Frequently Asked Questions
How do I know which is the right cover for me?
We know choosing the right health insurance can be daunting. Fortunately, we're here to help you select the right cover for your needs.
Bupa Australia has an extensive range of health cover options. If you'd like to do your own research, this web site contains lots of information about different health covers to suit a range of budgets and lifestyles, plus you can join online.
However, if you'd feel more comfortable talking to someone about your options, please don't hesitate to call us on 131 243 from within Australia or +613 9937 3088 from outside Australia to speak to a consultant. Our opening hours are 8:30am - 8:30pm Monday to Thursday, 8:30am - 8:00pm Friday and 9:00am - 1:00pm Saturday (all times in AEST).
I have a Reciprocal Medicare card, what type of cover is best for me? Do I need to take out an overseas visitor cover?
If you are from a Reciprocal Health Care Agreement (RHCA) country and have a Reciprocal Medicare card, your access to Medicare may be limited to immediately necessary medical treatment. To ensure you are covered for inpatient and outpatient hospital services and treatment by a doctor in private practice, you will need to take out one of our overseas visitor covers. If you were to choose a cover for Australian residents, you would not be covered for these services, which would result in large out-of-pocket expenses.
Why does my accountant ask me to get a Tax Statement?
There may be a number of reasons why your accountant has asked you to obtain a Tax Statement, for example:
- Your accountant may ask you to get a Tax Statement so you can claim the Government Rebate. You are eligible for the Government Rebate if you have a Reciprocal Medicare card and extras cover.
- Your accountant may ask you to get a Tax Statement to exempt you from the Medicare Levy Surcharge (MLS). You are liable for the MLS if you are from a RHCA country, have a Reciprocal Medicare card, are working in Australia and earning over a certain amount.
If you are liable for the Medicare Levy Surcharge you can take out Reciprocal Health Cover, which will exempt you from it. If you have Reciprocal Health Cover we will send you a Tax Statement at the end of the financial year, which you can present to your accountant at tax time.
Can I suspend my membership for overseas travel?
Yes, you can suspend your membership if you are travelling overseas for a period of between 1 and 3 months. To be eligible, you will need to have been a continuous member with us for at least 6 months, and your membership will need to be financial as of the date of suspension. Memberships can be suspended once per calendar year during the first 3 years of membership.
Why can't my doctor bulk-bill me like Australian residents?
Bulk-billing is administered by Medicare, Australia's public health system. As an overseas visitor, you do not have full access to Medicare and are not eligible to use the bulk-billing system. If your level of cover with us includes benefits for outpatient medical services like visits to a GP or specialist, please lodge your claims for these types of services directly with us by fax or post as you will not be able to claim on-the-spot.
If I have Reciprocal Health Cover as well as overseas visitor cover, which cover should I claim my doctor's bills under?
All your bills should be claimed under your overseas visitors cover. Reciprocal Health Cover only exempts you from paying the Medicare Levy Surcharge.
I now have permanent residency and am eligible for full Medicare benefits, from what date should I start on Australian residents' cover?
You can start on a cover for Australian residents from the date you are eligible for full Medicare benefits. In order to change to a cover for Australian residents you will need to provide us with a copy of your Medicare eligibility letter as soon as possible after you receive it. To avoid any Lifetime Health Cover loading you will need to take out Australian residents' cover within 12 months of becoming eligible.
Covers for Australian residents can provide you with a wide range of alternative options to suit your needs and if you join one on an equivalent level of cover to your overseas visitor cover, you will continue to be covered for benefits on all services you were entitled to under your overseas visitors cover. This applies as long as you transfer to a cover for Australian residents within 30 days of ceasing your overseas visitor cover.
Can I take out cover before arriving in Australia?
Yes, you can join on an overseas visitor cover before arriving in Australia and your cover will start from the date you arrive in Australia. If you wish to do this, it is easiest to
join online.
If I change my level of health cover is there anything I need to be aware of?
If you're changing from a recognised overseas health fund, general insurer or Australian health insurer to us 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 need to transfer to us within 30 days of leaving your old insurer.
If your level of cover with us is higher than the cover you had with your previous insurer, the lower level of benefits will apply until any waiting periods on the upgrade have been served. You may also need to serve waiting periods for any new benefits, services or treatments offered under your new cover with us.
If you chose a lower level of cover than you previously held, then the lower benefits of your new cover will apply immediately.
Please note that when changing health insurers, extras benefits paid by your previous insurer will be counted towards your yearly maximums in the first year of membership with us.
Does my private health insurance cover me if I am sick when travelling interstate or overseas?
Your health insurance with us covers you in all states and territories of Australia. However, it does not cover you for any health care services overseas. You can take out travel insurance to cover you for health care services when you are overseas.
How can I pay my premiums?
We offer a variety of payment options so you can choose the most convenient method of payment for you.
View your payment options.
Can I claim the Federal Government Rebate on Private Health Insurance on any part of my cover?
If you have a Reciprocal Medicare card and take out extras cover or combined hospital and extras cover, you will be able to claim the Federal Government Rebate on your extras cover.
If you do not have a Reciprocal Medicare card you are not eligible to claim the rebate.
Why do I have to pay GST on hospital cover?
Under the new Private Health Insurance Act 2007, GST is included in all overseas visitor hospital cover premiums from 1 July 2008.
What is the Government Schedule fee?
The Government Schedule fee is the maximum fee set by the Government for every medical procedure in Australia. Medicare benefits are calculated based on the Government Schedule fee. Doctors may choose to charge more than the Government Schedule fee.
What is the AMA fee?
The AMA (Australian Medical Association) fee is a fee prescribed by the AMA for all medical and surgical procedures carried out in Australia. AMA fees are usually higher than the Government Schedule fee.
What are waiting periods?
A waiting period starts from the date you join Private health insurance. During a waiting period you are not covered and will not receive any benefits for the types of treatment affected by the waiting period. Once you have served the relevant waiting period, you will receive the full benefits listed under your level of cover for that treatment type.
All hospital covers have a 12 month waiting period for pre-existing ailments and pregnancy (childbirth), where applicable. If you transfer from another health insurer to an equivalent level of cover with our fund, we will honour all the waiting periods you have already served for benefits that you had on your old cover (as long as they are on your new level of cover with our fund). To confirm this, we require confirmation of your previous membership and level of cover in the form of a Clearance Certificate from the previous fund. To receive this continuity of cover, you will need to join our fund within one month of leaving your previous insurer.Where your level of cover with us differs from your cover with your old insurer, the lower level of benefits applies for pre-existing ailments in the first 12 months. When you upgrade to a higher level of cover, the benefits from your previous level of cover apply during Waiting Periods.
Do I have to provide a medical certificate for all claims in the first 12 months?
If your claim is in the first 12 months and relates to a pre-existing condition, you will need to provide a medical certificate.
However, if your claim is in the first 12 months, not related to a pre-existing condition and you ensure the section on medical symptoms on your claim form is completed, we will usually not require a medical certificate
What are the applicable waiting periods for 'No gap dental for kids'?
If you join on eligible hospital and extras cover the standard waiting periods apply for 'No gap dental for kids':
- 2 months for General Dental
- 12 months for Major Dental, root fillings, complex fillings, dental sleep apnoea devices and pre-existing ailments
I need to have my wisdom teeth removed. Am I covered?
There is a 12 month waiting period for the extraction of wisdom teeth. If you are planning on having your wisdom teeth removed by a dentist in private practice, you will need to have purchased one of our Extras policies that offers benefits towards general dental treatment. However, if you are likely to be admitted to hospital for the removal of your wisdom teeth, the dentist's account for the extractions would attract a benefit as long as you hold an Extras policy that offers general dental benefits and the hospital charges including accommodation would be covered as long as you have purchased a Hospital product. For full details it is important to speak with the fund.
What is meant by calendar year benefits in my extras cover?
Extras benefits are paid by us on a per calendar year basis. We define calendar year as 1 January to 31 December no matter what date you join.
What is electronic claiming?
With electronic claiming you can claim your extras services treatment on-the-spot. Simply swipe your membership card at the provider's room. The fund sends the applicable benefit directly to the provider and all you need to pay is the balance.
What is Ezyclaim?
If your doctor or specialist charges more than the Government Schedule Fee for your hospital treatment, it's up to you to pay the 'gap'. With our Ezyclaim system, your doctor agrees to the fee charged for services and bills us directly. So in most cases, there's no gap and no bill, and if there is a gap, you will know the maximum amount you will need to pay prior to your treatment as the doctor needs to provide you with Informed Financial Consent.
What is a Restricted Benefits period?
If a service is covered with Restricted Benefits, this means you will be covered with your choice of doctor for shared room accommodation in a public hospital only. If you go to a private hospital for a specific service which has Restricted Benefits, it is likely to result in large out-of-pocket expenses.
What is an exclusion?
If a service is excluded no benefits are payable for that service on your level of cover.
What are 'minimum' benefits?
Minimum benefits are the minimum level of benefits that private health insurers must pay in respect of members' claims for treatment provided in public hospitals, non-contracted private hospitals and day surgeries. These are set by the Government and usually updated around July each year.
What is meant by medically necessary?
Medically necessary treatment is defined as treatment that requires urgent medical attention and is deemed necessary by a medical practitioner.
Am I covered for prostheses?
In Australia, surgically implanted prostheses are classified by the government as 'no gap' or 'known gap' prostheses. If your doctor chooses a 'no gap' prosthesis you will not have any out-of-pocket expenses to pay where the prosthesis is implanted as part of your hospital treatment. However, if the prosthesis item used is classified as 'known gap' prosthesis, you will have to pay any gap charged by the hospital. If you would like to choose a 'no-gap' prosthesis simply ask your specialist there is one available for all surgical requirements.
Who are recognised providers?
To protect your interests, you can claim benefits for services provided to you by providers who are 'recognised' by us and in private practice. If we do not recognise a particular provider, we will not be able to pay benefits for services they provide to you.
What are considered compensation and damages from other sources?
Benefits are not payable when compensation and/or damages can be claimed from another source.
For example:
- Workers' Compensation
- Compulsory Third Party Insurance
- Common Law
- Sports Insurance
- Travel Insurance
- Litigation
We reserve the right to recover any benefits paid in this regard.
Who do I talk to if I have a complaint?
If you have a complaint or query regarding your cover or the terms and conditions that apply to your cover, please contact us [link to other_contact_options.htm]. Our consultants will endeavour to resolve any issues you may have.If you are not satisfied with our consultant's response, please contact our Customer Relations Manager in writing:
Customer Relations Manager
600 Glenferrie Road
Hawthorn VIC 3122
If you have contacted our Customer Relations Manager in writing and still do not feel satisfied with our response, you may contact the Private Health Insurance Ombudsman on 1800 640 695. This has been established by the Commonwealth Government to deal with enquiries and complaints about any aspect of private health insurance.
