA) and not appearing on our exclusions list.

Emergency Treatment is any treatment required where a person:

• is in a life-threatening situation and requires urgent assessment and resuscitation
• has suspected acute organ or system failure
• has an illness or injury where the function of a body part or organ is acutely threatened
• has a drug overdose, toxic substance or toxin effect
• has psychiatric disturbance whereby the health of the person or other people are at immediate risk
• has severe pain and the function of a body part or organ is suspected to be acutely threatened
• has acute haemorrhaging and requires urgent assessment and treatment
• has a condition that requires immediate admission to avoid imminent threat to their life and where a transfer to another facility is impractical.

Situations when you are likely not be covered or may incur significant additional expenses include:

• treatment during a waiting period (unless Emergency Treatment is required)
• when specific services or treatments are a restricted cover or excluded from your level of cover
• when you are treated at a non-agreement hospital you will not be fully covered
• for the fixed fee charged by a fixed fee hospital or a hospital that has a fixed fee service
• when you have not been admitted into hospital and are treated as an outpatient (eg emergency room treatment, outpatient antenatal consultations with an obstetrician prior to childbirth), you will not be fully covered
• hospital treatment provided by a practitioner not authorised by a hospital to provide that treatment
• hospital treatment for which Medicare pays no benefit, including medical costs in relation to surgical podiatry (including the fees charged by the podiatric surgeon); most cosmetic surgery; respite care; experimental treatment and/or any treatment/procedure not approved by the Medical Services Advisory Committee (MSAC)
• personal expenses such as: pay TV, non-local phone calls, newspapers, boarder fees, meals ordered for you visitors, hairdressing and any other personal expenses charged to you unless included in your cover
• if you are in hospital for more than 35 days and have been classified as a ‘nursing home type’ patient. In this situation you may receive limited benefits and be required to make a personal contribution towards the cost of your care
• for pharmacy items not opened at the point of leaving the hospital, unless covered on your OSHC or extras cover
• if you choose to use your own allied health provider (eg chiropractors, dietitians or psychologists) rather than the hospital's practitioner for services that form part of your in-hospital treatment
• where compensation, damages or benefits may be claimed by another source (eg workers compensation)
• treatment for any children on a family membership if they are over 18 years of age
• additional charges applied for single room accommodation in a public hospital
• some non-PBS and high cost drugs
• any treatments or services rendered outside Australia
• if you do not hold a valid visa at the time of admission to hospital and for the duration of your hospital stay.

Please note that no cover is provided for Cosmetic Surgery. See our glossary for a definition.

You will not be covered for

• medical services for surgical procedures performed by a dentist, surgical podiatrist, or any other practitioner or service that is not eligible for a rebate through Medicare
• Outpatient medical services provided by an allied health provider (e.g. psychologist, optometrist, physiotherapist)
• costs for medical examinations, x-rays, inoculation or vaccinations and other treatments required relating to acquiring a visa for entry into Australia or permanent residency visa.

A waiting period is the time when you are not covered for a particular service. It starts on the date that you enter Australia or the date that you start your membership, whichever is the later date. If you receive a service or treatment during a waiting period, you are not eligible to receive a benefit payment from us, regardless of when you submit the claim.  We will only pay a benefit for treatment received during a waiting period if the treatment is classified as Emergency Treatment (see above for more information on Emergency Treatment). Different waiting periods apply for different services.

If you transfer to us from another OSHC provider you’ll continue to be covered for all benefit entitlements that you had with your previous provider. We will honour all the waiting periods you have already served when we receive confirmation of your previous membership.

When you upgrade to a higher level of cover, the benefits from your previous level of cover apply during waiting periods.

The following waiting periods apply for hospital cover:

• Pre-existing conditions, ailments or illnesses of a psychiatric nature – 2 months⁺
• Pregnancy (including childbirth) – 12 months
• All other pre-existing conditions, ailments or illnesses for hospital and outpatient medical services – 12 months

Waiting periods don’t apply when:

• Treatment is required as a result of an accident sustained after joining us
• You have a condition which is defined under the Emergency Treatment section of the Important Information Guide at bupa.com.au/oshc-Info

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

Overseas Student Health Cover excludes some specific services. This means you will not be covered for that specified service or treatment whilst you are on OSHC. For the duration of this cover you will not receive cover for:

• Assisted reproductive services
• All other cosmetic surgery
• Repatriation
• Family in-hospital benefit
• Crutches and wheelchairs benefit
• Cover for extras services (e.g. Dental, optical, physio)
• Travel and accommodation
• Services not covered by Medicare
• Medical expenses for surgical procedures performed in hospital by a dentist or podiatrist
• Treatment for a student's child who is over 18 years of age
• Expenses relating to medical examinations, X-rays, inoculations or vaccinations or other treatments related to acquiring a visa or permanent residency
• Any treatments or services rendered outside of Australia. This includes treatment arranged before you arrived in Australia treatment while travelling to or from Australia expenses for treatment outside of Australia, or transportation into or out of Australia in any circumstance

OSHC Extras is an extras cover designed for young and healthy students looking for great value. OSHC Extras can be taken out in addition to your visa compliant Overseas Student Health Cover (OSHC) and offers extra services that are not covered by OSHC alone, up to the relevant yearly visit limits. For more details on OSHC Extras, click here.