Just joined Bupa? Here’s what you need to know so you can get the most out of your membership.
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.
How to make a claim for your hospital expenses
For your hospital expenses
Use one of Bupa's Network 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 centre or download one from mybupa.com.au
All hospital statement of benefits are issued on a weekly basis.
Claiming within the first 12 months of your current level of cover for hospitalisation
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 needs to apply to your admission before Bupa can advise if a benefit will be payable to you. If a waiting period does need to apply no benefits will be payable by Bupa for 12 months from the commencement of your level of cover.
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.
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 Gap Cover Scheme. If they do, they'll bill us directly . We'll take care of the fees. 100% of the payment will be paid directly to the medical provider on your behalf. When your doctor uses Bupa's Gap Cover Scheme, no cheques are sent directly to you.
If your doctor doesn't use Bupa's Gap Cover 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 centre 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 a benefit.
When there is an unpaid amount
For any medical insurance claims where there is an unpaid amount for any medical services, the cheque will be sent to you but will be made out to the provider/doctor who provided your medical services. You will be required to forward this onto the medical provider to settle the account for the medical services you received.
Your Statement Of Benefit will be sent to you at the same time as the cheque.
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 Gap Cover Scheme there is no gap. Just check with your doctor.
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 providers.
- Can be used as your Bupa ID if you’re admitted to hospital.
- Helps you to redeem member discounts in person via Bupa Plus.
Manage your membership online with myBupa
myBupa is your personalised online portal. With myBupa, you’ll enjoy:
- Quicker, easier claiming for most Extras.
- Access to important information about your policy, including tax statements.
- Access to an exclusive range of discounts through Bupa Plus.
- 24/7 control and flexibility to keep your details up-to-date.
Easy ways to claim on Extras
1. Claim on-the-spot
Electronic claiming is the fastest way to make your health insurance claims. Providers around Australia offer this service.
Simply swipe your membership card and we’ll process the claim automatically. There won’t be any paperwork so all you’ll need to do is pay the outstanding balance.
2. Claim online
To claim for most Extras* services online simply log on to myBupa, head to the ‘claim online’ section and enter your receipt details or use the Bupa app to claim with our step-by-step tool. We'll transfer the payment directly to your bank account, so you’ll need your BSB and account number. It’s one of the quickest ways to get your claims processed and you’ll generally receive payment into your bank account within five business days.
*Services exempt are treatments in hospital, including hospital, specialist, doctor and ambulance fees. A number of extras services are also exempt including: Pharmacy, Health Management Extras Service and all Health Aids and Appliances. Claiming is still subject to the conditions of your cover, including waiting periods and limits.
3. Claim by post
To claim by post, download a claim form, fill it out and attach your invoice and receipt. Then simply send it to:
Bupa Reply Paid 990
Adelaide SA 5001
If you provide your bank account and BSB details we'll make the payment by electronic funds transfer (EFT). If you don't provide these details on the claim form, we’ll send you a cheque.
If you haven’t paid in full, we’ll still pay you, but you’ll need to settle any outstanding amount with your provider.
We’ll also mail your statement of benefit to you.
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.
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 clarify 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