Because Life Happens Health Insurance - Bupa
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Because Life Happens Health Insurance Effective 24 November 2021
Hospital Basic Accident
Basic Plus Bronze Plus Silver Plus Silver Plus Gold
cover options Only Hospital
Starter
Hospital
Simple
Hospital
Essential
Hospital
Advanced
Hospital
Complete
Hospital
EXCESS OPTIONS > $500/$750 $500/$750 $250/$500/$750 $250/$500/$750 $250/$500/$750 $500/$750
CLINICAL CATEGORIES
Lung and chest P1 P1 P P P P
Rehabilitation R R R P P P
Hospital Psychiatric services R R R R R P
Palliative care R R R P P P
Tonsils, adenoids and grommets O P P P P P
Joint reconstructions O P P P P P
Hernia and appendix O P P P P P
Gastrointestinal endoscopy O P P P P P
Gynaecology O P P P P P
Miscarriage and termination of pregnancy O P P P P P
Dental surgery O P P P P P
Brain and nervous system O O P P P P
Blood O O P P P P
Chemotherapy, radiotherapy and immunotherapy for cancer2 O O P P P P
Eye (not cataracts) O O P P P P
Ear, nose and throat O O P P P P
Bone, joint and muscle O O P P P P
Kidney and bladder O O P P P P
Digestive system O O P P P P
Male reproductive system O O P P P P
Diabetes management (excluding insulin pumps) O O P P P P
Pain management O O P P P P
Breast surgery (medically necessary) O O P P P P
Skin O O P P P P
Sleep studies O O P P P P
Podiatric surgery (provided by a registered podiatric surgeon) O O P P P P
Implantation of hearing devices O O O P P P
Back, neck and spine O O O P P P
Heart and vascular system O O O P P P
Plastic and reconstructive surgery (medically necessary) O O O P P P
Cataracts O O O O P P
Joint replacements O O O O P P
Insulin pumps O O O O P P
Pain management with device O O O O P P
Dialysis for chronic kidney failure O O O O O P
Weight loss surgery O O O O O P
Pregnancy and birth O O O O O P
Assisted reproductive services O O O O O P
ADDITIONAL BENEFITS
Travel and Accommodation P P P P P P
Accident Inclusion P P P P P P
Capped Emergency Ambulance P P P P O O
No Excess for Kids O O P P P P
Uncapped Emergency Ambulance O O O O P P
R Restricted cover applies, see the Important Information Guide at bupa.com.au/info to find out more. O Indicates the service is excluded, whereby no benefits are payable. 1. In response to COVID-19, we have added Lung and Chest cover to our
Basic and Basic Plus policies from 26 March 2020. This means private patient hospital admissions for Lung and Chest conditions, which includes
most COVID-19 related treatments, are included on ALL our hospital policies during this time. 2. Some non-PBS drugs may not be covered.
2 3
FLEXtras FLEXtras
New Bupa FLEXtras lets you create your own cover. You choose the
services you’re covered for, who treats you and how much you get back. SERVICES
WAITING Standard Higher
PERIODS Limits Limits
Simply decide:
General dental 2 months $500 $750
1 2 3 Major dental 12 months $500
$600
$750
$800
Orthodontics 12 months Lifetime Limit Lifetime Limit
If you’d like to include The % you’d like How much you $1200 $1600
4 or 6 services in to get back at any get back. Choose Optical 2 months $200 $250
your product, and Extras provider. between a
Physiotherapy 2 months $350 $500
which services they Choose between Standard limit or
are. 50% back or 60% Higher limits (see Chiropractic 2 months $350 combined $500 combined
limit with limit with
back at a recognised table to the right). Osteopathy 2 months chiro & osteo chiro & osteo
provider.
Podiatry 2 months
$350 includes $500 includes
orthotics orthotics
Orthotics 12 months
Acupuncture 2 months $100 $150
Chinese Herbalism 2 months $100 $150
Exercise Physiology 2 months $200 $350
Remedial Massage 2 months $180 $225
Ante and Post Natal 2 months $200 $350
Mental Health and Digital Mental Health 2 months $250 $400
Dietary 2 months $200 $300
Speech therapy 2 months $200 $300
Occupational therapy 2 months $200 $300
Eye therapy 2 months $200 $300
Pharmacy 2 months $300 $400
Health Management 6 months x x
Health Aids & Appliances1 12 months x x
Hearing aids 12 months x x
Travel: $100 & Travel: $100 &
Travel and accommodation 2 months
Accom: $150 Accom: $150
Home Nursing 2 months $200 $350
Capped Capped
Ambulance 1 day
Emergency Emergency
4 1. Combined yearly limit applies to this service category 5
Extras
cover options Freedom
50 Extras
Freedom
60 Extras
This table details the services available under each
of our Extras cover options. Yearly limits shown are
per person, or per membership (where applicable). At least At least
50% back at 60% back at
Bupa recognised Bupa recognised
SERVICES WAITING PERIODS providers providers
$5001 Year 1 to $7001 Year 1 to
$700 Year 3+ t $900 Year 3+ t
General dental 2 months
$1,0001 Year 1 to $1,4001 Year 1 to
$1,400 Year 3+ l $1,800 Year 3+ l
Major dental 12 months O O
Orthodontics 12 months O O
Optical 2 months O $150 t $300 l
Physiotherapy 2 months
Combined with Combined with
General dental General dental
Chiropractic and osteopathy 2 months
Natural therapies (includes
remedial massage, acupuncture 2 months Massage
O $100 t $200 l
and Chinese herbalism)
Exercise Physiology 2 months O O
Antenatal and Postnatal 2 months O O
Health Management 6 months O O
Pharmacy (includes travel vaccines)2 2 months O O
Dietary 2 months O O
Mental Health (includes Psychology, 2 months O O
Counselling and Digital Mental Health)
Podiatry (excludes orthotics) 2 months O O
Speech Therapy 2 months O O
Eye Therapy 2 months O O
Occupational Therapy 2 months O O
Home Nursing 2 months O O
Health aids and appliances3 12 months O O
Travel and accommodation 2 months O O
Emergency ambulance services 4
No waiting period 1 service t 2 services l
t Per person l Per membership n Combined Maximum
1. This amount increases year on year up to a maximum of six years. For major dental and orthodontics, benefits start after 12 month waiting period served. 2. Benefits
for prescription items that are non-PBS, TGA approved, and not appearing on our exclusions list. 3. A combined yearly limit applies to this service category. 4. Fund
rules apply.
6 7Standard Extras Super Top
Range Inclusions Starter
Extras
Value
Extras
Lifestyle
Extras
Super
Extras
Extras
Active
Top
Extras
Extras
Boost
This table details the services available under each
of our Extras cover options. Yearly limits shown are
per person, or per membership (where applicable).
At least 60% At least 60% At least 60% At least 60% At least 60% At least 70% At least 80%
back at Members back at Members back at Members back at Members back at Members back at Members back at Members
First providers1 First providers1 First providers1 First providers1 First providers1 First providers1 First providers1
SERVICES WAITING PERIODS
$700 & Unlimited for $900 & Unlimited for $800 & Unlimited for $1000 & Unlimited $1100 & Unlimited
General dental 2 months $500 n $600 n
Preventative Dental Preventative Dental Preventative Dental Preventative Dental Preventative Dental
Major dental 12 months O $600 $650 $900 $800 $1,000 $1,100
$600 $800 $1000
Orthodontics 12 months O O O O
Lifetime Limit $1200 Lifetime Limit $1600 Lifetime Limit $2000
Optical
(Higher set benefits with optical partners and lower 2 months $150 t $300 l $180 t $360 l $220 $250 $250 $300 $350
Set Benefits with all other recognised providers)
Physiotherapy 2 months
Combined with Combined with
Chiropractic 2 months $700 n $800 n $800 n $950 n $1,150 n
General Dental n General Dental n
Osteopathy 2 months
Podiatry 2 months $200 n $300 n $300 n $450 n $500 n
O O
Foot Orthotics 12 months Combined with Podiatry Combined with Podiatry Combined with Podiatry Combined with Podiatry Combined with Podiatry
Natural therapies 2 months O O O $300 n $300 n $450 n $650 n
Combined with Combined with Combined with Combined with
Exercise Physiology 2 months O O O
Natural therapies n Natural therapies n Natural therapies n Natural therapies n
Remedial Massage (Includes Remedial Massage,
Myotherapy and Traditional Chinese Medicine 2 months $100 t $200 l $150 t $300 l $200 t $400 l $200 $200 $250 $300
Remedial Massage)
Ante and Post Natal 2 months O O O O $200 $250 $300
Mental Health (includes Psychology and Counselling) 2 months O O O Combined with Combined with Combined with Combined with
Digital Mental Health 2 months O $100 $150 Natural therapies n Natural therapies n Natural therapies n Natural therapies n
Dietary 2 months O O O
Speech therapy 2 months O O O
$300 n $300 n $450 n $650 n
Occupational therapy 2 months O O O
Eye therapy 2 months O O O
Pharmacy2 2 months O O $300 $400 $400 $400 $500
Health Management 6 months O O O O O O O
Health Aids3 & Appliances4 12 months O O O $300 O $500 $700
Hearing aids5 12 months O O O $500 O $1,000 $1,200
$100 Travel $100 Travel $100 Travel $100 Travel $100 Travel
Travel and accommodation 2 months O O
$150 Accommodation $150 Accommodation $150 Accommodation $150 Accommodation $150 Accommodation
Home Nursing 2 months O O $100 $250 $200 $350 $450
Ambulance6 1 day Capped Emergency Capped Emergency Capped Emergency Capped Emergency Capped Emergency Capped Emergency Capped Emergency
t Per person l Per membership n Combined Maximum t Per person l Per membership n Combined Maximum
1. For most items at our Members First Extras providers covering dental, physio, chiro and podiatry (podiatry is not covered in Starter Extras, Value Extras)
consultations. Yearly limits, waiting periods, fund and policy rules apply. Excludes orthodontics, orthotics and hospital treatments. Set benefits apply at other
recognised providers. 2. Benefits for prescription items that are non-PBS, TGA approved, and not appearing on our exclusions list 3. Hire and repair of health aids
and appliances available, for which a 6 month waiting period applies. A combined yearly limit applies to this service category. 4. A combined yearly limit applies to
this service category 5. 1 service(s) every 3 years 6. Fund rules apply
8 910 11
See next page for associated Extras for these packages.
Packages Basic Plus
Active Saver
Basic Plus
Young Singles/
Bronze Plus
Young Singles/
Silver Plus
Prime
Gold Ultimate
Health Cover
Couples Saver Couples Choice
(Hospital Cover)
$100 $50 $50 Nil/$250/
EXCESS/ CO-PAYMENT OPTIONS > Nil
Co-Payment1 Co-Payment2 Co-Payment2 $500/$750
CLINICAL CATEGORIES
Rehabilitation R R R P P
Hospital Psychiatric services R R R P P
Palliative care R R P P P
Brain and nervous system O O P P P
Blood O O P P P
Chemotherapy, radiotherapy and immunotherapy for cancer 3 O O P P P
Eye (not cataracts) O O P P P
Cataracts O O O P P
Ear, nose and throat O O P P P
Implantation of hearing devices O O P P P
Tonsils, adenoids and grommets P P P P P
Bone, joint and muscle O O P P P
Joint reconstructions P P P P P
Joint replacements O O O P P
Back, neck and spine O O O P P
Kidney and bladder O O P P P
Dialysis for chronic kidney failure O O O P P
Digestive system O O P P P
Hernia and appendix P P P P P
Gastrointestinal endoscopy O O P P P
Weight loss surgery O O O O P
Heart and vascular system O O O P P
Lung and chest P4 P4 P P P
Gynaecology P P P P P
Miscarriage and termination of pregnancy P P P P P
Pregnancy and birth O O O O P
Assisted reproductive services O O O O P
Male reproductive system O O P P P
Diabetes management (excluding insulin pumps) O O P P P
Insulin pumps O O P P P
Pain management O O P P P
Pain management with device O O P P P
Breast surgery (medically necessary) O O P P P
Plastic and reconstructive surgery (medically necessary) O O P P P
Skin O O P P P
Dental surgery P P P P P
Sleep studies O O P P P
Podiatric surgery (provided by a registered podiatric surgeon) P P P P P
ADDITIONAL BENEFITS
Unemployment Cover O O O O P
Travel Insurance Bonus5 O P P P P
Capped Emergency Ambulance P P P O O
Uncapped Emergency Ambulance O O O P P
$200 Gap Bonus (on join and every calendar year thereafter) O O O O P
Travel and Accommodation P P P P P
Accident Inclusion 6 P P O O O
O Indicates the service is excluded, whereby no benefits are payable. Insurance Australia Limited ABN 11 000 016 722 AFSL 227681, trading as CGU Insurance. Any advice is general only and does not take into account your personal circumstances.
R Restricted cover applies, see the Important Information Guide at bupa.com.au/info to find out more. Consider the relevant Product Disclosure Statement (PDS) and Target Market Determination (TMD) at bupa.com.au to see if a product is right for you. 6. This is where hospital
1. Capped at $500 per admission. 2. Capped at $250 per admission. 3. Some non-PBS drugs may not be covered. 4. In response to COVID-19, we have added Lung and Chest cover to treatment that is restricted or an exclusion will be treated as included if a member requires hospital treatment as the result of an accident that occurred in Australia after
our Basic and Basic Plus policies from 26 March 2020. This means private patient hospital admissions for Lung and Chest conditions, which includes most COVID-19 related treatments, joining. Treatment must have been sought within 72 hours of the accident and any further treatment for that accident where an admission or readmission is required must be
are included on ALL our hospital policies during this time. 5. Bupa Travel Insurance is distributed by Bupa HI Pty Ltd ABN 81 000 057 590 an authorised representative of the issuer, within 180 days of the event.
12 13Packages Basic Plus
Active Saver
Basic Plus
Young Singles/
Bronze Plus
Young Singles/
Silver Plus
Prime
Gold Ultimate
Health Cover
(Extras Cover) Couples Saver Couples Choice
At least 70% back at
The services below are the Extras available in our Members First providers1
Packaged options, listed on page 18. Yearly limits At least 60% back at At least 60% back at At least 60% back at Top-up Bonus of $50 as Up to 100% back at
per person or per membership (where applicable). Members First providers1,9 Members First providers1 Members First providers1 a single and $100 as a Members First providers 1,2
couple, increasing by 20%
each year10
SERVICES WAITING PERIODS
General dental 2 months $300 Unlimited Unlimited
Major dental 12 months $700 n $850 n $1,000 $1,600
$300 n
Orthodontics Orthodontics
Orthodontics and
– Accident only – Accident only $1,000 t
Orthodontics 12 months major dental
O Lifetime Limit $3,200
– Accident only
Optical 2 months O $150 $150 $180 $30011
Physiotherapy 2 months $300 $500 n $1,500
$500 n $350 t $1,000 t
Chiropractic and osteopathy 2 months $300
$700 l $2,000 l
$450 t n
Natural therapies Massage sub-limit $100 t
2 months $1,000
(includes remedial massage, acupuncture and Chinese herbalism) $500 t $300 t n
$300 Massage sub-limit
Massage sub-limit $100 t Massage sub-limit $100 t
$250 t $500 l
Exercise Physiology 2 months
Antenatal and Postnatal 2 months O O O O $500
Health Management 6 months $50 $50 $75 $100 $300
Pharmacy (includes travel vaccines)3 2 months O $75 $200 $350 $1,500
Combined with
Dietary 2 months $200 $250 $300 $1,000
Natural Therapies n
$100 $200 $300 $200 $1,000
Mental Health (includes Psychology, Counselling and
2 months Digital Mental Health Digital Mental Health Digital Mental Health Digital Mental Health Digital Mental Health
Digital Mental Health)
sub-limit N/A sub-limit $100 sub-limit $100 sub-limit $100 sub-limit $150
Podiatry (excludes orthotics) 2 months $200 $250 $300 $400 $1,000
Speech Therapy 2 months O O O O $1,000
Eye Therapy 2 months O O O O $1,000
Combined with
Occupational Therapy 2 months O O O $1,000
Physiotherapy n
Home Nursing 2 months O O O $200 $400
$8007 85% of cost7
Health aids and appliances4 12 months O O O Sub-limits apply Sub-limits apply
Laser Eye Correction Surgery 36 months O O O O 100% of cost8
$2,000 t
Accident Benefit5 No waiting period O O O O $4,000 l
$100 travel, $200 travel, $300
Travel and accommodation 2 months O O O $150 accommodation accommodation
Emergency ambulance services6 No waiting period 1 service t 2 services l 1 service t 2 services l Uncapped Emergency Ambulance
t Per person l Per membership n Combined Maximum t Per person l Per membership n Combined Maximum
1. For most items at our Members First Extras providers covering dental, physio, chiro, podiatry consultations. Yearly limits, waiting periods, 5. Accident benefit can only be used towards hospital excess or co-payment, or to boost Extras limits if service yearly limits has been reached
fund and policy rules apply. Excludes orthodontics, orthotics and hospital treatments. Set benefits apply at other recognised providers. 2. Up because of an accident sustained after joining. 6. Fund rules apply. 7. Hire and repair of health aids and appliances available, for which a 6
to yearly limits and subject to set limits. 100% back in most instances up to the first $500 then benefits of 90% apply for general dental. 100% month waiting period applies. Sub-limits apply. 8. At Bupa recognised providers. A 3 year waiting period applies to Laser Eye Correction
for first 10 standard physio & chiro visits, and podiatry consultations per person per calendar year then benefits of at least 90% apply. Waiting Surgery. 9. Combined yearly limit of $1,000 applies to all Extras services. 10. This amount increases by 20% each year you remain a customer,
periods, fund and policy rules apply. 3. Benefits for prescription items that are non-PBS, TGA approved, and not appearing on our exclusions until it doubles in Year 6 Applies each calendar year, and where benefits are payable for the service. Any unused amount does not roll over into
list. 4. A combined yearly limit applies to this service category. the next year. 11. From 1 January 2022 the annual optical limit will be $420 for Gold Ultimate Health Cover
14 15Health cover
for when
life happens
Go to bupa.com.au/fundrules to see our fund rules.
Unsure of any words? Visit: bupa.com.au/glossary
To find out more about what the Australian
Government Rebate on private health insurance
means for you, visit: bupa.com.au/rebate
For more information
Go to bupa.com.au
Visit a Bupa Health Insurance store
Call us on 134 135
Bupa HI Pty Ltd | ABN 81 000 057 590 | Effective 24 November 2021 12027-11-21You can also read
