Corporate Insurance - Bupa · 2020-03-03 · Health Insurance explained 1. More control if you need...

Corporate Insurance

2

Health Insurance explained

1. More control if you need to go to hospital for a non-emergency treatment. You’ll have more choice when it comes to your hospital, your specialist and when you’d like your treatment to take place. You might also be able to request a private room.

2. Reduced wait times for non-emergency hospital treatments at a private hospital. If you’re not privately insured, you may have to be on a public hospital waiting list for months.

3. The ability to claim money back on some everyday health services that may not be covered through the public system, such as dental and physio.

Understanding tax and rebatesDepending on your age and income, there are several ways having health insurance can actually assist you financially:

• If you take out Hospital cover before July 1st following your 31st birthday, you can avoid paying the Australian Government’s Lifetime Health Cover (LHC) loading.

• There’s also the Government’s Medicare Levy Surcharge (MLS) which may apply to you and you could avoid paying. See page 23 for more details.

• The Government may contribute an amount (known as a ‘rebate’) towards the cost of your private health insurance premium.

For more information on the above, please refer to page 23 of the brochure.

As Australians, we’re lucky enough to have access to a quality, public health system. But this system has its limitations. For example, it doesn’t cover all treatments and services, and limits things like where and when you’re treated. Private Health Insurance means:

3

1For most items at Members First Extras providers covering dental, physio, chiro, podiatry consultations and selected optical. Yearly limits, waiting periods, fund and policy rules apply. Excludes orthodontics, orthotics and hospital treatments. Set benefits apply at other recognised providers. 2Eligible Extras products do not include Your Choice Extras 60 where general dental cover is not selected, Orange 50 and Orange 60. Waiting periods, fund and policy rules apply.

Why choose Bupa Health insurance?

More savings with age-based discountingIf you’re aged 18-29, you are entitled to receive age-based discounts on your domestic Hospital cover. The discount is calculated at 2% for each year you’re aged under 30, when you first purchase your domestic Hospital cover, up to a maximum of 10%. You will retain that discount rate until you turn 41, as long as you have hospital cover.

Refer to page 20 for more information on how it works.

Members First Extras network The Members First Extras network is made up of thousands of registered healthcare providers across Australia brought together by Bupa. As a Bupa Extras member, you’ll have access to a range of great benefits throughout the network across dental, optical, physiotherapy, podiatry and chiropractic providers.

When you choose to visit a Members First provider, in most instances you will receive higher benefits and have the certainty of knowing how much you’ll get back.1

Pay nothing for your regular dental check-upPay nothing for your regular dental check-up and more at Members First Platinum dentists, when you combine Hospital and Extras that include general dental. Up to yearly limits.2

At Members First Platinum, you’ll also get the benefits of Members First, including more money back towards most other dental services.

Find out more at: bupa.com.au/members-first-platinum

Support for your mental healthAt Bupa we know that mental health is just as important as physical health. We pay towards the cost of both psychology and counselling, at recognised providers, under our mental health category on most mid to high extras and packaged covers.

Minimising out-of-pocket for hospitalAt Bupa, we aim to make a hospital stay as affordable as possible and that’s why at many of the private hospitals we have an agreement with, we’ll pay hospital costs for included services.

For more information, please refer to pages 21 and 22 of the brochure.

Excess free kidsOn selected Hospital covers and on our family packages, you won’t pay the excess for any child (up to the age of 25 years) covered on your membership who is admitted to hospital.

For more information, please refer to pages 12 and 13 of the brochure.

Members First Day HospitalIf you are treated in a Members First Day Hospital, there are no out-of-pocket expenses for medical services (e.g. your surgeon, anaesthetist or other specialist fees). Not available in NT. Any co-payment or excess related to your cover will still apply.

Bupa Plus rewards and discountsEven when you’re in great health, there are still plenty of ways to get everyday value thanks to Bupa Plus. An exclusive range of rewarding health discounts, tools and more to help you live a healthier, happier life.

We have teamed up with a number of Australian organisations to bring you corporate health cover to suit your needs. You can look forward to competitive premiums and corporate health benefits to suit you or your family – no matter what life stage you are at.

bupa.com.au/corporate

To log in, get your log in ID and password from your employer or call us on 134 135

4

Find the right cover for youWe understand that your choice of health cover is often a balance between what you need and what you can afford. That’s why we’ve designed a range of quality options to suit where you currently are in life and your budget.

Your choice starts here

Still not sure where to start? Talk to our friendly staff.

5

Packaged cover at a glance

Page 8 & 9

Things to consider when

choosing health insurance

Page 6

Hospital & Extras at a glancePage 10 & 11

Already done your research?

Need help finding the right cover for you?

or

6

1. It pays to join earlier in lifeAt Bupa, we understand that increasing health cover costs can create difficulties for many young Australians. That’s why we’re introducing the age-based discount to help young Aussies gain access to Hospital cover.

If you’re aged 18-29, you are entitled to receive a discount on your domestic Hospital cover. This discount is calculated at 2% for each year you’re aged under 30, when you first purchase your domestic Hospital cover. The maximum discount is 10% for 18 to 25 year olds.

Once you’ve received your age-based discount, you will retain that discount rate until you turn 41, when it will gradually start to phase out.

2. Choosing the right level of Hospital and Extras coverGoing to hospital is something we’d all rather avoid, but with Bupa, our aim is to make your visit as smooth and cost effective as possible. Hospital cover gives you more choice and control of your treatment in the event you need to go to hospital. If you’re injured in an accident or diagnosed with an illness, your private Hospital cover can help with the cost of your treatment and care. Similarly, regular trips to the dentist or physio can add up. That’s where Extras cover can come in handy, covering you for those ‘out of pocket’ expenses that you or your partner or family may require.

When you’re weighing up different covers, remember it is likely that a basic tier Hospital cover will often only cover you for selected treatments as a private patient in a private hospital. On the other hand, a gold tier of Hospital cover will typically ensure you’re covered as a private patient in a private hospital for every service included on the cover.

Further, most of the services in Extras cover aren’t covered through the public system or are only covered in selected circumstances. This means if you need to or choose to use one of these services without Extras cover, you will generally need to pay the full amount charged for the service. Extras cover allows you to claim back some or all of the cost, depending on your level of cover.

3. Understanding waiting periodsAll health insurance products have waiting periods, and this is the length of time you may have to wait after joining or moving to a higher level of cover before you can use and claim various services included in your cover. It’s important to note that different waiting periods apply for Hospital and Extras services, and can vary between insurers.

4. Understanding restricted coverThe Australian Government sets an amount to charge for hospital costs, which is called the ‘minimum benefit’. If your policy says you have ‘restricted cover’ for a type of treatment, it means we will only pay the minimum benefit for your hospital costs.

In most cases, if you were to stay in a shared room in a public hospital, you’d be covered but, there may be an amount for you to pay. For a private room, or a private hospital, the hospital may charge even more, leaving a significant amount for you to pay.

Keep in mind that choosing Hospital cover that includes restricted cover or exclusions is a way to help keep your premium down. You will need to consider how likely you would be to need a service, and how and where you would like to be treated for that service.

Things to consider when choosing health insuranceSometimes knowing where to start to find the cover that best suits where you’re at in life, can be overwhelming. That’s why we have included a list of things to consider when choosing the cover that’s right for you.


To log in, get your log in ID and password from your employer or call us on 134 135

Still not sure where to start? Talk to our friendly staff.

7

8

Packaged cover at a glance

1For most items at our Members First extras providers covering dental, physio, chiro, podiatry consultations and selected optical. Yearly limits, waiting periods, fund and policy rules apply. Excludes orthodontics, orthotics and hospital treatments. Set benefits apply at other recognised providers. 2Waiting periods, fund and policy rules apply. 3Applies each calendar year, and where benefits are payable for the service. Any unused amount does not roll over into the next year. 4Private room or money back guarantee means that, at our Members First hospitals, you’ll receive a private room when you book and request one at least 24 hours before the overnight admission. If a private room is not available, you’ll receive $50 back, per night, from the hospital. You’ll also receive a complimentary daily newspaper and complimentary local calls. Applies to overnight admissions only. Excludes ‘nursing home type patients’, emergency care same-day or occasions where a private room is medically inappropriate. 5For most items covering dental, physio, chiro, podiatry consultations and selected optical packages. Available on Budget Family - Silver Plus, Growing Family - Silver Plus, Established Family - Silver Plus, Ultimate Health Cover

Low Cover

Young Singles / Couples Choice - Bronze PlusAffordable Hospital and Extras designed for young couples.

• You’ll receive 60% back for most Members First dental, physio, chiro and podiatry consultations up to your yearly limits.1

• Pay nothing for your regular dental check-up and more at Members First Platinum dentists. Up to yearly limits.2

• In the first year you’re with Bupa, you’ll get a Top-up Bonus of $75 as a single and $150 as a couple to use towards out-of-pocket Extras expenses. This amount increases by 20% each year you remain a customer, until it doubles in Year 6.3

• Co-payments - $50 per day capped at $250 per admission.

• Private room or money back guarantee (at our Members First private hospitals).4

Growing Family - Silver PlusHospital and Extras cover for those planning or extending their family. Includes pregnancy and birth, and assisted reproductive services.



• Pay nothing for kids on most dental, physio, chiro, podiatry consultations and selected optical packages up to yearly limits, at Members First providers.5

• Top-up Bonus on Extras. Enjoy a $100 top-up bonus per membership each calendar year towards out-of-pocket Extras expenses.3

• Covers pregnancy and birth and assisted reproductive services. Provides benefits for Bupa registered lactation consultants.


9

- Gold, and Top Extras 60, Top Extras 75 & Top Extras 90 when taken with Hospital cover, on a family membership. Yearly limits, waiting periods, fund and policy rules apply. Child dependants only. Excludes orthodontics, orthotics and hospital treatments. Set benefits apply at other recognised providers. 6Based on cost of Essentials travel insurance for under 65’s at standard rates. 7Travel, Home & Car Insurance products are issued by Insurance Australia Limited (IAL) ABN 11 000 016 722 AFSL 227681. Any advice is general advice only and does not take into account your individual circumstances. The relevant Product Disclosure Statements are available at bupa.com.au and should be considered before making any decision on these products. Bupa HI Pty Ltd ABN 81 000 057 590 is an authorised representative (number 3542669) of IAL. 8Subject to set limits. 100% back in most instances up to the first $500 then benefits of 90% apply for general dental. 100% for first 10 standard physio & chiro visits, and podiatry consultations per person per calendar year then benefits of at least 90% apply. Waiting periods, fund and policy rules apply. 9A 3 year waiting period applies to Laser Eye Correction Surgery.

High Cover

Ultimate Health Cover - GoldA comprehensive packaged cover that helps pay for hospital expenses in private and public hospitals. Includes cover for medical expenses when you’re admitted to hospital and a large range of extras.

• You’ll receive 100% back for most Members First dental, physio, chiro, podiatry consultations and selected optical up to your yearly limits.8


• Pay nothing for kids on most dental, physio, chiro, podiatry consultations and selected optical packages up to yearly limits, at Members First providers.5

• 100% back for Laser eye correction surgery at recognised Bupa providers.9

• Ultimate gap bonus – receive $200 when you join and every calendar year thereafter. This can be used towards a doctor or specialist’s out-of-pocket costs (whilst in hospital) and any unused bonus amounts will accumulate each year.

• Ultimate Advice Line gives you access to information on a range of topics, including 24 hour medical and accident advice and counselling and grief support.


Prime - Silver PlusHospital and Extras for people who no longer need cover for pregnancy and birth. Includes cover for Dietitian Health-coaching, a Top-up Bonus recognising loyalty and more.



• In the first year you’re with Bupa, you’ll get a Top-up Bonus of $50 as a single and $100 as a couple to use towards out-of-pocket Extras expenses. This amount increases by 20% each year you remain a customer, until it doubles in Year 6.3

• You can receive up to eight days (seven nights) of Essentials travel insurance annually. Alternatively, you can use the equivalent value as a discount on your premium for any Bupa Travel Insurance policy.6, 7

• Access up to 2 x Bupa dietitian health-coaching sessions.


10

Hospital & Extras at a glanceYou can choose between any of the products below and create a unique combination just for you, or you can simply choose Hospital only or Extras only depending on your needs.

Below we have included the key features of each cover, from a basic tier of cover all the way to the highest tier of cover. In the following pages, you’ll also find more detailed information on the Hospital covers’ benefits and Extras covers’ limits.

Excess Options $250 $500 $750

• Cover for many hospital treatments including heart and vascular system, back, neck and spine, rehabilitation, chemotherapy, radiotherapy and immunotherapy for cancer1.

• No excess for kids.

Excess Options NIL $250 $500 $750

• Unemployment Cover (subject to eligibility).3

• Ultimate Advice Line gives you access to information on a range of topics, including 24 hour medical and accident advice and counselling & support.

• Complimentary access to Best Doctors, providing medical support and guidance through their Expert Second Opinion and Doctor Online services.2

Excess Options NIL $250 $500 $750

• Ultimate Advice Line gives you access to information on a range of topics, including 24 hour medical and accident advice and counselling & support.

• Complimentary access to Best Doctors, providing medical support and guidance through their Expert Second Opinion and Doctor Online services.2

• Covers pregnancy and birth and assisted reproductive services.

Excess Options $250 $500 $750

• Covers a range of hospital treatments like chemotherapy, radiotherapy and immunotherapy for cancer1 and more.

• Includes treatment for accidents sustained after joining, that are normally restricted or excluded.

• No excess for kids.

Lite Hospital - Bronze PlusAffordable Hospital cover for the budget conscious.

Mid Hospital - Silver PlusMid range Hospital cover to help keep the larger concerns covered.

Top Hospital No Pregnancy - Silver PlusHospital cover excluding pregnancy and birth and assisted reproductive services.

Top Hospital with Pregnancy - GoldTop Hospital cover for a broad range of services for total peace of mind.

Hospital Cover

Low C

overH

igh C

over

1Some non-PBS drugs may not be covered. 2The services provided by Best Doctors are informational only and do not constitute a substitute for a medical diagnosis, treatment, evaluation or therapeutic recommendation by your treating doctors. You should obtain specific advice regarding your medical condition from your treating doctor. Bupa is not responsible for any loss or damage arising from the service. 3Cover for your premiums for up to 12 months in the event you lose your permanent full time employment due to involuntary retrenchment or redundancy. Must have held selected covers for 12 months. Unemployment must have occurred within 12 months of claim. Other eligibility criteria apply. Contact us for details. The Group Policy is a contract of insurance between Bupa HI Pty Ltd and

11

• Medium Extras cover.

• Select four services that suit you best. Capped emergency ambulance is automatically included in this cover.

• Receive up to 60% back for most items at our Members First network of dental, physio, chiro, podiatry and selected optical providers, up to your yearly limits.4

• Includes Loyalty Maximums which increases how much you can claim each year by 20% of the initial amount for most Extras services.6

• Medium Extras cover.

• Receive 60% back increasing to 66% with loyalty benefits that increase each year for most items at our Members First network of dental, physio, chiro, podiatry and selected optical providers, up to your yearly limits.4

• Includes benefit bonus.5

• High level Extras cover.

• Receive 75% back increasing to 82.5% with loyalty benefits that increase each year for most items at our Members First network of dental, physio, chiro, podiatry and selected optical providers, up to your yearly limits.4


• Low-level Extras cover.• Receive up to 60% back for most items at our Members First network

of dental, physio, chiro and selected optical providers up to your yearly limits.4

Budget Extras 60Stay in great health with a healthy range of Extras.

Your Choice Extras 60Flexible Extras cover tailored by you, for you.

Top Extras 60All-round excellent Extras cover to keep your health in check.

Top Extras 75High-level Extras cover, with generous general dental and other Extras for your needs.

• High level Extras cover.

• Receive 90% back increasing to 100% with loyalty benefits that increase each year for most items at our Members First network of dental, physio, chiro, podiatry and selected optical providers, up to your yearly limits.4


Top Extras 90Our most feature-packed standalone Extras cover, with the highest limits in our standalone Extras range.

Extras Cover

Insurance Australia Limited ABN 11 000 016 722 AFSL 227681 4For most items at our Members First Extras providers covering dental, physio, chiro, podiatry consultations and selected optical packages. Yearly limits, waiting periods, fund and policy rules apply. Excludes orthodontics, orthotics and hospital treatments. Set benefits apply at other recognised providers. 5On Top Extras 60, Top Extras 75 and Top Extras 90, your percentage back on Extras claims at Members First providers grows by 2% of the original benefit each year, up to a maximum of 10%. The set benefit you get back at other recognised providers also grows by 2% of the original benefit each year, up to a maximum of 10%. 6Applies after the first 12 months up to a maximum increase of 100% on yearly limits over 6 years.

Low C

overH

igh C

over

orHospital Extras&Hospital Extras

12

Hospital Cover

Lite Hospital - Bronze Plus

Mid Hospital - Silver Plus

Top Hospital No Pregnancy

- Silver Plus

Top Hospital with Pregnancy

- Gold

Excess Options $250 / $500 / $750 Nil / $250 / $500 / $750

Clinical categories

Rehabilitation R P P PHospital Psychiatric services R R P PPalliative care R P P PBrain and nervous system P P P PBlood P P P PChemotherapy, radiotherapy and immunotherapy for cancer2 P P P PEye (not cataracts) P P P PCataracts O O P PEar, nose and throat P P P PImplantation of hearing devices P P P PTonsils, adenoids and grommets P P P PBone, joint and muscle P P P PJoint reconstructions P P P PJoint replacements O O P PBack, neck and spine O P P PKidney and bladder P P P PDialysis for chronic kidney failure O O P PDigestive system P P P PHernia and appendix P P P PGastrointestinal endoscopy P P P PWeight loss surgery O O O PHeart and vascular system O P P PLung and chest P P P PGynaecology P P P PMiscarriage and termination of pregnancy P P P PPregnancy and birth O O O PAssisted reproductive services O O O PMale reproductive system P P P PDiabetes management (excluding insulin pumps) P P P PInsulin pumps P P P PPain management P P P PPain management with device P P P PBreast surgery (medically necessary) P P P PPlastic and reconstructive surgery (medically necessary) P P P PSkin P P P PDental surgery P P P PSleep studies P P P PPodiatric surgery (provided by a registered podiatric surgeon) P P P PAdditional benefitsUnemployment Cover O O P PTravel Insurance Bonus P O O OCapped Emergency Ambulance P P O OUncapped Emergency Ambulance O O P PNo Excess for Kids P P P PTravel and Accommodation P P P P

R Restricted cover applies, see the Important Information Guide at bupa.com.au/corporate-info to find out more. X Indicates the service is excluded, whereby no benefits are payable. 1Capped at $250 per admission. 2Some non-PBS drugs may not be covered.

Hospital Only

13

Young Singles/Couples Choice

- Bronze Plus

Growing Family

- Silver Plus

Prime - Silver Plus

Ultimate Health Cover

- Gold

Excess Options $50 Co-Payment1

$250 / $500 / $750

Nil / $250 / $500 / $750 NIl

Clinical categories

Rehabilitation R P P PHospital Psychiatric services R P P PPalliative care P P P PBrain and nervous system P P P PBlood P P P PChemotherapy, radiotherapy and immunotherapy for cancer2 P P P PEye (not cataracts) P P P PCataracts O O P PEar, nose and throat P P P PImplantation of hearing devices P P P PTonsils, adenoids and grommets P P P PBone, joint and muscle P P P PJoint reconstructions P P P PJoint replacements O O P PBack, neck and spine O P P PKidney and bladder P P P PDialysis for chronic kidney failure O O P PDigestive system P P P PHernia and appendix P P P PGastrointestinal endoscopy P P P PWeight loss surgery O P O PHeart and vascular system O P P PLung and chest P P P PGynaecology P P P PMiscarriage and termination of pregnancy P P P PPregnancy and birth O P O PAssisted reproductive services O P O PMale reproductive system P P P PDiabetes management (excluding insulin pumps) P P P PInsulin pumps P P P PPain management P P P PPain management with device P P P PBreast surgery (medically necessary) P P P PPlastic and reconstructive surgery (medically necessary) P P P PSkin P P P PDental surgery P P P PSleep studies P P P PPodiatric surgery (provided by a registered podiatric surgeon) P P P PAdditional benefitsUnemployment Cover O O O PTravel Insurance Bonus P O P PCapped Emergency Ambulance P P O OUncapped Emergency Ambulance O O P PNo Excess for Kids O P O N/A

Travel and Accommodation P P P P

Packages (Hospital and Extras cover)

Want to see the

Extras cover that comes with your package?

Go to pages 14 & 15

14

Packages (Hospital and Extras cover)Young Singles / Couples

Choice - Bronze PlusGrowing Family

- Silver Plus Prime - Silver Plus Ultimate Health Cover - Gold

At least 60% back at Members First providers1



Up to 100% back at Members First providers2

Services Waiting periods

General dental 2 months$850 n

Orthodontics – Accident only

$700 Unlimited Unlimited

Major dental12 months

$600 $1,000 $1,600

Orthodontics $400 tLifetime Limit $1,300 O

$1,000 t Lifetime Limit $3,200

Optical

2 months

$210 Ë$150 º

$260 Ë$180 º

$260 Ë$180 º

$420 Ë$300 º

Physiotherapy$500 n

$450 $500 n $1,500

Chiropractic and osteopathy $350 t$500 l

$350 t$500 l

$1,000 t$1,600 l

Natural therapies

Includes massage (remedial massage, myotherapy, and Traditional Chinese Medicine remedial massage) acupuncture, and Chinese herbalism

$500 t Massage sub-limit $100 t


$300 t n Massage sub-limit $100 t

$1,000 Massage sub-limit $250 t $500 l

Exercise Physiology

Antenatal and Postnatal O $300 O $500

Health Management 6 months $75 $100 $100 $300

Pharmacy (includes travel vaccines)3

2 months

$200 $400 $350 $1,500

Dietary $300 $200 Combined with Natural Therapies n

$1,000

Mental Health (includes Psychology and Counselling) $300 $200 $200 $1,000

Podiatry (excludes orthotics) $300 $200 $400 $1,000

Speech Therapy

O

$200O

$1,000

Eye Therapy

O

$1,000

Occupational Therapy Combined with Physiotherapy n

$1,000

Home Nursing $200 $400

Health aids and appliances4 12 months $8007

Sub-limits apply85% of cost7

Sub-limits apply

Laser Eye Correction Surgery 36 months O 100% of cost8

Accident Benefit5 No waiting period O$2,000 t $4,000 l

Travel and accommodation 2 months $100 travel, $150 accommodation

$200 travel, $300 accommodation

Emergency ambulance services6 No waiting period 1 service per year (singles) 2 services per membership (couples / families) Uncapped Emergency Ambulance

1For most items at our Members First Extras providers covering dental, physio, chiro, podiatry consultations and selected optical. Yearly limits, waiting periods, fund and policy rules apply. Excludes orthodontics, orthotics and hospital treatments. Set benefits apply at other recognised providers. 2Up to yearly limits and subject to set limits. 100% back in most instances up to the first $500 then benefits of 90% apply for general dental. 100% for first 10 standard physio & chiro visits, and podiatry consultations per person per calendar year then benefits of at least 90% apply. Waiting periods, fund and policy rules apply. 3Benefits for prescription items that are non-PBS, TGA

Packaged Extras cover optionsThis table outlines the Extras services that may be available with the packages shown on Page 15. Yearly limits shown are per person, or per membership (where applicable).

15

Packages (Hospital and Extras cover)Young Singles / Couples

Choice - Bronze PlusGrowing Family

- Silver Plus Prime - Silver Plus Ultimate Health Cover - Gold




Up to 100% back at Members First providers2

Services Waiting periods

General dental 2 months$850 n

Orthodontics – Accident only

$700 Unlimited Unlimited

Major dental12 months

$600 $1,000 $1,600

Orthodontics $400 tLifetime Limit $1,300 O

$1,000 t Lifetime Limit $3,200

Optical

2 months

$210 Ë$150 º

$260 Ë$180 º

$260 Ë$180 º

$420 Ë$300 º

Physiotherapy$500 n

$450 $500 n $1,500

Chiropractic and osteopathy $350 t$500 l

$350 t$500 l

$1,000 t$1,600 l

Natural therapies




$300 t n Massage sub-limit $100 t

$1,000 Massage sub-limit $250 t $500 l

Exercise Physiology

Antenatal and Postnatal O $300 O $500

Health Management 6 months $75 $100 $100 $300


2 months

$200 $400 $350 $1,500

Dietary $300 $200 Combined with Natural Therapies n

$1,000

Mental Health (includes Psychology and Counselling) $300 $200 $200 $1,000

Podiatry (excludes orthotics) $300 $200 $400 $1,000

Speech Therapy

O

$200O

$1,000

Eye Therapy

O

$1,000

Occupational Therapy Combined with Physiotherapy n

$1,000

Home Nursing $200 $400


Sub-limits apply85% of cost7

Sub-limits apply

Laser Eye Correction Surgery 36 months O 100% of cost8

Accident Benefit5 No waiting period O$2,000 t $4,000 l

Travel and accommodation 2 months $100 travel, $150 accommodation

$200 travel, $300 accommodation

Emergency ambulance services6 No waiting period 1 service per year (singles) 2 services per membership (couples / families) Uncapped Emergency Ambulance

t Per person l Per membership Ë Members First º Non-Members First n Combined Maximum

approved, and not appearing on our exclusions list. 4A combined yearly limit applies to this service category. 5Accident benefit can only be used towards hospital excess or co-payment, or to boost Extras limits if service yearly limits has been reached. 6Fund rules apply. 7Hire and repair of health aids and appliances available, for which a 6 month waiting period applies. Sub-limits apply. 8At recognised providers. A 3 year waiting period applies to Laser Eye Correction Surgery,

16

Choose your own ExtrasBudget

Extras 60Your Choice

Extras 60Top

Extras 60Top

Extras 75Top

Extras 90




At least 75% back at Members

First providers1


First providers1

Services Waiting periods Gap Free dental, physio, chiro, podiatry consults, and selected optical packages for kids at Members First providers.2

General dental 2 months $350 t $700 l $7007 Year 1 to $1,400 Year 6+ Unlimited Unlimited Unlimited

Major dental

12 months O

$5007 Year 2 to $1,000 Year 7+ $1,000 $1,100 $1,200

Orthodontics$4507 Year 2 to $900 Year 7+

Lifetime Limit $1,300

$700 t Lifetime Limit

$2,000


$2,600

$900 t Lifetime Limit $2,800

Optical

2 months

$210 tË $420 lË$150 tº $300 lº

$260 Ë$180 º

$290 Ë$200 º

$340 Ë$240 º $380 Ë $280 º

Physiotherapy

$350 t $700 l nNatural therapies

sub-limit $100 t $200 l

$4507 Year 1 to $900 Year 6+ $700 $800 $900

Chiropractic and osteopathy $3507 Year 1 to $700 Year 6+8

$500 t $1,000 l

$600 t $1,200 l $700 t $1,400 l

Natural therapies


$5007 Year 1 to $1,000 Year 6+

Massage sub-limit $100 t

$400 tMassage sub-limit

$150 t $300 l

$500 tMassage sub-limit $200 t $400 l


Exercise Physiology

Antenatal and PostnatalCombined with

physiotherapy n $350 Sub-limit

$350 $400 $450

Health Management 6 months $50 $100 $100 $150 $200


2 months

$100 t $200 l $3007 Year 1 to $600 Year 6+ $500 $600 $750

Dietary

O

O$400 $500 $750

Mental Health (includes Psychology and Counselling) $400 $500 $750

Podiatry (excludes orthotics) $3507 Year 1 to $700 Year 6+ $400 $500 $750

Speech Therapy$4007 Year 1 to $800 n Year 6+

$400 $500 $750

Eye Therapy $400 $500 $750

Occupational Therapy $400 $500 $750

Home Nursing

O

$350 $350 $400


Sub-limits apply$1,0009


Sub-limits apply

Laser Eye Correction Surgery 36 months O O O

Accident Benefit5 No waiting period O O O

Travel and accommodation 2 months $100 travel/$150 accommodation

Emergency ambulance services6 No waiting period 1 service per year (singles) 2 services per membership (couples / families)

Extras only cover optionsThis table outlines the Extras services that may be available with the Extras covers shown on Page 17. Yearly limits shown are per person, or per membership (where applicable).

1For most items at our Members First Extras providers covering dental, physio, chiro, podiatry consultations and selected optical. Yearly limits, waiting periods, fund and policy rules apply. Excludes orthodontics, orthotics and hospital treatments. Set benefits apply at other recognised providers. 2For most items covering dental, physio, chiro, podiatry consultations and selected optical packages. Available on Budget Family - Silver Plus, Growing Family - Silver Plus, & Established Family - Silver Plus, Ultimate Health Cover - Gold, Top Extras 60, Top Extras 75 & Top Extras 90 when taken with Hospital cover on a family membership. Waiting periods, fund and policy rules apply. Child dependants only. Excludes orthodontics, orthotics and hospital treatments. Set benefits apply at other recognised providers. 3Benefits for prescription items that are non-

17

Choose your own ExtrasBudget

Extras 60Your Choice

Extras 60Top

Extras 60Top

Extras 75Top

Extras 90





First providers1


First providers1

Services Waiting periods Gap Free dental, physio, chiro, podiatry consults, and selected optical packages for kids at Members First providers.2

General dental 2 months $350 t $700 l $7007 Year 1 to $1,400 Year 6+ Unlimited Unlimited Unlimited

Major dental

12 months O

$5007 Year 2 to $1,000 Year 7+ $1,000 $1,100 $1,200

Orthodontics$4507 Year 2 to $900 Year 7+

Lifetime Limit $1,300


$2,000


$2,600

$900 t Lifetime Limit $2,800

Optical

2 months

$210 tË $420 lË$150 tº $300 lº

$260 Ë$180 º

$290 Ë$200 º

$340 Ë$240 º $380 Ë $280 º

Physiotherapy

$350 t $700 l nNatural therapies

sub-limit $100 t $200 l

$4507 Year 1 to $900 Year 6+ $700 $800 $900

Chiropractic and osteopathy $3507 Year 1 to $700 Year 6+8

$500 t $1,000 l

$600 t $1,200 l $700 t $1,400 l

Natural therapies


$5007 Year 1 to $1,000 Year 6+

Massage sub-limit $100 t

$400 tMassage sub-limit

$150 t $300 l



Exercise Physiology

Antenatal and PostnatalCombined with

physiotherapy n $350 Sub-limit

$350 $400 $450

Health Management 6 months $50 $100 $100 $150 $200


2 months

$100 t $200 l $3007 Year 1 to $600 Year 6+ $500 $600 $750

Dietary

O

O$400 $500 $750

Mental Health (includes Psychology and Counselling) $400 $500 $750

Podiatry (excludes orthotics) $3507 Year 1 to $700 Year 6+ $400 $500 $750

Speech Therapy$4007 Year 1 to $800 n Year 6+

$400 $500 $750

Eye Therapy $400 $500 $750

Occupational Therapy $400 $500 $750

Home Nursing

O

$350 $350 $400




Sub-limits apply

Laser Eye Correction Surgery 36 months O O O

Accident Benefit5 No waiting period O O O

Travel and accommodation 2 months $100 travel/$150 accommodation

Emergency ambulance services6 No waiting period 1 service per year (singles) 2 services per membership (couples / families)

t Per person l Per membership Ë Members First º Non-Members First n Combined Maximum

PBS, TGA approved, and not appearing on our exclusions list. 4A combined yearly limit applies to this service category. 5The accident benefit can be used to boost your limits on Extras services which have been reached, if resulting from an accident. 6Fund rules apply. 7This amount increases year on year up to a maximum of six years. For major dental and orthodontics, benefits start after 12 month waiting period served. 8Membership limits: $500 Year 1 to $1,000 Year 6+. 9Hire, repair of health aids and appliances available, for which a 6 month waiting period applies.

18

Health & Wellbeing

1Waiting periods, fund and policy rules apply. Child defendants only. Excludes orthodontics and hospital treatment. Available on all family packages, Ultimate Health Cover - Gold, and Top Extras 60, Top Extras 75 and Top Extras 90 cover, when taken with hospital cover on a family membership. 2On selected optical packages. Conditions apply. Optical benefits are subject to your level of cover. Yearly limits, waiting periods, fund and policy rules apply

Gap free optical Our Members First providers and Optical Partners Specsavers offer you access to a range of ‘no gap’ packages on glasses and contact lenses at no additional cost.2

Parent & Baby Wellbeing ProgramA confidential consultation and support phone service from the Parent-Infant Research Institute (PIRI), for parents who are finding the transition to parenthood difficult, helping adjust to the changes at this exciting time.

To access the program, contact PIRI between 9am-5pm, Monday to Friday AEST on 1300 360 913.

Life skills program At Bupa, we understand that corporate life comes with its own set of challenges. Which is why we’re constantly looking for ways to help you improve your health and wellbeing. As part of your corporate health plan, you will enjoy direct access to the Life Skills program, a set of online modules that provide tools and strategies to help you manage your life.

Find out more at bupa.com.au/corporatelifeskills

Find a Members First providerThe Find a Provider tool will enable you to find your nearest healthcare providers on the Members First network, hospitals and Bupa centres, giving you access to the best value closest to you.

bupa.com.au/find-a-provider

We believe all members deserve help and support to achieve and maintain improved health and wellbeing, from programs that support you in achieving better health outcomes to self-management guides for long-term health conditions. It’s all part of our commitment to helping you live a healthier, happier life.

19

More for our members

3Minimum premiums may apply. The 10% discount will not apply to the extent any minimum premium is reached. Bupa Travel, Home, Landlords, Car and Valuables Insurance is issued by Insurance Australia Limited ABN 11 000 016 722 AFSL 227681. Any advice is general advice only and does not take into account your individual circumstances. A Product Disclosure Statement should be considered before making any decision on these products. Bupa HI Pty Ltd ABN 81 000 057 590 is an authorised representative of Insurance Australia Limited. Bupa Pet Insurance is general insurance issued by the insurer The Hollard Insurance Company Pty Ltd (ACN 090 584 473; AFSL 241436) (Hollard), is promoted by Bupa HI Pty Limited (ACN 000 057 590; AR 354269) (Bupa) and administered by PetSure (Australia) Pty Ltd (ACN 075 949 923; AFSL 420183.

Valuables InsuranceInsure one (or multiple) items that you care about most, such as your mobile, laptop, tablet or even your musical instrument from damage, theft and everyday accidents.

Visit bupa.com.au/valuables-insurance to find out more.

Pet InsuranceProtect your best friend today with affordable cover and great discounts.

There are three affordable levels of cover to choose from, providing up to 80% back.

Visit bupa.com.au/pet-insurance to find out more.

Car InsuranceSave more and get more with Bupa car insurance.

With three levels of cover to choose from; Comprehensive Cover, Third Party Fire and Theft or Third-Party Property Damage, Bupa has an option to help cover you whatever your needs.

Visit bupa.com.au/car-insurance to find out more.

Gap free dental for kids Our Members First providers offer you and your family gap free dental cover on most kids dental treatments on selected covers, up to your yearly limits at Members First providers1. Including check-ups, cleans, x-rays, fillings and more.

Bupa Plus rewards & discounts There are still plenty of ways to get everyday value through your health insurance. So, to thank our members for their loyalty, you’ll get access to an exclusive range of rewarding health discounts, tools and more through Bupa Plus including;

• Up to 15% off entry to Dreamworld, WhiteWater World, SkyPoint and SkyPoint Climb

• 20% off full priced online products

• 30% off Blackmores products when purchased online

Bupaplus.com.au

10% discount

for Bupa health members

10% discount3 for Bupa health

members

10% discount

on annually paid premiums

20

Important things you need to know about your health coverSwitching from another insurerHere’s what you need to know:

1. We handle the paperwork. Just give us permission to get in touch with your old insurer when you apply. We’ll make sure your insurance is cancelled and obtain your ‘clearance certificate’ from your previous fund.

2. You don’t have to re-serve waiting periods. You won’t have to serve waiting periods again for any treatments you’ve been previously covered for, as long as your clearance certificate shows that the same services are also offered equivalently on your new Bupa cover.

For more information on switching please refer to the important information guide; bupa.com.au/info

Age-based discounting to reduce your hospital premiumIf you’re aged 18-29, you are entitled to receive an age-based discount on your domestic Hospital cover. The discount is calculated at 2% for each year you’re aged under 30, when you first purchase your domestic Hospital cover. The maximum discount is 10% for 18 to 25 year olds.

Continuity of the age-based discountsIf you currently have health insurance with another fund, we’ll verify your level of discount once we’ve received a clearance certificate from your old health insurer – but don’t worry, we’ll manage this process behind the scenes, so there’s no need for you to do a thing.

How does it work?The younger you are when you purchase Hospital cover, the more discount you may be entitled to. Here’s an example of how it might work:

• If you’re a single aged between 18 and 25, you may be entitled to the full 10% discount on your Hospital cover, until you turn 41.

• If you’re a couple aged 25 and 29, you may be eligible to receive the applicable discount for your age. The discount for a couple’s policy will be applied as an average to the total premium. The partner aged 25 may be eligible for a 10% discount on their Hospital cover, while the partner aged 29 may be eligible for a 2% discount, resulting in a 6% average discount each year they hold Hospital cover until they turn 41.

Going to hospital1. Hospital waiting periodsWhen you first take out or upgrade health cover there’s a period of time before you can make a claim on your new level of cover. You can’t claim for services that you receive during this period at your new level of cover, even if you wait to submit the claim once the period is over.

Different waiting periods apply to different hospital services:

Hospital cover Waiting period

Pre-existing conditions, ailments or illnesses

12 months

Pregnancy and birth 12 months

Palliative care, Hospital psychiatric and rehabilitation services

2 months

All other treatments included in your cover

2 months

Emergency ambulance and treatment after accidents

None

21

Pre-existing conditionsA 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.

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 pre-existing, 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.

Restricted cover The Australian Government sets an amount to charge for hospital costs, which is called the ‘minimum benefit’. If your policy says you have ‘restricted cover’ for a type of treatment, it means we will only pay the minimum benefit for your hospital costs. In most cases, if you were to stay in a shared room in a public hospital, you’d be covered but, there may be an amount for you to pay. For a private room, or a private hospital, the hospital may charge even more, leaving a significant amount for you to pay.

2. Costs of going to hospitalThe below will help you understand the type of costs you might encounter during your hospital stay (assuming you are covered by your policy for the treatment you’re receiving in hospital and that you have served all relevant waiting periods).

Hospital costs:Charges related to staying in the actual hospital such as the use of the bed, food and operating theatre, plus nursing and allied health services. A couple of things to note;

• How you’re covered for hospital costs when you’re admitted as an ‘inpatient’ depends on your choice of hospital.

• If a treatment is listed as having ‘restricted cover’ on your policy information, we pay less toward your hospital costs. This means you’re likely to have more to pay for these services.

Medical costs:The fees charged by a surgeon, physician, anaesthetist, or other medical specialist when they are treating you in hospital.

How fees for medical treatments are set. The Australian Government sets the fees for medical services.

How medical costs are covered. Medicare and Bupa both pay a portion of this (75% and 25% respectively). However, your specialist may choose to charge more than the set fee. This means you would have a ‘gap’ to pay yourself. The Bupa Medical Gap Scheme is designed to eliminate or minimise the amount you’ll have to pay in cases like this. Go to page 22 for more information.

3. Reducing your out-of-pocket hospital costsPrivate hospitals do vary in cost and the facilities they provide. Below are some of the ways you can reduce your out-of-pocket costs, when you are treated as a private patient in a Members First or Network Hospital;

• No Gap Cardiac ServicesBupa has partnered with GenesisCare, Australia’s largest group of privately practising cardiologists, to help achieve better health outcomes for patients with heart disease.

As a Bupa member, you’ll have no out-of-pocket expenses for services from a GenesisCare cardiologist when you’re admitted to hospital (not available in NSW, TAS & NT).

• Members First Day HospitalsIf you are treated in a Members First Day Hospital, there are no out-of-pocket expenses for medical services (e.g. your surgeon, anaesthetist or other specialist fees). Not available in NT. Any co-payment or excess related to your cover will still apply.

22 1Yearly limits, waiting periods, fund and policy rules apply.

• Medical Diagnostics (Radiology and Pathology)You’ll pay no gap for in-hospital pathology and radiology diagnostic tests where recognised by Medicare and performed by Bupa contracted providers.

For more information visit,www.bupa.com.au/radiology or www.bupa.com.au/pathology

• Private room or money back guarantee (at our Members First private hospitals)Private room or money back guarantee at our Members First hospitals, means that you’ll receive a private room when you book and request one at least 24 hours before the overnight admission. If a private room is not available, you’ll receive $50 back, per night, from the hospital. You’ll also receive a complimentary daily newspaper and complimentary local calls. Applies to overnight admissions only. Excludes ‘nursing home type patients’, emergency care same-day or occasions where a private room is medically inappropriate.

Bupa Medical Gap SchemeThe Bupa Medical Gap Scheme is designed to remove or reduce the costs you pay for your treatment in hospital. Where a doctor chooses to use the Scheme for your treatment, they agree to only charge up to a certain fee. Bupa then pays a much higher amount than we normally would to help cover the extra cost. If a doctor uses the no-gap option, Bupa covers all of the extra charges, so you pay nothing for that doctor’s medical fees. Otherwise, for each doctor choosing to use the Gap Scheme, the most you’ll pay is up to $500 out-of-pocket on medical costs. Each doctor involved in your treatment can choose to use the Bupa Medical Gap Scheme for your admission in a Public Hospital, or a Private Hospital with which Bupa has an agreement.

See bupa.com.au/medicalgapscheme for more.

Your Extras Cover1. Extras Provider NetworkWith Bupa Extras cover, we’ll pay towards the cost of treatment you receive from any Bupa recognised provider. We’ve also built a network of providers. Our Members First network provides you with certainty on how much you will pay – keeping your costs as low as possible on most services.

• Members First Platinum - Pay nothing for your regular dental check-up and more at Members First Platinum dentists, when you combine Hospital and Extras that include general dental. Up to yearly limits.1 This includes bitewing x-rays, and mouthguards, if you need them. Plus, you’ll get all the benefits of Members First on most other dental services.

• Members First Providers - Our national network of extras providers can help you to reduce or eliminate out-of-pocket expenses on most items depending on your level of cover.

• Recognised Providers - If we recognise a provider, we’ll pay:

- A basic, set amount toward the cost of any Extras services covered under your policy. It will usually be a lower amount than we’d pay for services from Members First Platinum, and Members First Providers.

2. Extras waiting periodsWhen you first take out or upgrade your health cover there’s a period of time before you can make a claim on your new level of cover. This is common across the health insurance industry.

You can’t claim for services that you receive during this period at your new level of cover, even if you wait to submit the claim once the period is over.

23

Extras cover Waiting period

Hire and repair of health aids and appliances

6 months

Health management programs

6 months

Major Dental 12 months

Orthodontics 12 months

Purchase of health aids and appliances

12 months

All other extras services 2 months

3. Claiming on ExtrasGetting around the health insurance system can be tough, so we’ve created ‘myBupa’ – an online hub that makes using your cover easier than ever. With its intuitive design and 24/7 access across laptop, desktop and mobile, it’s the quickest way to make claims and manage your membership. You can;

• Claim online

• Get an estimate online before you get treatment

• Check your remaining limits

• Get your tax statements; and

• Manage your payments and payment information

Government and tax considerations1. Lifetime Health Cover Loading (LHC)Lifetime Health Cover (LHC) is an Australian Government initiative to encourage Australian residents with full access to Medicare to take out Hospital cover earlier in life and to keep it.

If you don’t have Hospital cover before 1 July following your 31st birthday, you’ll pay an additional 2% on your Hospital cover premium every year you delay – up to a maximum of 70%. This extra cost will remain in place until you’ve had appropriate private Hospital cover for 10 continuous years.

To avoid the LHC loading you’ll need to take out Hospital cover by 30 June following your 31st birthday and maintain your cover.

2. Government rebateDepending on your age and income, the Australian Government contributes an amount (known as a ‘rebate’) towards the cost of your private health insurance premium. If you’re eligible, it may reduce the cost of your yearly premium.

You can choose to receive the rebate as a reduction to your premium to lower your upfront costs, or it can be calculated when you lodge your tax return.

The rebate percentages change yearly from 1 April. The Government announced that, from 1 April 2014 and every year thereafter, the rebate will be linked to the Consumer Price Index (CPI) growth or the industry average health insurance premium increase, whichever is less.

3. Medicare Levy Surcharge (MLS)To have access to Australia’s public health insurance system (Medicare), most Australian residents pay a Medicare Levy of 2% of their taxable income. Non-Australian residents generally don’t pay the Medicare Levy as they don’t access Medicare benefits.

If you’re single and earn over $90,000 per annum, or a couple/family and earn over $180,000 per annum and don’t have appropriate Hospital cover for you and all your dependants over the whole year, you may be charged the additional Medicare Levy Surcharge (MLS) as part of your tax return, in addition to the Medicare Levy.

You could choose to pay the Medicare Levy Surcharge as part of your tax return. For more information please refer to the Important Information Guide.

Bupa PO Box 14639

Melbourne VIC 3001

Bupa HI Pty Ltd ABN 81 000 057 590

Effective 1 July 2019 11570-07-19

Unsure of any words? Visit: bupa.com.au/glossary

Other important information you should know can be found at: bupa.com.au/corporate-info

Go to bupa.com.au/fundrules to see our fund rules.

To find out more about what the Australian Government Rebate on private health insurance means for you, visit: bupa.com.au/rebate

Bupa health cover made easy

For more information134 135


Visit a Bupa store

Corporate Insurance - Bupa · 2020-03-03 · Health Insurance explained 1. More control if you need...

Documents

Transcript of Corporate Insurance - Bupa · 2020-03-03 · Health Insurance explained 1. More control if you need...