Effective 1 July 2019 What you need to know at a glance · Brain and nervous system P P P O Eye...

What you need to know at a glanceFor hospital staff and providers only

Bupa Hospital CoversEffective 1 July 2019

The Australian Government introduced reforms to private health insurance to hospital policies with the aim of making them easier to understand.

1 July 2019 changes for Bupa hospital coversPrivate hospital cover will be classified in four easy to understand tiers, these being; gold, silver, bronze and basic, which will include the use of standard clinical definitions or categories, with the aim to make inclusions and exclusions for treatments easier to identify.

The Australian Government published the table below to display minimum requirements of standard clinical categories to be offered within each tier for hospital treatment products.

Where Bupa has chosen to provide more than the minimum requirements as set by the Australian Government you will see a “Plus” in the title of the hospital product, this product may be an on sale, off sale, domestic or corporate product.

Please note, for Visitors Hospital Covers, Working and Non-Working products, there may be slight variations to some of the standard clinical definitions or categories. Additional categories may also apply. The four tiers do not apply to these covers.

To learn more about the Private Health Insurance reforms, visit bupa.com.au/reforms

Australian Government: private health insurance reforms

What does optional cover mean?Optional: A health insurer may choose to offer this on a restricted or unrestricted level of coverage.

Clinical categories Gold Silver Bronze Basic

Rehabilitation P R R RHospital psychiatric services P R R RPalliative care P R R RBrain and nervous system P P P OEye (not cataracts) P P P OEar, nose and throat P P P OTonsils, adenoids and grommets P P P OBone, joint and muscle P P P OJoint reconstructions P P P OKidney and bladder P P P OMale reproductive system P P P ODigestive system P P P OHernia and appendix P P P OGastrointestinal endoscopy P P P OGynaecology P P P OMiscarriage and termination of pregnancy P P P OChemotherapy, radiotherapy and immunotherapy for cancer P P P OPain management P P P OSkin P P P OBreast surgery (medically necessary) P P P ODiabetes management (excluding insulin pumps) P P P OHeart and vascular system P P OLung and chest P P OBlood P P OBack, neck and spine P P OPlastic and reconstructive surgery (medically necessary) P P ODental surgery P P OPodiatric surgery (provided by a registered podiatric surgeon)# P P OImplantation of hearing devices P P OCataracts P OJoint replacements P ODialysis for chronic kidney failure P OPregnancy and birth P OAssisted reproductive services P OWeight loss surgery P OInsulin pumps P OPain management with device P OSleep studies P O

If there is a blank cell in the table this indicates that the clinical category is not a minimum requirement for that given tier. Please refer to each individual product to see if Bupa has included the clinical category within a “Plus” product.

Key: R = Restricted O = Optional #Limited hospital accommodation and approved prostheses benefits only.

32

This guide is for the use of hospital staff and providers only and does not contain all product information. Detailed product information can be found at:

www.bupa.com.au/retail-info for retail information

www.bupa.com.au/corporate-info for corporate hospital covers

www.bupa.com.au/visitors-info for visitors hospital covers

www.bupa.com.au/oshc-info for student hospital covers

Please note there is some important changes to this document including:

• Other arrangements — Bupa Australia administers overseas visitors cover and overseas student health cover insurance products issued by other entities for, respectively, overseas visitors and overseas students. Where Bupa has negotiated a Hospital Agreement with a Hospital Provider, the benefits are applicable to such persons.

Please also note this guide is subject to change without notice.

Private health insurance reforms 3

Retail hospital covers at a glance 8

Corporate hospital covers at a glance 23

Visitors hospital covers at a glance 28

Bupa membership cards 35

Bupa global membership cards 36

Pre-authorisation hospital checks for Bupa global members 37

Contents

4 5

Product summary

Retail Hospital CoversOld hospital product name Hospital product name as at 1 July 2019 Tier Page

Active Saver Active Saver - Basic Plus Basic+ 8

Advantage Hospital $750 Excess Advantage Hospital $750 Excess - Gold Gold 9

Lite Hospital $250, $500 or $750 Excess

Lite Hospital $250, $500 or $750 Excess - Bronze Plus Bronze+ 9

Budget Family $250, $500 or $750 Excess

Budget Family $250, $500 or $750 Excess - Silver Plus Silver+ 10

Mid Hospital $250, $500 or $750 Excess

Mid Hospital $250, $500 or $750 Excess - Silver Plus Silver+ 10

Budget Hospital $750 Excess Budget Hospital $750 Excess - Bronze Plus Bronze+ 11

Choices 70, 80 and 90 Choices 70, 80 and 90 - Basic Plus Basic+ 11

Established Family $250, $500 or $750 Excess

Established Family $250, $500 or $750 Excess - Silver Plus Silver+ 12

FamilyFirst with $250, $500 or $750 Excess

FamilyFirst $250, $500 or $750 Excess - Gold Gold 12

Growing Family with $250, $500 or $750 Excess

Growing Family $250, $500 or $750 Excess - Silver Plus Silver+ 13

HealthSmart 80 $250, $500 or $750 Excess

HealthSmart 80 $250, $500 or $750 Excess - Gold Gold 13

HealthSmart 70 $250, $500 or $750 Excess

HealthSmart 70 $250, $500 or $750 Excess - Gold Gold 14

HealthSmart $250, $500 or $750 Excess

HealthSmart $250, $500 or $750 Excess - Silver Plus Silver+ 14

Top Hospital Cover with Excess Bonus

Top Hospital Cover with Excess Bonus - Gold Gold 15

Hospital Cover with Excess Hospital Cover with Excess - Gold Gold 15

Hospital Economy Cover Hospital Economy Cover - Gold Gold 16

Old hospital product name Hospital product name as at 1 July 2019 Tier Page

Hospital Economy Cover with Excess Bonus

Hospital Economy Cover with Excess Bonus - Gold Gold 16

Prime $250, $500 or $750 Excess

Prime Nil, $250, $500 or $750 Excess - Silver Plus Silver+ 17

Simple Start Simple Start - Basic Plus Basic+ 17

Singles Choice Saver Singles Choice Saver - Basic Plus Basic+ 18

Standard Hospital with $250 or $500 Excess

Standard Hospital with $250, $500 or $750 Excess - Silver Plus Silver+ 18

Start ‘n Save Start ‘n Save - Gold Gold 19

Top Hospital No Pregnancy $250, $500 or $750 excess

Top Hospital No Pregnancy NIl, $250, $500 or $750 excess - Silver Plus Silver+ 19

Top Hospital Cover Top Hospital Cover - Gold Gold 20

Top Hospital Cover with co-payment

Top Hospital Cover with co-payment - Gold Gold 20

Top Hospital $250 or $500 Excess

Top Hospital $250 or $500 Excess - Gold Gold 20

Top Hospital with Pregnancy Top Hospital with Pregnancy - Gold Gold 20

Top Hospital with Pregnancy $250, $500 or $750 excess

Top Hospital with Pregnancy $250, $500 or $750 excess - Gold Gold 20

Ultimate Health Cover Ultimate Health Cover - Gold Gold 21

Young Singles / Couples ChoiceYoung Singles / Couples Choice - Bronze Plus Bronze+ 21

Young Singles / Couple SaverYoung Singles / Couple Saver - Basic Plus Basic+ 22

Disclaimer for Retail Hospital Covers at a glance 22

Visitors Hospital Covers: Working VisaHospital product name Page

Classic Visitors Cover 32

Essential Visitors Cover / Essential 50 Visitors Cover 33

Premium 90 Visitors Cover 33

Premium 90 Visitors Cover $500 excess 33

Premium Visitors Cover 33

Premium Visitors Cover $500 excess 33

Ultimate Corporate Visitors Cover 34

Disclaimer for Visitors Hospital Covers: Working Visa 34

Note: This guide is for the use of hospital staff and providers only and does not contain all product information. Please also note this guide is subject to change without notice.

Old hospital product name Hospital product name as at 1 July 2019 Tier Page

Corporate Hospital Cover Level 1, 2, 3 or 4

Corporate Hospital Cover Level 1, 2, 3 or 4 - Gold Gold 23

Corporate Hospital Intermediate Level 1, 2 or 3

Corporate Hospital Intermediate Level 1, 2 or 3 - Silver Plus Silver+ 24

Corporate Hospital Saver Level 1, 2 or 3

Corporate Hospital Saver Level 1, 2 or 3 - Silver Plus Silver+ 24

Corporate Hospital Top Level 1, 2 or 3

Corporate Hospital Top Level 1, 2 or 3 - Gold Gold 25

HealthLink Advantage / Classic / Essentials $250, $500 or $750 Excess

HealthLink Advantage / Classic / Essentials $250, $500 or $750 Excess - Gold

Gold 25

HealthLink Hospital HealthLink Hospital - Gold Gold 26

HealthLink Hospital $250, $500 or $750 Excess

HealthLink Hospital $250, $500 or $750 Excess - Gold Gold 26

Mining and Resources Health Cover Level 1 or 2

Mining and Resources Health Cover Level 1 or 2 - Gold Gold 26

Ultimate Corporate Health Cover Ultimate Corporate Health Cover - Gold Gold 27

Disclaimer for Corporate Hospital Covers 27

Visitors Hospital Covers: Non-Working VisaHospital product name Page

Advantage Visitors Cover 28

Guardian 60 Visitors Cover 29

Mid Visitors Cover 29

Overseas Student Health Cover/ Advantage Overseas Student Health Cover 30

Short Stay Visitors Cover 30

Standard Visitors Cover/ Standard 50 Visitors Cover 31

Disclaimer for Visitors Hospital Covers: Non-Working Visa 31

6 7

Corporate Hospital Covers

98 Refer to page 22 for disclaimers

Active Saver - Basic Plus

On Sale Product

Hospital Cover

Members First & Network Hospitals: Cover for hospital accommodation (including private room) and theatre fees — only for accidents requiring urgent medical attention and the services included below. All other services that are not excluded receive Minimum Benefits for shared room accommodation.

Public Hospitals: For Accidents requiring urgent medical attention and the services listed below. Minimum benefits for shared room accommodation as set by the Australian Government plus a fixed add on benefit for an overnight private room** for included services. Nil benefit for excluded services.

Inclusions applying to Private and Public Hospitals:• Joint reconstructions

• Tonsils, adenoids and grommets

• Hernia and appendix

• Gynaecology

• Miscarriage and termination of pregnancy

• Dental surgery

Excess

N/A

Co-payment

$100 a day (including overnight and day services in private and public hospitals), up to a maximum of $500 per hospital stay.

The co-payment does not apply on admissions for services with a minimum benefit and for approved private hospital ambulatory/ day programs.

Shared Room Minimum Benefits (Also known as ‘restricted cover’)

For the duration of this cover:

• Hospital psychiatric services

• Rehabilitation

• Palliative care

• Podiatric surgery (provided by an accredited podiatric surgeon)

Exclusions (No benefits apply)


• Procedures not recognised by Medicare or not approved by the Medical Services Advisory Committee and experimental treatment

• Everything that is not an included or a minimum benefit service is excluded.

• All cosmetic surgery

Additional Inclusions - Clincal categories covered in addition to minimum requirements for this tier

• Joint reconstructions



• Gynaecology


• Dental surgery

Waiting Periods

• 2 month initial, Palliative care, Hospital psychiatric services and Rehabilitation

• 12 months pre-existing condition

• No waiting period for accidents sustained after joining (provided admission is within 180 days of the accident and that treatment was initially sought within 72 hours of the accident)

Advantage Hospital $750 Excess - Gold Lite Hospital $250, $500 or $750 Excess - Bronze Plus

Off Sale Product On Sale Product

Hospital Cover

Members First & Network Hospitals: Cover for hospital accommodation (including private room) and theatre fees except for Minimum Benefit and excluded services.Public Hospitals: Minimum benefit for shared room accommodation as set by the Australian Government plus a fixed add on benefit for an overnight private room** for included services.

Members First & Network Hospitals: Cover for hospital accommodation (including private room) and theatre fees for accidents requiring urgent medical attention and services that are not Minimum Benefit or excluded services.

Public Hospitals: Minimum benefits for shared room accommodation as set by the Australian Government plus a fixed add on benefit for an overnight private room** for included services. Nil benefit for excluded services.

Excess

$750 per hospital admission (including overnight and day services in private and public hospitals).Capped each calendar year at once per adult when amount has been met in full.The excess does not apply to any child dependants up to the age of 25 covered on the membership. The excess does not apply on admissions for services with a minimum benefit and for approved private hospital ambulatory/ day programs.

$250, $500 or $750 per hospital admission (including overnight and day services in private and public hospitals).Capped each calendar year at once per adult, twice per couples or family membership when amount has been met in full.The excess does not apply to any child dependants up to the age of 25 covered on the membership.The excess does not apply on admissions for services with a minimum benefit and for approved private hospital ambulatory/ day programs.

Co-payment

N/A N/A


For the duration of this cover:• Podiatric surgery

(provided by an accredited podiatric surgeon)

For the duration of this cover:• Hospital psychiatric services• Rehabilitation• Palliative care• Podiatric surgery (provided by an accredited podiatric surgeon)


For the duration of this cover:• Procedures not recognised by Medicare or not approved by

the Medical Services Advisory Committee and experimental treatment


For the duration of this cover:• Heart and vascular system• Back, neck and spine• Cataracts• Joint replacements• Dialysis for chronic kidney failure• Pregnancy and birth• Assisted reproductive services• Weight loss surgery• Procedures not recognised by Medicare or not approved by




The following services are included in addition to those in the Bronze tier for the duration of this cover: • Lung and chest• Blood• Plastic and reconstructive surgery (medically necessary)• Dental surgery• Implantation of hearing device• Insulin pumps• Pain management with device• Sleep studies

Waiting Periods



• 12 months Pregnancy and birth





Retail Hospital covers at a glance

10 11Refer to page 22 for disclaimers

Budget Family $250, $500 or $750 Excess - Silver Plus

Mid Hospital $250, $500 or $750 Excess - Silver Plus

On Sale Product On Sale Product

Hospital Cover

Members First & Network Hospitals: Cover for hospital accommodation (including private room) and theatre fees for services that are not Minimum Benefit or excluded services.

Public Hospitals: Minimum benefits for shared room accommodation as set by the Australian Government plus a fixed add on benefit for an overnight private room** for included services. Nil benefit for excluded services



Excess

$250, $500 or $750 per hospital admission (including overnight and day services in private and public hospitals).

Capped each calendar year at once per adult when amount has been met in full.

The excess does not apply to any child dependants up to the age of 25 covered on the membership.

The excess does not apply on admissions for services with a minimum benefit and for approved private hospital ambulatory/day programs.


Capped each calendar year at once per person, twice per couples or family membership when amount has been met in full.

The excess does not apply to:

• Admissions for services with a minimum benefit

• For approved private hospital ambulatory/day programs

• For admissions of child dependants up to age 25 covered on the membership.

Co-payment

N/A N/A











• Cataracts

• Joint replacements

• Dialysis for chronic kidney failure

• Pregnancy and birth

• Assisted reproductive services

• Weight loss surgery




• Cataracts








The following services are included in addition to those in the Silver tier for the duration of this cover:

• Insulin pumps

• Pain management with device

• Sleep studies


• Insulin pumps


• Sleep studies

Waiting Periods







Budget Hospital $750 Excess - Bronze Plus

Choices 70, 80 and 90 $250 Excess - Basic Plus

Off Sale Product Off Sale Product

Hospital Cover

Members First & Network Hospitals: Cover for hospital accommodation (including private room) and theatre fees for services that are not Minimum Benefit or excluded services.Public Hospitals: Minimum benefits for shared room accommodation as set by the Australian Government plus a fixed add on benefit for an overnight private room** for included services. Nil benefit for excluded services.

Members First & Network Hospitals: Cover for hospital accommodation (including private room) and theatre fees — only for accidents requiring urgent medical attention and the services included below. All other services that are not excluded receive Minimum Benefits for shared room accommodation.Public Hospitals: For Accidents requiring urgent medical attention and the services listed below. Minimum benefits for shared room accommodation as set by the Australian Government plus a fixed add on benefit for an overnight private room** for included services. Nil benefit for excluded servicesInclusions applying to Private and Public Hospitals:• Accidents sustained after joining• Joint reconstructions• Tonsils, adenoids and grommets• Hernia and appendix• Dental surgery

Excess

$750 per hospital admission (including overnight and day services in private and public hospitals).Capped each calendar year at once per person, twice per couples or family membership when amount has been met in full.The excess does not apply on admissions for services with a minimum benefit and for approved private hospital ambulatory/day programs.

$250 per hospital admission (including overnight and day services in private and public hospitals).Capped each calendar year at once per person, twice per couples membership when amount has been met in full.The excess does not apply on admissions for services with a minimum benefit and for approved private hospital ambulatory/day programs.

Co-payment

N/A N/A


For the duration of this cover:• Hospital psychiatric services• Podiatric surgery (provided by an accredited podiatric surgeon)

• Hospital psychiatric services• Rehabilitation• Palliative care• Podiatric surgery (provided by an accredited podiatric surgeon)


For the duration of this cover:• Heart and vascular system• Back neck and spine• Cataracts• Joint replacements• Dialysis for chronic kidney failure• Pregnancy and birth• Assisted reproductive services• Weight loss surgery• Procedures not recognised by Medicare or not approved by the

Medical Services Advisory Committee and experimental treatment• All cosmetic surgery

Everything that is not an included or a minimum benefit service is excluded.


The following services are included in addition to those in the Bronze tier for the duration of this cover:• Lung and chest

• Blood

• Plastic and reconstructive surgery (medically necessary)

• Dental surgery

• Implantation of hearing device

• Insulin pumps


• Sleep studies

• Joint reconstructions• Tonsils, adenoids and grommets• Hernia and appendix• Dental surgery

Waiting Periods• 2 month initial, Palliative care, Hospital psychiatric services and

Rehabilitation• 12 months pre-existing condition• No waiting period for accidents sustained after joining (provided

admission is within 180 days of the accident and that treatment was initially sought within 72 hours of the accident)


• 12 months pre-existing condition• No waiting period for accidents sustained after joining (provided


Retail Hospital covers at a glance - Effective 1 July 2019


Established Family $250, $500 or $750 Excess - Silver Plus

FamilyFirst $250, $500 or $750 Excess - Gold

On Sale Product Off Sale Product

Hospital Cover



Members First & Network Hospitals: Cover for hospital accommodation (including private room) and theatre fees except for Minimum Benefit and excluded services.


Excess

$250, $500 or $750 excess per hospital admission (including overnight and day services in private and public hospitals).



The excess does not apply on admissions for services with a minimum benefit and for approved private hospital ambulatory/ day programs.





Co-payment

N/A $50 a day (including overnight and day services in private and public hospitals), up to a maximum of $250 per hospital stay.

A co-payment does not apply to any child dependants covered on the membership. The co-payment does not apply on admissions for services with a minimum benefit and for approved private hospital ambulatory/day programs.









• Cataracts












• Insulin pumps


• Sleep studies

Waiting Periods








Growing Family $250, $500 or $750 Excess - Silver Plus

HealthSmart 80 $250, $500 or $750 Excess - Gold


Hospital Cover





Excess






Capped each calendar year at once per person, twice per couple or family membership when amount has been met in full.


Co-payment

N/A $50 a day (including overnight and day services in private and public hospitals), up to a maximum of $250 per hospital stay.










• Cataracts







Additional Inclusions - Clinical categories covered in addition to minimum requirements for this tier





• Insulin pumps


• Sleep studies

Waiting Periods











HealthSmart 70 $250, $500 or $750 Excess - Gold

HealthSmart $250, $500 or $750 Excess - Silver Plus


Hospital Cover





Excess


Capped each calendar year at once per person, twice per couple or family membership when amount has been met in full.


$250, $500, or $750 per hospital admission (including overnight and day services in private and public hospitals).

Capped each calendar year at once per person, twice per couples membership when amount is met in full.


Co-payment

N/A N/A


















• Cataracts



• Insulin pumps


• Sleep studies

Waiting Periods








Top Hospital Cover with Excess Bonus - Gold Hospital Cover with Excess - Gold


Hospital Cover





Excess

$200 per hospital admission (including overnight and day services in private and public hospitals).

Capped each calendar year at once per adult when amount is met in full.



Excess Bonus Dollars: Existing dollar amounts under the previous Excess Bonus dollar scheme may be used towards excess.





Co-payment

N/A N/A













Waiting Periods











Hospital Economy Cover - Gold Hospital Economy Cover with Excess Bonus - Gold


Hospital Cover





Excess









Excess Bonus Dollars: Existing dollar amounts under the previous Excess Bonus dollar scheme may be used towards any excess.

Co-payment


The co-payment will not apply to any child dependent covered on the membership.


N/A













Waiting Periods









Prime $250, $500 or $750 Excess - Silver Plus Simple Start - Basic Plus


Hospital Cover



Members First & Network Hospitals: Cover for hospital accommodation (including private room) and theatre fees — only for accidents requiring urgent medical attention and the services included below. All other services that are not excluded receive Minimum Benefits for shared room accommodation.Public Hospitals: For Accidents requiring urgent medical attention and the services listed below. Minimum benefits for shared room accommodation as set by the Australian Government plus a fixed add on benefit for an overnight private room** for included services. Nil benefit for excluded servicesInclusions applying to Private and Public Hospitals:• Tonsils, adenoids and grommets



• Gynaecology


• Dental surgery

Excess

$250,$500 or $750 options. Applies per hospital admission including overnight and day services in private and public hospitals.Capped each calendar year at once per person, twice per couples membership when amount has been paid in full.The excess does not apply on admissions for services with a minimum benefit and for approved private hospital ambulatory/ day programs.

$500 per hospital admission (including overnight and day services in private and public hospitals).Capped each calendar year at once per adult when amount has been met in full.The excess does not apply on admissions for services with a minimum benefit and for approved private hospital ambulatory/ day programs.

Co-payment

N/A N/A


For the duration of this cover:• Podiatric surgery (provided by an accredited podiatric surgeon)





• Pregnancy and birth• Assisted reproductive services• Weight loss surgery• All cosmetic surgery





The following services are included in addition to those in the Silver tier for the duration of this cover: • Cataracts



• Insulin pumps


• Sleep studies

The following services are included in addition to those in the Basic tier for the duration of this cover:• Tonsils, adenoids and grommets



• Gynaecology


• Dental surgery

Waiting Periods









Singles Choice Saver - Basic Plus Standard Hospital $250, $500 or $750 Excess - Silver Plus


Hospital Cover

Members First & Network Hospitals: Cover for hospital accommodation (including private room) and theatre fees — only for accidents requiring urgent medical attention and the services included below. All other services that are not excluded receive Minimum Benefits for shared room accommodation.Public Hospitals: For Accidents requiring urgent medical attention and the services listed below. Minimum benefits for shared room accommodation as set by the Australian Government plus a fixed add on benefit for an overnight private room** for included services. Nil benefit for excluded services.Inclusions applying to Private and Public Hospitals:• Tonsils, adenoids and grommets • Joint reconstructions • Hernia and appendix • Gynaecology • Miscarriage and termination of pregnancy • Dental surgery

Members First & Network Hospitals: Cover for hospital accommodation (including private room) and theatre feesfor services that are not Minimum Benefit or excluded services.Public Hospitals: Minimum benefits for shared room accommodation as set by the Australian Government plus a fixed add on benefit for an overnight private room** for included services. Nil benefit for excluded services.

Excess

N/A $250, $500 or $750 per hospital admission (including overnight and day services in private and public hospitals).


For $250 or $500 Excess covers the excess does not apply to any child dependants covered on the membership.


Co-payment

N/A N/A







For the duration of this cover:• Procedures not recognised by Medicare or not approved by the

Medical Services Advisory Committee and experimental treatment• Cataracts• Joint replacements• Dialysis for chronic kidney failure• Assisted reproductive services• All cosmetic surgery


The following services are included in addition to those in the Basic tier for the duration of this cover • Tonsils, adenoids and grommets



• Gynaecology


• Dental surgery

The following services are included in addition to those in the Silver tier for the duration of this cover: • Pregnancy and birth • Weight loss surgery

• Insulin pumps


• Sleep studies

Waiting Periods





• 12 months pre-existing condition• 12 months Pregnancy and birth• No waiting period for accidents sustained after joining (provided


Start ‘n Save $500 Excess - Gold

Top Hospital No Pregnancy Nil, $250, $500 or $750 Excess - Silver Plus

Off Sale Product On Sale Product

Hospital Cover


Public Hospitals: Minimum benefit for shared room accommodation as set by the Australian Government. Private room** add on benefit not applicable for minimum benefit services. Nil benefit for excluded services.


Public Hospitals: Minimum benefit for shared room accommodation as set by the Australian Government. All other services that are not excluded receive shared room minimum benefits. Nil benefit for excluded services.

Excess





Excess Bonus Dollars: Existing dollar amounts under the previous Excess Bonus dollar scheme may be used towards any additional excess.

For the excess options: Nil, $250, $500 or $750 per hospital admission (including overnight and day services in private and public hospitals).




Co-payment


The co-payment does not apply to any child dependant on the membership.

The co-payment does not apply on admissions for services with a minimum benefit and for approved private hospital ambulatory/day programs.

N/A










For the duration of this cover:• Pregnancy and birth• Assisted reproductive services• Weight loss surgery• Procedures not recognised by Medicare or not approved by the

Medical Services Advisory Committee and experimental treatment• All cosmetic surgery


The following services are included in addition to those in the Silver tier for the duration of this cover: • Cataracts



• Insulin pumps


• Sleep studies

Waiting Periods


• 12 months pre-existing condition• 12 months Pregnancy and birth• No waiting period for accidents sustained after joining (provided







Top Hospital Cover Nil, $250 & $500 Excess - Gold Top Hospital Cover with co-payment - Gold

Top Hospital with Pregnancy Nil, $250, $500 or $750 Excess - Gold

Off Sale Products On Sale Product

Hospital Cover





This product includes uncapped Emergency Ambulance.

Excess

For the excess options: Nil, $250 or $500 per hospital admission (including overnight and day services in private and public hospitals).




For the excess options: Nil, $250, $500 or $750 per hospital admission (including overnight and day services in private and public hospitals).



The excess does not apply on admissions for services with a Minimum benefit and for approved private hospital ambulatory/ day programs.

Co-payment

For the co-payment option: no excess applies, a $50 a day (including overnight and same day services in private and public hospitals), up to a maximum of $250 per hospital stay.

The co-payment does not apply to child dependants on the membership.


N/A













Waiting Periods









Ultimate Health Cover - Gold Young Singles / Couples Choice - Bronze Plus


Hospital Cover

Members First & Network Hospitals: Cover for hospital accommodation (including private room) and theatre fees except for Minimum Benefit and excluded services.Ultimate Health Cover members charged a fixed daily fee by any of our contracted fixed fee hospitals will be reimbursed or have the fee paid directly to the hospital.Public Hospitals: Minimum benefits for shared room accommodation as set by the Australian Government plus a fixed add on benefit for an overnight private room** for included services. Nil benefit for excluded services. In addition, this product covers laser eye correction procedures used to adjust the eyeball to correct sight (excludes laser eye procedures involving lens implants). Only available at Bupa approved centres.

Members First & Network Hospitals: Cover for hospital accommodation (including private room) and theatre fees for services that are not Minimum Benefit or excluded services. Public Hospitals: Minimum benefits for shared room accommodation as set by the Australian Government plus a fixed add on benefit for an overnight private room** for included services. Nil benefit for excluded services

Excess

N/A N/A

Co-payment

$50 a day (including overnight and day services in private and public hospitals), up to a maximum of $250 per hospital stay. The co-payment does not apply to admissions for services with a minimum benefit, and for approved private hospital ambulatory/day programs.



For the duration of this cover:• Hospital psychiatric services• Rehabilitation• Podiatric surgery (provided by an accredited podiatric surgeon)





For the duration of this cover:• Procedures not recognised by Medicare or not approved by the

Medical Services Advisory Committee and experimental treatment• Heart and vascular system• Back, neck and spine• Cataracts• Joint replacements • Dialysis for chronic kidney failure• Pregnancy and birth• Assisted reproductive services• Weight loss surgery • All cosmetic surgery


The following services are included in addition to those in the Bronze tier for the duration of this cover: • Lung and chest

• Blood

• Plastic and reconstructive surgery (medically necessary)

• Dental surgery

• Implantation of hearing device

• Insulin pumps


• Sleep studies

Waiting Periods


• 12 months pre-existing condition• 12 months Pregnancy and birth• 36 month laser eye correction for a pre-existing condition

(excludes lens implant for eye correct)***• No waiting period for accidents sustained after joining (provided






22 23

This guide is for the use of hospital staff and providers only and does not contain all product information. Please also note this guide is subject to change without notice.

Please note some companies cover the cost of the excess on behalf of their employees on selected corporate covers. In this situation, we will confirm to you if the excess should be charged when you conduct an eligibility check.

Corporate Hospital covers at a glance

Corporate Hospital Cover Level 1, 2, 3 or 4 - Gold

On Sale Product

Hospital Cover



Excess

• Level 1 – Nil Excess

• Level 2 – $250 per hospital admission for adults


• Level 4 - $750 per hospital admission for adults

Excess payable including overnight and day services in private and public hospitals.



Co-payment

N/A








Waiting Periods



• 12 months pregnancy and birth


Young Singles / Couples Saver - Basic Plus

On Sale Product

Hospital Cover

Members First & Network Hospitals: Cover for hospital accommodation (including private room) and theatre fees — only for accidents requiring urgent medical attention and the services included below. All other services that are not excluded receive Minimum Benefits for shared room accommodation.

Public Hospitals: For Accidents requiring urgent medical attention and the services listed below. Minimum benefits for shared room accommodation as set by the Australian Government plus a fixed add on benefit for an overnight private room** for included services. Nil benefit for excluded services.

Inclusions applying to Private and Public Hospitals:• Tonsils, adenoids and grommets



• Gynaecology


• Dental surgery

Excess

N/A

Co-payment


The co-payment does not apply on admissions for services with a minimum benefit, and for approved private hospital ambulatory/day programs.




• Rehabilitation

• Palliative care





• Everything that is not an included or minimum benefit service is excluded.



The following services are included in addition to those in the Basic tier for the duration of this cover:




• Gynaecology


• Dental surgery

Waiting Periods




Disclaimers:

Bupa Medical Gap Scheme benefits only apply to overnight or same day patients who are admitted in Private Hospitals with which Bupa has an agreement or Public Hospitals. More information is available at bupa.com.au/for-providers/bupa-medical-gap-scheme

Excess applies to inpatients only.

Please note there is a small number of Network hospitals that may charge a fixed daily fee for some services.

This fixed daily fee is capped at a maximum number of days for inpatient stays but is uncapped for day programs.

Surgically implanted prostheses up to the approved benefit in the Australian Government’s Prostheses List.

A small number of non-PBS drugs are not covered — contact Bupa pharmacy advisor [email protected]

Minimum benefits for same day psychiatric/rehabilitation services in a private hospital are only payable where Type C requirements are met, or where a specific contracted psychiatric/rehabilitation benefit exists.

**The definition of “Private Room” applying from 1 June 2017 means, for the purposes of a private room in a public hospital, a room in a hospital which: is purpose built and suitable for no-one other than a single admitted adult patient; holds one single sized bed; and has a dedicated ensuite.

***12 month waiting period for laser eye correction surgery applied to members who joined before 1 July 2018. For all members who joined on or after 1 July 2018 a 36 month waiting period will apply for laser eye correction surgery. (Excludes lens implants for eye correction).

Refer to page 27 for disclaimers



Corporate Hospital Intermediate Level 1, 2 or 3 - Silver Plus

Corporate Hospital Saver Level 1, 2 or 3 - Silver Plus


Hospital Cover





Excess









• Level 2 – $250 per hospital admission

• Level 3 – $500 per hospital admission




Co-payment

N/A N/A










• Cataracts






• Cataracts











• Insulin pumps


• Sleep studies



• Insulin pumps


• Sleep studies

Waiting Periods








Corporate Hospital Top Level 1, 2 or 3 - Gold

HealthLink Advantage / Classic / Essentials Nil, $250, $500 or $750 Excess - Gold

Off Sale Product Off Sale Products

Hospital Cover





Excess





Capped each calendar year at once per adult when amount has been met in full. The excess does not apply to any child dependants up to the age of 25 covered on the membership.


Nil, $250, $500 or $750 capped at once per person, twice per membership per calendar year when amount has been met in full.


The excess does not apply to any child dependants up to the age of 25 covered on HealthLink Advantage only.


Co-payment

N/A N/A













Waiting Periods









Corporate Hospital covers at a glance - Effective 1 July 2019


HealthLink Hospital Nil, $250, $500 or $750 Excess - Gold

Mining and Resources Health Cover Level 1 or 2 - Gold


Hospital Cover





Excess

Nil, $250, $500, or $750 capped at once per person, twice per membership per calendar year when amount has been met in full.









Co-payment

N/A N/A













Waiting Periods









Ultimate Corporate Health Cover - Gold

Off Sale Product

Hospital Cover


Ultimate Corporate Health Cover members charged a fixed daily fee by any of our contracted fixed fee hospitals will be reimbursed or have the fee paid directly to the hospital.


In addition, this product covers laser eye correction procedures used to adjust the eyeball to correct sight (excludes laser eye procedures involving lens implants). Only available at Bupa approved centres.

Excess

N/A

Co-payment

N/A








Waiting Periods




• 36 months laser eye correction for a pre-existing condition (excludes lens implant for eye correction)***


Disclaimers for Corporate Covers:







**The definition of “Private Room” applying from 1 June 2017 means, for the purposes of a private room in a public hospital, a room in a hospital which: is purpose built and suitable for no-one other than a single admitted adult patient; holds one single sized bed; and has a dedicated ensuite.

***12 month waiting period for laser eye correction surgery applied to members who joined before 1 July 2018.For all members who joined on or after 1 July 2018 a 36 month waiting period will apply for laser eye correction surgery. (Excludes lens implants for eye correction).

Corporate Hospital covers at a glance - Effective 1 July 2019


Advantage Visitors Cover

Off Sale Product

Hospital Cover


Public Hospitals: Cover for hospital accommodation. For Minimum Benefit services, reduced amount equivalent to shared room benefit for Australian resident. Nil benefit for excluded services.

Excess

N/A

Co-payment

N/A


For the period specified:

• 2 years - Cataracts

• 2 years - Joint replacements (Hip and Knee)








Waiting Periods



Medical Cover

Up to 100% of MBS fee for inpatient services.

Up to 100% of MBS fee as a hospital out-patient or by a doctor or specialist in private practice anywhere in Australia.

Guardian 60 Visitors Cover Mid Visitors Cover


Hospital Cover


Public Hospitals: Cover for hospital accommodation. Shared room accommodation only for Minimum Benefit services. Nil benefit for excluded services.

Members First & Network Hospitals: Minimum Benefits for shared room accommodation as set by the Australian Government.


Excess


Capped each calendar year at once per adult, when amount has been met in full. The excess does not apply to any child dependants up to the age of 25 covered on the membership.


N/A

Co-payment

N/A N/A




For the first 6 months:

• Heart and vascular systems

• Joint replacements (Hip and Knee)

• Cataracts







• Assisted reproductive services• Organ transplants• Bone marrow transfusion or transplant• All cosmetic surgery

For the duration of this cover:• Assisted reproductive services• Cataracts• Joint replacements (Hip and Knee)• Procedures not recognised by Medicare or not approved by


• Plastic and reconstructive surgery (medically necessary) • All cosmetic surgery

Waiting Periods

• 2 months Hospital psychiatric services• 2 months Rehabilitation• 2 months Palliative care• 12 months pre-existing conditions except for Hospital Psychiatric

services, rehabilitation and palliative care related conditions• 12 months Pregnancy and birth



• 12 months Hospital psychiatric services

• 12 months Rehabilitation

Medical Cover


Up to 100% of MBS fee as a hospital outpatient or by a doctor or specialist in private practice anywhere in Australia.

Up to 100% of AMA Schedule fee for inpatient services.



Visitors Hospital Covers: Non-Working Visa at a glance

30 31Refer to page 31 for disclaimers Refer to page 31 for disclaimers

Standard Visitors Cover / Standard 50 Visitors Cover

On Sale Product

Hospital Cover



Excess

N/A

Co-payment

N/A



• Heart and vascular system



For the duration of this cover:• Pregnancy and birth• Assisted reproductive services• Cataracts• Joint replacements (Hip and Knee)• Dialysis for chronic kidney failure• Procedures not recognised by Medicare or not approved by


• Plastic and reconstructive surgery (medically necessary)• All cosmetic surgery

Waiting Periods

• 12 months pre-existing condition• 12 months Hospital psychiatric services • 12 months Rehabilitation

Medical Cover



Overseas Student Health Cover / Advantage Overseas Student Health Cover

Short Stay Visitors Cover


Hospital Cover


Public Hospitals: Cover for hospital accommodation. Shared room accommodation only for Minimum Benefit services. Nil Benefit for excluded services.



Excess

N/A $250 per hospital admission (including overnight and day services in private and public hospitals).

Capped each calendar year at once per adult, when amount has been met in full.


Co-payment

N/A N/A







For the duration of this cover• Assisted reproductive services • Procedures not recognised by Medicare or not approved by



For the duration of this cover• Assisted reproductive services • All pre-existing ailments, illnesses or conditions• Pregnancy and birth • Cataracts• Joint replacements (Hip and Knee)• Procedures not recognised by Medicare or not approved by


• Plastic and reconstructive surgery (medically necessary) • All cosmetic surgery

Waiting Periods

• 12 months for pre-existing conditions, excluding ailments or illnesses of a psychiatric nature.

• 12 months Pregnancy and birth• Waiting periods don’t apply when you have a condition which is

defined under the Emergency Treatment section of the Important Information Guide at bupa.com.au/oshc-info

• 12 months Hospital psychiatric services

• 12 months Rehabilitation

• 12 months Palliative care

Medical Cover

Up to 100% MBS fee for inpatient services.

Up to 100% MBS fee as an outpatient by a doctor or specialist in private practice anywhere in Australia.

Up to 100% MBS fee for inpatient services.

Up to 100% MBS fee as a hospital outpatient or by a doctor or specialist in private practice anywhere in Australia.

Disclaimers for Non-Working Visa Cover:

Bupa Medical Gap Scheme benefits only apply to overnight or same day patients who are admitted in Private Hospitals with which Bupa has an agreement or Public Hospitals. More information is available at bupa.com.au/for-providers/bupa-medical-gap-scheme.






The definition of “Private Room” applying from 1 June 2017 means, for the purposes of a private room in a public hospital, a room in a hospital which: is purpose built and suitable for no-one other than a single admitted adult patient; and holds one single sized bed.

To claim medical benefits for non residents, the Provider must list the MBS item that would be applicable as though the Policy holder was an Australian resident eligible for Medicare.

Minimum benefits for same day Hospital psychiatric/Rehabilitation services in a private hospital are only payable where Type C require-ments are met, or where a specific contracted psychiatric/rehabilita-tion benefit exists.

Visitors Hospital Covers: Non-Working Visa at a glance - Effective 1 July 2019


Classic Visitors Cover

Off Sale Product

Hospital Cover

Members First & Network Hospitals: Minimum Benefits for shared room accommodation as set by the Australlian Government.


Excess

N/A

Co-payment

N/A









Waiting Periods

• 2 months pre-existing conditions relating to Hospital psychiatric services, Rehabilitation and Palliative care

• 12 months pre-existing conditions except for Hospital psychiatric services, Rehabilitation and Palliative care related conditions


Medical Cover




Essential Visitors Cover / Essential 50 Visitors Cover

Premium Visitors Nil or $500 Excess Cover / Premium 90 Visitors Nil or $500 Excess Cover


Hospital Cover





Excess

N/A Nil excess option or $500 per hospital admission (including overnight and day services in private and public hospitals).

Capped each calendar year at once per adult, when amount has been met in full.



Co-payment

N/A N/A







For the duration of this cover:• Outpatient psychiatric benefits• Assisted reproductive services• Bone marrow transfusion or transplant• Organ transplants• Procedures not recognised by Medicare or not approved by



For the duration of this cover:• Assisted reproductive services• Procedures not recognised by Medicare or not approved by



Waiting Periods


• 12 months pre-existing conditions except for Hospital psychiatric services,Rehabilitation and Palliative care related conditions





Medical Cover






Visitors Hospital Covers: Working Visa at a glance

34 35

Visitors Hospital Covers: Working Visa at a glance - Effective 1 July 2019


The following membership cards should be recognised at your hospital or practice.

If members would like to order a new card they should contact us or log in tomyBupa.com.au

From 2014, Bupa no longer prints the name of the cover on membership cards.If a membership card was issued to a member before this date then their card will have printed on the front their level of cover. If they have been issued or re-issued with a card after this date then their level of cover will not be printed on the front of their card.

Ultimate Corporate Visitors Cover

On Sale Product

Hospital Cover

Members First & Network Hospitals: Cover for hospital accommodation (including private room) and theatre fees for services that are not Minimum Benefit or excluded services.Ultimate Corporate Visitors Cover members will be reimbursed if charged a fixed daily fee by any of our contracted fixed fee hospitals/services or have the fee paid directly to the hospital.


Excess

N/A

Co-payment

N/A





For the duration of this cover:• Assisted reproductive services• Procedures not recognised by Medicare or not approved by



Waiting Periods




Medical Cover

100% of cost for inpatient services.

100% of cost as a hospital outpatient or by a doctor or specialist in private practice anywhere in Australia.

Disclaimers for Working Visa Cover:







The definition of “Private Room” applying from 1 June 2017 means, for the purposes of a private room in a public hospital, a room in a hospital which: is purpose built and suitable for no-one other than a single admitted adult patient; and holds one single sized bed.

To claim medical benefits for non residents, the Provider must list the MBS item that would be applicable as though the Policy holder was an Australian resident eligible for Medicare.

Bupa membership cards

OSHC and OVCBupa membership cardsThe following membership cards should be recognised at your hospital or practice.

36 37

Bupa global membership cardsBupa Global members are covered by Bupa Australia hospital contracts.

Bupa global health insuranceBupa Australia is part of the worldwide health and care specialists, BUPA.Bupa Global provides health insurance to expatriates living and working in other countries, including Australia.

Bupa global membership cards The following membership cards should be recognised at your hospital or practice.

Members with the following cards are covered by Bupa Global:• Bupa Global

• Bupa Global Middle East (BGME)

• Bupa Hong Kong

• Bupa Latin America

• Bupa Thailand

• IHI Bupa

• Max Bupa

• Sanitas (Bupa) Spain

• USA Medical Services Corporation

Bupa Global offers the following products:• Bupa Global Health Plans

• Bupa Global Gold with dental

• Bupa Worldwide Health options

• Corporate bespoke plans

• Company Gold Superior

• IHHP (International Health Hospital Plan)

• ISM (International Swiss Medical)

• Lifeline Classic

• Lifeline Essential

• Lifeline Gold

Bupa Australia administers overseas visitors cover and overseas student heath cover insurance products issued or underwritten by other entities for, respectively, overseas visitors and overseas students. Persons holding valid products are eligible for treatment.

A pre-authorisation hospital check for Bupa Global members is required via fax or email with the form downloaded from the following website:bupa-intl.com/partner/for-providers

Alternatively, you can call the Bupa Global Helpline. Please see below for details.

Contact information for Pre-Authorisation:

Bupa Global

Tel: +44 1273 333911

Fax: +44 1273 866301

Email: [email protected]

ihi Bupa

Tel: +45 33 15 33 00

Fax: +45 33 32 25 60

Email: [email protected]

Note: Helpline operates: 24 / 7 / 365 days a year

For general enquiries to the Provider Services Department, they may be contacted via:[email protected]

If you need to pre-authorise treatment for a member of Bupa Latin America, please contact USA Medical Services on:

Tel: +1 305 275 1500, for USA

Tel: +1 800 726 1203, free of charge from USA

Whenever a patient requires day-case or inpatient treatment, please contact us as per the above with the following information:

• Medical records

• Symptoms

• Diagnosis

• Procedure

• Admission and discharge date

On receipt of the above information, the request will be reviewed, and response given:

• If requested by telephone: immediate response

• If requested by email or fax: response within 72 hours

Please note that in case of an emergency admission always contact the 24 hour helplines.

Hospital Services for Bupa Global Members:Where a Bupa Global member attends a Members First, Network or Day hospital for a service Covered under the Bupa Australia Agreement, the Bupa Global member should be billed under the terms and conditions of the Bupa Australia Agreement.

Hospital Claims for Bupa Global Members should be sent to Hospital Claims, GPO Box 990, Adelaide, SA, 5001.

Pre-authorisation hospital checks for Bupa global members

Bupa membership cards - Effective 1 July 2019

38

Bupa PO Box 14639 Melbourne VIC 3001

Bupa HI Pty Ltd ABN 81 000 057 590

Effective 8 October 2019 10248-010-19

For more information:Hospital useTo ensure a timely response to your enquiry, please contact the correct department for assistance.

Pre-Admission patient eligibility checks:To verify a membership, hospitals can check Bupa Australia entitlement via the online eligibility system through Eclipse. This system is available 24/7.

Membership Checking — eclipse.civica.com.au/ECFWeb

If this system is unavailable due to system issues at Bupa Australia or Medicare, then Emergency checks can be done via telephone to Contact Centre on 134 135(Current hours 8.30am to 5.00pm EST Monday to Friday only).

Post-Admission hospital claims enquiries:Department: Hospital Claims DepartmentFor: Queries regarding a benefit received following hospitalisation

Email: [email protected] Tel: 1300 663 590Hours availability: 8.30am – 5.00pm EST Monday to Friday

Doctors Rooms useFor queries regarding payment of a medical claim please ring: 134 135 (choose the provider option 3, followed by option 3 and another option 3)Email: [email protected]

Effective 1 July 2019 What you need to know at a glance · Brain and nervous system P P P O Eye...

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