Visitors Insurance Your Important Information Guide - Bupa
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Visitors Insurance Your Important Information Guide This guide is here to help you navigate our healthcare system and health cover. For further information on your overseas visitor’s health insurance policy with us, please read your policy information.
Welcome to Bupa How Australia’s
healthcare system works
It’s our purpose that makes us different – helping Australia is said to have one of the best health systems in the world. However, the
our members to live longer, healthier, happier lives. system is complex and we understand that accessing healthcare can be confusing
We focus on your health, so you can get back to for new visitors. That’s why we aim to provide the best advice and support to help
your everyday life. you find what’s right for your needs, so you can be confident you are getting the best
healthcare services, when you need them.
Things to know
The Australian Government has arrangements in place to ensure Australian residents
Take time to read this guide to further understand have access to public hospitals at minimal cost and to subsidised medical services,
and learn about your visitors cover with us. As a pharmacy and some additional services.
Bupa member, knowing how your cover works will
help you to get the most value from your health The private sector, which includes private health insurance, provides an extensive
insurance. range of services to complement these.
Bupa makes it possible for an overseas visitor to access a broad range of health
services across both the public and private sectors.
Contents What is Medicare? There are two kinds of cover:
Medicare is Australia’s universal system • Hospital cover pays benefits towards
How Australia’s healthcare system works 3 available for Australian citizens and the costs of hospital treatment as a
permanent residents and visitors from private patient.
What to do when you feel sick 4 countries that have reciprocal healthcare
agreements (subject to the terms of those • General treatment (‘ancillary’ or
Understanding your visitor’s health cover 5 ‘extras’) cover for some
agreements), that subsidises medical fees
What is covered 5 and some services by dentists and allied non-medical health services not
health professionals. covered by Medicare – such as dental,
What is not covered 12 physiotherapy and optical services.
In addition, under the arrangements
Ambulance cover 15 between the Australian and State What are you covered for
Extras cover 16 governments, when you’re treated as a with Bupa?
“public” (free) patient, you may be treated We pay benefits towards hospital care
Changing your cover 18 by doctors in training, although under in private or public hospitals, choice of
supervision from qualified specialists. doctor, out-of-hospital medical and allied
Definitions 20
health professional fees, pharmacy, and
What is private health insurance? a range of additional services.
This guide is in addition to our Fund Rules Many Australians pay extra towards the
available online or by contacting us. cost of their health care and have private
For working visitor covers, health insurance. This provides access
visit bupa.com.au/fundrules/workingcover to benefits towards treatment in private
hospitals and a range of additional dental
or for non-working visitor covers, and allied health services, not available
visit bupa.com.au/fundrules/visitingcover through Medicare.
When you use your private health
insurance you can choose the doctor
who will be primarily responsible for your
treatment and you will be covered for
a private room if you request one and
where one is available.
2 3
Understanding your
What to do when you feel sick visitor’s health cover
What is covered? When admitted to hospital, in most cases you
will be covered for in-hospital charges when
Hospital costs
Emergency Non-Emergency With private hospital cover, you can choose
provided as part of your inpatient hospital
treatment including:
health issues health issues to be treated as a private patient in either a
• Accommodation for overnight
private or public hospital.
or same-day stays.
Visit your local What if I am treated in a Members First • Operating theatre, intensive care
Visit your local GP or Network Hospital? and labour ward fees.
hospital emergency
or medical centre Depending on your level of cover you are
department • Reimbursement on emergency
covered as a private patient in most hospitals department fees at any private or public
that Bupa has an agreement with, known hospital, including administration fees,
as Members First and Network hospitals, if admitted (or in all circumstances
Call 000 across Australia for any treatment which is
Receive treatment depending on your level of cover).
(triple zero) recognised by Medicare and is not either
from your GP • Supplied pharmaceuticals approved for the
for an ambulance excluded or restricted under your cover.
condition to be treated by the Australian
At our Members First hospitals, you’ll receive Government’s Pharmaceutical Benefits
a private room if a private room is available. If Scheme (PBS) Schedule, and provided as
GP refers you to a a private room is not available, you’ll receive part of your inpatient hospital treatment.
specialist or other $50 back per night from the hospital. Please
note that the following conditions apply: • Physiotherapy, occupational therapy, speech
health service therapy and other allied health services.
You must book and request a private room
in a Members First hospital at least 24 hours • Surgically implanted prosthesis up to
before admission. It applies to overnight the approved benefit published on the
admissions only. It excludes ‘nursing home Australian Government’s Prostheses List.
type patients’, admissions via an Emergency
Choosing a hospital? Call us first Department, same day admissions or where • Private room where available.
We recommend you call us first on 134 135 to discuss your hospital options and a private room is medically inappropriate
to get the most out of your visitors cover. You can also find out if a hospital has Members First Day Hospitals
(e.g. medical practitioner requires the patient
an agreement with us by visiting bupa.com.au/find-a-provider to an Intensive Care Unit or other particular If you are treated in a Members First Day
ward rather than a private room). You’ll also Hospital, there are no out-of-pocket expenses
get complimentary local calls, TV usage and a for inpatient medical services charged by
daily newspaper. a surgeon, anaesthetist or other specialists
If you’re not sure if it’s an emergency health Do some non-residents have access when admitted to hospital for included
issue, it’s better to treat it as an emergency. to Medicare? If you are treated in a Members First Day services. (Not available in NT).
If you need more advice about your health Yes, the Australian Government has Hospital, there are no out-of-pocket expenses Any co-payment or excess related to your
issue, you could also: Reciprocal Health Care Agreements for inpatient medical services charged by a level of cover will still apply.
• See a GP (RHCA) with a selected number of countries. surgeon, anaesthetist or other specialists when
admitted to hospital for included services. We recommend you call us first before
These agreements enable residents of these
• Visit healthdirect.gov.au (Not available in NT). Any co-payment or excess making a booking to confirm that your
countries to receive Medicare benefits when
related to your level of cover will still apply. hospital of choice gives you certainty of full
• Call the Australian Government’s health visiting or working in Australia.
cover. We can also discuss any excess that
advice line on 1800 022 222 The level of Medicare cover and the period At a small number of Network Hospitals, may be applicable to your level of cover.
If it’s a mental health issue, you can also call for which you receive it varies depending on an additional set amount or ‘fixed fee’ may
be charged by the hospital, capped at a You can find out if a hospital has an
LifeLine on 13 11 14. which country you are from.
maximum number of days per stay. The agreement with us by checking our website
For more information and for a list of bupa.com.au/find-a-provider
hospital should inform you of this fee when
countries visit humanservices.gov.au
you make a booking. This fee is in addition to
or contact us.
any excess or co-payment you may have as
4
part of your hospital cover. 5
What happens if I choose a private If this benefit is less than the hospital charge, They will be covered for $60 per night for
hospital that Bupa doesn’t have an the hospital should let you know what out-of- accommodation in hospital and up to $30
agreement with? pocket expenses you will have to pay. Bupa a day for hospital meals. Hospital meals are
If you are admitted to a private hospital also pays benefits for prosthesis up to the covered when provided at a hospital cafeteria
that Bupa does not have an agreement approved benefit in the Australian Government or patient meal menu for the non-admitted
with, you will have restricted cover for your Prostheses List. The above applies for any person staying with the patient in hospital only.
hospital costs, and cover for prosthesis up treatment recognised by Medicare unless it is
to the approved benefit in the Australian excluded or restricted under your level of cover. Crutches and wheelchairs benefit
Government Prostheses List. This will apply It is important to note that in public hospitals, If you are on Ultimate Corporate Visitors Cover,
for any treatment recognised by Medicare, private rooms are generally allocated to people Premium 90 Visitors Cover, Premium Visitors
unless it is excluded or restricted under your who medically need them. Cover or Mid 60 Visitors Cover, you will receive
level of cover. The amount we pay will only As a private patient in a public hospital you a benefit for crutches and wheelchairs.
partially cover the full cost and you will have will also be responsible for personal expenses For a benefit to be payable, the hire or
significant out-of-pocket expenses. such as TV hire and telephone calls together purchase must be linked to an inpatient
It is important to note that you will be with any fee doctor/surgeon charges above admission resulting in the requirement the
responsible for the cost of your stay and the benefit Bupa pays and prosthesis charges item. We will not pay benefits without evidence
may be charged directly for your hospital above the approved benefit in the Australian of a hospital admission. If eligible, we will pay
accommodation, doctor’s services (including Government Prostheses List. 100% of the cost up to a maximum limit of
any diagnostic tests), surgically implanted Please also refer to the Inpatient and Outpatient $500 per person per calendar year for any hire
prosthesis (such as artificial hips) and personal Medical Costs section of this guide. or purchase of crutches or wheelchairs.
expenses such as TV hire and telephone calls.
Some of these hospitals bill Bupa directly for Inpatient medical costs Outpatient medical services (when
the limited benefits we pay. Please also refer you’re not admitted into hospital)
These are the fees charged by your doctor,
to the Inpatient and Outpatient Medical Costs surgeon, anaesthetist or other specialist for any Also known as outpatient medical services,
section of this guide. treatment given to you when you are admitted this is cover for treatment by a General
to a hospital as an inpatient. Depending on Practitioner (GP), specialist in private practice,
What happens if I choose to be a your level of cover, we cover you for either or at a hospital when you’re not admitted
private patient in a public hospital? the Medicare Benefits Schedule (MBS) Fee (including diagnostic services such as radiology
Whether a public hospital will accept or or the Australian Medical Association (AMA) and pathology).
admit a patient, or whether a doctor provides Schedule Fee, or the cost of treatment. The You’re covered for:
treatment at a public hospital, or performs a Schedule Fees mentioned above are the fees
particular procedure in a public hospital, is • Depending on what is set out in your level of
determined by the Australian Government and
outside of Bupa’s control. cover we will cover you for up to either 100%
Still not sure where the AMA respectively, as the appropriate fee
or 150% of the Medicare Benefits Schedule
As a private patient in a public hospital you for a specific service for Australian residents.
to start? Talk to are entitled to choose your doctor, if they Please check your level of cover to determine
Fee (MBS Fee) for outpatient services or for
Ultimate Corporate Visitors Cover only, the
the benefits that apply. If your doctor or
our friendly team. are available. However, it is important to
specialist charges more than the Schedule Fee
cost of treatment. The MBS Fee is the amount
understand that you may still be subject to determined by the Australian Government for a
public hospital waiting lists. Depending on there will be a ‘gap’ for you to pay.
134 135 specific service for Australian residents. If your
your illness or condition, this may be the doctor or specialist charges more than the
same doctor who would have been allocated Family In-Hospital Benefit
bupa.com.au/overseas MBS Fee there will be a gap for you to pay.
to you by the hospital as a public patient. If you are on Ultimate Corporate Visitors Cover,
Visit a Bupa Health Premium 90 Visitors Cover, Premium Visitors • We will determine the appropriate MBS item
Insurance store If you are admitted as a private patient in a Cover or Mid 60 Visitors Cover which provides number for the service that has been provided,
public hospital, you will have restricted cover Family In-Hospital Benefit, you could receive which may, in limited cases, be different from
for your hospital costs, and cover for prosthesis benefits for accommodation and meal costs if the item number provided. This can mean the
up to the approved benefit in the Australian your partner, immediate family member, carer amount we cover is lower than the benefit for
Government Prostheses List. or next of kin is required to stay at hospital the item number on your treatment bill, and
with you or a person on your membership. there may be an additional cost to you.
6 7
• On Essential Lite Visitors Cover, a $300 Travel and accommodation
annual limit applies for outpatient medical We can help cover the cost of travel for
services per person, up to $600 annual limit essential medical or hospital treatment not
per policy. available close to home on your Hospital
Please check your level of cover to determine cover, where the total return distance is 200
which (if any) benefits apply. kilometres or more from where you live. Up to
$100 per person, per trip for travel expenses
To find out the Medicare Benefit Schedule and $50 per night up to $150 per person,
(MBS) fee visit mbsonline.gov.au per trip for accommodation. 2 month waiting
period and eligibility criteria apply.
Medicines
You can also receive benefits on selected
pharmacy items including discharge
medication prescribed as an outpatient by a
doctor or specialist. This is provided the item’s
usage is approved by the Therapeutic Goods Help reduce your medical costs
Administration (TGA). Please check your level with the Bupa Medical Gap Scheme
of cover to determine the benefits that apply. Bupa’s Medical Gap Scheme helps to
remove or reduce the costs you pay for
Repatriation benefit your treatment in hospital.
If you are on Ultimate Corporate Visitors Where a doctor chooses to use the
Cover, Premium 90 Visitors Cover, Premium scheme for your treatment, they agree
Visitors Cover, Mid 60 Visitors Cover, Essential to only charge up to a certain fee. We’ll
50 Visitors Cover, Essential Visitors Cover or then pay a much higher amount than we
Essential Lite Visitors Cover, you will receive normally would to help cover the extra
cover for repatriation to your country of origin cost. If a doctor uses the no-gap option,
if you become terminally ill or if you suffer we cover all of the extra charges, so you
a substantial life altering illness/injury up to pay nothing for that doctor’s medical fees.
$100,000. Or for the return of mortal remains Otherwise, for each doctor choosing to use
up to $10,000. Benefits are only payable once the Gap Scheme, the most you’ll pay is up
approved by Bupa. to $500 out-of-pocket on medical costs.
No Repatriation Benefit will be paid if, within Each doctor involved in your treatment
six months prior to the date your policy can choose to use the Bupa Medical Gap
commenced, the insured was: Scheme for your admission in a Public
• first diagnosed as Terminally Ill; or, Hospital, or a Private Hospital with which
Bupa has an agreement.
• a reasonable person would have first become
aware of the Terminal Illness; or, For more info visit
bupa.com.au/medicalgapscheme
• suffering a substantial Life Altering Illness/
Injury.
8 9
Hospital Cover
Choosing a hospital? Call us first
We recommend you call us first on 134 135 to discuss your hospital options and
to get the most out of your visitors cover. You can also find out if a hospital has
The below is a guide on the in-hospital treatments on sale visitors cover provides. an agreement with us by visiting bupa.com.au/find-a-provider
For further information, including off sale products, refer to your policy information.
Working Cover Non-Working Cover
Essential Essential Essential Mid 60 Premium Premium Standard Standard 50
Hospital & Medical services Lite Visitors Visitors 50 Visitors Visitors Visitors 90 Visitors Short Stay
Hospital & Medical services Visitors Visitors
Cover
Cover Cover Cover Cover Cover Cover Cover Cover
Rehabilitation P P P P P P Rehabilitation* O O P
Hospital psychiatric services P P P P P P Hospital psychiatric services P P P
Palliative care P P P P P P
Palliative care P P P
Brain and nervous system P P P P P P
Brain and nervous system P P P
Blood P P P P P P
Bone marrow transfusion or transplant Blood P P P
O O O P P P
Chemotherapy, radiotherapy and Bone marrow transfusion or transplant O O P
immunotherapy for cancer P P P P P P Chemotherapy, radiotherapy and immunotherapy for cancer P P P
Eye (not cataracts) P P P P P P Eye (not cataracts) P P P
Cataracts P P P P P P Cataracts O O O
Ear, nose and throat P P P P P P Ear, nose and throat P P P
Implantation of hearing devices P P P P P P Implantation of hearing devices P P P
Tonsils, adenoids and grommets P P P P P P Tonsils, adenoids and grommets P P P
Bone, joint and muscle P P P P P P Bone, joint and muscle P P P
Joint reconstructions P P P P P P Joint reconstructions P P P
Joint replacements (other than Hip and Knee) P P P P P P Joint replacements (other than Hip and Knee) P P P
Joint replacements (Hip and Knee) P P P P P P
Joint replacements (Hip and Knee) O O O
Back, neck and spine P P P P P P
Back, neck and spine P P P
Kidney and bladder P P P P P P
Organ transplant Kidney and bladder P P P
O O O P P P
Dialysis for chronic kidney failure P P P P P P Organ transplant O O P
Digestive system P P P P P P Dialysis for chronic kidney failure O O P
Hernia and appendix P P P P P P Digestive system P P P
Gastrointestinal endoscopy P P P P P P Hernia and appendix P P P
Weight loss surgery P P P P P P Gastrointestinal endoscopy P P P
Heart and vascular system P P P P P P Weight loss surgery P P P
Lung and chest P P P P P P Heart and vascular system R R P
Gynaecology P P P P P P Lung and chest P P P
Miscarriage and termination of pregnancy P P P P P P Gynaecology P P P
Pregnancy and birth P P P P P P Miscarriage and termination of pregnancy P P P
Assisted reproductive services O O O O O O Pregnancy and birth O O O
Male reproductive system P P P P P P Assisted reproductive services O O O
Diabetes management (excluding insulin pumps) P P P P P P Male reproductive system P P P
Insulin pumps P P P P P P Diabetes management (excluding insulin pumps) P P P
Pain management P P P P P P
Insulin pumps P P P
Pain management with device P P P P P P
Pain management P P P
Breast surgery (medically necessary) P P P P P P
Plastic and reconstructive surgery Pain management with device P P P
(medically necessary) P P P P P P Breast surgery (medically necessary) P P P
All cosmetic surgery O O O O O O Plastic and reconstructive surgery (medically necessary) O O O
Skin P P P P P P Skin P P P
Dental surgery P P P P P P Dental surgery P P P
Sleep studies P P P P P P Sleep studies P P P
Podiatric surgery Podiatric surgery (provided by an accredited podiatric surgeon)
(provided by a registered podiatric surgeon)# P P P P P P P P P
10 # Limited hospital accommodation and approved prostheses benefits only. * Rehabilitation is not covered following an inpatient care for an acute condition. 11What is not covered
Hospital costs cost of your care. • When a service is excluded or restricted The following waiting periods apply to
(including prosthesis and pharmacy costs) • Some hospital-substitute treatment and under your level of cover. these covers:
Situations when you are likely not to be covered operative services that are a continuation • When you have reached the limits on your
product including yearly, lifetime or service Hospital cover Waiting period
or to have significant additional expenses of care associated with an early discharge
include: from hospital. limits for the service you are claiming.
Palliative care,
• During a waiting period. • For pharmaceuticals items supplied upon • Cosmetic surgery. Please refer to your Policy rehabilitation and
discharge from the hospital unless covered Information and our definitions on page 20 2 months
• When a service is excluded or restricted hospital psychiatric
under your level of cover. on your visitors or Extras cover. for more information. services
• When you are treated at a non-agreement • If you choose to use your own allied health For Ultimate Corporate Visitors Cover we will
private hospital you will not be fully covered. provider (e.g. chiropractors, dieticians or pay for all actual, necessary and reasonable Pre-existing conditions,
12 months
psychologists) rather than the hospital’s expenses incurred by you and any other ailments or illnesses
• For the fixed fee charged by a fixed fee
practitioner for services that form part of person covered by your membership.
hospital or a hospital that has a fixed fee Pregnancy and birth
your inpatient hospital treatment. 12 months
service. This does not apply to Ultimate Should your doctor, surgeon, anaesthetist or (obstetrics)
Corporate Visitors Cover as any fixed fee • Where compensation, damages or benefits other specialist charge us an unreasonable
will be reimbursed. may be claimed by another source fee (compared to standard practice) for
(e.g. workers compensation). your medical costs, we reserve the right to See page 23 for more information on
• Depending on your level of cover, if you have pregnancy and birth related services.
not been admitted into a hospital and are • For any amount charged by a public or investigate the fee. In the unlikely event that
treated as an outpatient (e.g. emergency non-agreement hospital which is not covered this occurs, we will contact you to advise if
Standard Visitors Cover and Standard 50
room treatment, outpatient ante-natal by us or which is above the benefit that payment of your claim is delayed.
Visitors Cover waiting periods
consultations with an obstetrician) you may we pay.
Waiting periods The following waiting periods apply to these
not be covered. • For any treatments or services rendered levels of cover:
A waiting period is the time when you are not
• For hospital psychiatric and rehabilitation outside Australia.
covered for a particular service. It starts on the
day programs, at a hospital that Bupa does • For any treatments or services arranged in date that you enter Australia or the date that Hospital cover Waiting period
not have an agreement with. advance of your arrival in Australia. you start your membership, whichever is the
Hospital psychiatric
• Hospital treatment provided by a practitioner • Non-PBS, high cost drugs. later date. 12 months
services
not authorised by a hospital to provide that • If you do not hold a valid visa at the time of If you receive a service or treatment during a
treatment. admission to hospital and for the duration of Pre-existing conditions,
waiting period, you are not eligible to receive
• Hospital treatment for which Medicare 12 months
your hospital stay. a benefit payment from us, regardless of when ailments or illnesses
pays no benefit, including: medical costs in • Cosmetic surgery. you submit the claim. Different waiting periods
relation to surgical podiatry (including the apply for different services. Emergency ambulance
fees charged by the podiatrist); cosmetic Check your Policy Information and definitions on
page 20 for more information. If you’re switching from another private health and on-the-spot
surgery; respite care; experimental treatment treatment and non- 1 day
and/or any treatment/procedure not insurer, you may be eligible to have some
Medical costs waiting periods that you’ve previously served emergency ambulance
approved by the Medical Services Advisory transportation
Committee (MSAC). Situations when you are likely not to be honoured on your new level of cover.
covered or to have significant additional Check page 18 for details.
• Personal expenses such as: pay TV, non-local
expenses include: See page 22 for more information
phone calls, newspapers, boarder fees, meals
• Medical services for surgical procedures Ultimate Corporate Visitors Cover, Premium on pre-existing conditions, ailments
ordered for your visitors, hairdressing and
performed by a dentist, surgical podiatrist, 90 Visitors Cover, Premium Visitors Cover, or illnesses.
any other personal expenses charged to you
unless included in your level of cover. or any other practitioner or service that is Mid 60 Visitors Cover, Essential 50 Visitors
not eligible for a rebate through Medicare. Cover, Essential Visitors Cover and Essential
• If you are in hospital for more than 35 days Lite Visitors Cover waiting periods
and you have been classified as a ‘nursing • Costs for medical examinations, x-rays,
home type’ patient. In this situation you may inoculation or vaccinations and other
receive limited benefits and be required to treatments required relating to acquiring a
make a personal contribution towards the visa for entry into Australia or permanent
residency visa.
12 13Ambulance Cover
Short Stay Visitors Cover waiting periods Ambulance Cover for all visitors cover Emergency Ambulance Cover
The following waiting periods apply to (other than Short Stay Visitors Cover) for Short Stay Visitors Cover
this cover: For all visitors cover (other than Short Stay As part of your cover under Short Stay Visitors
Visitors Cover), you will receive unlimited Cover, you will receive unlimited emergency
Hospital cover Waiting period emergency ambulance services. That means only ambulance services. That means we
we will pay 100% of the charges for emergency will pay 100% of the charges for emergency
Palliative care, transportation when medically necessary transportation when medically necessary
rehabilitation and for admission to hospital, and emergency for admission to hospital, and emergency
12 months
hospital psychiatric treatment on-site, by our Recognised treatment on-site, by our Recognised
services Ambulance Providers. Ambulance Providers.
You will also receive limited non-emergency Transportation means a journey from the
Short Stay Visitors Cover does not cover any ambulance services. This means your cover place where immediate medical treatment
pre-existing conditions, illnesses or ailments. will be limited to three times per person, is sought to the casualty department of a
per calendar year, for non-emergency receiving hospital.
When to contact us
transportation from a hospital to your home,
If you have been a Bupa member for less Whether the transportation is deemed an
a nursing home or another hospital, by our
than 12 months on your current visitors cover, emergency is determined by the paramedic
Recognised Ambulance Providers.
it is important to contact us before you are and usually recorded on the account.
admitted to hospital and find out whether the Transportation means a journey from the
On Short Stay Visitors Cover, you are not
pre-existing condition waiting period applies place where immediate medical treatment
covered for non-emergency Ambulance
to you. Please note: Short Stay Visitors Covers is sought to the casualty department of a
transportation or on the spot treatment.
exclude benefits for pre-existing conditions. receiving hospital.
We need about five working days to make the Whether the transportation is deemed an Recognised Ambulance Providers
pre-existing condition assessment, subject to emergency is determined by the paramedic We will generally only pay benefits towards
the timely receipt of information from your and usually recorded on the account. ambulance services when they are provided by
treating medical practitioner/s. Make sure any of the following recognised providers:
you allow for this timeframe when you agree If you need to make a claim for ambulance
benefits, we will give you a Patient Ambulance • ACT Ambulance Service.
to a hospital admission date. If you proceed
with the admission without confirming Transportation Form to complete. • Ambulance Service of NSW/PTS.
benefit entitlements and we (the health fund) • Ambulance Victoria.
subsequently determine your condition to • Queensland Ambulance Service.
be pre-existing, you will be required to pay
all hospital charges and medical charges not • South Australia Ambulance Service.
covered by Medicare. • St John Ambulance NT.
• St John Ambulance WA.
Planning for a baby
• Ambulance Tasmania.
If you are thinking about starting a family we
recommend that you contact us to check Still not sure where Working Visa Members
whether your current level of cover includes
pregnancy and birth in advance. This is
to start? Talk to our We will also pay ambulance costs
(as per your policy), where the services
because there is a 12-month waiting period friendly team. are provided by a Australian Government
applied to pregnancy and birth.
approved ambulance service.
No waiting periods will apply to the newborn 134 135
provided they have been added to the
bupa.com.au/overseas
appropriate family visitors cover within 90
days of their birth. Visit a Bupa Health
Insurance store
14 15Extras Cover Additional
What is covered? What is not covered? benefits
With Extras cover, you can claim benefits for services that may not be covered by Extras benefits will not be payable:
Medicare. You can claim for those services listed on your cover as long as benefits are • During a waiting period.
not claimable from a third party, the provider is in a private practice and recognised With offers from over 40 partners, Bupa
• Where a third party, including Medicare,
by us and the service meets our Overseas Visitors Rules and Fund Rules. We Plus is our way of saying thanks to everyone
a Australian Government body, or an
recommend you contact us before booking with a provider, so we can check how who chooses Bupa as their health insurer.
insurance company provided a benefit
much you can claim and these details for you.
(except for hearing aids and breast Visit myBupa.com.au/offers to find out
prosthesis items). more. Terms and conditions apply.
For example, Medicare may not provide benefits for:
• For different services within the same service
type from the same provider on the same 24 hour advice line
day. For example, if you went to see an • Advice on simple medical problems.
acupuncturist and then received a remedial • Medical translation services.
massage from the same provider on the
• Contact details and location of the
same day, you cannot claim for both services.
Dental Physiotherapy Chiropractic Occupational nearest medical facilities.
examinations services therapist • When orthoses, orthotics or surgical shoes
are not custom made. Please check your Call +61 3 9937 3999
and treatment
policy for more information.
Because we’re more than just
• Where the service is not covered under health insurance
your product. Bupa’s also here to help protect your
• When a provider is not recognised by home, car, pets and holidays. Plus, Bupa
us for benefit purposes. Health members can save up to 15%.7
• For any treatment or service rendered Learn more at
Speech therapy Podiatry1 Mental health Acupuncture2 outside Australia. bupa.com.au/general-insurance
Services or other natural • When you have reached the limits on your
(includes psychology therapies myBupa
and counselling) product including yearly, lifetime or service
limits for the service you are claiming. myBupa.com.au is our member self
service area. It helps you easily manage
Waiting periods and understand your Health Insurance
The following waiting periods apply for online. In addition, if you register for
Extras cover: myBupa you will get access to an exclusive
range of discounts, experiences, tools and
Extras cover Waiting period information to help you get more out of
Eye therapy Glasses Health aids Home nursing
and contact lenses and appliances every day.
Hire and repair of health
6 months5 7
Bupa health members get a 10% discount on Bupa Home, Car
aids and appliances
and Pet Insurance, and a 15% discount on Bupa Travel Insurance.
Minimum premiums may apply to the discount on Bupa
Home, Car and Travel Insurance. For premiums less than the
Pay nothing for your regular dental check-up minimum premium, no discount will apply. Bupa Travel, Home,
Pay nothing for your regular dental check-up and more at Members First Platinum dentists, Major dental, orthodontics, Landlords, Car and Valuables Insurance. is issued by Insurance
selected health aids and 12 months6 Australia Limited ABN 11 000 016 722 AFSL 227681, trading
when you combine Hospital and Extras Cover that include general dental, up to yearly limits.3 as CGU Insurance. Bupa HI Pty Ltd ABN 81 000 057 590 is an
appliances authorised representative of Insurance Australia Limited. Bupa
At Members First Platinum, you’ll also get the benefits of Members First, including pay nothing Pet Insurance products are issued by The Hollard Insurance
for kids4, more money back, and the certainty of what you’ll pay. Company Pty Ltd (ABN 78 090 584 473, AFSL 241436)
(Hollard), administered by PetSure (Australia) Pty Ltd (ABN
Find o1ut more at: All other Extras services 2 months 95 075 949 923, AFSL 420183) (PetSure) and promoted by Bupa
bupa.com.au/members-first-platinum HI Pty Ltd (ABN 81 000 057 590, AR No. 354269) an authorised
representative of PetSure. Terms, conditions, limits and
1
Does not include Orthotics, where applicable, benefits may be payable under Health Aids and Appliances. 2Unless part of a doctor’s exclusions apply. Please read the relevant Product Disclosure
consultation. 3Waiting periods, fund and policy rules apply. Excludes Freedom 50 Extras, Freedom 60 Extras and Your Choice Extras 60 Statement (PDS) at bupa.com.au for details, and to see if these
when general dental is not selected. 4For most services including dental, physio, chiro, podiatry consultations and selected optical packages. products are right for you. Any advice is general advice only and
Available on Premium 90 Visitors Cover, Mid 60 Visitors Cover, and Top Extras 60, Top Extras 75 & Top Extras 90 when taken with hospital does not take into account your personal circumstances.
cover, on a family membership. Yearly limits, waiting periods, fund and policy rules apply. Child dependants only. Excludes orthodontics, 5
Only applicable to Premium 90 Visitors Cover and Mid 60 Visitors Cover.
16 orthotics and hospital treatments. Set benefits apply at other recognised providers. 6
Only applicable to Premium 90 Visitors Cover and Mid 60 Visitors Cover. 17Changing
your cover
Switching from another health fund Changing from Bupa overseas Changes to Medicare Access
If you’re changing from another Australian If you’re joining us from Bupa overseas you If you obtain full access to Medicare benefits,
health fund or general insurer to Bupa, will be required to cancel the policy yourself, you can change to one of our domestic health
you’ll continue to be covered for all benefit however all you have to do is provide us with covers. This may occur when you apply for or
entitlements that you had on your previous your Bupa overseas membership details and obtain permanent residency. You will continue
cover, as long as these services are offered on we can ensure continuity of your cover on an to be covered for all benefit entitlements on
your new cover with us. This is referred to as equivalent level of cover. your old cover, as long as you change over
‘continuity of cover’. To receive continuity of within 60 days of ceasing your visitors cover.
cover, and start claiming, you’ll need to transfer Changing from any registered
Don’t forget that, unless you transfer to a
to us within 60 days of your end date with international insurer or Australian insurer
domestic health cover policy within 12 months
your previous fund and ensure that Bupa have If you had previous cover with any registered
of becoming eligible for full Medicare benefits,
received your clearance certificate (which can international insurer or Australian insurer,
you may be required to pay the Lifetime Health
be requested from your previous fund). you will be required to cancel the policy
Cover (LHC) Loading. Ask us for more details.
yourself and provide us with a Clearance/
When changing health funds, extras benefits
Member Certificate, a Certificate of Currency If you have reciprocal access to Medicare, or
paid by your previous fund will be counted
or a document on an official letterhead obtain full access to Medicare benefits and are
towards your yearly limits in your first year of
confirming your membership. We will also a high income earner, you may be required to
membership with us. Any benefits paid by your
provide continuity of cover on an equivalent pay the Medicare Levy Surcharge if you do not
previous fund also count towards lifetime limits.
level of cover, when you’ve joined us within have an appropriate level of private hospital
It’s important to note that when you change to 60 days of your end date. Please note: if you cover. Check with your tax agent if this applies
Bupa from another fund you may need to wait are transferring to a non-working visa cover to you.
before you can access your new benefits. from any recognised overseas health insurer
or general insurer, you will need to re-serve all Ending your membership
In this situation, your benefit entitlements are
waiting periods. You can contact us to cancel your health
based on our nearest equivalent cover to what
cover and a refund will be provided for any
you previously held. Where your new cover is
higher than what you had with your old fund,
Changing your cover with us premiums paid in advance from the date
If you change your health cover, you may you’ve contacted us. We will not, however,
the lower benefit (including different excess
need to wait before you can access your refund the first months premium paid on our
levels) will apply for the waiting period relevant
new benefits. Where your new level of cover range of Overseas Visitors Covers. We have the
for that service. Please refer to the listed waiting
is higher than what you previously held, the right to end a person’s membership as set out
periods earlier in this guide.
lower level of benefit applies. Please refer to in our Overseas Visitors Rules, including where
If you choose a lower level of cover than you the listed waiting periods included earlier in premiums have not been paid or on notice at
held previously, then the lower benefits on your this guide. the reasonable discretion of Bupa.
new cover will apply immediately. This may
include a different excess level or restricted During this time you will be covered, however
Still not sure where cover. You may also need to serve waiting you will receive the lower benefits of the two
covers (this includes any applicable excess).
periods for services or treatments that weren’t
to start? Talk to our covered on your previous cover. In this case you If you choose a lower level of cover than
friendly team. won’t be covered during the waiting period. you previously held, then the lower benefits
on your new cover will apply immediately
134 135 and may include different excess levels or
restricted cover. You may also need to serve
bupa.com.au/overseas
waiting periods for services or treatments
Visit a Bupa Health that weren’t covered on your previous cover.
Insurance store In this case you won’t be covered during the
waiting period. If you have any questions about
18 transfers or waiting periods, just contact us. 19Definitions
Accidents the number of times that benefits are payable • Has psychiatric disturbance whereby the Health aids and appliances
An unforeseen event, occurring by chance for the same service (e.g. dental check-ups). health of the person or other people are at To access benefits for health aids and appliances
and caused by an unintentional and external immediate risk. you’ll need to visit or purchase from one of
These limits apply from the date of service
force or object resulting in involuntary hurt or purchase. Some services also have lifetime • Has severe pain and the function of a body our recognised providers. You’ll also need to
or damage to the body, which occurred in limits (e.g. orthodontics). Per person yearly part or organ is suspected to be acutely meet the eligibility criteria, provide proof of
Australia and requires within 72 hours of the limits are not transferable to any other member threatened. purchase and a clinical referral where required.
event, medical advice or treatment from a on your policy. • Has acute haemorrhaging and requires It is important to note that benefits are not
registered practitioner other than the policy urgent assessment and treatment. payable for orthoses, orthotics or surgical shoes
holder and, if necessary, any further medical Calendar year • Has a condition that requires immediate if they are not custom made. Visit our website or
treatment where such admission (including any A calendar year is 1 January to 31 December. admission to avoid imminent threat to their contact us to find out more.
readmission) or treatment must be within 180 life and where a transfer to another hospital Benefits for hire and repair of health aids
days of the event. Cosmetic Surgery is impractical. and appliances are not payable in the first
A cosmetic treatment is one which is 12 months after purchasing an item; within
Admissions to a public hospital concerned with altering the appearance of Excess 12 months following a repair; or on items where
With regard to a public hospital, an admission a body part or tissue which lies within the On selected covers there may be an excess hire and repair are deemed inappropriate.
to Hospital or Hospital admission means bounds of normal variation. option which may lower the amount that you
where the treating medical officer has formally pay for your cover. Excesses are only payable Health Management
admitted you to the hospital in accordance Examples of Cosmetic Surgery:
on overnight and same-day inpatient hospital Depending on your Extras cover, you might
with the applicable State or Territory rules • Rhinoplasty (nose reconstruction) without
admissions in any hospital. be able to claim some of the cost of approved
for an admission, given the applicable clinical previous trauma or congenital defect.
• The total excess amount is paid each time a health-related programs. We call this ‘Health
circumstances. • Breast enlargement.
person on your membership is admitted into Management’. A 6 month waiting period applies.
For the purposes of a private room in a public • Liposuction. hospital, to a maximum of once per person
• Nicotine replacement therapy.
hospital, this is a room in a hospital which is and twice per membership each calendar
Emergency admissions year unless otherwise specified • Weight management programs by specified
purpose built and suitable for no-one other
than a single admitted adult patient; holds one In an emergency, we may not have time recognised providers only.
• If the total excess amount for an individual
single sized bed; and has a dedicated ensuite. to determine if you are affected by the
is not reached in a single hospital admission, • Health subscriptions to Diabetes Australia
pre-existing condition rule before your
the remaining balance of that excess and the Asthma Foundation.
Agents admission. Consequently, if you have been
is payable.
A third party such as a broker or agent a Bupa member for less than 12 months you For information about how to claim, please see
• No excess applies to your dependent
may establish and administer your policy or might have to pay for some or all of the hospital bupa.com.au/healthmanagement
children on all visitors covers.
corporate health plan. In these cases, some and medical charges if you are admitted to
information about you such as your name, hospital and you choose to be treated as a Please contact us for further details. Life Altering Illness/Injury
address and other policy information will be private patient, and we later determine that your An illness/injury considered to be a serious
condition was pre-existing. Exclusions medical condition leading to a reduction
given and received from the agent to help
Bupa HI administer your policy or corporate If you require treatment for a specific in life expectancy to less than 12 months,
We tell you more about pre-existing
health plan. This will not include personal procedure or service that is excluded under a requirement for ongoing care support or
conditions on page 22.
claims information (also see Privacy Statement your level of cover you will not receive any continuous inpatient hospitalisation, or any
on page 26). Once the policy has been set up, Emergency Treatment benefits towards your hospital, medical and other deficit or health care need as assessed
the third party or agent will need to obtain prosthesis costs and you may have significant by a Medical Practitioner appointed by Bupa
‘Emergency Treatment’ is any treatment
your authority to administer the policy. out-of-pocket expenses. as warranting support for repatriation.
required where a person:
• Is in a life threatening situation and requires If a service is not covered by Medicare
Yearly limits and service limits Medical Practitioner
urgent assessment and resuscitation. there will be no benefit payable from your
A yearly limit (also known as an annual visitors cover so you should always check A person registered or licensed as a medical
• Has suspected acute organ or system failure. practitioner under a law of a State or Territory.
maximum) is the maximum amount you with us to see if you’re covered before
• Has an illness or injury where the function of This does not include anyone whose
can claim in a service category per person and receiving treatment.
a body part or organ is acutely threatened.
per calendar year (unless otherwise stated).
For certain services, service limits also apply to • Has a drug overdose, toxic substance
or toxin effect.
20 21registration or licence to practise has been the remaining balance up to the set amount Keep in mind that a doctor appointed by us will • Enrol your adult children under their own
suspended or cancelled following an inquiry under your chosen level of Extras cover. decide whether your condition is pre-existing. policy within 60 days after they no longer
relating to his or her conduct and whose That said, the appointed doctor must consider qualify under your cover (to avoid reserving
There are some items that are not covered by
registration or licence has not been reinstated. your treating doctors’ opinions on the signs and waiting periods).
our pharmacy benefits and these include:
symptoms of your condition, although they’re • Provide proof of purchase of what you have
Mortal Remains • Over-the-counter and non-prescription items. not bound to agree with them. spent before we can reimburse you for any
The body of the deceased person for • Compounded items.
services received.
the purposes of Repatriation benefits. • Weight loss medication. Pregnancy and birth
• Submit your claims within two years of when
Does not include cremation or ashes of a • Body enhancing medications Pregnancy and birth are services and the service was given (we don’t pay benefits
deceased person. (e.g. anabolic steroids). treatment provided for the care of women for any claims that are older than this).
during pregnancy, the delivery of your baby
Out-of-pocket expenses Pharmacy in-hospital and following delivery. We will not refund the first months premium
You are likely to experience out-of-pocket We pay for all drugs that are PBS listed paid to Bupa under any circumstance.
Any treatment or services that you are not
expenses when you are not fully covered for for your condition, when the drugs are admitted to hospital for, like consultations
services and benefits, or when a set benefit administered in hospital. If you are treated
Private room in a public hospital
with your obstetrician, are part of out-patient For the purposes of a private room in a public
applies. You should refer to what is and isn’t with a drug that is not PBS listed (which may medical cover.
covered for your relevant level of cover to include some private prescriptions) we will not hospital, this is a room in a hospital which is
determine when an out-of-pocket expense pay benefits and the hospital may charge you. Pregnancy complications such as ectopic purpose built and suitable for no one other
may occur. You should also refer to our You should be advised by the hospital of any pregnancy, termination and miscarriage are than a single admitted adult patient; holds one
Overseas Visitors Rules for any additional charges before treatment. considered gynecological services. single sized bed; and has a dedicated ensuite.
information on benefits payable. Anything related to helping you conceive is
Pharmacy Saver Proof of identity and/or age
It is important to ensure when being admitted an “Assisted Reproductive Service” and is not
Add Pharmacy Saver to your chosen visitors Bupa may require you to provide proof of
to hospital that Informed Financial Consent is considered as pregnancy and birth.
cover with extras and enjoy savings on your identity, visa details and/or age when joining,
provided to you for a pre-booked admission changing your level of cover or in relation to
to allow you to understand any out-of-pocket
pharmaceutical and healthcare purchases all Premium and benefits
year round at National Pharmacies stores. any other transaction with us.
expenses upfront. If you have received any You or your employer (in the case of company
out-of-pocket expenses and require You’ll get a 20% discount on a variety of paid plans) must pay the premium that applies Reconstructive Surgery
clarification, please contact us directly. health-related products. Pharmacy Saver to you. In addition, if you have Extras cover
Surgery to restore function or typical
is not available for prescriptions on which as an add-on to visitors cover, please note
appearance by reconstructing defective
Pharmacy – Visitors cover the Australian Government does not allow premiums for extras differ between states
organs or parts. The reason for the surgery
On most visitors covers you receive discounts. Visit a National Pharmacies store due to different state charges. If you move
is what’s important. It would usually follow
benefits for selected prescription items for more information (outlets located in to another state your premium will change
a previous medically necessary surgery, a
prescribed as an outpatient that are Australian VIC, SA and NSW; online discounts too. Therefore you must let us know about
traumatic event that caused a change in the
Government’s Pharmaceutical Benefit Scheme available nationally). any change of address. To access the benefits
appearance and/or function of a part of the
(PBS) Schedule listed or non-PBS listed and TGA available on your cover, you need to:
body or a significant congenital problem
approved, prescribed by a doctor or a specialist Pre-existing conditions • Complete the application process and (something you were born with), that created
and not appearing on our exclusions list. Refer A pre-existing condition is any condition, ensure your premiums are paid one month problems with how your body works.
to your cover details for more information. ailment or illness that you had signs or in advance. (It is up to you to make sure For example, after a mastectomy for breast
A co-payment may apply to your level of cover. symptoms of during the six months before you payments are made during times of unpaid cancer, there may be a desire to reconstruct
joined or upgraded to a higher level of cover leave or if your employment ends). the breast back to an acceptable appearance
Pharmacy – Extras cover with us. It is not necessary that you or your • Ensure that newborns are enrolled onto for you, whereas changing the appearance of
Your extras pharmacy entitlement pays benefits doctor knew what your condition was or that a family membership within 90 days of the breast for most other reasons would be
on prescription items that are only non-PBS the condition had been diagnosed. their birth to avoid any waiting periods for cosmetic in nature and intent.
listed and TGA approved and not appearing on your baby.
our exclusions list. When you make a claim, we Other examples of ‘Reconstructive Surgery’:
will deduct a pharmacy co-payment and pay • Repairing a scar resulting from an
accident or previous surgery (unless it
was cosmetic surgery).
22 23Other important information
• Facial reconstructive surgery following Suspension rules Direct Debit Service Agreement
severe trauma, cancer surgery or a major If you are travelling overseas for work or This agreement outlines the responsibilities We may provide information to our or your
congenital problem (from birth). leisure, you can suspend your membership. of Bupa HI Pty Ltd (“we”, “us”, “our”) and you financial institution to resolve a dispute on
• Repairing a body part after a trauma injury. You can suspend your cover under the with regard to direct debiting your nominated your behalf. You must ensure your nominated
following circumstances: financial account for the payment of premiums. account permits direct debiting and that
Restricted Cover Direct debiting through the Bulk Electronic sufficient cleared funds are available in that
• For a minimum period of one month.
Guardian 60 Visitors Cover Clearing System (BECS) is not available on account on the due date to cover the premiums
• For a maximum period of nine months.
and Working Visa Customers all financial accounts and you should contact due. Your financial institution may charge a
• You can suspend your policy up to three
Restricted Cover means we will only pay your financial institution to confirm if your fee if the payment cannot be met. You must
times per calendar year.
minimum benefits (an amount set by the account is eligible or for help in completing ensure the authorisation given to draw on the
State Government). If a treatment is listed • One month contributions are required
this agreement. We will confirm the direct nominated account is identical to the account
as Restricted Cover, it means that during the between each suspension period.
debit arrangements prior to the first drawing signing instruction held by the financial
restricted cover period, if you go to a public To be eligible to suspend your cover you must: (including the premium amount and frequency) institution where the account is based. You must
or a private hospital for these treatments, • Have been a financial member for and debit your nominated account. Deductions notify us if the nominated account is transferred
most of the time, the hospital will charge a at least two months will occur on the nominated day, except for or closed. You must pay your premium by an
lot more than what we will pay, so you are • Have a financial membership at the deductions nominated for the 28th, 29th, 30th alternative method if either you or we cancel
likely to have a large amount to pay yourself. time of suspension or 31st, which will occur on the first day of the the direct debit arrangements. You must ensure
• Apply for suspension prior to the following month. If the nominated day falls on your payments are up-to-date, whether a notice
For all other Non-working Visa Covers departure date a weekend or public holiday, deductions will be is received from us or not. If paying by credit
Restricted Cover means we will only pay • Notify us of your return to Australia made on the closest business day. We will debit card, you need to advise us of your new expiry
minimum benefits (an amount set by the within 14 days of your arrival all payments in advance and will automatically date prior to expiry. You may request that we
Government for Australian residents). vary the deduction amount if your premiums or cancel or alter the debit drawing arrangements
• Complete an overseas travel
If a treatment is listed as Restricted Cover, level of cover change. If we vary the deduction by contacting us and providing at least five
suspension form.
it means that during the restricted cover amount, we will give you at least 14 days written working days’ notice of any requested changes.
period, if you go to a public or a private Your membership will be cancelled if notice, except when the previous deduction is These changes may include deferring the debit,
hospital for these treatments, most of the not resumed. dishonoured, when we may deduct the previous altering the debit dates, stopping an individual
time, the hospital will charge a lot more period’s payment together with the current debit, suspending the direct debit arrangement
than what we will pay, so you are likely to Terminally Ill amount due. or cancelling the direct debit completely. You
have a large amount to pay yourself. Someone with a life expectancy of less than can dispute any debit drawing or terminate
Should your financial institution dishonour a
6 months as diagnosed by a Medical Practitioner the deductions at any time by notifying us in
Surgically implanted prosthesis drawing, we may draw the payment plus any
and determined by a Medical Practitioner writing not less than seven days before the next
other overdue amounts 14 days from the date
You will be covered up to the approved appointed by Bupa, after consideration of any scheduled debit drawing or by notifying your
the last payment was due. If your financial
benefit set out in the Australian Government’s relevant clinical information. financial institution. We may change the terms
institution dishonours this attempted drawing
Prostheses List for a listed prosthesis which of this agreement by giving you at least 14 days
we may make another attempt to do so 14 days
is surgically implanted as part of your Travel and accommodation written notice or such further period as required
from the date of the first attempt.
hospital treatment. We can now help cover the costs of your travel under the Bupa Fund Rules.
and accommodation expenses, if you need to If, due to an account or debit card closure
The Prostheses List includes: pacemakers, If you have any queries about your direct debit
travel 200km or more for medically essential or other technical reasons, we are unable to
defibrillators, cardiac stents, joint agreement, please contact us. We undertake
treatment not available in your local area. The attempt a second drawing or, in any other
replacements, intraocular lenses and other to respond to queries concerning disputed
benefit is per person, per trip (limits apply), case, after two or more drawings are returned
devices. If a hospital proposes to charge you transactions within five working days of
and can be used as many times as needed unpaid by your financial institution, we will stop
a ‘gap’ for your prosthesis, they need your notification.
throughout the year. If you have an extras deducting your premiums from your nominated
informed financial consent. Please contact
cover with us, we’ll only pay account and will start sending you renewal
us for further details.
the travel and accommodation benefit on notices, pending further instructions from you.
For more terms explained visit your hospital cover. See your policy We will maintain the privacy and confidentiality
bupa.com.au/glossary information for more details. of your billing information (unless you have
requested or consented that we can disclose it
to a third party or the law requires us to do so).
24 25You can also read
