Gold Visitors Cover With Signature Extras

Benefits included on cover:
	Accommodation for overnight and same-day stays
	Operating theatre, intensive care, ward fees
	Bupa Medical Gap Scheme available
	Allied services (eg physiotherapy in hospital)
	Private hospital admissions
	Public hospital admissions
	Inpatient medical expenses - 100% of AMA
	Outpatient medical expenses - 150% of MBS
	457, 482 visa compliant
Inpatient services included on cover:
	Pregnancy and birth related services
	IVF and assisted reproductive services
	Cosmetic Surgery
	Bone marrow transplants
	Organ transplants
	All other inpatient treatments receiving a Medicare benefit
Additional Items:
	Outpatient pharmacy benefits*
	100% emergency ambulance services
	Repatriation benefits
	Family in-hospital benefit that helps pay for in-hospital partner/family accommodation or meals
	Crutches and wheelchairs benefit
	Reimbursement on emergency department facility fees charged at any private or public hospital including administration fees even if not admitted to hospital
Excess options: Nil, $500
Legend:    Glossary
	Covered
	Not covered
AMA Fee	Australian Medical Association Fee
MBS Fee	Medicare Benefit Schedule Fee
* you pay $20, we refund a 90% of balance per script per item up to $600 per person per calendar year.

What is covered?

Hospital costs

With private hospital cover, you can choose to be treated as a private patient in either a public or a private hospital.

What if I am treated in a Members First or Network Hospital?

Depending on your level of cover you are fully covered as a private patient in most hospitals that Bupa has an agreement with known as Members First and Network hospitals across Australia for any treatment which is recognised by Medicare and is not either restricted or excluded under your cover.

A small number of these hospitals may charge a fixed daily fee, capped at a maximum number of days per stay. The hospital should inform you of this fee when you make a booking. This fee is in addition to any excess you may have as part of your hospital cover.

When admitted to hospital, in most cases you will be covered for in-hospital charges when provided as part of your in-hospital treatment including:

• accommodation for overnight or same-day stays
• operating theatre, intensive care and labour ward fees
• 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).
• supplied pharmacy items approved by the Pharmaceutical Benefits Scheme (PBS)
• physiotherapy, occupational therapy, speech therapy and other allied health services
• a surgically implanted prosthesis up to the Government minimum benefit published in the Government's Prosthesis List
• private room where available.^

^Conditions apply. Contact us for more information.

Members First day facilities

If you are treated in a Members First day facility, there are no out-of-pocket expenses for medical services (eg your specialist’s fees). (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 hospital of choice gives you certainty of full cover. We can also discuss any excess that may be applicable to your level of cover. You can find out if a hospital has an agreement with us by checking bupa.com.au/find-a-provider.

What happens if I choose to be a private patient in a public hospital or go to a private hospital that doesn't have an agreement with Bupa?

With us, if you elect to be treated as a private patient in a public hospital or are admitted to a non-agreement private hospital, you are covered as set out below for any treatment recognised by Medicare unless it is excluded or restricted under your cover. If you choose to be treated 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.

In a non-agreement private hospital, you are responsible for the cost of your stay and may be charged directly for your hospital accommodation, doctor's services (including diagnostic tests), surgically implanted prostheses (eg artificial hips) and personal expenses such as TV hire and telephone calls. Some of these hospitals bill Bupa directly for the benefits we pay for your hospital stay under your policy.

The amount we will pay towards your accommodation in a non-agreement private hospital is limited to a minimum shared room benefit. For a non-agreement private hospital this will only partially cover the full cost and you will have significant out-of-pocket expenses. If you request a single room in a non-agreement private hospital, and you receive one, you will incur out-of-pocket expenses as the hospital may charge you more for the room than the benefit that Bupa pays. It is important to note that in public hospitals, single rooms are generally allocated to people who medically need them the most. If required we will also cover any prostheses that are surgically implanted in you during your hospital stay up to the minimum benefit listed on the Government's Prostheses List.

We will cover you for your in-hospital medical costs incurred during an admission in public or non-agreement hospital in the same way as set out under the heading "Inpatient Medical Costs" below.

The hospital and the treating doctor should let you know what you'll be billed for and how much you will be charged, ie they should obtain your Informed Financial Consent before you receive the treatment – if they don't, make sure to ask for full details. Call us to confirm what benefits we'll pay for your public hospital or non-agreement private hospital stay.

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. Put simply, we pay 100% of a schedule fee or 100% of the cost of inpatient medical fees. Depending on your level of cover, we cover you for either the Australian Medical Association (AMA) Schedule fee or the Medicare Benefits Schedule (MBS) fee, or the full cost of treatment. The schedule fees mentioned above are the fees determined by the AMA and the Federal Government respectively, as the appropriate fee for a specific service.

Please check your product summary to determine the benefits that apply.

Outpatient medical costs

This is cover for any treatment you receive from a doctor or specialist in private practice, or as an outpatient (ie where you are not admitted into hospital) anywhere in Australia.

Depending on what is set out in your level of cover we cover you for 100% to 150% of the Medicare Benefits Schedule (MBS) fee or 100% of the MBS Scheduled fee for Outpatient costs. The MBS fee is set for each specific service by the Federal Government. Outpatient medical cover is available on most of our visitors covers. Please check your product summary to determine the benefits that apply.

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 that apply. A co-payment of $20 applies.

Repatriation benefit

You will receive cover for repatriation to your country of origin if you become terminally ill or if you suffer a substantial life altering illness/injury up to $100,000. Or for the return of mortal remains up to $10,000. Benefits are only payable once approved by Bupa.

No Repatriation Benefit will be paid if you were:

• first diagnosed as terminally ill
• a reasonable person would have first become aware of the terminal illness
• if you suffered a substantial life altering illness or injury within the six months prior to the date your cover commenced.

Family In-Hospital Benefit

You could receive benefits for accommodation and meal costs if your partner, immediate family member, carer or next of kin is required to stay at hospital with you or a person on your membership. They will be covered for $60 per night for accommodation in hospital and up to $30 a day for hospital meals.

Hospital meals are covered when provided at a hospital cafeteria or patient meal menu. A $1,000 per person, per calendar year annual maximum applies to Family In-Hospital Benefit.

Crutches and wheelchairs benefit

You will receive a benefit for crutches and wheelchairs.

For a benefit to be payable, the hire or purchase must be linked to an inpatient admission resulting in the requirement of the item. We will not pay benefits without evidence of a hospital admission.

If eligible, we will pay 100% of the cost up to a maximum limit of $500 per person per calendar year for any hire or purchase of crutches or wheelchairs.

Excess

On selected covers there may be an excess option which may lower the amount that you pay for your cover. Excesses are only payable on overnight and same-day inpatient hospital admissions in any hospital.

• The total excess amount is paid each time a person on your membership is admitted into hospital, to a maximum of once per person and twice per membership each calendar year unless otherwise specified.
• If the total excess amount for an individual is not reached in a single hospital admission, the remaining balance of that excess is payable in any subsequent hospital admission.
• No excess applies to your dependent children. Please contact us for further details.

What is not covered?

Hospital costs

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

• during a waiting period
• when a service is excluded from your level of cover
• when specific services or treatments are a restricted cover
• labour ward fees on Short Stay Visitors 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. This does not apply to Ultimate Corporate Visitors Cover as any fixed fee will be reimbursed
• depending on your level of cover, if you have not been admitted into a hospital and are treated as an outpatient (eg emergency room treatment, outpatient ante-natal consultations with an obstetrician) you may not be covered
• for psychiatric and rehabilitation day programs, at a hospital Bupa does not have an agreement with
• 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); cosmetic surgery where not clinically necessary; 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 your 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 you 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
• some hospital-subsititute treatment and operative services that are a continuation of care associated with an early discharge from hospital
• for pharmacy items not opened at the point of leaving the hospital unless covered on your visitors or extras cover
• if you choose to use your own allied health provider (eg chiropractors, dieticians 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)
• for any amount charged by a public or non-agreement hospital which is not covered by us or which is above the benefit that we pay
• for any treatment or service rendered outside Australia
• for any treatments arranged in advance of your arrival in Australia
• Non-PBS, high cost drugs
• if you do not hold a valid visa at the time of admission to hospital and for the duration of your hospital stay.

Medical costs

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
• 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.

Waiting periods - Hospital

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.  Once you have completed your waiting period, you will receive the benefits listed under your level of cover for that service.

Please note: you commence serving your waiting periods from the date you arrive into Australia, and not the start date.
 

Understanding your ambulance cover

You will receive unlimited emergency ambulance services. That means we will pay 100% of the charges for emergency transportation and on-the spot treatment, by our recognised providers.

You will receive limited non-emergency ambulance services. This means your cover will be limited to three times per person, per calendar year, for non-emergency transportation by our recognised providers.

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.

For more information about our working and non-working visitors covers, please refer to the Visitors Cover Brochure and Visitors Cover Important Information Guide.