Bupa Hospital Health Cover

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.

Speak to a health insurance advisor

What hospital plans does Bupa have?

Bupa has six levels of cover available:

• Basic Accident Only Hospital. This covers you for services like intensive care, operating theatre and ward fees. It also comes with a feature called Accident Inclusion which covers you in a private hospital for treatments that are excluded or restricted on your cover.
• Basic Plus Starter Hospital. This policy includes services such as tonsils, adenoids and grommets, dental surgery, joint reconstructions and Accident Inclusion.
• Bronze Plus Simple Hospital. This policy covers all services required for a bronze rating as well as dental surgery, brain surgery, tonsil removal, hernia repair and cancer treatments.
• Silver Plus Essential Hospital. This covers you for 32 of the 38 clinical categories, 5 more than the minimum requirement for a silver policy.
• Silver Plus Advanced Hospital. This policy covers most services but excludes pregnancy so is ideal for those who are not planning on having children. It also comes with a special feature: Best Doctor second opinion service.
• Gold Complete Hospital. This covers all 38 treatments required for a gold level policy including pregnancy, assisted reproductive services and weight loss surgery.

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

Waiting periods

• 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.

Other expenses

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.