Bupa Health Insurance

Compare Bupa Health Insurance and find the right cover for you.

Bupa is a trusted name in the Australian health industry and boasts a robust 27% of the health insurance market, including 4.7 million members in Australia and New Zealand. Bupa Australia is part of Bupa Group, which provides services to over 22 million members in 190 countries.

Besides health insurance, Bupa also have an array of insurance options including pet insurance, travel insurance, life insurance, car insurance and home insurance.

Keep reading to find out more about the benefits and policies available from Bupa.

finder.com.au does not currently have access to this health insurance brand. You may wish to compare options available on the health insurance homepage.

Bupa health insurance cover options

Hospital cover

There are different options for the hospital covers which include Budget Hospital, Standard Hospital and Top Hospital covers. The policies differ in the treatments covered and the premiums charged. Some treatments are available in all three covers like Appendicitis, dental surgery, accommodation, operation theatre fees, Bupa medical gap scheme, surgically implanted prostheses and more. Whereas other treatments like pregnancy provide full benefits to standard and top hospital covers only. A few benefits like unemployment cover, health subscription refunds, hip/knee replacement are available only to top hospital cover members.

There are three levels: Budget hospital, Standard hospital and Top hospital cover.

  • Budget hospital. Budget hospital provides cover for accommodation, operation theatre fees, ward fees, Medical gap, surgically implanted prostheses, appendicitis, dental surgery, minor gynaecological surgery, cardiac related services and emergency ambulance services.
  • Standard hospital. Standard hospital cover provides additional cover for pregnancy, psychiatric services, gastric banding and obesity-related services.
  • Top hospital. Top hospital cover provides additional benefits for treatments like cataract, eye lens procedure, hip/knee replacement, renal dialysis for chronic renal failure and assisted reproductive services (IVF). It also provides unemployment cover, health subscription refunds and family in-hospital benefits.

Extras cover

These options cover the expenses in treatments like optical, physiotherapy, pharmacy, dietary, psychology, dental and more. There are a wide range of options for extras cover. They are bronze extra, your choice extras, silver extras, gold extras and platinum extra. Bronze extra cover provides a basic cover level whereas platinum extra provides a complete cover for all the expenses on extras.

You can also choose from the packages designed by Bupa. These packages hospital and extra cover for different age groups, income levels and health conditions. You can choose between simple start, active saver, young singles saver, young couples choice, budget family, ultimate health cover and other packages.

There are five levels of cover for extras including:

  • Bronze extras. It provides cover for basic expenses like general dental, optical, physiotherapy, pharmacy, antenatal and postnatal and emergency ambulance services.
  • Your choice extras. The additional benefits of this cover are podiatry, speech therapy, eye therapy and occupational therapy.
  • Silver extras. In addition to the benefits of your choice extras, customers also get cover for dietary, psychology, home nursing, health aids and travel and accommodation expenses.
  • Gold extras. The main additional benefit for this level is a higher percentage back on extras at Member First providers. This level provides 75% back against 60% for the prior three levels.
  • Platinum extras. This level provides 90% back on extras at Member First providers.

Ambulance cover

Bupa provides two ambulance cover options: Emergency only ambulance cover and premium ambulance cover. The first option provides ambulance treatment and transport in emergency situations like sudden collapse, severe chest pain, fractured bones, etc. The second option provides on-the-spot treatment anywhere in Australia and an added security of $5,000 worth of non-emergency road and air ambulance trips.

Corporate plans

Bupa also has a host of plans for corporates which provide adequate cover to employees and their family. Currently, it provides this service to over 2,900 Australian companies.

Bupa broader health programs

Bupa offers an extensive range of broader health programs and services, including:

  • Online tools and calculators, such as an online health assessment and pregnancy planning tool
  • Self-management programs for conditions like back pain, osteoarthritis and asthma
  • Member Support programs to help members manage conditions such as heart disease, recover from a heart attack or stroke and more
  • Living Well programs, which are included on selected extras policies and provide benefits for gym memberships, kids’ swimming lessons, pilates and yoga classes and weight management programs

Bupa Health Insurance general exclusions, waiting periods and restrictions

  • Waiting period. This is a cornerstone for every health insurance policy across the globe. Under this clause members will not receive benefits for a given period after taking the policy. This waiting period varies according to the treatment required. Some of the waiting periods include 12 months for pre-existing conditions, six months for living well program, two months for general dental, etc.
  • Minimum benefits. Some of the policies provide minimum benefits specified under the PHI Act. This depends on the level of cover and customers should look at the exact benefits before finalising a particular cover for Hospital or Extras insurance.
  • Benefits from other sources. Benefits will not be paid in case a member can take up, has or will take up, a benefit from another source. The difference amount is paid when a member receives benefits from other sources that is less than the level of cover. Treatment taken overseas will not be paid any benefits.
  • Type of treatment. No benefit is paid if the treatment is not covered under Medicare, is cosmetic surgery, is experimental, or relates to a clinical trial of pharmaceuticals.
  • Other exclusions. Other exclusions include any costs incurred as a result of a criminal activity, treatment from a suspended practitioner or services which are considered as excessive or reasonably unnecessary.

How much does Bupa Health insurance cost?

There are different levels of cover according to which the premiums vary. These premiums vary according to location, type of insurance, government rebate and excess option taken.

These costs can be easily understood through the following cases.

Case 1

Harry is 34 years old. He is transferring from another policy and wishes to take Budget Hospital Cover with Bupa. He lives in Australian Capital Territory (ACT). He earns $55,000 and has taken an excess option of $500. This will require him to pay *$16.85/week.

Case 2

Mary and Eric Smith are both 58 years old. Both of them are currently working and are earning a combined income of $165,000. Eric is not keeping good health and they wish to take a complete cover which will meet all their health needs in the future. They live in South Australia. They want to take Top Hospital cover with Platinum Extras. They also would like zero excess. In this situation they will have to pay *$110.35/week which will cover both of them.

Case 3

Matt and Liz Taylor are 29 and 28 years respectively. They have been married for two years and are planning to start a family. Their combined income is $110,000 and they live in VIC and would like to opt for a $500 excess payment. They have taken a Growing Family package from Bupa. This will cost them *$77.40/week as premiums.

*Prices correct as of 26 May 2015

Bupa health insurance excess

Excess payments are one of the most important parts of any health insurance policy. By choosing an excess payment customers agree to pay an initial amount for treatment. This amount is capped at $500 by Bupa. Having an Excess reduces the burden on the insurer, allowing them to provide the policies at a lower premium. Few policies like budget hospital cover require a minimum excess of $250 whereas in other policies it varies from $0 to $500.

If an individual is young, fit and healthy it is better to opt for excess payments as it allows to reduce the premiums substantially.

How to save on your Bupa health insurance policy?

There are various means by which customers can reduce the premium cost on their Bupa health insurance policies. They are:

  • Reasonable cover. There are wide choices for the level of cover  a customer wants, however, it is better to go for reasonable cover instead of choosing the highest possible cover. A young and healthy adult can opt for basic or medium cover instead of ultimate cover which will provide Top Hospital cover and all the extras. Many treatments in higher cover include knee/hip replacements, heart surgeries, and other expensive procedures which might not be required for a young adult.
  • Cover for maternity. Couples who are not planning to have further kids can opt out of maternity cover which will reduce the premium cost.
  • Excess payments. By choosing higher excess payments the premium cost is dramatically reduced. If there is no need for medical assistance in that year the person will save on paying the excess and have a lower premium cost.

How to make claims?

Claims for extras can be made by:

  • On-the-spot claims. Customers can use the electronic claims facility to get instant benefits. This facility is available at 20,000 service providers including dentists, chiropractors, podiatrists, physiotherapists and more. By swiping the membership card the claim will be processed automatically and members only need to pay the balance amount required.
  • Online claims. Online claims can be made by logging into myBupa account and filling the details.
  • Claim by post. A claim form can be filled and sent to Bupa. Payments will be made through EFT or cheque.

Claiming for hospital expenses

  • Bupa’s gap cover scheme. If the doctor uses Bupa’s gap cover scheme the billing will directly be taken care of my Bupa. 100% of the payment will be paid to the provider on behalf of the member.
  • Without Bupa’s gap cover scheme. If the doctor doesn’t use this scheme they will send a bill for the medical services. This needs to be taken to Medicare and then Bupa for payment.

Make a claim using the Bupa claims app

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Faqs about Bupa

Q. Can I suspend the policy?

  • A. The policy can be suspended for a given period of time if a member is traveling overseas for longer period or facing financial hardships or imprisonment. The benefits will not be provided during this time. The maximum period for suspension varies from 12 months in financial hardship to four years for imprisonment.

Q. What if my premium payments fall into arrears?

  • A. If the premiums are not paid by the due date, the policy is considered to be in arrears. If the arrears are more than two months Bupa may cancel the policy.

Q. Will my premium change?

  • A. The premiums can change if the level of cover is changed. Also with a change of address there might be different premium for the new address. The premiums are changed to reflect the changes in the circumstance.

Q. Is there an option for overseas visitors?

  • A. Yes, Bupa has a host of options for overseas visitors. These vary from Essential Visitors Cover which provides basic cover to Platinum Visitors Cover which provides a much wider coverage. These plans are for people working in Australia.

People who are visiting Australia can choose between Standard Visitors Cover and Guardian Plus Visitors Cover.

Are there any additional benefits?

Having health insurance not only provides faster and better health services but also has additional benefits. These include:

  • Tax benefits. Citizens who are earning above $90,000 need to pay Medicare Levy Surcharge (MLS) which varies from 1% to 1.5% in case they do not have a private health insurance. By using even a basic insurance plan this additional tax can be saved.
  • Rebate from government. The premiums quoted by the private insurers are heavily rebated by the government. A person below 65 years with income less than $90,000 can get a rebate of 26.791% which makes these policies much more affordable.
  • Lifetime health cover loading. There is a 2% additional cost every year for hospital cover if it is taken after the 31st birthday. This cost can add up to as high as 70% which can make these policies much more expensive in older age. By using the policy from a younger time, this cost can be saved.

Benefit payments under Bupa

The amount of money you receive in cover will change depending on which health insurance provider you choose. If you are thinking of going with Bupa you can use this table to see how much their benefit payment will be for specific conditions and treatments, and compare them with the amount paid by Medicare (MBS):

ProcedureMBSBUPA*
Appendicectomy$445.40$635.45
Basal Cell Carcinoma or Squamous Cell Carcinoma removal from nose, eyelid, lip, ear, digit or genetalia$221.35$315.80
Breast, benign lesion surgical biopsy of excision$260.05$380.55
Carpal Tunnel Release$276.80$453.75
Cataract Surgery$760.55$1,184.20
Cholecystectomy$739.35$1,054.85
Colonoscopy$334.35$470.25
Complicated Delivery (of baby)$1,629.35$2,406.65
Coronary Artery Bypass$2,200.00$3,294.85
Craniotomy$1,586.75$2,602.05
Cytotoxic Chemotherapy$97.95$118.05
Femoral on Inguinal Hernia$464.50$662.70
Haemorrhoidectomy$367.75$517.20
Hip Replacement$1,317.80$2,094.35
Knee Replacement$2,047.60$2,094.35
Overnight investigation for sleep apnoea$588.00$703.45
Tonsils or Tonsils and Adenoid$295.70$481.30
Uncomplicated Delivery (of baby)$693.95$2,057.05
Vaginal Hysterectomy$674.70$1,076.80
Varicose Veins$109.80$164.45
Vasectomy$229.85$353.15

*NSW, #AHM

I recognise most of these funds except for the AHSA, what is that?

The Australian Health Service Alliance is a management services organisation that represents a number of small to medium sized health insurance funds, allowing them to combine resources to deliver a higher quality of service to their members.

The funds represented by the ASHA are:

  • ACA Health Benefits Fund
  • Australian Unity Health Limited
  • CBHS Health Fund Limited
  • CUA Health Limited
  • Defence Health
  • GMF Health
  • GMHBA
  • Budget Direct Health Insurance
  • Frank Health Insurance
  • GU Health
  • HBF Health Ltd
  • Health Care Insurance Limited
  • health.com.au
  • Health Insurance Fund of Australia Limited
  • Health Partners
  • Navy Health
  • onemedifund
  • Peoplecare Health Insurance
  • Phoenix Health Fund
  • Police Health Limited
  • Queensland Country Health Fund Limited
  • Reserve Bank Health Society Ltd
  • rt health fund
  • Teachers Health Fund > UniHealth Insurance
  • Teachers Union Health
  • The Doctors' Health Fund Pty Ltd
  • Transport Health
  • Westfund
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10 Responses to Bupa Health Insurance

  1. Default Gravatar
    Mary | November 21, 2016

    Does BUPA offer extra government rebates for seniors as some health funds do?

  2. Default Gravatar
    Sunflower | May 23, 2016

    Is the 12 months suspension (for financial hardship) for the lifetime of the membership?

    • Staff
      Richard | May 23, 2016

      Hi Sunflower,

      Thanks for your question. finder.com.au is a comparison service and Bupa is not currently part of the panel of insurers we have access to. If you would like to find out more about suspending your membership, you can find out more by reading the Bupa fund rules.

      I hope this was helpful,
      Richard

  3. Default Gravatar
    nicole | April 3, 2016

    Hi ,i was inquiring about the extra cost happening this April.Why is the cost so expensive ? and as any changes been made to what you could claim up to April this year. .I am paying for my parents who are on the ultimate cover and they are elderly 87 years old . Is there any changes to be aware off for myself .Iam a single mum and i have two son on my ultimate cover 19 year old and 23 year old ..I there any changes i need to be aware of.Can you also advice me about travel insurance for myself and son who will be travelling with me mid may this year, and returning to Australia about the 6 Th of June.I have ms so i need to be well covered and also my son who is coming also to help me .regards Nicole

    • Staff
      Richard | April 4, 2016

      Hi Nicole,

      Thanks for your question. finder.com.au is a comparison service and we are not permitted to provide our users with personalised financial advice. Health insurance premiums reflect the rising cost of health care, so there are myriad factors that go into the rising premiums. You may find the following articles useful:
      Why do premiums increase?
      Health insurance premiums for 2016
      As for the travel insurance. Getting travel insurance with a pre-existing conditions such as MS may be more difficult but not impossible. You may find the following article useful:
      Travel insurance for MS

      I hope this was helpful,
      Richard

  4. Default Gravatar
    JB | March 28, 2016

    I have product name budget hospital with $500 excess and silver extras.my question is that is massage is covered,and if covered how much I will get ( $50 are the charges for massage) from bupa.

    JB

    • Staff
      Richard | March 29, 2016

      Hi JB,

      Thanks for your question. finder.com.au is a comparison service and Bupa is not currently one of the funds in the panel of health insurers that we have access to. If you would like to know more about Bupa services, you should contact them directly.

      All the best,
      Richard

  5. Default Gravatar
    Terry | March 1, 2016

    What providers does bupa have for alcohol and drug rehabilitation centres

    • Staff
      Richard | March 1, 2016

      Hi Terry,

      Thanks for your question. finder.com.au is a comparison service and not an insurer. If you would like to speak with Bupa about its offerings, you can do so by calling 134 135. You may also find the Bupa provider finder useful.

      I hope this was helpful,
      Richard

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