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CORPORATE HEALTH COVER
B R I N G I N G YO U
C O R P O R AT E B E N E F I T S
A
B
W E LCO M E
T O B U PA
We all want to live longer, healthier,
happier lives. Bupa has a range of
health covers designed to help ﬁnd a
healthier you.
It’s about more than just what you can
claim. Throughout these pages, you’ll
discover we’re committed to supporting
you for the long term, no matter where
life takes you. It’s all about creating a
healthier Australia, and it starts
right here.
The information in this brochure and
the guides in the back pocket are
important and should be read carefully
and kept in a safe place.
CONTENTS
1
Why private health insurance?
2
The Australian Government Rebate
on private health insurance
4
Why Bupa?
6
We’ve made choosing simple
11
Hospital Cover
13
Extras Cover
23
Ultimate Corporate Health Cover
35
Member exclusives
40
Join us today
42
Important information
44
W H Y PRIVAT E H EALTH I NS U R A N C E ?
1 . FO R P E AC E
OF MIND
CHOICE IS A
WO N D E R F U L T H I N G
Private health insurance covers most private hospital
costs. This means you can generally choose your own
doctor and where you are treated without worrying
about treatment costs. And, if you choose to be
treated in a private hospital, you don’t have to worry
about public hospital waiting lists. You can also enjoy
cover for a wide range of extras services including:
dental, optical, physio, chiro and massage, which are
not fully covered by Medicare.
THINKING ABOUT
S TA R T I N G A FA M I LY ?
If so, taking out or upgrading your private health
insurance can ensure you’re covered for important
services like pregnancy and childbirth. Then you can
rest easy and focus on enjoying life knowing that your
health insurance needs are covered.
R E ST E ASY K N OW I N G
YO U ’ R E C OV E R E D
There are a number of good ﬁnancial and practical
reasons for getting private health insurance. But
when it comes down to it, the peace of mind it gives
you and your loved ones is just as important. It’s a
good idea to review your private health insurance
from time to time to ensure you still have the most
relevant level of cover for you.
2
2 . I T C A N S AV E
YO U M O N E Y
I T PAY S T O J O I N
EARLIER IN LIFE
0%
+20%
LOADING
LOADING
You could pay more for hospital cover depending on
what age you ﬁrst take it out. After age 31, the Federal
Government’s Lifetime Health Cover (LHC) Loading
means your premium could increase by 2% a year to a
maximum of 70%. This applies for 10 years straight. To
avoid paying any loading simply take out and maintain
hospital cover by 30 June following your 31st birthday.
For couples, any loadings are shared across both adults
on the membership.
M O N E Y B AC K
I N YO U R P O C K E T
The Australian Government Rebate on private health
insurance makes private health cover more affordable
for most customers. The rebate is income tested and
reduced on a tiered basis (see full details on page 4). It is
available to all Australians who are eligible for Medicare
and applies to all covers in this brochure. The rebate is
quick and easy to claim – you can choose to get it as a
reduced premium, claim it directly from Medicare or as a
lump sum at tax time.
GET MORE FOR
YO U R M O N E Y
Did you know the Government’s Medicare Levy
Surcharge kicks in if you don’t have private
hospital cover but earn over $84,000 (for singles)
or $168,000 (for couples)?* This means you may
have to pay extra tax – more than the cost of some
of our hospital covers. You should ask your tax
adviser for more information or visit ato.gov.au
ADAM
JENNY
FIRST JOINED
AT AGE 30
FIRST JOINED
AT AGE 40
$84K
$168K
*Note: thresholds are effective 1 July 2012 and are indexed annually. On a family membership this increases by $1,500 per child
after the ﬁrst child. The family thresholds apply to single parent families, couples including de facto couples. There are speciﬁc
rules for calculating adjusted taxable income for Medicare Levy Surcharge and income testing purposes.
For more information go to ato.gov.au
3
TH E AUSTR ALIAN
G OVER N M ENT R EBATE O N
PRIVATE H E ALTH I N SU R AN C E
The Australian Government Rebate on private health insurance is income tested and the Medicare
Levy Surcharge (MLS) increased for high income earners. When you join Bupa we will make it
easy for you to choose the option that best suits your needs, including nominating a rebate tier.
See the table below for details on the rebate you are entitled to based on your income, along with
the corresponding MLS.
W H AT A M I E N T ITL E D TO A N D H OW M U C H M L S W I L L I
H AV E TO PAY ?
Australian Government Rebate and Medicare Levy Surcharge income thresholds 2012/2013
Singles
Income
Up to
$84,000
$84,001 –
$97,000*
$97,001 –
$130,000*
More than
$130,000*
Rebate Tiers
Base Tier
Tier 1
Tier 2
Tier 3
up to 65 years
30%
20%
10%
0%
65 – 69 years
35%
25%
15%
0%
70 years and over
40%
30%
20%
0%
0%
1%
1.25%
1.50%
Income
Up to
$168,000
$168,001 –
$194,000*
$194,001 –
$260,000*
More than
$260,000*
Rebate Tiers
Base Tier
Tier 1
Tier 2
Tier 3
up to 65 years
30%
20%
10%
0%
65 – 69 years
35%
25%
15%
0%
70 years and over
40%
30%
20%
0%
0%
1%
1.25%
1.50%
PHI Rebate
Medicare Levy Surcharge
Couples/Families
PHI Rebate
Medicare Levy Surcharge
Indicates changes for higher income earners that take effect from 1 July 2012.
*Note: thresholds are effective 1 July 2012 and are indexed annually. On a family membership this increases by $1,500 per
child after the ﬁrst child. The family thresholds apply to single parent families, couples including de facto couples. There are
speciﬁc rules for calculating adjusted taxable income for Medicare Levy Surcharge and income testing purposes. For more
information go to ato.gov.au
4
R EBATE C L A I M I N G O P TI O N S
There are three ways that you can claim the Australian Government Rebate on
private health insurance:
° upfront as a premium reduction
° directly from Medicare
° it can be taken into account when you lodge your next tax return.
If you are concerned about a tax liability you can nominate a rebate tier to apply to your
policy using the relevant section in the application form. If you nominate to receive a rebate
but don't specify a tier we will proceed with nominating you under the base tier (i.e. 30% if
under 65, 35% if 65–69 and 40% if 70 and over).
If at any time after joining your circumstances change and you need to update your rebate
tier, there are a number of ways to do this. Contact us for more details.
Natalie is 28 years old and earns $68k
per year as an accountant.
Tristan and Geniveve together earn
$217k per year.
Natalie will receive a 30% rebate and
won't pay the Medicare Levy Surcharge.
Their rebate will be 10% and their
Medicare Levy Surcharge will be 1.25% if
they don't maintain/hold an appropriate
level of private hospital cover.
5
W H Y BUPA?
W E WA N T YO U T O
L I V E A LO N G E R ,
H E A LT H I E R ,
HAPPIER LIFE
Bupa is a healthcare leader proudly
looking after the needs of more than
three million Australians. We have
been around for over 60 years and
we’re part of a global group whose
care and expertise now stretches
across 190 countries.
It is our purpose that makes us
different. We exist to help our members
live longer, healthier, happier lives.
Which is why our global family reinvests
its proﬁts to provide better services
for members and to ensure quality
healthcare remains affordable.
We are dedicated to helping ﬁnd a
healthier you. To ﬁnd out more:
Call us on 134 135
Visit bupa.com.au/corporate
Drop by your local Bupa centre
6
WE PUT OUR
M E M B E R S AT
THE HEART OF
EVERYTHING
WE DO
We know the health system
By your side wherever you are
We know the health system can be
confusing. That’s why our friendly team
are here to help you make sense of it. They
can answer important questions like: what
you’re currently covered for, what to ask
your doctor before treatment and how much
you’ll get back.
If the unexpected happens during your
stay or while you’re travelling overseas,
we’re always here to provide phone-based
support and guidance. Our 24-hour advice
line is exclusive to Bupa and provides
you with helpful information, including:
° basic advice on simple medical problems
provided by doctors and nurses
For your convenience
° contact details and location of
the nearest medical facilities
We give you choice so you can manage
your cover whenever, wherever. You can
contact us by phone or talk to someone face
to face at one of over 100 retail centres. Or
just jump online or use your smart phone to
access myBupa.
° medical translation services,
including reviewing bills and help
booking medical appointments ° passing telephone messages
on to your family.
Freedom to choose your provider
And if you’re planning a trip overseas, you
can get pre-departure medical information
on the countries you are visiting. We’ll advise
you on the health risks of that country and
give you tips on how to stay healthy while
you’re travelling.
We pay the same dollar beneﬁt at all
recognised providers.
If you choose to be treated at a Members
First provider you will also have the added
certainty of receiving between 70–100% of
the cost back for selected services depending
on your level of your extras cover.
Just look for the number on the back of your
membership card.
Keeping healthcare affordable
We know that when you’re sick you need
to focus on the most important issue –
your health and recovery. With us you are
fully covered as a private patient in most
Members First and Network hospitals across
Australia. Plus, if you need to be admitted,
in most cases you will be covered for all
in-hospital charges.*
*A small number of Members First and Network hospitals may have a service where a ﬁxed fee applies. An excess may
apply depending on your level of cover.
7
W H Y BUPA?
FIND A
H E A LT H I E R
YO U
At Bupa, we know that everyone
wants to be healthy, but sometimes
life gets in the way. That’s why we
support you with health programs,
tools and apps, and world-class health
information to help you take your ﬁrst
step towards a healthier you.
Programs and support
We have developed a range of
programs and guides to support
members with chronic conditions
like asthma, depression or diabetes.
Members can also beneﬁt from other
resources like our specialised parent
and baby wellbeing program.
World-class health information
Visit our website to stay in the know on
health topics that are important to you.
The information is designed by health
professionals and ranges from conditions
and treatments through to exercise
and diet tips. We also recommend
other reputable websites because our
knowledge is your knowledge.
See page 40 for other member exclusives.
8
G E T T I N G TO A
H E A LT H I E R YO U
myBupa
Online Health Assessment
myBupa is a new and improved way to
manage your health cover online. It really is
your very own little piece of Bupa. Here are
just a few things you can now do whenever
it suits you:
To really take charge of your health, you need
to know just how healthy you are in the ﬁrst
place. Our new Online Health Assessment is
very easy to use, and will help you take your
ﬁrst step towards a healthier you.
° make a claim on most extras
° change payment details
What you’ll ﬁnd out
° Your “real health age”
° lifestyle risk scores
° make one off payments
° order a membership card
° recommended changes you can make to
help improve your health age
° ﬁnd a provider
° contact us.
° Bupa programs that may be helpful to you.
Visit bupa.com.au and log into myBupa. It’s
very easy and will only take a few minutes.
You will ﬁnd new things there all the time.
Take your Online Health Assessment at
bupa.com.au/OHA
We are regularly developing more new tools
and apps so keep checking bupa.com.au/Apps
and our social media sites for updates:
You can now do all this from your mobile by
visiting bupa.com.au on your smartphone or
by downloading the Bupa mobile app from
the iTunes Store* or Google Play.^
Twitter.com/BupaAustralia
Facebook.com/BupaAustralia
Youtube.com/BupaAustralia
*Apple, iPad, iPhone, iPod Touch, and iTunes are trademarks of Apple Inc., registered in the U.S. and other countries. App Store is a
service mark of Apple Inc. ^Android and Google Play are trademarks of Google Inc.
9
B E N E F I T S AVA I L A B L E O N
C O R P O R AT E H E A LT H C O V E R
Higher beneﬁts
Corporate health cover offers higher beneﬁts on extras when compared to
both Bupa’s similar product offered to retail customers and those of our main
competitors.
Gap free physio and dental for kids*
We’ll cover the cost of your kids’ physio and general dental until they turn
25. That means no out-of-pocket expenses for kids’ dental check-ups, teeth
cleaning, ﬁllings, x-rays and more.* And no out-of-pocket costs for physio in most
instances.* At Bupa, we take care of your kids’ health.
No gap optical packages
You’ll have access to the ‘no gap’ range of ﬁxed-priced packages on glasses
and contact lenses at no additional cost† if you visit our Members First optical
providers including: BLINK Optical, Kevin Paisley Fashion Eyewear, National
Pharmacies Optical, Prevue Eyewear, Stacey and Stacey Optometrists and
selected independent retailers. Also, at Specsavers you can choose from a
range of ﬁxed-priced frames and lens packages with no out–of–pocket costs.†
Freedom to choose your provider
We pay the same dollar beneﬁt at all recognised providers. If you choose to be
treated at a Members First provider you will also have the added certainty of
receiving between 70–100% of the cost back for selected services depending
on your level of your extras cover.
Excess waiver
Available on Corporate Hospital Top, Corporate Hospital Intermediate and
Corporate Hospital Saver Level 2, which means singles and single parents
won’t have to pay the ﬁrst excess per calendar year and families won’t have to
pay the ﬁrst two excesses per calendar year.
No excess for kids
There is also no excess payable if your child is admitted to hospital on
Corporate Hospital Top and Corporate Hospital Intermediate.
Accident beneﬁt
If you are involved in an accident and require urgent hospital treatment, the
accident beneﬁt provides up to $2,000 per person, $4,000 per policy which
can be used to pay for:
a) Hospital excess(es) and/or
b) To boost extras cover in the event that limits have been reached.
*Available on Ultimate Corporate Health Cover, Corporate Advantage and Corporate Classic covers when
taken with hospital cover on a family membership, when treatment is provided by a Members First dentist
or physiotherapist. Fund rules, waiting periods and annual maximums apply. Child dependants only. Includes
Major Dental in VIC and SA only. Excludes orthodontics and hospital treatments. †Optical beneﬁts are subject
to your level of cover, annual maximums and waiting periods. Conditions apply.
10
WE’VE MADE
CHOOSING SIMPLE
We know private health insurance can be confusing so we’re here
to help you ﬁnd what you’re looking for.
To tailor your own cover simply choose any of our hospital covers
then add one of our extras covers. Alternatively, you can select our
Ultimate Corporate packaged cover which combines hospital and
extras already. You can even choose to have a hospital or extras
cover on its own.
The following pages will help you to understand your options so
you can choose what’s right for you.
1. CHOOSE
YO U R H O S P I TA L
COV E R
2. CHOOSE
YO U R E X T R A S
COV E R
This helps pay for treatment
in hospital and generally gives
you the peace of mind of
choosing your doctor as well
as when and where you are
treated. See page 13.
Extras covers you for services
that Medicare often doesn’t
cover such as: dental, optical,
physio, chiro, massage and
much more. See page 23.
+
OR
3 . U LT I M AT E C O R P O R AT E
H E A LT H C O V E R
Ultimate Corporate Health Cover gives you our very
best level of hospital cover combined with our top
extras cover in one premium package. See page 35.
11
N O E XC E S S
FOR KIDS
There is no excess payable
for dependant children on
your membership.*
*No excess offer applies to Corporate
Hospital Top and Corporate Hospital
Intermediate cover. See the Important
Information section at the back of this
brochure for more details.
12
HOSPITAL COVER
1.
C H O O S E YO U R
H O S P I TA L C O V E R
13
HOSPITAL COVER
HOW MUCH
COV E R D O
YO U N E E D ?
We want to help you choose the most
relevant level of cover for you. So
we have laid out our hospital covers
for you to explore and make the
best decision.
To see our detailed comparison table,
including services covered, go to page 21.
BAS IC
C O R P O R AT E
H O S P I TA L S AV E R
C O R P O R AT E H O S P I TA L
I N T E R M E D I AT E
This option covers you for most
services while restricting some
treatments that you’re unlikely
to need for now. Together with
excess options, this helps keep your
premium down. Note that pregnancy
related services (including childbirth)
are restricted.
This level of hospital cover gives
you cover for services including
pregnancy, which is restricted on
Corporate Hospital Saver. You also
get a choice of excess options to
help lower the cost of your cover.
See page 17.
See page 16.
LEVEL 1
LEVEL 2
NIL
$
EXCESS
LEVEL 3
LEVEL 1
LEVEL 2
250 $500
NIL
$
EXCESS
EXCESS
EXCESS
14
LEVEL 3
250 $500
EXCESS
EXCESS
A L L C O V E R S S U I TA B L E F O R
S I N G L E S , C O U P L E S A N D FA M I L I E S
COM P R E H E N S I V E
C O R P O R AT E
H O S P I TA L T O P
If you want the true peace of mind
that comes with our top hospital
cover, this may be a good option
for you. There are no exclusions and
you get a choice of excesses to help
lower the cost of your premium.
See page 18.
LEVEL 1
LEVEL 2
NIL
$
EXCESS
15
LEVEL 3
250 $500
EXCESS
EXCESS
HOSPITAL COVER
+ +
HOSPITAL COVER
C O R P O R AT E H O S P I TA L S AV E R
An ideal option if you’re young and active – this basic cover gives you a
‘safety net’ for many hospital treatments while keeping it very affordable.
WH AT ’ S COVERED?
° schedule fees charged by a doctor,
surgeon, anaesthetist or other specialist
for your inpatient medical treatment, plus
additional coverage if your doctor uses
the Bupa Medical Gap Scheme
You’re covered for all hospital treatments
recognised by Medicare, except the services
that pay minimum beneﬁts listed below.
Examples of what you are covered for include:
° hospital accommodation – overnight and
same-day
° pathology and radiology diagnostic
tests performed in hospital by Bupa
contracted providers.
° theatre and intensive care fees
° surgically implanted prostheses
up to the approved beneﬁts in the
Government’s Prostheses List
Waiting periods apply see page 20.
WH AT ’ S N OT FULLY COV ER ED?
There are some services that are not fully
covered or not covered at all by any of our
hospital covers, such as cosmetic surgery
that is not clinically required. See page 20
for details.
The following services only receive public
hospital shared room beneﬁts
(minimum beneﬁts):
° hip and knee joint replacement
(including arthroplasty, revision and
resurfacing procedures)
° cataract and eye lens procedures
° pregnancy related services (including
childbirth) and assisted reproductive services
° psychiatric services.
Look after your health and get more value with:
° a choice of excesses to lower the cost of your cover
° Excess Waiver Feature for adults on Corporate Saver Level 2
(see page 20 for details)
LEVEL 1
LEVEL 2
NIL
$
EXCESS
LEVEL 3
250 $500
EXCESS
EXCESS
° our Members First and Network hospital agreements which help to eliminate or reduce
your out-of-pocket expenses*
° a single room or $50 back when you book your overnight admission at Members First hospitals
(conditions apply – contact us for details)*
° no out-of-pocket hospital expenses and no gaps on your doctors’ fees at our Members
First day facilities*^
° limited emergency and on-the-spot ambulance services included in your cover.~
See pages 20–21 and the Important Information section at the back of this brochure to ﬁnd
out more about your hospital cover.
*To see if your chosen facility has an arrangement with us, view our current Bupa Hospital Listing on our website or call us.
^Available in NSW, QLD, SA, VIC and WA. ~Limits apply.
16
HOSPITAL COVER
C O R P O R AT E H O S P I TA L
I N T E R M E D I AT E
This medium-level option gives you coverage for pregnancy and childbirth,
as well as cardiac related services.
WH AT ’ S COVERED?
° schedule fees charged by a doctor,
surgeon, anaesthetist or other specialist
for your inpatient medical treatment, plus
additional coverage if your doctor uses
the Bupa Medical Gap Scheme
You’re covered for all hospital treatments
recognised by Medicare, except the services
that pay minimum beneﬁts listed below.
Examples of what you are covered for include:
° hospital accommodation – overnight
and same-day
° pathology and radiology diagnostic tests
performed in hospital by Bupa
contracted providers.
° theatre and intensive care fees
° surgically implanted prostheses
up to the approved beneﬁts in the
Government’s Prostheses List
Waiting periods apply see page 20.
WH AT ’ S N OT FULLY COV ER ED?
There are some services that are not fully
covered or not covered at all by any of our
hospital covers, such as cosmetic surgery
that is not clinically required. See page 20
for details.
The following services only receive public
hospital shared room beneﬁts
(minimum beneﬁts):
° hip and knee joint replacement
(including arthroplasty, revision and
resurfacing procedures)
° cataract and eye lens procedures.
Look after your health and get more value with:
° a choice of excesses to lower the cost of your cover
° no excess if your child is admitted to hospital
LEVEL 1
LEVEL 2
NIL
$
EXCESS
LEVEL 3
250 $500
EXCESS
EXCESS
° Excess Waiver Feature for adults on Corporate Intermediate Level 2 (see page 20 for details)
° our Members First and Network hospital agreements which help to eliminate or reduce
your out-of-pocket expenses*
° a single room or $50 back when you book your overnight admission at Members First
hospitals (conditions apply – contact us for details)*
° no out-of-pocket hospital expenses and no gaps on your doctors’ fees at our Members
First day facilities*^
° limited emergency and on-the-spot ambulance services included in your cover.~
See pages 20–21 and the Important Information section at the back of this brochure to ﬁnd
out more about your hospital cover.
*To see if your chosen facility has an arrangement with us, view our current Bupa Hospital Listing on our website or call us.
^Available in NSW, QLD, SA, VIC and WA. ~Limits apply.
17
HOSPITAL COVER
C O R P O R AT E H O S P I TA L T O P
Our highest level of corporate hospital cover with no exclusions and a range of
additional beneﬁts.
WH AT ’ S COVERED?
° schedule fees charged by a doctor,
surgeon, anaesthetist or other specialist
for your inpatient medical treatment, plus
additional coverage if your doctor uses
the Bupa Medical Gap Scheme
You’re covered for all hospital treatments
recognised by Medicare.
Examples of what you are covered for include:
° hospital accommodation – overnight and
same-day
° pathology and radiology diagnostic
tests performed in hospital by Bupa
contracted providers.
° theatre and intensive care fees
° surgically implanted prostheses
up to the approved beneﬁts in the
Government’s Prostheses List
Waiting periods apply see page 20.
E XC LU SION S (services not covered)
No exclusions speciﬁc to this cover.
There are some services that are not fully
covered or not covered at all by any of our
hospital covers, such as cosmetic surgery
that is not clinically required. See page 20
for details.
Look after your health and get more value with:
° a choice of excesses to lower the cost of your cover
° no excess if your child is admitted to hospital
LEVEL 1
LEVEL 2
NIL
$
EXCESS
LEVEL 3
250 $500
EXCESS
EXCESS
° Excess Waiver Feature for adults on Corporate Top Level 2 (see page 20 for details)
° our Bupa Members First and Network hospital agreements which help to eliminate or reduce
your out-of-pocket expenses*
° a single room or $50 back when you book your overnight admission at Members First
hospitals (conditions apply – contact us for details)*
° no out-of-pocket hospital expenses and no gaps on your doctors’ fees at our Members
First day facilities*^
° limited emergency and on-the-spot ambulance services included in your cover~
° Special Beneﬁts – provisions for a family member to stay with you in hospital
° baby books (available for expectant parents)
° health subscription refunds (e.g. Asthma Foundation membership fees) – not available on
Corporate Hospital Top Level Three.
See pages 20–21 and the Important Information section at the back of this brochure to ﬁnd
out more about your hospital cover.
* To see if your chosen facility has an arrangement with us, view our current Bupa Hospital Listing on our website or call us.
^Available in NSW, QLD, SA, VIC and WA. ~Limits apply.
18
HOSPITAL COVER
PARENT AND
BABY WELLBEING
PROGRAM
Members with newborn
babies, who may be
feeling overwhelmed or
struggling to cope, can
access conﬁdential support
and advice through this
specialised program.ˆ
ˆAvailable to members who have hospital
or packaged cover.
19
HOSPITAL COVER
H O S P I TA L
COV E R
What’s covered
Hospital cover helps pay for treatments that
are recognised by Medicare when you are
admitted to hospital. When a treatment is
included in your hospital cover we will help
pay for things like: your room, theatre fees,
surgically implanted prostheses and fees
charged by your doctor/s when they treat
you in hospital.
There is no waiting period for treatment you
require as a result of an accident sustained
after joining us. There are also no waiting
periods for newborn babies provided you
are on a family hospital cover and the baby
is added to your membership no later than
two months after their birth.
Excess
What’s not covered
An excess is a set amount you agree to
pay upfront before your beneﬁt is paid
for overnight or same-day admissions at
any hospital. The excess is paid when you
are admitted into hospital, and is capped
at $500 for singles and $1,000 for single
parents and families per calendar year.
There are situations where you are likely not to
be covered under any of our hospital covers.
The following are not covered by us at all
(nil hospital, prosthesis or medical beneﬁts):
procedures not recognised by Medicare;
procedures not approved by the Medical
Services Advisory Committee; experimental
treatment; respite care; cosmetic surgery that
is not clinically required. Surgical podiatry
receives minimum beneﬁts (if a prosthesis is
surgically implanted during a procedure, the
cost of this will be covered).
The Excess Waiver feature, available on
Corporate Hospital Top, Corporate Hospital
Intermediate and Corporate Hospital Saver
Level 2, means singles and single parents
won’t have to pay the ﬁrst excess per calendar
year and families won’t have to pay the ﬁrst
two excesses per calendar year. There is also
no excess payable if your child is admitted
to hospital on Corporate Hospital Top and
Corporate Hospital Intermediate.
Waiting periods
A waiting period is the time between when
you joined us and when you are covered
for a service or treatment. If you receive a
service or treatment during this time, you
are not eligible to receive a beneﬁt payment
from us, regardless of when you submit the
claim. The following waiting periods apply to
hospital cover:
Bupa Medical Gap Scheme
This is a direct billing arrangement between
Bupa and your doctor/s that either eliminates
or reduces out-of-pocket expenses for
in-hospital doctors’ fees (the ‘gap’). See
page 43 for more information.
° pre-existing conditions, ailments or
illnesses and pregnancy related services
(including childbirth) – 12 months
You should also see the Important
Information section at the back of this
brochure for more details.
° all other treatments covered by your
product – two months.
20
C O R P O R AT E
H O S P I TA L
I N T E R M E D I AT E
C O R P O R AT E
H O S P I TA L
TO P
See page 16
See page 17
See page 18
Accommodation for Overnight and
Same-day Stays
9
9
9
Operating Theatre, Intensive Care,
Ward Fees
9
9
9
Bupa Medical Gap Scheme available
9
9
9
Surgically Implanted Prothesis
9
9
9
Accidents After Joining
9
9
9
Knee Arthroscopy and
Meniscectomy Procedures
9
9
9
Appendicitis
9
9
9
Removal of Tonsils and Adenoids
9
9
9
Dental Surgery
9
9
9
Minor Gynaecological Surgery
9
9
9
Psychiatric Services
z
9
9
Rehabilitation Services
9
9
9
Pregnancy Related Services
(including childbirth) and Assisted
Reproductive Services
z
9
9
Cardiac and Cardiac Related Services
(e.g. open heart and bypass surgery)
9
9
9
Renal Dialysis for Chronic Renal Failure
9
9
9
Cataract and Eye Lens Procedures
z
z
9
Hip/Knee Replacement
(including arthroplasty, revisions and
resurfacing procedures)
z
z
9
All Other Joint Replacements
9
9
9
All other Inpatient Treatments Receiving a
Medicare beneﬁt
9
9
9
Services
For Inpatient Services included on cover:
Inpatient Services included on cover:
Additional Items:
Baby Books (contact us for details)
9
Emergency Ambulance Services^
9
9
9
Health Subscription Refunds^^
9
Special Beneﬁts
(contact us for details)
9
Nil, $250, $500
Excesses
Excess Options*
Nil, $250, $500
Nil, $250, $500
No Excess for Kids
9
9
Excess Waiver*
9
9
9
zSee the Important Information section for more details about Minimum Beneﬁts. Indicates the service is not included.
^Limits apply – see the Important Information section for details. ^^Health Subscription Refunds applies to Corporate
Hospital Top, Levels 1 and 2 only (i.e. nil and $250 excess). *Excess Waiver Feature applies to the $250 excess level on
Corporate Hospital Top, Corporate Hospital Intermediate and Corporate Hospital Saver Level 2 cover only.
21
HOSPITAL COVER
C O R P O R AT E
H O S P I TA L
S AV E R
F R E E D O M TO
C H O O S E YO U R
P ROV I D E R
Depending on your extras
cover, at Members First
providers you will receive
between 70–100% of the cost
back for selected services. If
you choose to visit a provider
outside of our network, you
will still receive the same dollar
beneﬁt amount back as at our
Members First providers.
22
EXTRAS COVER
2.
C H O O S E YO U R
E X T R AS COV E R
23
EX T RAS COV ER
HOW MUCH
COV E R D O
YO U N E E D ?
We want to help you choose the most
relevant level of cover for you. So we
have laid out our extras covers side by
side to help you to compare.
To see our detailed comparison table,
including services covered and annual
maximums for each level of cover, go to
pages 31–33.
BAS IC
C O R P O R AT E
ESSENTIALS
C O R P O R AT E
CLASSIC
Enjoy access to a wide range of
services with at least 70% back at
Members First providers. Plus, you’ll
receive the same dollar beneﬁt
amount at all other providers.
If you want generous beneﬁts and a
high level of cover, this option may
suit you. It gives you access to a
wide range of services that Medicare
doesn’t cover with at least 80% back
at Members First providers. And
you’ll receive the same dollar beneﬁt
amount at all other providers.
See page 26.
See page 28.
24
A L L C O V E R S S U I TA B L E F O R
S I N G L E S , C O U P L E S A N D FA M I L I E S
COM P R E H E N S I V E
C O R P O R AT E
A D VA N TA G E
Get peace of mind knowing that
you’re covered to our highest level of
extras cover. The real advantage here
is access to a wide range of services
that Medicare doesn’t cover with
at least 90% back at Members First
providers. And the same dollar beneﬁt
amount at all other providers.
See page 29.
25
EXTRAS COVER
+ +
EX T RAS COV ER
C O R P O R AT E
ESSENTIALS
A basic level of extras cover with good beneﬁts and coverage for the
services that may be relevant to your needs.
AT L E A S T 7 0 % B A C K AT M E M B E R S F I R S T P R O V I D E R S
S E RVICES
ANNUAL M AXI M UM S
Per Person Per Calendar Year
WA I TI N G
P E R I O DS
2 months
General Dental
$350
Major Dental
Combined with general dental
Optical
$200 – No Gap optical packages – see p30
12 months
2 months
Physiotherapy, Chiropractic,
$150 Combined
Osteopathy and Natural Therapies
2 months
Living Well (see p40)
$100
6 months
Pharmacy (see p32)
$150
2 months
Emergency Ambulance ~
1 service per calendar year (singles)
2 services per calendar year (families)
None
Freedom to choose your provider
We pay the same dollar beneﬁt at all recognised providers. If you choose to be treated at a
Members First provider you will also have the added certainty of receiving between 70–100%
of the cost back for selected services depending on your level of your extras cover.
See pages 31–33, the Important Information section and the Corporate Benefits Guide in the
back of this brochure to ﬁnd out more about your extras cover.
For most items at our Members First providers covering dental, physio and chiro services. Includes major dental in VIC
and SA only. ~Limits apply.
26
EXTRAS COVER
GET A PAIR ON US
Find out how you can get
a pair of spectacles or a
supply of contact lenses
completely covered by us.†
†Conditions apply. Please refer to the
Corporate Benefits Guide for more details.
27
EX T RAS COV ER
C O R P O R AT E
CLASSIC
Cover for a wide range of services with high beneﬁts and annual maximums.
AT L E A S T 8 0 % B A C K AT M E M B E R S F I R S T P R O V I D E R S
S E RV IC E S
General Dental
Major Dental
ANNUAL M AXI M UM S
Per Person Per Calendar Year
Year 1 $400 – Year 6+ $800
No Gap for kids – see p30
WA ITIN G
PER IODS
12 months
2 months
Orthodontics
Year 1 $400 – Year 6+ $800
$1,600 Lifetime Limit
Optical
$225 – No Gap optical packages – see p30
2 months
Chiropractic and Osteopathy
$500 per person $1,000 per membership
2 months
Physiotherapy
Year 1 $350 – Year 6 $700
No Gap physio for kids – see p30
2 months
Antenatal and Postnatal
Living Well (see p40)
$100
6 months
Pharmacy (see p32)
Natural Therapies
(see p32 for a full list)
Dietary
Psychology
Podiatry (excludes orthotics)
Speech Therapy
Eye Therapy
Occupational Therapy
Health Aids and Appliances
(see p32 for the full list)
Hire, Repair and Maintenance
of Health Aids and Appliances
Home Nursing
$300
2 months
$600
2 months
Combined with Natural Therapies and other
services annual maximum (sub-limits apply)
$100 sub-limit within Natural Therapies
and other services annual maximum
$350
Accident Beneﬁt
$2,000 per person $4,000 per membership
Travel and Accommodation
$100 – Travel $150 – Accommodation
1 service per calendar year (singles)
2 services per calendar year (families)
Emergency Ambulance ~
12 months
2 months
12 months
6 months
2 months
None
2 months
None
See pages 31–33, the Important Information section and the Corporate Benefits Guide to ﬁnd out
more about your extras cover.
Loyalty maximums
We increase how much you can claim each
year by 20% of the initial amount for most
extras services (applies after the ﬁrst 12
months up to a maximum increase of 100%).
Freedom to choose your provider
We pay the same dollar beneﬁt at all
recognised providers. If you choose to be
treated at a Members First provider you will
also have the added certainty of receiving
between 70–100% of the cost back for
selected services depending on your level
of your extras cover.
For most items at our Members First providers covering dental, physio and chiro services. Includes major dental in VIC
and SA only. ~Limits apply.
28
C O R P O R AT E
A DVA N TAG E
Cover for a wide range of services with higher beneﬁts and annual maximums.
AT L E A S T 9 0 % B A C K AT M E M B E R S F I R S T P R O V I D E R S
SE RV IC E S
ANNUAL M AXI M UM S
Per Person Per Calendar Year
WA ITIN G
PER IODS
General Dental
Unlimited – No Gap for kids – see p30
Major Dental
$800
12 months
Orthodontics
$1,200 per person $2,400 Lifetime Limit
12 months
Optical
$250 – No Gap optical packages – see p30
2 months
Chiropractic and Osteopathy
$600 per person $1,200 per membership
2 months
Physiotherapy
Year 1 $400 – Year 6 $800
No Gap physio for kids – see p30
2 months
$400
2 months
$100
6 months
Antenatal and Postnatal
Natural Therapies
(see p30 for a full list)
Living Well (see p40)
2 months
2 months
Pharmacy (see p32)
$450
2 months
Psychology
Dietary
Podiatry (excludes orthotics)
Speech Therapy
Eye Therapy
Occupational Therapy
Home Nursing
Health Aids and Appliances
(see p32 for a full list)
Hire, Repair and Maintenance
of Health Aids and Appliances
Accident Beneﬁt
$500 per person $1,000 per membership
2 months
$500
2 months
$350
2 months
$850
12 months
Travel and Accommodation
Emergency Ambulance ~
$100 sub-limit within Health Aids and Appliances
annual maximum
$2,000 per person $4,000 per membership
Travel – $100 Accommodation – $150
1 service per calendar year for singles
2 services per calendar year for families
6 months
None
2 months
None
See pages 31–33, the Important Information section and the Corporate Benefits Guide to ﬁnd out
more about your extras cover.
Loyalty maximums
We increase how much you can claim each
year by 20% of the initial amount for most
extras services (applies after the ﬁrst 12
months up to a maximum increase of 100%).
Freedom to choose your provider
We pay the same dollar beneﬁt at all
recognised providers. If you choose to be
treated at a Members First provider you will
also have the added certainty of receiving
between 70–100% of the cost back for
selected services depending on your level
of your extras cover.
For most items at our Members First providers covering dental, physio and chiro services. Includes major dental in VIC
and SA only. ~Limits apply.
29
Are all extras services covered?
Our extensive Members First provider
network offers nation-wide access to
general dental, optical, physiotherapy and
chiropractic services. If you have extras
cover with us, you will have the certainty of
knowing how much you’ll get back in most
instances when you visit these providers.
Visit our website to ﬁnd a Members First
provider near you. Also, keep an eye out for
the following logo at your providers:
There are instances when extras beneﬁts
are not payable including:
° for different services within the same
service type from the same provider on the
same day. For example, if you went to see an
acupuncturist and then received a massage
from the same provider on the same day,
you cannot claim for both services
° when a provider is not recognised by us
for beneﬁt purposes
° when a third party provides a beneﬁt
(e.g. when you hold a state
ambulance subscription).
Gap free physio and dental for kids*
Set beneﬁts
If you visit a non-Members First provider
you will receive a set amount back known
as a set beneﬁt. This beneﬁt amount is
the same as what you would receive at a
Members First provider.
For a services where we do not have a
Members First Network, you will receive a set
beneﬁt as well. See the Corporate Benefits
Guide in the back of this brochure or call us
if you want to know how much you will get
back before you visit your extras provider.
We‘ll cover the cost of your kids’ physio
and general dental until they turn 25. That
means no out-of-pocket expenses for kids’
dental check-ups, teeth cleaning, ﬁllings,
x-rays and more.* And no out-of-pocket
costs for physio in most instances.* At
Bupa, your kids’ health is taken care of.
*Available on Ultimate Corporate Health Cover,
Corporate Advantage and Corporate Classic covers
when taken with hospital cover on a family membership,
when treatment is provided by a Members First dentist
or physiotherapist. Fund rules, waiting periods and
annual maximums apply. Child dependants only. Includes
Major Dental in VIC and SA only. Excludes orthodontics
and hospital treatments.
Annual maximums and service limits
There are limits to the amount you can
claim back and/or the number of times you
can claim on most services.
See pages 31–33 and the Important
Information section at the back of this
brochure to ﬁnd out more.
MEMBERS FIRST OPTICAL
OT H E R O P T I C A L B E N E F I T S
Our Members First optical providers
include BLINK Optical, Kevin Paisley
Fashion Eyewear, National Pharmacies
Optical, Prevue Eyewear, Stacey and Stacey
Optometrists and selected independent
retailers. You’ll have access to the ‘no gap’
range of ﬁxed-priced packages on glasses
and contact lenses at no additional cost†
and up to $100 off all fashion frames if you
visit one of these providers.#
At Specsavers you can choose from a
range of ﬁxed-priced frames and lens
packages with no out–of–pocket costs.†
†Optical beneﬁts are subject to your level of cover, annual
maximums and waiting periods. Conditions apply. #Not in
conjunction with any other offers.
30
EXTRAS COVER
Save with our Members First network
EX T RAS COV ER
H OW M U C H C A N YO U C L A I M U P TO ?
C O R P O R AT E
ESSENTIALS
Services
Waiting
Periods
C O R P O R AT E
A D VA N TA G E
70% back*
80% back*
90% back*
Annual Maximums
Per Person
Per Calendar Year
Annual Maximums
Per Person
Per Calendar Year
Annual Maximums
Per Person
Per Calendar Year
General
Dental
2 months
$350
Combined
annual
maximum
Major
Dental
C O R P O R AT E
CLASSIC
12 months
Year
1
2
3
4
5
6+
Amount
Year
Amount
1
2
3
4
5
6
6+
$0_
$400
$480
$560
$640
$720
$800
$400
$480
$560
$640
$720
$800
Unlimited
$800
12 months
$1,600 Lifetime Limit
for orthodontics
2 months
$200
$225
$250
$500 per person
$1,000 per membership
$600 per person
$1,200 per membership
Orthodontics
$1,200 per person
$2,400 Lifetime Limit
Optical
Chiropractic
and
Osteopathy
2 months
Physiotherapy
Antenatal
and
postnatal
$150
Combined
annual
maximum
2 months
Year
Amount
Year
Amount
1
2
3
4
5
6+
$350
$420
$490
$560
$630
$700
1
2
3
4
5
6+
$400
$480
$560
$640
$720
$800
*For most items at our Members First providers covering dental, physio and chiro services. Includes major dental and
orthodontics in VIC and SA only. Annual maximums and waiting periods apply. Loyalty Maximums (see page 29) other dollar
amounts relate to annual maximums. _ New members.
31
C O R P O R AT E E S S E N T I A L S
Set Beneﬁts
Services
Waiting Periods
Annual Maximums
Per Person Per Calendar Year
Living Well (see p40)
6 months
$100
Pharmacy^^
2 months
$150
Natural Therapies
Includes: acupuncture, Alexander Technique,
Chinese herbalism, exercise physiology, Feldenkrais,
homeopathy, iridology, naturopathy, Western
herbalism and massage.
2 months
Combined with Physiotherapy
annual maximum
Massage includes: aromatherapy, Bowen
Technique, kinesiology, reﬂexology, shiatsu,
and remedial massage.
Psychology
2 months
Dietary
2 months
Podiatry (excludes orthotics)
2 months
Speech Therapy
2 months
Eye Therapy
2 months
Occupational Therapy
2 months
Home Nursing
2 months
Health Aids and Appliances+
Sub-Limits
Asthma Pumps
Blood Glucose Monitors or INR Blood
Testing Devices (Coagucheck)
Deﬁned Appliances (includes orthotics)^
Surgical Stockings
12 months
CPAP Devices#
Hearing Aids
TENS Machine
Blood Pressure Monitors
Hire, Repair and Maintenance of Health Aids
and Appliances
Travel and Accommodation
Accident Beneﬁt~
Emergency Ambulance Services~
2 months
No waiting period
No waiting period
1 service per year (singles)
2 services per year (families)
^^Beneﬁts for prescription items that are non-PBS, TGA approved, and not appearing on our exclusions list. +A combined annual
maximum applies to this service category. ^Deﬁned Appliances includes orthotics, orthopaedic and corrective footwear, pressure
garments, braces and artiﬁcial limbs. Limits apply per item.
32
C O R P O R AT E A D VA N TA G E
Set Beneﬁts
Set Beneﬁts
Annual Maximums
Per Person Per Calendar Year
Annual Maximums
Per Person Per Calendar Year
$100
$100
$300
$450
$400
Combined annual maximum $600
$500 per person, $1,000 per membership
$500
$350
$350
Combined with Natural Therapies
annual maximum (sub-limits apply)
$850
1 claim every 3 years
1 claim every 3 years up to $300
1 claim per year
1 claim per year up to $500
$500 per year
$500 per year
$100 per year
$100 per year
1 claim every 2 years
1 claim every 2 years up to $750
1 claim every 3 years
1 claim every 3 years up to $850
$175 per year
$175 per year
$175 per year
$175 per year
$100 per calendar year combined annual maximum with
Natural Therapies
$100 – Travel
$150 – Accommodation
$100 per calendar year combined annual maximum with
Health Aids and Appliances
$100 – Travel
$150 – Accommodation
$2000 per person $4000 per membership
$2000 per person $4000 per membership
1 service per year (singles)
2 services per year (families)
1 service per year (singles)
2 services per year (families)
#Subject to eligibility. Call us for details. ~When an accident requires urgent hospital treatment, can boost annual maximums on
extras or pay for your hospital excess. Limits apply – see the Important Information section for more details.
33
EXTRAS COVER
C O R P O R AT E C L A S S I C
GAP BONUS
Receive a $200 Gap
Bonus when you join, and
another $200 at the start
of each calendar year per
membership, to help pay for
any medical gaps charged
by your doctor or specialist
when admitted to hospital.
Plus, any unused bonus
amounts will accumulate.
34
ULTIMATE CORPORATE HEALTH COVER
3.
C H O O S E U LT I M AT E
C O R P O R AT E
H E A LT H C O V E R
35
U LTIM AT E CO R P OR ATE H EALT H COV E R
U LT I M AT E
C O R P O R AT E
H E A LT H C O V E R
Ultimate Corporate Health Cover gives you our very best level of hospital
cover with no excess or co-payment to pay combined with our top extras
cover. With a range of additional beneﬁts, some unique to this cover, you can
relax knowing that this premium package gives you genuine peace of mind.
H O S P I TA L
WH AT ’ S COVERED?
EXC LUS I O N S (services not covered)
You're covered for all hospital treatments
recognised by Medicare.
No exclusions speciﬁc to this cover.
Examples of what we pay beneﬁts for include:
° hospital accommodation – overnight and
same-day
° theatre and intensive care fees
° surgically implanted prostheses
up to the approved beneﬁts in the
Government’s Prostheses List
There are some services that are not fully
covered or not covered at all by any of our
hospital covers, such as cosmetic surgery
that is not clinically required. See page 20
for details.
° schedule fees charged by a doctor,
surgeon, anaesthetist or other specialist
for your inpatient medical treatment, plus
additional coverage if your doctor uses
the Bupa Medical Gap Scheme
° pathology and radiology diagnostic
tests performed in hospital by Bupa
contracted providers.
You should also see the Important
Information section at the back of this
brochure for more details.
Waiting periods apply.
36
U P T O 1 0 0 % B A C K AT M E M B E R S F I R S T P R O V I D E R S
S E RVICES
A N N UA L M A X I M U M S
Per Person Per Calendar Year
WA I TI N G
P E R I O DS
General Dental
Unlimited (No Gap for kids see p39)
Major Dental
Year 1 $800 – Year 6+ $1,600
12 months
Orthodontics
$1,400 per person
$3,200 Lifetime Limit
12 months
Optical
$420 or $300
(No Gap optical packages see p39)
2 months
Physiotherapy
Year 1 $750 – Year 6+ $1,500
(No Gap for kids see p39)
2 months
Chiropractic and Osteopathy
Year 1 $500 – Year 6+ $1,000 (per person)
Year 1 $800 – $1,600 (per family)
2 months
Antenatal and Postnatal
$500
2 months
Year 1 $500 – Year 6+ $1,000
Includes sub-limits for massage:
$250 per person, $500 per membership
2 months
Living Well (see p40)
$100
6 months
Pharmacy^^
Year 1 $750 – Year 6+ $1,500
2 months
Dietary
Year 1 $500 – Year 6+ $1,000
2 months
Psychology
Year 1 $500 – Year 6+ $1,000
2 months
Podiatry (excludes orthotics)
Year 1 $500 – Year 6+ $1,000
2 months
Speech Therapy
Year 1 $500 – Year 6+ $1,000
2 months
Eye Therapy
Year 1 $500 – Year 6+ $1,000
2 months
Occupational Therapy
Year 1 $500 – Year 6+ $1,000
2 months
Home Nursing
$400
Health Aids and Appliances
$1,000
Hire Repair and Maintenance of Health Aids
and Appliances
$100 combined limit with
Health Aids and Appliances
6 months
Travel and Accommodation
$200 – Travel, $300 – Accommodation
2 months
Emergency Ambulance Services~
1 service per year (singles)
2 services per year (families)
2 months
Natural Therapies
Includes: acupuncture, Alexander Technique, Chinese
herbalism, exercise physiology, Feldenkrais, homeopathy,
iridology, naturopathy and Western herbalism.
Massage includes: aromatherapy, Bowen Technique,
kinesiology, reﬂexology, shiatsu, and remedial massage.
2 months
12 months
None
= Members First = non-Members First
See pages 20 and 36, the Important Information section and the Corporate Benefits Guide
in the back of this brochure to ﬁnd out more about your hospital and extras cover.
For most items at our Members First providers covering dental, physio and chiro services. Includes major dental in
VIC and SA only. Loyalty Maximums (see page 38). ^^Benefits for prescription items that are non-PBS, TGA approved,
and not appearing on our exclusions list. ~Limits apply.
37
ULTIMATE CORPORATE HEALTH COVER
EXTRAS
U LT IMAT E CO R P OR ATE H EALT H COV E R
F O R U LT I M AT E
P E AC E O F M I N D
A N D VA L U E
Receive 100% back for:
Can also enjoy:
° general dental at any recognised provider up
to the ﬁrst $500 per person per year
° major dental at any recognised provider
up to your annual maximums
° a single room or $50 back when you book
your overnight admission at our Members
First hospitals (conditions apply – contact
us for details) *
° all orthodontics at any recognised
provider until your annual maximum and
lifetime limit has been reached
° Special Beneﬁts – to help pay for meals
and accommodation for a relative or carer
who stays with you in hospital
° physio and chiro at any recognised
provider up to the ﬁrst $350 per person
per year
° health subscription refunds (e.g. Asthma
Foundation membership fees)
° a bowel cancer screening kit beneﬁt
° baby books plus a ‘parent and baby’
wellbeing program (available for
expectant parents).
° a range of ﬁxed-priced packages on
spectacles and contact lenses from our
Members First providers
° your hospital costs (in most instances) at our
Members First, Network and public hospitals
Loyalty Maximums
We increase how much you can claim each
year by 20% of the initial amount for most
extras services (applies after the ﬁrst 12
months up to a maximum increase of 100%).
See page 37 for more details.
° your hospital expenses and doctors' fees
at our Members First day facilities*^
° a subscription with your state ambulance
provider (where available), and limited
emergency and on-the-spot ambulance
services included in your cover.~
See the Important Information section and the Corporate Benefits Guide in the back of this
brochure for more information.
*To see if your chosen facility has an arrangement with us, view our current Bupa Hospital Listing on our website or call us.
^Available in NSW, QLD, SA and VIC. ~Limits apply to ambulance cover included in your cover.
38
100% cover for laser eye surgery
100% cover for most laser eye corrective surgery when performed by
a Bupa approved provider. A three year waiting period applies and
excludes lens implant.
Gap Bonus
Receive a $200 Gap Bonus when you join, and another $200 at the
start of each calendar year per membership, to help pay for any
medical gaps charged by your doctor or specialist when admitted to
hospital. Plus, any unused bonus amounts will accumulate.
Fixed fee reimbursement
Ultimate Corporate Health Cover members will be reimbursed if charged
a ﬁxed daily fee by any of our contracted ﬁxed fee hospitals.^
By your side wherever you are
If the unexpected happens while you’re travelling overseas, we’re always
here to provide phone-based support and advice. Our 24-hour overseas
health advice line is exclusive to Bupa members – just look for the
number on the back of your membership card.
Gap free physio and dental for kids*
We‘ll cover the cost of your kid’s physio and general dental until
they turn 25. That means no out-of-pocket expenses for kids’
dental check-ups, teeth cleaning, ﬁllings, x-rays and more.* And no
out-of-pocket costs for physio in most instances.* At Bupa, your kids’
health is taken care of.
No gap optical packages
You’ll have access to the ‘no gap’ range of ﬁxed-priced packages
on glasses and contact lenses at no additional cost† if you visit our
Members First optical providers including: BLINK Optical, Kevin Paisley
Fashion Eyewear, National Pharmacies Optical, Prevue Eyewear, Stacey
and Stacey Optometrists and selected independent retailers.†
Also, at Specsavers you can choose from a range of ﬁxed-priced frames
and lens packages with no out–of–pocket costs.†
^To see if your chosen facility has an arrangement with us, view our current Bupa Hospital
Listing on our website or call us. *Available on Ultimate Corporate Health Cover, Corporate
Advantage and Corporate Classic covers when taken with hospital cover on a family
membership, when treatment is provided by a Members First dentist or physiotherapist. Fund
rules, waiting periods and annual maximums apply. Child dependants only. Includes Major
Dental in VIC and SA only. Excludes orthodontics and hospital treatments. †Optical beneﬁts
are subject to your level of cover, annual maximums and waiting periods. Conditions apply.
39
ULTIMATE CORPORATE HEALTH COVER
B E N E F I T S AVA I L A B L E
O N U LT I M AT E
M EMB E R E XC LU S I V ES
MORE
VA L U E F O R
MEMBERS
We believe good health includes both
physical and mental wellbeing. So if you
need time-out, you’re keen on ﬁtness and
sports or you’re interested in travel – you
can enjoy activities without it costing an
arm and a leg. Choose what suits your needs
from our range of additional beneﬁts and
selected discount partners.
Shine magazine
Twice a year, we send out Shine – a free
health and wellness magazine packed full
of topical articles from travel, nutrition and
exercise to proﬁles and giveaways. Simply
login to myBupa online and select your
mailing preference.
Living Well
Travel, home and car
We’re more than a health insurance provider.
Through our partnership with CGU, we’re
able to offer you a full range of insurance
products from travel insurance, home and
contents insurance, to motor vehicle and
caravan insurance. What’s more, just for being
a Bupa member, you’ll also get a 10% discount
on your home and contents insurance or
motor vehicle insurance premiums, plus a 15%
discount on travel insurance.†
Bupa Life Insurance
As a Bupa member you’ll get a 10% discount
on your Life Insurance premium.*
To ﬁnd out more go to bupa.com.au/insurance,
call 134 135 or drop by your local Bupa centre.
Living Well provides practical support to
help you reach your goals by covering some
of the costs for health-related programs.
These include: ﬁrst aid courses, nicotine
replacement therapy, weight management
programs, gym membership fees, Pilates
and yoga courses. Eligibility criteria and
conditions apply, so please contact us to
ﬁnd out more.
†Insurance is issued by CGU Insurance Limited (CGU) ABN 27 004 478 371 AFSL 238291. This is general advice only and
does not take into account your individual circumstances. Product Disclosure Statements are available at bupa.com.au
and should be considered before making any decision on these products. Bupa Australia Pty Ltd ABN 81 00 057 590
and Bupa Australia Health Pty Ltd ABN 50 003 098 655 (together Bupa) are authorised representatives of CGU. *Life
Insurance products issued by ClearView Life Assurance Limited. Before making a decision about one of these products
consider the relevant Product Disclosure Statement available by calling 134 135.
40
For details on how to receive these offers, full terms and conditions and a complete list of
all of our member discount partners, please call us or visit bupa.com.au/MemberExclusives
Get up to 25% discount on movie tickets
when purchased online.
Get a 15% discount when you purchase
tickets online for Dreamworld, WhiteWater
World and Skypoint.
eventcinemas.com.au
Get up to 25% discount on movie tickets
when purchased online.
Get a 10% discount at Warner Village Theme
Parks on day admission for adults, children
and pensioner passes.
Get 25% off two full priced games and shoe
hire at any AMF Bowling Centre.
Get 15% off the monthly membership fee
at EFM Health Clubs.
Delight your senses with 25% off all full price
online purchases.
Get 20% off the usual retail price on a
range of sunglasses displayed at any
BLINK Optical store.
Get a 10% discount on a 12-month
membership and a waiver of the joining fee.
Get 20% off the usual retail price on a range
of sunglasses displayed at any National
Pharmacies Optical store.
Get up to 20% off selected Guy Leech products.
Receive $30 off any RedBalloon experience
when you spend $129 or more.
Receive up to 20% off the usual retail price on
selected frames, lenses and contact lenses, and
up to 10% off the usual retail price of sunglasses.
41
MEMBER EXCLUSIVES
M E M B E R D I S C O U N T PA R T N E R S
J O IN US TODAY
JOINING IS
SIMPLE
Only one form to ﬁll in
Switching to Bupa is simple
Simply ﬁll in our application form and mail it
back to us using our reply paid address, or
drop it into your local Bupa centre. Or just call
us on 134 135 or visit bupa.com.au/corporate
to join online.
Enjoy a hassle-free experience when you
transfer to us from your existing health
fund. Simply ﬁll in our application form and
cancel any direct debit arrangements you
have previously made. If you already have
a clearance certiﬁcate, please send it to us
or complete the relevant section on your
application form.
Easy ways to pay
You can choose to pay via Direct Debit or
payroll deduction. If you are choosing payroll
deduction, check with your employer ﬁrst that
this option is available to you.
30-Day cooling off period
We’re conﬁdent you’ll be happy with your
cover; however, if you decide to cancel we’ll
refund any premiums you have paid within the
ﬁrst 30 days of your membership commencing
provided you haven’t made a claim.
42
JOIN US TODAY
CLAIMING
MADE EASY
CLAIM ON YOUR HOSPITAL
CLAIMING ON BOTH HOSPITAL
AND EXTRAS
Bupa Medical Gap Scheme
This is a direct billing arrangement between
Bupa and your doctor/s that in most
instances eliminates your out-of-pocket
expenses for in-hospital doctors’ fees (the
‘gap’). Under this scheme some doctors can
charge you a known gap which means you
have some out-of-pocket expenses to pay
but they are limited to a deﬁned amount.
By mail
Doctors need to agree to participate in this
scheme for it to apply so make sure you
ask them about it before you are treated.
Otherwise our medical beneﬁts are limited
to the Medicare Beneﬁts Schedule (MBS) fee
and if your doctor charges above the MBS
you will have a gap to pay.
You can submit your claims at your local
Bupa centre. Most centres are able to
process claims on the spot and provide you
with beneﬁts, either by cash (limits apply),
cheque or bank transfer.
If a doctor proposes to charge you a ‘gap’
they need your informed ﬁnancial consent.
Please contact us for details.
Remember that claims can only be paid
within two years of the date that the service
was provided and are subject to standard
conditions including waiting periods and
annual maximums.
Simply print a claim form off our website,
ﬁll it in and attach any original accounts or
receipts from your health care provider/s.
Then mail it to us at: Bupa, Reply Paid 990,
ADELAIDE SA 5001.
In person
CLAIM ON YOUR EXTRAS
On the spot
Simply swipe your membership card after your
treatment at one of 40,000 providers around
Australia and your claim will automatically
be processed. Then you just need to pay the
balance of the bill (if applicable).
Online or by smart phone
Claim queries
Call our friendly Bupa team on 134 135, visit
bupa.com.au or drop by your local Bupa
centre if you have any questions about:
° the status of your claim
° how to ﬁll in a claim form
° what documents you need to attach
to your claim form.
You can easily claim online via our website,
or by using the myBupa app. If you have a
smart phone you can also claim through our
mobile friendly website.# Payment will then
be made directly into your account.
#The
following services are not claimable online: Living Well, Bupa Medical Gap, pharmacy, health aids and
appliances, ambulance services, orthodontics, travel and accommodation and hospital claims.
43
IMP ORTA NT I NFOR M ATI ON
° allied services including physiotherapy,
occupational therapy and dietetics
Over the next few pages you will ﬁnd
information to help you understand how your
health cover with us works. We recommend
you keep this information in a safe place so
that you can always refer to it.
° dressings and other consumables
° pathology and radiology diagnostic
tests performed in hospital by Bupa
contracted providers
From time to time, things can change.
Before you seek any treatment call us so
we can give you the most complete and
up-to-date information.
° surgically implanted prostheses up to the
approved beneﬁts in the Government’s
Prostheses List
° single room where available.
We recommend you call us ﬁrst before
making a booking to conﬁrm that your
hospital of choice gives you certainty of full
cover. We can also discuss any excess or
co-payment that may be applicable to your
level of cover. You can ﬁnd out if a hospital has
an agreement with us by checking our website
at bupa.com.au/ﬁnd-a-provider
Please be aware that these rules apply in
addition to our Fund and Policy Rules.
UNDERSTANDING
YOUR HOSPITAL COVER
What is covered?
Hospital costs
With private hospital cover, you can choose to
be treated as a private patient in either a public
or a private hospital.
What happens if I choose to be a private
patient in a public hospital or go to a
private hospital that doesn’t have an
agreement with Bupa?
What if I am treated in a Members First or
Network hospital?
With us, if you elect to be treated as a private
patient in a public hospital or are admitted
to a non-agreement private hospital, you are
covered as set out below for any treatment
recognised by Medicare unless it is excluded
or restricted under your cover.
With us you are fully covered as a private
patient in most hospitals that Bupa has an
agreement with known as Members First
and Network hospitals across Australia for any
treatment that is recognised by Medicare
and is not either restricted or excluded under
your cover.
A small number of these hospitals may charge
a ﬁxed daily fee, capped at a maximum number
of days per stay. The hospitals should inform
you of this fee when you make a booking. This
fee is in addition to any excess or co-payment
you may have as part of your hospital cover.
When admitted to a Members First or Network
hospital, in most cases you will be covered for
all in-hospital charges when provided as part of
your in-hospital treatment including:
° accommodation for overnight or
same-day stays
° operating theatre, intensive care and
labour ward fees
° pharmaceuticals supplied under the
Pharmaceutical Beneﬁts Scheme
If you choose to be treated as a private patient
in a public hospital you are entitled to choose
your doctor, if they are available. Depending on
your illness or condition, this may be the same
doctor who would have been allocated to you
by the hospital as a public patient.
In both a public hospital and a non-agreement
private hospital, you are responsible for the
cost of your stay and may be charged directly
for your hospital accommodation, doctor’s
services (including diagnostic tests), surgically
implanted prostheses (e.g. artiﬁcial hips)
and personal expenses such as TV hire and
telephone calls. Some of these hospitals bill
Bupa directly for the limited beneﬁts we pay
for your hospital stay under your policy.
The amount we will pay towards your
accommodation in a public or non-agreement
private hospital is limited to a minimum shared
44
medical costs and we will cover the remaining
25%. If your specialist charges more than the
MBS fee there will be a ‘gap’ for you to pay.
However, the Bupa Medical Gap Scheme can
help eliminate or reduce the gap for you if your
doctor/s choose to use it. If a doctor proposes
to charge you a ‘gap’ they need your informed
ﬁnancial consent. Please contact us for details.
At Members First day facilities, not only
will you be fully covered for the facility
accommodation and theatre fees but there
are no out-of-pocket expenses for medical
treatments (e.g. your specialist’s fees).
If required we will also cover any prostheses
that are surgically implanted in you during your
hospital stay up to the approved beneﬁt listed
on the Government’s Prostheses List.
To ensure peace of mind, ask your
doctor about their fees and whether
they participate in our Medical Gap
Scheme for your hospital treatment
prior to admission. Remember to also
ask your doctor about the fees for other
practitioners that may be involved in
your hospital treatment such as: the
anaesthetist and assistant surgeons.
We will cover you for your in-hospital medical
costs incurred during an admission in public or
non-agreement hospital in the same way as
set out under the heading “Medical Costs” in
this brochure.
The hospital and the treating doctor should
let you know what you’ll be billed for and how
much you will be charged, i.e. they should
obtain your Informed Financial Consent before
you receive the treatment – if they don’t, make
sure to ask for full details. Call us to conﬁrm
what beneﬁts we’ll pay for your public hospital
or non-agreement private hospital stay.
Medical costs
These are the fees charged by a doctor,
surgeon, anaesthetist or other specialist for
any treatment given to you in hospital. Private
health insurance provides you with the choice
of your own doctor, and you decide whether
you will go to a public or a private hospital
that your doctor attends. You may also have
more choice as to when you are admitted
to hospital.
You are covered for:
° the cost of these medical treatments up to
the Medicare Beneﬁt Schedule (MBS) fee.
The MBS fee is the amount set by the Federal
Government for each medical service covered
by Medicare. You must be eligible for Medicare
in order to be covered up to the MBS fee. If you
choose to be treated as a private patient in a
hospital (public or private), Medicare will cover
you for 75% of the MBS fee for associated
What is not covered?
Hospital costs
Situations when you are likely not to be
covered include:
° during a waiting period
° when speciﬁc services or treatments are
paid at minimum benefits or excluded
from your level of cover
° when you are treated at a non-agreement
hospital you will not be fully covered
° for the ﬁxed fee charged by a ﬁxed
fee hospital or a hospital that has a
ﬁxed fee service
° when you have not been admitted into a
hospital and are treated as an outpatient
(e.g. emergency room treatment, outpatient
ante-natal consultations with an obstetrician
prior to child birth)
° hospital treatment provided by a
practitioner not authorised by a hospital to
provide that treatment
45
IMPORTANT INFORMATION
room beneﬁt. In some cases this may cover
the full cost of a public hospital’s charges but
for a non-agreement private hospital this will
only partially cover the full cost and you will
have signiﬁcant out-of-pocket expenses. If
you request a single room in a public or a
non-agreement private hospital, and you
receive one, you will incur out-of-pocket
expenses as the hospital may charge you more
for the room than the beneﬁt that Bupa pays.
It is important to note that in public hospitals,
single rooms are generally allocated to people
who medically need them the most.
° hospital treatment for which Medicare
pays no beneﬁt, including: medical costs in
relation to surgical podiatry (including the
fees charged by the podiatric surgeon); most
cosmetic surgery; respite care; experimental
treatment and/or any treatment/procedure
not approved by the Medical Services
Advisory Committee (MSAC)
Waiting periods
The following waiting periods apply for
hospital cover:
° laser eye surgery, covered only under
Ultimate Corporate Health Cover
– three years
° personal expenses such as: pay TV, non-local
phone calls, newspapers, boarder fees, meals
ordered for your visitors, hairdressing and
any other personal expenses charged to you
unless included in your cover
° if you are in hospital for more than 35 days
and you have been classiﬁed as a ‘nursing
home type’ patient. In this situation you may
receive limited beneﬁts and be required to
make a personal contribution towards the
cost of your care
° all other treatments included in your cover
– two months.
If you have been a Bupa member for less than
12 months on your current hospital cover,
it is important to contact us before you are
admitted to hospital and ﬁnd out whether the
pre-existing condition waiting period applies
to you. We need about ﬁve working days to
make the pre-existing condition assessment,
subject to the timely receipt of information
from your treating medical practitioner/s.
Make sure you allow for this timeframe when
you agree to a hospital admission date. If you
proceed with the admission without conﬁrming
beneﬁt entitlements and we (the health fund)
subsequently determine your condition to
be pre-existing, you will be required to pay
all hospital charges and medical charges not
covered by Medicare.
° if you choose to use your own allied health
provider (e.g. chiropractors, dieticians or
psychologists) rather than the hospital’s
practitioner for services that form part of
your in-hospital treatment
° where compensation, damages or beneﬁts
may be claimed by another source (e.g.
workers compensation)
° any amount charged by a public or
non-agreement hospital which is not
covered by us or which is above the
beneﬁt that we pay
Planning for a baby
° any treatment or service rendered
outside Australia
° some non-PBS, high cost drugs.
Medical costs
You will not be covered for:
° medical services for surgical procedures
performed by a dentist, surgical podiatrist, or
any other practitioner or a service that is not
eligible for a rebate through Medicare.
If you are admitted as a private inpatient, you
will be covered for the services listed in your
chosen level of hospital cover. If you receive
treatment as an outpatient (i.e. you are not
admitted), in most instances you will not be
covered by private health insurance. If eligible
these services may be claimed from Medicare.
° pre-existing conditions, ailments or
illnesses and pregnancy related services
(including childbirth) – 12 months
When to contact us
° for pharmacy items not opened at the point
of leaving the hospital
Inpatient vs outpatient
° palliative care, psychiatric and
rehabilitation services – two months
If you are thinking about starting a family
we recommend that you contact us to check
whether your current level of cover includes
pregnancy and other related services in
advance. This is because there is a 12-month
waiting period applied to all pregnancy
related services (including childbirth) and
assisted reproductive services.
No waiting periods will apply to the newborn
provided they have been added to the
appropriate family hospital cover within two
months of their birth.
46
° for any treatment or service rendered
outside Australia
What is covered?
With extras cover, you can claim beneﬁts for
those services listed on your cover and that
are not claimable elsewhere (e.g. from a third
party like Medicare).
For example, Medicare does not provide
beneﬁts for:
° when you have reached the maximums on
your product including annual, lifetime or
service limits for the service you
are claiming.
Waiting periods
The following waiting periods apply for
extras cover:
° initial waiting period – two months
° hire, repair and maintenance of health aids
and appliances; and Living Well Programs
– six months
° most dental examinations and treatment
° most physiotherapy, occupational therapy,
speech therapy, eye therapy, chiropractic
services, podiatry or psychology services
° major dental, orthodontics, selected health
aids and appliances – 12 months.
° acupuncture (unless part of a doctor’s
consultation) or other natural therapies
UNDERSTANDING
YOUR AMBULANCE COVER
° glasses and contact lenses
° most health aids and appliances
° home nursing.
Extras cover allows you to claim beneﬁts for
extras services as long as:
Emergency Ambulance deﬁnition
° they meet the criteria set out in our Policy and
Fund Rules.
When you take out our hospital cover, extras
cover or packaged cover, you will receive
cover for recognised emergency ambulance
transport and on-the-spot treatment. This
is capped at one emergency service each
calendar year for a singles membership and
two for a couples/families membership.
We recommend you contact us before
making a booking to conﬁrm how much you
can claim and to check that your chosen
provider is registered with us.
An emergency is when there is reason to
believe that the patient’s life may be in
danger or the patient should be attended to
without undue delay.
What is not covered?
Transportation will mean a journey from the
place where immediate medical treatment
is sought to the casualty department of a
receiving hospital.
° the treatment is given by a private practice
provider who is recognised and registered
with us for beneﬁt purposes
Extras beneﬁts will not be payable:
° during a waiting period
° where a third party, including Medicare,
a Government body, or an insurance
company provided a beneﬁt (except for
hearing aids and breast prosthesis items)
° for different services within the same service
type from the same provider on the same
day. For example, if you went to see an
acupuncturist and then received a massage
from the same provider on the same day,
you cannot claim for both services
° when a prescribed treatment is not fully
custom made (e.g. orthotics, surgical shoes)
Emergency ambulance transportation is
deﬁned as air or road transportation by
a Recognised Ambulance Provider of an
unplanned and of a non-routine nature for
the purpose of providing immediate medical
attention to a person.
Whether the transportation is deemed an
emergency is determined by the paramedic
and usually recorded on the account.
Beneﬁts are not payable for:
° when a provider is not recognised by us for
beneﬁt purposes
° transportation from a hospital to your home
° transportation from a hospital to a
nursing home
47
IMPORTANT INFORMATION
UNDERSTANDING
YOUR EXTRAS COVER
° transportation from a hospital to another
hospital where the customer has been
admitted to the transferring (ﬁrst) hospital
° transportation from the person’s home, a
nursing home or hospital for ongoing medical
treatment, (e.g. chemotherapy, dialysis).
you will be covered by Bupa up to the annual
cap, as long as your level of cover contains
ambulance cover and the services are provided
by a recognised provider.
Recognised Ambulance Providers
Bupa will only pay beneﬁts towards
ambulance services when they are provided
by any of the following recognised providers:
Ambulance Cover
We recommend that you take out an
ambulance subscription with your recognised
° ACT Ambulance Service
State Ambulance Provider if it’s available in your
° Ambulance Service of NSW
state (VIC, SA, NT and rural postcodes in WA).
° Ambulance Victoria
We will only provide ambulance beneﬁts, in
° Queensland Ambulance Service
accordance with your level of cover, when you
do not hold a subscription with an ambulance
° South Australia Ambulance Service
provider and a state ambulance scheme does
° St John Ambulance Service NT
not provide cover.
° St John Ambulance Service WA
NSW and ACT members: If you reside in
° Tasmanian Ambulance Service.
New South Wales or the Australian Capital
Certain types of concession cards issued by
Territory and you have hospital cover, you pay
Centrelink or the Department of Veterans
an ambulance levy as part of your premium.
Affairs (DVA) entitle the cardholders to free
This entitles you to free emergency ambulance
ambulance services. These arrangements
transport under the State Government
also vary per state so should be checked
ambulance transport schemes. When you
directly with Centrelink or the DVA.
receive an account for ambulance transport,
simply send it to us and we’ll endorse it for you
to send back to the appropriate ambulance
CHANGING YOUR COVER
transport scheme.
Switching from another health fund
QLD and TAS members: If you reside in
If you’re changing from another Australian
health fund to Bupa, you’ll continue to be
covered for all beneﬁt entitlements that you
had on your old cover, as long as these services
are offered on your new cover with us. This is
referred to as ‘continuity of cover’. To receive
continuity of cover, you’ll need to transfer to us
within 60 days of leaving your old fund.
Queensland or Tasmania, you are covered
under your state service scheme.
VIC, SA, WA and NT members: If you reside
in Victoria, South Australia, Western Australia
or the Northern Territory you will receive
cover for recognised emergency ambulance
transport and on-the-spot treatment from us.
This is as long as you don’t have an ambulance
subscription with your state ambulance service
or cover through a state-based arrangement.
Most state schemes cover their respective
residents within their state of residence only.
However, some states have entered into
reciprocal agreements that allow you to be
covered for ambulance services when you travel
outside your state of residence. You should
check with your state ambulance provider for
when these reciprocal arrangements apply and
the level of cover offered.
When changing health funds, extras beneﬁts
paid by your old fund will be counted towards
your annual maximums in your ﬁrst year of
membership with us. Any beneﬁts paid by your
old fund also count towards lifetime limits.
It’s important to note that when you change
to Bupa from another fund you may need to
wait before you can receive your new benefits.
In this situation, your beneﬁt entitlements are
based on our nearest equivalent cover to what
you previously held. Where your new cover is
higher than what you had with your old fund,
If you fall outside your state-based arrangement the lower beneﬁt (including different excess
(including any reciprocal agreement) and are
levels) will apply for the waiting period relevant
not covered for emergency ambulance services,
48
If you choose a lower level of cover than you
held previously, then the lower beneﬁts on your
new cover will apply immediately. This may
include a different excess level or minimum
benefits. You may also need to serve waiting
periods for services or treatments that weren’t
covered on your previous cover. In this case you
won’t be covered during the waiting period.
Changing your cover with us
If you change your health cover, you may
need to wait before you can receive your
new beneﬁts. Where your new level of cover
is higher than what you previously held, the
lower level of beneﬁt applies. Please refer
to the listed waiting periods included under
the Understanding Your Extras Cover and
Understanding Your Hospital Cover sections of
this guide.
72 hours) medical advice or treatment from
a registered practitioner other than
the policyholder.
Annual maximums and service limits
An annual maximum is the maximum amount
you can claim in a service category per person
and per calendar year (unless otherwise
stated). For certain services, service limits also
apply on the number of times that beneﬁts
are payable for the same service (e.g. initial
consultations). These maximums apply from
the date of service or purchase. Some services
also have lifetime limits or periodic annual
maximums (e.g. orthodontics). Per person
annual maximums are not transferable to any
other member on your policy.
Bupa Medical Gap Scheme
This is a direct billing arrangement between
Bupa and your doctor/s that in most instances
eliminates your out-of-pocket expenses for
in-hospital doctors’ fees (the ‘gap’).
During this time you will be covered, however
you will receive the lower beneﬁts of the two
covers (this includes any applicable excess).
If your doctor charges up to the Medicare
Beneﬁts Schedule (MBS) fee or is participating
in the Bupa Medical Gap Scheme, in most cases
you will have no medical gap costs to pay.
If you choose a lower level of cover than you
previously held, then the lower beneﬁts on
your new cover will apply immediately and
may include different excess levels or minimum
benefits. You may also need to serve waiting
periods for services or treatments that weren’t
covered on your previous cover. In this case you
won’t be covered during the waiting period.
For doctors who are not participating in our
Medical Gap Scheme and are charging above
the MBS fee, we will pay the difference
between the Medicare beneﬁt and the MBS
fee. Any amount above the MBS fee will be
the amount you are required to pay and this
is referred to as the ‘Medical Gap’.
If you have any questions about transfers or
waiting periods, just contact us.
If a doctor proposes to charge you a ‘gap’ they
need your informed ﬁnancial consent. Please
contact us for details.
Ending your membership
We have the right to end a person’s membership
as set out in our Fund Rules, including where
premiums have not been paid or on notice at the
reasonable discretion of Bupa.
DEFINITIONS
Accidents
An accident is an unforeseen event,
occurring by chance and caused by an
unintentional and external force or object
resulting in involuntary hurt or damage to
the body, which requires immediate (within
Calendar year
A calendar year is 1 January to 31 December.
Emergency admissions
In an emergency, we may not have time
to determine if you are affected by the
pre-existing condition rule before your
admission. Consequently, if you have been
a Bupa member for less than 12 months
you might have to pay for some or all of the
hospital and medical charges if:
49
IMPORTANT INFORMATION
for that service. Please refer to the listed waiting
periods included under the Understanding Your
Extras Cover and Understanding Your Hospital
Cover sections of this guide.
° you are admitted to hospital and you
choose to be treated as a private patient,
and we later determine that your condition
was pre-existing.
Excess
To lower the cost of your hospital cover, on
selected covers you can choose to include an
excess. Excesses are only payable on overnight
and same-day inpatient hospital admissions in
any hospital.
° An excess is a set amount you pay upfront
before your beneﬁt is paid. The excess is paid
when you are admitted into hospital, and is
capped at $500 for singles and $1,000 for
single parents and families per calendar year.
° No excess applies to your children on
certain hospital covers. See pages 15-19 for
more details.
° Excess waivers apply for ﬁrst one or two
admissions on selected covers, see page 18
for details.
If a service is not covered by Medicare there will
be no beneﬁt payable from your hospital cover
so you should always check with us to see if
you’re covered before receiving treatment.
Health aids and appliances
To receive beneﬁts for health aids and
appliances you’ll need to visit one of our
recognised providers. You’ll also need to
meet the eligibility criteria, provide proof of
purchase and a clinical referral where required.
It is important to note that beneﬁts are not
payable when a prescribed treatment is not
fully custom made (e.g. orthotics). Visit our
website or contact us to ﬁnd out more.
Home nursing
Beneﬁts are payable towards some home
nursing services that do not need to take
place in a hospital and are provided in the
home. Please contact us to ﬁnd out more.
Our Living Well Programs help cover
health-related programs from approved,
recognised providers. You can visit our website
for a list of our recognised providers. A Living
Well Program’s approval form must be
completed by your doctor for gym memberships,
children’s swimming lessons (eligible products
only), yoga and Pilates to conﬁrm that the
program is medically necessary. Other beneﬁt
and recognition criteria apply. Visit our website
or contact us to ﬁnd out more.
Minimum Beneﬁts
For services paid at minimum beneﬁts there will
be full cover in a shared room with your choice
of doctor in a public hospital and minimum
beneﬁts in a private hospital which would not be
adequate to cover all hospital costs and are likely
to result in large out-of-pocket expenses.
Out-of-pocket expenses
Exclusions
Beneﬁts for hire, repair and maintenance of
health aids and appliances are not payable
in the ﬁrst 12 months after purchasing an
item; within 12 months following a repair;
or on items where hire and repair are
deemed inappropriate.
Living Well Programs
You are likely to experience out-of-pocket
expenses when you are not fully covered for
services and beneﬁts, or when a set beneﬁt
applies. You should refer to what is and isn’t
covered for your relevant level of cover to
determine when an out-of-pocket expense
may occur. You should also refer to our
Fund Rules for any additional information on
beneﬁts payable. A copy of our Fund Rules
can be found on our website or in our retail
centres. It is important to ensure when being
admitted to hospital that Informed Financial
Consent is provided to you for a pre-booked
admission to allow you to understand any
out-of-pocket expenses upfront. If you have
received any out-of-pocket expenses and
require clariﬁcation, please contact us directly.
Pharmacy
Your extras pharmacy entitlement covers
you for prescription only items that are not
supplied under the PBS (Pharmaceutical
Beneﬁts Scheme); are TGA (Therapeutic Goods
Administration) approved; are prescribed by a
registered medical practitioner; supplied by a
Bupa recognised, registered pharmacist; and not
otherwise excluded by Bupa.
When you make a claim, we will deduct a
pharmacy PBS co-payment and pay the remaining
balance up to the set amount under your chosen
level of cover.
50
° over the counter or non-prescription items
° compounded items
° weight loss medication (some weight loss
medications are covered under the Living
Well Programs)
° body enhancing medications (e.g.
anabolic steroids).
Pharmacy in-hospital
When in hospital, if you are treated with drugs
that are not PBS approved, you may not be fully
covered and the hospital may charge you for all
or part of the cost. You should be advised by the
hospital of any charges before treatment.
Pre-existing conditions
A pre-existing condition 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.
A condition can still be classed as pre-existing
even if you hadn’t seen your doctor about it
before joining or upgrading to a higher level
of cover.
If you knew you weren’t well, or had signs of a
condition that a doctor would have detected (if
you had seen one) during the six months prior to
joining or upgrading, then the condition would
be classed as pre-existing. A doctor appointed
by us decides whether your condition is preexisting, not you or your doctor. The appointed
doctor must consider your treating doctors’
opinions on the signs and symptoms of your
condition, but is not bound to agree with them.
Premium and beneﬁts
You must pay the premium and the Lifetime
Health Cover Loading that applies to you.
Premiums differ from state to state due
to different state charges. If you move to
another state your premium will change too.
Therefore you must let us know about any
change of address.
To receive the beneﬁts available on your
cover, you need to:
° fully complete the application process and
pay your premiums one month in advance.
Or, if you’re on a corporate plan, it’s up
to you to make sure payments are made
during times of unpaid leave or if your
employment ends
° ensure that newborns are enrolled onto a
family membership within two months of
their birth to avoid any waiting periods for
your baby
° enrol your adult children under their own
names within 60 days after they no longer
qualify under your cover (to avoid a break
in their cover)
° provide proof of purchase of what you
have spent before we can reimburse you
for any services received
° submit your claims within two years of when
the service was given (we don’t pay beneﬁts
for any claims that are older than this).
Proof of identity and/or age
Bupa may require you to provide proof of
identity and/or age when joining, changing
your level of cover or in relation to any other
transaction with us.
Special Beneﬁts
If you’re on a cover that provides Special
Beneﬁts cover, you could receive beneﬁts
for accommodation and meal costs if your
partner, immediate family member, carer
or next of kin is required to stay at hospital
with you or a person on your membership.
They will be covered for $60 per night for
accommodation in hospital and up to $30
a day for hospital meals. Hospital meals are
covered when provided at a hospital cafeteria,
kiosk or patient meal menu. A $1,000 per
person, per calendar year annual maximum
applies to Special Beneﬁts.
Surgically implanted prostheses
You will be covered up to the beneﬁt set out in
the Government’s Prostheses List for a listed
prosthesis which is surgically implanted as part
of your hospital treatment.
The Prostheses List includes: pacemakers,
deﬁbrillators, cardiac stents, joint replacements,
intraocular lenses and other devices. If a
hospital proposes to charge you a ‘gap’ for your
prosthesis, they need your informed ﬁnancial
consent. Please contact us for further details.
51
IMPORTANT INFORMATION
There are some additional items that are
not covered by our pharmacy beneﬁt and
these include:
Suspension rules
A membership may be suspended when
travelling overseas for work or leisure. You
can suspend your cover under the following
circumstances:
° for a minimum period of two months’
travel; and
OTHER IMPORTANT
INFORMATION
Direct Debit Service Agreement
If you’ve chosen to pay your premiums by direct
debit then you’ve accepted the terms of our
Direct Debit Service Agreement.
This agreement outlines the responsibilities
of Bupa Australia Pty Ltd (“we”, “us”, our”)
and you. We will conﬁrm the direct debit
You can only suspend your policy twice
arrangements prior to the ﬁrst drawing
per calendar year. Your membership will be
(including the premium amount and frequency)
cancelled if not resumed.
and debit your nominated account. Deductions
One month contributions are required between will occur on the nominated day, except for
each suspension period.
deductions nominated for the 28th, 29th, 30th
To be eligible to suspend your cover you must:
or 31st, which will occur on the ﬁrst day of the
following month. If the nominated day falls on
° have been a ﬁnancial member for at least
a weekend or public holiday, deductions will be
12 months
made on the closest business day. We will debit
be
ﬁnancial
at
the
time
of
suspension
°
all payments in advance and will automatically
° apply for suspension prior to the
vary the deduction amount if your premiums or
departure date
level of cover change. If we vary the deduction
amount, we will give you at least 14 days written
° provide overseas travel documentation
notice, except when the previous deduction is
showing your departure and return dates
dishonoured, when we will deduct the previous
° notify us of your return to Australia within
period’s payment together with the current
30 days of your arrival; and
amount due. If you pay premiums at three,
° complete an overseas travel suspension form. six, and 12 month intervals, then should your
Your membership will be cancelled if
ﬁnancial institution dishonour a drawing, we will
not resumed.
draw the payment on the nominated day of the
following month. If two or more drawings are
Travel and accommodation
returned unpaid by your ﬁnancial institution, we
will also stop deducting your premiums from
On select levels of extras cover, if you’re
your nominated account and will start sending
travelling for essential medical or hospital
you renewal notices, pending further instructions
treatment because treatment you need cannot
from you. We will maintain the privacy and
be provided by your own doctor, we will help
conﬁdentiality of your billing information (unless
cover the cost when the total return distance is
you have requested or consented that we can
200 kilometres or more from your normal place
disclose it to a third party or the law requires or
of residence.
allows us to do so). We may provide information
We also give a beneﬁt towards your
to our or your ﬁnancial institution to resolve a
overnight accommodation outside of hospital for dispute on your behalf. You must ensure your
you and a caregiver. Check your extras cover to
nominated account permits direct debiting
determine if you are covered for these beneﬁts.
and that sufficient cleared funds are available
in that account on the due date to cover the
Waiting periods
premiums due. Your ﬁnancial institution may
A waiting period is the time between when
charge a fee if the payment cannot be met. You
you joined us and when you are covered for a
must ensure the authorisation given to draw
service or treatment. If you receive a service or
on the nominated account is identical to the
treatment during this time, you are not eligible
account signing instruction held by the ﬁnancial
to receive a beneﬁt payment from us, regardless institution where the account is based. You must
of when you submit the claim. Different waiting notify us if the nominated account is transferred
periods apply for different services.
or closed. You must pay your premium by an
° for a maximum period of two years
per suspension.
52
If paying by credit card, you need to advise us
of your new expiry date prior to expiry. You
may request that we cancel or alter the debit
drawing arrangements by contacting us and
providing at least ﬁve working days notice
of any requested changes. These changes
may include deferring the debit, altering the
debit dates, stopping an individual debit,
suspending the direct debit arrangement or
cancelling the direct debit completely. You
can dispute any debit drawing or terminate
the deductions at any time by notifying us in
writing not less than seven days before the
next scheduled debit drawing. If you have any
queries about your direct debit agreement,
please contact us. We undertake to respond
to queries concerning disputed transactions
within ﬁve working days of notiﬁcation.
personal information as set out here and in our
Information Handling Policy. Each person on a
policy aged 17 or over may complete a ‘Keeping
your personal information conﬁdential’ form
to specify who should receive information
about their health claims. You are entitled to
reasonable access to your personal information.
We reserve the right to charge a reasonable fee
for collating such information. If you or any other
person on your membership do not consent
to the way we handle personal information,
or do not provide us with the information we
require, we may be unable to provide you with
our products and services. We may use your
personal (including health) information to
offer you health management programs and
services. When you take out cover with us, you
consent to us using your personal information
to contact you (by phone, email, SMS or post)
about products and services that may be of
interest to you. If you do not wish to receive this
information, you may opt out by contacting us.
Can we help?
Privacy and your personal information
Your privacy and maintaining the conﬁdentiality
of your personal information is important to
Bupa Australia Pty Ltd (“we”, “us”, “our”). This
statement provides a summary of how we
handle your personal and health information.
For further information about how we handle
your personal information, you should refer
to our Information Handling Policy, available
on our website or by calling us. We will only
collect personal information (including health
information) about you and those people insured
under your policy to provide, manage and
administer our products and services to you and
to operate an efficient and sustainable business.
We are required to collect and maintain certain
information about you and those on your policy
to comply with the Private Health Insurance
Act 2007 (Cth) and related legislation. We may
also collect personal and health information
about you from health service providers for
the purposes of administering or verifying
any claim. We may disclose your personal
information to our related entities and bodies
corporate, or to third parties such as healthcare
providers, government and regulatory bodies,
other private health insurers and any persons or
entities engaged by us or acting on our behalf.
If you are the policyholder, you’re responsible
for ensuring that each person on your policy
is aware that we collect, use and disclose their
If you have any questions we’re always happy
to help. Simply refer to the back cover for our
contact details and call us, visit our website
or pop by your local centre. If you would like
more information about our Fund Rules or the
Federal Government’s Private Health Insurance
Industry Code of Conduct, you can ﬁnd this
information on our website. The Federal
Government’s Private Patient’s Hospital
Charter is available at privatehealth.gov.au
Resolution of problems
If you have any concerns or you don’t
understand a decision we have made, we’d
like to hear from you.
You can contact us by:
Telephone:
Fax:
Email:
Mail:
1800 802 386
1300 662 081
[email protected]
Customer Relations Manager
Bupa Australia
PO Box 14639
Melbourne VIC 8001
If you’re still not satisﬁed with your
outcomes from Bupa you may contact
the Private Health Insurance Ombudsman
on 1800 640 695 or visit them at
privatehealth.gov.au
53
IMPORTANT INFORMATION
alternative method if either you or we cancel
the direct debit arrangements. You must ensure
your payments are up-to-date, whether a notice
is received from us or not.
54
Mailing
details:
Mailing
details:
Bupa
Bupa
POGlenferrie
Box 14639Road
600
MELBOURNE
VIC
8001
HAWTHORN
VIC
3122
FOR MO R E IN FO R MAT I O N
Call us on 134 135
Bupa
Australia
Pty
Ltd
Bupa
Australia
Pty
Ltd
ABN
000
057
590
ABN
8181
000
057
590
Visit bupa.com.au/corporate
Effective
1 July 20122011
Effective
1 November
10283-07-12S
10283-10-11S
Drop by your local Bupa centre
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