With Bupa Hospital Cover, you can choose from 5 levels of cover and tailor your policy further with a range of benefits. Learn more reasons why Bupa could be the right choice for you.
Bupa is a giant in healthcare, both in Australia and overseas. This means you can access a wide range of benefits, such as a nation-wide network of affiliated providers and private hospitals as well as other forms of insurance, overseas healthcare and more.
Bupa offers affordable health cover for singles, couples and families alike. They offer a range of benefits, but there are some limitations to their cover.
What hospital plans does Bupa have?
Bupa has five levels of cover available:
- Basic Hospital. Entry level cover for the young and healthy who are looking for good value hospital cover. Helps to pay for medical services and accommodation in a public or private hospital, with the option to reduce your premium by increasing the amount of excess you pay.
- Budget Hospital. Cover that provides the important benefits without paying too much. Includes a range of hospital treatments such as cardiac and cancer and helps towards medical services and accommodation in a public or private hospital, with no excess for kids when admitted to hospital.
- Standard Hospital. Covers many inpatient hospital treatments including pregnancy and cardiac. It pays minimum benefits on a range of common procedures a younger person is likely to need, with no excess for kids when admitted to hospital.
- Top Hospital No Pregnancy. Provides all the benefits of top hospital cover without cover for pregnancy. Helps to pay for medical treatment and accommodation in a private or public hospital and includes a range of additional Bupa benefits such as Best Doctors, Ultimate Advice Line, Unemployment Cover, No Excess for Kids, Family-In Hospital Benefits and Emergency Ambulance.
- Top Hospital. Comprehensive cover for a wide range of procedures and treatments including pregnancy and birth-related procedures. Provides cover for public or private hospital access as needed, with no excess for kids upon admission and all of the extra benefits provided in Top Cover No Pregnancy, plus access to Bupa Plus rewards and discounts.
Benefits available with each plan
|Conditions||Top||Top No Pregnancy||Standard||Budget||Basic|
|Accidents after joining|
|Hip / knee replacement|
|All other joint replacements|
|Knee arthroscopy and meniscectomy procedures|
|All other joint arthroscopy and meniscectomy procedures|
|Cataract and eye lens procedures|
|Pregnancy and Birth related services|
|IVF and assisted reproductive services|
|Minor gynaecological surgery|
|Obesity related procedures and surgeries|
|Abdominoplasty and lipectomy|
|Removal of tonsils and adenoids|
|Breast reconstruction post cancer|
|All other in-patient treatment receiving Medicare benefits|
|Emergency ambulance services|
|Health subscription refunds|
|Family in-hospital benefit|
|Involuntary unemployment cover|
|Travel insurance bonus|
|The benefit||What it does||Basic||Budget||Standard||Top||Top No Pregnancy|
|Emergency ambulance||Covers the costs of ambulance calls that result in hospitalisation|
|Family/partner accommodation||$60 a night for accommodation and $30 a day for meals when family needs to stay in hospital with you|
|Health subscription refunds||50% refund for subscriptions to the Arthritis Foundation, Asthma Foundation and Diabetes Australia|
|Unemployment cover||From the second month of retrenchment or involuntary unemployment, your premiums are covered for up to 12 months at your current level of cover*|
|Varying excess options||Choose your own excess to raise or lower your premiums|
*With couples or family health plans, only the main income earner is eligible for unemployment cover benefits. To be eligible, you must meet the following criteria:
- You have been with the same company for 6 months prior to unemployment.
- You are not a contactor or self-employed.
- You have held your health cover for 12 months.
- You can provide proof of unemployment.
What are the costs?
The cost of your policy will depend on your chosen excess, your level of cover, the rebates you may be entitled to and a range of other factors. Naturally, singles or couples cover will cost more.
What are the limitations, exclusions and waiting periods?
It’s important to note that Bupa plans do not cover the following procedures:
- Surgical podiatry
- Cosmetic procedures that are not medically necessary
- Respite care
- Experimental treatments
- Certain high-cost non-PBS drugs
- Any treatment or procedure not approved by the Medical Services Advisory Committee.
In addition, you will not have cover for the following:
- Outpatient treatments
- Expenses above the minimum benefit at private hospitals for procedures that are only minimally covered by your plan
- Hospital co-payments
- Psychiatric and day programs at non-Bupa partner hospitals
- Treatments provided by unregistered providers
- Personal in-hospital expenses like pay TV, newspapers and similar
- Any services or treatments provided outside of Australia
- Any pharmacy items purchased and not opened before leaving hospital
- 12 months. Pre-existing conditions, pregnancy and childbirth
- 2 months. Everything else as well as psychiatric treatments for pre-existing conditions, palliative care and rehabilitation
These waiting periods may also apply when you increase your cover level. For example, if you’re on a budget plan, then you would need to upgrade to a higher level at least 12 months in advance to have cover for a private hospital birth.
Inpatient vs outpatient expenses
The plan does not cover outpatient treatments. That includes treatments received only in a hospital emergency department.
You only become an inpatient when you are admitted to hospital instead of simply receiving treatments in a hospital. For example, if you go to a hospital specifically for x-rays or a blood test, then you would still most likely be an outpatient and not covered under these plans.
When admitted to a non-agreement hospital, you are only covered up to the minimum benefits and the Medicare Benefits Schedule limits.
When you go to a public hospital as a private patient, you are only covered for the minimum shared-room accommodation benefit, but higher level plans might pay additional sums to help defray the cost of a private room.
Whether you go to a public or private hospital, Medicare will cover you for 75% of the MBS fee for any eligible treatments covered under Medicare, while Bupa can pay the remaining 25%.
Before getting treatments, you can check whether a practitioner participates in the Bupa no gap scheme and whether they’re no gap or known gap.
- Participating no gap doctors. These practitioners have limited costs and will bill Bupa directly, leaving you with no treatment costs.
- Participating known gap doctors. These practitioners charge more than the specified amount. You will have some out-of-pocket expenses, up to a maximum of $500.
- Non-participating doctors. Medicare will cover 75% of the MBS amount, Bupa will pay 25% of it and you will need to pay any additional amount above the MBS amount.