Switching from another health fund
If you've joined us from another health fund, welcome to Bupa. There's a few key things you need to know when moving your cover from another fund. To help you with your membership, we've prepared this guide and video for you.
Making your move
When you joined Bupa, the information you gave us allows us to request details about your previous cover. This exchange of information may take 14 days. We receive this information from the clearance certificate your previous insurer provides us. During these 14 days you may not be able to make a claim.
The clearance certificate tells us what level of cover you had, your history of claims, who was on the membership and how long you had the cover for. We need this to ensure your premium is correct, that we consider any limits you may have reached, or still have remaining and to ensure you don't have to wait for any services you've already served a waiting period for.
Once we've received the clearance certificate, you'll be able to make any claims you are entitled to make, subject to waiting periods.
If something wasn't previously covered or to the same amount, there is still up to a 12 month waiting period.
A 12 month waiting period may apply if a condition is assessed as pre-existing. That's any ailment, illness or condition, the signs and symptoms of which when assessed by a medical professional from Bupa, is found to exist 6 months prior to starting or upgrading to a higher level of cover with us. For further information, see claiming for hospital expenses further down below.
A 12 month waiting period may also apply on pregnancy and birth services. No waiting periods apply to a newborn provided they have been added to your level of cover within 90 days of their birth.
If you have laser eye correction surgery on your cover, there's a 3 year waiting period that applies.
See your policy information for more details on what waiting periods apply to you.
Claiming the Private Health Insurance rebate
You might be asked to complete an Australian Government rebate form by logging into myBupa, our self-service members area where you can access your account 24/7. The Australian Government rebate may help to reduce the cost of your health insurance premium based on your income and age.
If we don't receive the rebate form within 30 days, your premiums could go up. You can always claim this amount back in your tax return.
Making a claim
Once we've received your clearance certificate and honoured any waiting periods you may have already served after 14 days, you can make any claims you are entitled to make.
Three things you need to know when moving to Bupa from another fund
1. Making your move
When you join Bupa, an information exchange takes place between us and your previous fund. This exchange tells us your claims history including any waiting periods you may have served, provided to us as a clearance certificate from your fund. This can take up to 14 days, in which time you may not be able to make a claim.
Once we receive this information, we’ll recognise the level of cover you had, carrying over any remaining limits such as optical Extras cover. If you want to be covered for something new or to a new amount, a waiting period may apply.
2. Private Health Insurance Rebate
You might be asked to complete an Australian Government Rebate Form by logging onto myBupa.
This may help to reduce he cost of your health insurance premiums based on your income.
Your premiums could go up if we don’t receive the form within 30 days. Don’t worry though, you can claim the cost back with your tax.
3. Making a claim
When it’s time to make your first claim, like a trip to the opticians for example, you have three options to pick from:
Online
Log onto myBupa and enter the details found on your receipt. We’ll transfer the payment directly to your bank account.
On-the-spot
Where on-the-spot claiming is available, simply swipe your membership card. No forms, and you’ll only pay the remaining balance.
By post
Fill out a claim form, attach your invoice and receipt and post it to us. We’ll make the payment by bank transfer or cheque.
Claiming for your Extras services
Once you've had your treatment or made a purchase (for example, a new pair of glasses), the next step is to make a claim on your health insurance. It's actually pretty simple. Your options are:
On-the-spot health insurance claims
Electronic claiming is the fastest way to make your medical insurance claims. Around 20,000 dentists, physiotherapists, chiropractors, podiatrists, naturopaths, remedial massages therapists, acupuncturists, exercise physiologists and optical outlets around Australia provide this service. After your treatment, swipe your membership card and the claim will be processed automatically. There are no forms for you to complete and you'll only pay the balance of the account.
How to make a claim online
Simply log into myBupa and enter the details found on your receipt via the ‘claim online' section. We'll transfer the payment directly to your bank account (have your BSB and account number ready).*
*Not available for medical insurance claims on ambulance, health aids and appliances, orthodontics, travel and accommodation, pharmacy or medical claims.
How to make a claim by post
Fill out a claim form, attach your invoice and receipt and post to:
Bupa Reply Paid 990
Adelaide SA 5001
and we'll make the payment by EFT or cheque.
If you haven't provided your EFT details on the claim form, then a cheque will be sent directly to you.
Where there is an unpaid amount the cheque will be made out to you but you may still need to settle any outstanding amount with your provider.
Your statement of benefit will be sent to you in the mail.
Tap fast, claim quick. With just one tap you can claim with your iPhone, Apple Watch or Android phone.
Your digital card will automatically process your claim* on the spot. You'll know what you owe, and what Bupa has paid on the spot. If you have an iPhone or Android phone, simply download the myBupa app and sign-in. Then you can unlock your phone and tap to claim against the HICAPS machine.
*Subject to remaining limits, yearly limits, waiting periods fund and policy rules.
How does it work?
Step 1: Download the myBupa App from Google Play. Already have the myBupa App? Make sure you have the most up-to-date version.
Step 2: Look out for the HICAPS machine after your respective health appointment.
Step 3: Unlock your phone and hold for a few seconds within three centimetres of the HICAPS terminal.
Step 4: Wait until you feel a vibration, hear a beep or see a visual confirmation.
Learn more at: bupa.com.au/card
How to make a claim for health management extras
Health Management is a feature on selected Extras covers that provides benefits towards the costs of approved health-related programs. Depending on your Extras cover, you might be able to claim some of the cost of health-related programs under the Health Management extras service.
How to make a claim for your hospital expenses
For your hospital expenses
Use one of Bupa's Network or Member's First Hospitals and you might not even see a bill. The bill will be sent directly to us by the hospital so we can take care of the finances. If you do receive a bill from the hospital, just send it to us with a claim form from your local Bupa store or download one from mybupa.com.au.
All hospital statement of benefits are issued on a weekly basis. This statement explains what 'benefit', or money has been paid toward your treatment.
Medical expenses are separate to your hospital expenses. See the medical expenses section below for more details.
Claiming for hospital expenses within 12 months of your current level of Hospital cover
If you are in the first 12 months of your current level of cover (either recently joined or you have changed your cover after joining), we will need to determine whether a waiting period applies to your admission to hospital before Bupa can advise if a benefit will be payable to you.
If a waiting period does need to apply or your condition is deemed pre-existing, no benefits will be payable by Bupa for 12 months from the commencement of your level of cover.
A pre-existing condition has a 12 month waiting period and is any condition, ailment or illness that you had signs or symptoms of during the six months before you joined or upgraded to a higher level of cover with us. It is not necessary that you or your doctor knew what your condition was or that the condition had been diagnosed.
See your policy information for details on what waiting periods may apply to you.
To enable Bupa to assess whether your hospitalisation will have a benefit payable to you, we require you to complete two Medical Certificates (PDF, 105Kb) – one to be completed by your General Practitioner and the other to be completed by your Specialist/s and have it sent to us for review, along with any referral letters or correspondence between your GP and any specialists.
How to make a claim for medical expenses
How you claim your medical expenses that are incurred whilst you are a patient in hospital (for example, your specialist/doctors' fee) depends on whether your doctor uses Bupa's Medical Gap Scheme. If they do, the doctor can choose to eliminate or reduce your costs to a maximum of $500 per specialist. If they eliminate your costs, they will bill Bupa directly, so there's nothing left for you to do. If they cap your out-of-pocket costs, they will bill us directly, but there will be up to $500 left over for you to pay directly to your doctor.
If your doctor doesn't use Bupa's Medical Gap Scheme, they may send you a bill for their services. You can then take it to Medicare and then Bupa for payment.
If you take your claim to a Medicare office, Medicare will pay 75% of the Medicare Benefits Schedule Fee. You then need to take your claim to a Bupa store where the remaining 25% of the Medicare Benefits Schedule Fee is then paid.
Alternatively, if you don't have time to visit Medicare, you can use a two-way claim form. When you complete one of these forms, Medicare will forward your claim directly on to Bupa on your behalf. Both Medicare and Bupa will send you any benefit you are eligible for based on your cover, fund rules and waiting periods.
When there is an unpaid amount
For any hospital insurance claims where there is an unpaid amount for any medical services, the benefit will be payable by you. To settle the invoice with your provider directly, send any payments you receive from Bupa to them.
Your statement of benefit will be sent to you at the same time as the cheque.This will explain how much of your treatment was covered or paid for by Bupa and whether there is an out-of-pocket expense payable by you.
How to make a claim for out-of-pocket expenses
If you have any out-of-pocket costs, your doctor should have informed you of these costs before your admission. In most cases with Bupa's Medical Gap Scheme there is no gap or no more than $500 per specialist. Check with your specialist before agreeing to any treatment, so you have Informed Financial Consent.
Your Bupa card
Soon after joining, you’ll receive your Bupa card. Your card:
- Displays your membership number and the people covered by your policy.
- Allows you to make on-the-spot claims for a treatment or service at many Extras registered providers.
- Can be used as your Bupa ID if you’re admitted to hospital.
Manage your membership online with myBupa
myBupa is your personalised online portal. With myBupa, you’ll enjoy:
- Quicker, easier claiming for most Extras
- View your claim history
- Check what you're covered for
- See important information about your policy, including tax statements
- Access an exclusive range of discounts through Life Rewards
- 24/7 control and flexibility to keep your details up-to-date.
Waiting periods for claiming on Hospital and Extras
When you first take out health insurance there’s a period of time before you can make a claim. You can’t claim for services that you receive during this period, even if you wait to submit the claim once the period is over.
If you’re switching from another insurer or upgrading your existing Bupa cover you’ll also have to wait before you can make a claim for services you didn’t have on your old health cover, as well as any higher limits or benefits you may eligible for on your new level of cover.
Waiting periods are common across the health insurance industry.
Different waiting periods apply to different services. You can learn about waiting periods for Hospital and Extras cover in our Important Information Guide and your policy information.
Changing your details
Small changes to your circumstances (like new contact details or payment information) can be made online at mybupa.com.au. Bigger changes, like adding or removing people from your cover or moving interstate can affect the cost and level of cover, including things like ambulance services. In these cases, you’re best to speak to us to ensure your cover is still appropriate. We can also check what your cover includes.
Get in touch on 134 135 (Mon-Fri, 8am-8pm AEST) or visit your nearest Bupa store.
Download the Important Information Guide