THINGS YOU NEED TO KNOW

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THINGS YOU NEED TO KNOW Powered By Docstoc
					IMPORTANT INFORMATION GUIDE

T H I N G S YO U N E E D
TO K N OW
Over the next few pages you will find                We recommend you call us first before making         What is not covered?                                    practitioner for services that form
information to help you understand how               a booking to confirm that your hospital of           Hospital costs                                          part of your in-hospital treatment (e.g.
your health cover with us works. We                  choice gives you certainty of full cover. We can                                                             chiropractors, dieticians or psychologists)
                                                                                                          Situations when you are likely not to be
recommend you keep this information in a             also discuss any excess or co-payment that                                                                 •	 where compensation, damages or
                                                                                                          covered include:
safe place so that you can always refer to it.       may be applicable to your level of cover. You                                                                benefits may be claimed by another
                                                     can find out if a hospital has an agreement with     •	 during a waiting period                              source (e.g. workers compensation)
From time to time, things can change
                                                     us by checking our website bupa.com.au
Before you seek any treatment call us so                                                                  •	 when specific services or treatments are           •	 any treatment or service rendered
we can give you the most complete and                Medical costs                                          excluded or restricted from your level                outside Australia
up-to-date information.                                                                                     of cover
                                                     These are the fees charged by a doctor,                                                                    •	 some non-PBS, high cost drugs.
                                                     surgeon, anaesthetist or other specialist for        •	 when you are treated at a non-agreement
Please be aware that these rules apply in                                                                                                                       Medical costs
                                                     any treatment given to you in hospital. Private        hospital you will not be fully covered
addition to our Fund and Policy Rules.                                                                                                                          You will not be covered for:
                                                     health insurance provides you with the choice        •	 for the fixed fee charged by a fixed
                                                     of your own doctor, and you decide whether             fee hospital                                        •	 medical services for surgical procedures
UNDERSTANDING                                        you will go to a public or a private hospital that
                                                                                                          •	 when you have not been admitted into a               performed by a dentist, surgical podiatrist,
YOUR HOSPITAL COVER                                  your doctor attends. You may also have more                                                                  or any other practitioner or service that is
                                                                                                            hospital and are treated as an outpatient
What is covered?                                     choice as to when you are admitted to hospital.                                                              not eligible for a rebate through Medicare.
                                                                                                            (e.g. emergency room treatment,
Hospital costs                                       You are covered for:                                   outpatient ante-natal consultations with            Inpatient vs outpatient
                                                                                                            an obstetrician prior to child birth)               You are an inpatient if you are admitted
With private hospital cover, you can choose          •	 the cost of these medical treatments up to
to be treated as a private patient in either a                                                            •	 hospital treatment provided by a                   into hospital for either a same-day or
                                                       the Medicare Benefit Schedule (MBS) fee.
public or a private hospital. With us you are                                                               practitioner not authorised by a hospital           overnight admission. If you are admitted as
                                                     The MBS fee is the amount set by the Federal           to provide that treatment                           a private inpatient, you will be covered for
fully covered as a private patient in most
                                                     Government for each medical service covered                                                                the services listed in your chosen level of
Members First and Network hospitals, and                                                                  •	 hospital treatment for which Medicare
                                                     by Medicare. You must be eligible for Medicare                                                             hospital cover. If you receive treatment as
all public hospitals across Australia. A small                                                              pays no benefit, including: medical costs
                                                     in order to be covered up to the MBS fee. If you                                                           an outpatient (i.e. you are not admitted),
number of hospitals may charge a fixed daily                                                                in relation to surgical podiatry (including
                                                     choose to be treated as a private patient in a                                                             in most instances you will not be covered
fee, capped at a maximum number of days                                                                     the fees charged by the podiatric surgeon);
                                                     hospital (public or private), Medicare will cover                                                          by private health insurance. If eligible these
per stay. These hospitals should inform you of                                                              most cosmetic surgery; experimental
                                                     you for 75% of the MBS fee for associated                                                                  services may be claimed from Medicare.
this fee when you make a booking. This fee is                                                               treatment and/or any treatment/procedure
                                                     medical costs and we will cover the remaining
in addition to any excess or co-payment you                                                                 not approved by the Medical Services                Waiting periods
                                                     25%. If your specialist charges more than the
may have as part of your hospital cover.                                                                    Advisory Committee (MSAC)
                                                     MBS fee there will be a ‘gap’ for you to pay.
                                                                                                                                                                The following waiting periods apply for
When admitted to hospital, in most cases             However, the Bupa Medical Gap Scheme can             •	 you will not be fully covered for hospital
                                                                                                                                                                hospital cover:
you will be covered for all in-hospital              help eliminate or reduce the gap for you if your       charges related to surgical podiatry
charges when provided as part of your in-            doctor/s choose to use it.                             and follow-up admissions to earlier                 •	 palliative care, psychiatric and
hospital treatment including:                                                                               cosmetic procedures where the follow-up               rehabilitation services – two months
                                                     At Members First day facilities, not only will you     procedure is recognised by Medicare
                                                     be fully covered for the facility accommodation                                                            •	 pre-existing conditions, ailments or
•	 accommodation for overnight or
                                                                                                          •	 personal expenses such as: pay TV,                   illnesses and pregnancy related services
  same-day stays                                     and theatre fees but there are no out-of-pocket
                                                                                                            non-local phone calls, newspapers,                    (including childbirth) – 12 months
•	 operating theatre, intensive care and
                                                     expenses for medical treatments (e.g. your
                                                                                                            boarder fees, meals ordered for your
                                                     specialist’s fees).                                                                                        •	 all other treatments included in your cover
  labour ward fees                                                                                          visitors, hairdressing and any other
                                                                                                                                                                  – two months.
•	 supplied pharmaceuticals approved                                                                        personal expenses charged to you unless
  by the Pharmaceutical Benefits Scheme                To ensure peace of mind, ask                         included in your cover                              When to contact us

•	 allied services including physiotherapy,            your doctor about their fees                       •	 if you are in hospital for more than 35 days       If you have been a Bupa member for less
  occupational therapy and dietetics                   and whether they participate                         and you have been classified as a ‘nursing          than 12 months on your current hospital
                                                       in our Medical Gap Scheme for                        home type’ patient. In this situation you           cover, it is important to contact us before
•	 medication, dressings and                                                                                                                                    you are admitted to hospital and find out
  other consumables                                    your hospital treatment prior to                     may receive limited benefits and be
                                                                                                                                                                whether the pre-existing condition waiting
•	 most diagnostic tests (e.g.
                                                       admission. Remember to also ask                      required to make a personal contribution
                                                                                                            towards the cost of your care                       period applies to you. We need about five
  pathology, radiology)                                your doctor about the fees for                                                                           working days to make the pre-existing
                                                       other practitioners that may be                    •	 for pharmacy items not opened at the
                                                                                                                                                                condition assessment, subject to the timely
•	 a surgically implanted prosthesis up to the
  applicable benefit on the Government’s
                                                       involved in your hospital treatment                  point of leaving the hospital
                                                                                                                                                                receipt of information from your treating
  Prostheses List                                      such as: the anaesthetist and                      •	 if you choose to use your own allied               medical practitioner/s. Make sure you allow
                                                       assistant surgeons.                                  health provider rather than the hospital’s          for this timeframe when you agree to a
•	 single room where available.

                                                 2                                                                                                          3
hospital admission date. If you proceed with          •	 they meet the criteria set out in our policies   Your Choice Extras) or packaged cover, you            emergency ambulance transport under the
the admission without confirming benefit                and Fund Rules.                                   will receive capped cover for recognised              State Government ambulance transport
entitlements and we (the health fund)                 We recommend you contact us before                  emergency ambulance transport and                     schemes. When you receive an account for
subsequently determine your condition to              making a booking to confirm how much you            on-the-spot treatment.                                ambulance transport, simply send it to us
be pre-existing, you will be required to pay          can claim and to check that your chosen                                                                   and we’ll endorse it for you to send back
                                                                                                          An emergency is when there is reason to
all hospital charges and medical charges not          provider is registered with us.                                                                           to the appropriate ambulance transport
                                                                                                          believe that the patient’s life may be in
covered by Medicare.                                                                                                                                            scheme.
                                                      What is not covered?                                danger or the patient should be attended to
Planning for a baby                                                                                       without undue delay.                                  QLD and TAS members: If you reside in
                                                      Extras benefits will not be payable:
If you are thinking about planning for a                                                                                                                        Queensland or Tasmania, you are covered
                                                                                                          Transportation will mean a journey from the
family we recommend that you contact                  •	 during a waiting period                                                                                under your state service scheme.
                                                                                                          place where immediate medical treatment
us to check whether your current level of             •	 where a third party, including Medicare, a       is sought to the casualty department of a             VIC, SA, WA and NT members: If you reside
cover includes pregnancy and other related              Government body, or an insurance company          receiving hospital.                                   in Victoria, South Australia, Western Australia
services in advance. This is because there              provided a benefit (except for hearing aids                                                             or the Northern Territory you will receive
is a 12-month waiting period applied to                 and breast prosthesis items)                      Emergency ambulance transportation is
                                                                                                                                                                cover for recognised emergency ambulance
all pregnancy related services (including                                                                 defined as transportation of an unplanned
                                                      •	 for different services within the same service                                                         transport and on-the-spot treatment from
childbirth) and assisted reproductive                                                                     and of a non-routine nature for the purpose
                                                        type from the same provider on the same                                                                 us. This is as long as you don’t have an
services.                                                                                                 of providing immediate medical attention to
                                                        day. For example, if you went to see an                                                                 ambulance subscription with your state
                                                                                                          a person.
No waiting periods will apply to the newborn            acupuncturist and then received a massage                                                               ambulance service or cover through a state-
provided they have been added to the                    from the same provider on the same day, you       Whether the transportation is deemed an               based arrangement.
appropriate family hospital cover within two            cannot claim for both services                    emergency is determined by the paramedic
                                                                                                                                                                Most state schemes cover their respective
months of their birth.                                •	 when a prescribed treatment is not fully         and usually recorded on the account.
                                                                                                                                                                residents within their state of residence only.
                                                        custom made (e.g. orthotics, surgical shoes)      Benefits are not payable for:                         However, some states have entered into
UNDERSTANDING                                         •	 when a provider is not recognised by us for                                                            reciprocal agreements that allow you to be
                                                                                                          •	 transportation from a hospital to                  covered for ambulance services when you travel
                                                        benefit purposes
YOUR EXTRAS COVER                                                                                           your home                                           outside your state of residence. You should
                                                      •	 for any treatment or service rendered
What is covered?                                                                                          •	 transportation from a hospital to a                check with your state ambulance provider for
                                                        outside Australia
                                                                                                            nursing home                                        when these reciprocal arrangements apply and
With extras cover, you can claim benefits for         •	 when you have reached the maximums on
those services listed on your cover and that                                                              •	 transportation from a hospital to another          the level of cover offered.
                                                        your product including annual, lifetime or
are not claimable elsewhere (e.g. from a third                                                              hospital where the customer has been                If you fall outside your state-based
                                                        service limits for the service you
party like Medicare).                                                                                       admitted to the transferring (first) hospital       arrangement (including any reciprocal
                                                        are claiming.
                                                                                                          •	 transportation from the person’s                   agreement) and are not covered for
For example, Medicare does not provide                Waiting periods
                                                                                                            home, a nursing home or hospital for                emergency ambulance services, you will
benefits for:                                         The following waiting periods apply for               ongoing medical treatment,                          be covered by Bupa up to the annual cap,
•	 most dental examinations and treatment             extras cover:                                         (e.g. chemotherapy, dialysis).                      as long as your level of cover contains
•	 most physiotherapy, occupational therapy,          •	 initial waiting period – two months              Ambulance Cover                                       ambulance cover and the services are
  speech therapy, eye therapy, chiropractic                                                                                                                     provided by a recognised provider.
                                                      •	 hire, repair and maintenance of health aids      We recommend that you take out an
  services, podiatry or psychology services             and appliances; and Living Well Programs          ambulance subscription with your                      Recognised Ambulance Providers
•	 acupuncture (unless part of a doctor’s               – six months                                      recognised State Ambulance Provider if it’s           Bupa will only pay benefits towards
  consultation) or other natural therapies            •	 major dental, orthodontics, selected health      available in your state (VIC, SA, NT and rural        ambulance services when they are provided
•	 glasses and contact lenses                           aids and appliances – 12 months                   postcodes in WA).                                     by any of the following recognised providers:
•	 most health aids and appliances                    •	 laser eye surgery, covered only under            We will only provide ambulance benefits, in           •	 ACT Ambulance Service
•	 home nursing.                                        Ultimate Health Cover - three years.              accordance with your level of cover, when
                                                                                                                                                                •	 Ambulance Service of NSW
                                                                                                          you do not hold a subscription with an
Extras cover allows you to claim benefits for                                                                                                                   •	 Ambulance Victoria
                                                      UNDERSTANDING                                       ambulance provider and a state ambulance
extras services as long as:
                                                                                                          scheme does not provide cover.                        •	 Queensland Ambulance Service
                                                      YOUR AMBULANCE COVER
•	 the treatment is given by a private practice                                                                                                                 •	 South Australia Ambulance Service
                                                                                                          NSW and ACT members: If you reside
  provider who is recognised and registered           Emergency Ambulance definition
                                                                                                          in New South Wales or the Australian                  •	 St John Ambulance Service NT
  with us for benefit purposes                        When you or your partner take out our               Capital Territory and you have hospital
                                                                                                                                                                •	 St John Ambulance Service WA
                                                      hospital cover, extras cover (emergency             cover, you pay an ambulance levy as part
                                                      ambulance services must be selected on              of your premium. This entitles you to free            •	 Tasmanian Ambulance Service.


                                                  4                                                                                                         5
Certain types of concession cards issued by             new benefits. Where your new level of cover        (e.g. orthodontics). Per person annual              hospital cover so you should always check
Centrelink or the Department of Veterans                is higher than what you previously held, the       maximums are not transferable to any other          with us to see if you’re covered before
Affairs (DVA) entitle the cardholders to free           lower level of benefit applies. Please refer       member on your policy.                              receiving treatment.
ambulance services. These arrangements                  to the listed waiting periods included under
                                                                                                           Calendar year                                       Health aids and appliances
also vary per state so should be checked                the ‘Understanding Your Extras Cover’ and
directly with Centrelink or the DVA.                    ‘Understanding Your Hospital Cover’ sections       A calendar year is 1 January to 31 December.        To receive benefits for health aids and
                                                        of this guide.                                                                                         appliances you’ll need to visit one of our
                                                                                                           Emergency admissions
                                                                                                                                                               recognised providers. You’ll also need to
CHANGING YOUR COVER                                     During this time you will be covered, however      In an emergency, we may not have time               meet the eligibility criteria, provide proof
                                                        you will receive the lower benefits of the two     to determine if you are affected by the             of purchase and a clinical referral where
Switching from another health fund                      covers (this includes any applicable excess).      pre-existing condition rule before your             required. It is important to note that
If you’re changing from another Australian                                                                 admission. Consequently, if you have been           benefits are not payable when a prescribed
health fund to Bupa, you’ll continue to be              If you choose a lower level of cover than
                                                                                                           a Bupa member for less than 12 months               treatment is not fully custom made (e.g.
covered for all benefit entitlements that               you previously held, then the lower benefits
                                                                                                           you might have to pay for some or all of the        orthotics). Visit our website or contact us to
you had on your old cover, as long as these             on your new cover will apply immediately
                                                                                                           hospital and medical charges if:                    find out more.
services are offered on your new cover with             and may include different excess levels
us. This is referred to as ‘continuity of cover’.       or restricted benefits. You may also need          •	 you are admitted to hospital and you             Benefits for hire, repair and maintenance of
To receive continuity of cover, you’ll need to          to serve waiting periods for services or             choose to be treated as a private patient,        health aids and appliances are not payable in
transfer to us within 60 days of leaving your           treatments that weren’t covered on your              and we later determine that your condition        the first 12 months after purchasing an item;
old fund.                                               previous cover. In this case you won’t be            was pre-existing.                                 within 12 months following a repair;
                                                        covered during the waiting period.                                                                     or on items where hire and repair are
                                                                                                           Excess or co-payment
When changing health funds, extras benefits                                                                                                                    deemed inappropriate.
paid by your old fund will be counted                   If you have any questions about transfers or       To lower the cost of your hospital cover,
towards your annual maximums in your first              waiting periods, just contact us.                  on selected covers you can choose to                Home nursing
year of membership with us. Any benefits                                                                   include an excess or co-payment. Excesses
                                                        Ending your membership                                                                                 Benefits are payable towards some home
paid by your old fund also count towards                                                                   or co-payments are only payable on
                                                        We have the right to end a person’s                                                                    nursing services that do not need to take
lifetime maximums.                                                                                         overnight and same-day inpatient hospital
                                                        membership as set out in our Fund Rules,                                                               place in a hospital and are provided in the
                                                                                                           admissions in any hospital.
It’s important to note that when you change             including where premiums have not been                                                                 home. Please contact us to find out more.
to Bupa from another fund you may need                  paid or on notice at the reasonable                •	 An excess is a set amount you pay
                                                                                                                                                               Living Well Programs
to wait before you can receive your new                 discretion of Bupa.                                  upfront before your benefit is paid. The
                                                                                                             excess is paid each time a person on your         Our Living Well Programs help cover health-
benefits. In this situation, your benefit
                                                                                                             membership is admitted into hospital, to          related programs from approved, recognised
entitlements are based on our nearest
equivalent cover to what you previously
                                                        DEFINITIONS                                          a maximum of once per person and twice            providers. You can visit our website for a list
                                                                                                             on the entire membership each calendar            of our recognised providers. A Living Well
held. Where your new cover is higher than               Accidents
                                                                                                             year unless otherwise specified.                  Programs approval form must be completed
what you had with your old fund, the lower
                                                        An accident is an unforeseen event,                                                                    by your doctor for gym memberships, yoga
benefit (including different excess levels)                                                                •	 A co-payment is an amount you agree
                                                        occurring by chance and caused by an                                                                   and Pilates to confirm that the program
will apply for the waiting period relevant for                                                               to pay towards the cost of your daily
                                                        unintentional and external force or object                                                             is medically necessary. Other benefit and
that service. Please refer to the listed waiting                                                             hospital bill. A co-payment is charged per
                                                        resulting in involuntary hurt or damage to                                                             recognition criteria apply. Visit our website or
periods included under the ‘Understanding                                                                    day and capped after five days for each
                                                        the body, which requires immediate (within                                                             contact us to find out more.
Your Extras Cover’ and ‘Understanding Your                                                                   hospital admission.
                                                        72 hours) medical advice or treatment
Hospital Cover’ sections of this guide.                                                                    •	 No excess or co-payment applies to your          Bupa Medical Gap Scheme
                                                        from a registered practitioner other than
If you choose a lower level of cover than               the policyholder.                                    children on certain hospital covers. Please       This refers to the difference between
you held previously, then the lower benefits                                                                 contact us for further details.                   what your doctor charges and the amount
                                                        Annual maximums and service limits                                                                     Medicare pays for inpatient procedures.
on your new cover will apply immediately.                                                                  Exclusions
This may include a different excess level               An annual maximum is the maximum
                                                        amount you can claim in a service category         If you require treatment for a specific             If your doctor charges up to the Medicare
or restricted benefits. You may also need                                                                  procedure or service that is excluded under         Benefit Schedule (MBS) fee or is
to serve waiting periods for services or                per person and per calendar year (unless
                                                        otherwise stated). For certain services,           your level of cover you will not receive any        participating in the Bupa Medical Gap
treatments that weren’t covered on your                                                                    benefits towards your hospital and medical          Scheme, in most cases you will have no
previous cover. In this case you won’t be               annual maximums also apply on the number
                                                        of times that benefits are payable for the         costs and you may have significant out-of-          medical gap costs to pay.
covered during the waiting period.                                                                         pocket costs.
                                                        same service (e.g. initial consultations). These                                                       For doctors who are not participating in
Changing your cover with us                             maximums apply from the date of service or         If a service is not covered by Medicare             our Medical Gap Scheme and are charging
                                                        purchase. Some services also have lifetime         there will be no benefit payable from your          above the MBS fee, we will pay the difference
If you change your health cover, you may
                                                        maximums or periodic annual maximums
need to wait before you can receive your

                                                    6                                                                                                      7
between the Medicare benefit and the MBS                 There are some items that are not covered by     To receive the benefits available on your             Suspension Rules
fee. Any amount above the MBS fee will be                our pharmacy benefit and these include:          cover, you need to:                                   A membership may be suspended when
the amount you are required to pay and this                                                                                                                     travelling overseas for work or leisure. If you
                                                         •	 over the counter items                        •	 fully complete the application process and
is referred to as the ‘Medical Gap’.                                                                                                                            are travelling overseas, you may choose
                                                         •	 compounded items                                pay your premiums one month in advance.
Surgically Implanted Prostheses                                                                             Or, if you’re on a corporate plan, it’s up          to suspend your membership during this
                                                         •	 non-prescription items                                                                              period of time. You can suspend your cover
You will be covered up to the benefit set                                                                   to you to make sure payments are made
                                                         •	 weight loss medication (some weight loss        during times of unpaid leave or if your             for the following period of time:
out in the Government’s Prostheses List
                                                           medications are covered under the Living         employment ends
for a listed prosthesis which is surgically                                                                                                                     •	 a minimum period of two months travel; and
                                                           Well Programs)
implanted as part of your hospital treatment.                                                             •	 ensure that newborns are enrolled onto a           •	 a maximum period of two years
                                                         •	 body enhancing medications (e.g. anabolic       family membership within two months of
The Prostheses List includes: pacemakers,                                                                                                                         per suspension.
                                                           steroids); and                                   their birth to avoid any waiting periods for
defibrillators, cardiac stents, joint                                                                                                                           You can only suspend your policy twice
                                                         •	 erectile dysfunction drugs, unless              your baby
replacements, intraocular lenses and other                                                                                                                      per calendar year. Your membership will be
                                                           prescribed by a specialist.                    •	 enrol your adult children under their own
devices. If a hospital proposes to charge you                                                                                                                   cancelled if not resumed.
a ‘gap’ for your prosthesis, they need your              When you make a claim, we will deduct              names within 60 days after they no longer
                                                                                                                                                                One month contributions are required
informed financial consent. Please contact us            a pharmacy co-payment and pay the                  qualify under your cover (to avoid a break
                                                                                                                                                                between each suspension period.
for further details.                                     remaining balance up to the set amount             in their cover)
                                                         under your chosen level of cover.                                                                      To be eligible to suspend your cover you must:
                                                                                                          •	 provide proof of purchase of what you
Out-of-pocket expenses                                                                                                                                          •	 have been a financial member for at least
                                                                                                            have spent before we can reimburse you
                                                         Pre-existing conditions
You are likely to experience out-of-pocket                                                                  for any services received                             12 months
                                                         A pre-existing condition is any condition,
expenses when you are not fully covered for                                                               •	 submit your claims within two years of             •	 apply for suspension prior to the
                                                         ailment or illness that you had signs or
services and benefits, or when a set benefit                                                                when the service was given (we don’t                  departure date
                                                         symptoms of during the six months before
applies. You should refer to what is and isn’t                                                              pay benefits for any claims that are older          •	 provide overseas travel documentation
                                                         you joined or upgraded to a higher level of
covered for your relevant level of cover to                                                                 than this).                                           showing your departure and return dates
                                                         cover with us. It is not necessary that you or
determine when an out-of-pocket expense
                                                         your doctor knew what your condition was         Proof of identity and/or age                          •	 notify us of your return to Australia within
may occur. You should also refer to our
                                                         or that the condition had been diagnosed.        Bupa may require you to provide proof of                30 days of your arrival; and
Fund Rules for any additional information on
benefits payable. A copy of our Fund Rules                                                                identity and/or age when joining, changing            •	 complete an overseas travel
                                                         A condition can still be classed as pre-
can be found on our website or in our retail                                                              your level of cover or in relation to any other         suspension form.
                                                         existing even if you hadn’t seen your doctor
centres. It is important to ensure when being                                                             transaction with us.
                                                         about it before joining or upgrading to a                                                              Travel and accommodation
admitted to hospital that Informed Financial             higher level of cover.                           Restricted cover/benefits                             On select levels of extras cover, if you’re
Consent is provided to you for a pre-booked
                                                         If you knew you weren’t well, or had signs       For restricted services there will be full            travelling for essential medical or hospital
admission to allow you to understand any
                                                         of a condition that a doctor would have          cover in a shared room with your choice of            treatment because treatment you need
out-of-pocket expenses upfront. If you have
                                                         detected (if you had seen one) during the six    doctor in a public hospital and restricted/           cannot be provided by your own doctor, we
received any out-of-pocket expenses and
                                                         months prior to joining or upgrading, then the   default benefits in a private hospital which          will help cover the cost when the total return
require clarification, please contact us directly.
                                                         condition would be classed as pre-existing.      would not be adequate to cover all hospital           distance is 300 kilometres or more from your
Pharmacy and pharmaceuticals                                                                              costs and are likely to result in large out-of-       normal place of residence.
                                                         A doctor appointed by us decides whether         pocket expenses.
Your extras pharmacy entitlement covers                                                                                                                         We also give a benefit towards your
                                                         your condition is pre-existing, not you or
you for prescription items that are non-PBS                                                               Special Benefits                                      overnight accommodation outside of
                                                         your doctor. The appointed doctor must
(Pharmaceutical Benefits Scheme) listed                                                                                                                         hospital for you and a caregiver. Check your
                                                         consider your treating doctors’ opinions on      If you’re on a cover that provides Special
drugs and are TGA (Therapeutic Goods                                                                                                                            extras cover to determine if you are covered
                                                         the signs and symptoms of your condition,        Benefits cover, you could receive benefits
Administration) approved for that condition.                                                                                                                    for these benefits.
                                                         but is not bound to agree with them.             for accommodation and meal costs if your
When in hospital, if you are treated with                                                                 partner, immediate family member, carer               Waiting periods
                                                         Premium and benefits
drugs that are not PBS approved, you may                                                                  or next of kin is required to stay at hospital
                                                         You must pay the premium and the Lifetime                                                              A waiting period is the time between when
not be fully covered and the hospital may                                                                 with you or a person on your membership.
                                                         Health Cover Loading that applies to you.                                                              you joined us and when you are covered
charge you for all or part of the cost. You                                                               They will be covered for $60 per night for
                                                         Premiums differ from state to state due                                                                for a service or treatment. If you receive a
should be advised by the hospital of any                                                                  accommodation in hospital and up to $30
                                                         to different state charges. If you move to                                                             service or treatment during this time, you
charges before treatment.                                                                                 a day for hospital meals. Hospital meals
                                                         another state your premium will change too.                                                            are not eligible to receive a benefit payment
                                                                                                          are covered when provided at a hospital
                                                         Therefore you must let us know about any                                                               from us, regardless of when you submit the
                                                                                                          cafeteria, kiosk or patient meal menu. A
                                                         change of address.                                                                                     claim. Different waiting periods apply for
                                                                                                          $1,000 per person, per calendar year annual
                                                                                                                                                                different services.
                                                                                                          maximum applies to Special Benefits.

                                                     8                                                                                                      9
OTHER IMPORTANT                                    identical to the account signing instruction      personal information to our related entities          Resolution of problems
INFORMATION                                        held by the financial institution where the       and bodies corporate, or to third parties             If you have any concerns or you don’t
                                                   account is based. You must notify us if the       such as healthcare providers, government              understand a decision we have made, we’d
Direct Debit Service Agreement                     nominated account is transferred or closed.       and regulatory bodies, other private health           like to hear from you.
If you’ve chosen to pay your premiums by           You must pay your premium by an alternative       insurers and any persons or entities engaged
direct debit then you’ve accepted the terms        method if either you or we cancel the direct      by us or acting or our behalf. If you are the         You can contact us by:
of our Direct Debit Service Agreement.             debit arrangements. You must ensure your          policyholder, you’re responsible for ensuring         Telephone: 1800 802 386
                                                   payments are up-to-date, whether a notice is      that each person on your policy is aware that         Fax:       1300 662 081
This agreement outlines the responsibilities       received from us or not.                          we collect, use and disclose their personal           Email:     customerrelations@bupa.com.au
of Bupa Australia Pty Ltd (“we”, “us”, our”)                                                         information as set out here and in our                Mail:      Customer Relations Manager
and you. We will confirm the direct debit          If paying by credit card, you need to advise us
                                                                                                     Information Handling Policy. Each person                         Bupa Australia
arrangements prior to the first drawing            of your new expiry date prior to expiry. You
                                                                                                     on a policy aged 17 or over may complete a                       PO Box 14639
(including the premium amount and                  may request that we cancel or alter the debit
                                                                                                     ‘Keeping it confidential’ form to specify who                    Melbourne VIC 8001
frequency) and debit your nominated                drawing arrangements by contacting us and
                                                                                                     should receive information about their health
account. Deductions will occur on the              providing at least five working days notice                                                             If you’re still not satisfied with your
                                                                                                     claims. You are entitled to reasonable access
nominated day, except for deductions               of any requested changes. These changes                                                                 outcomes from Bupa you may contact
                                                                                                     to your personal information. We reserve the
nominated for the 28th, 29th, 30th or 31st,        may include deferring the debit, altering the                                                           the Private Health Insurance Ombudsman
                                                                                                     right to charge a reasonable fee for collating
which will occur on the first day of the           debit dates, stopping an individual debit,                                                              on 1800 640 695 or email them at
                                                                                                     such information. If you or any other person
following month. If the nominated day falls        suspending the direct debit arrangement or                                                              privatehealth.gov.au
                                                                                                     on your membership do not consent to the
on a weekend or public holiday, deductions         cancelling the direct debit completely. You
                                                                                                     way we handle personal information, or
will be made on the closest business day. We       can dispute any debit drawing or terminate
                                                                                                     do not provide us with the information we
will debit all payments in advance and will        the deductions at any time by notifying us in
                                                                                                     require, we may be unable to provide you
automatically vary the deduction amount if         writing not less than seven days before the
                                                                                                     with our products and services. We may use
your premiums or level of cover change. If         next scheduled debit drawing. If you have any
                                                                                                     your personal (including health) information
we vary the deduction amount, we will give         queries about your direct debit agreement,
                                                                                                     to offer you health management programs
you at least 14 days written notice, except        please contact us. We undertake to respond
                                                                                                     and services. When you take out cover with
when the previous deduction is dishonoured,        to queries concerning disputed transactions
                                                                                                     us, you consent to us using your personal
when we will deduct the previous period’s          within five working days of notification.
                                                                                                     information to contact you (by phone, email,
payment together with the current amount           Privacy and your personal information             SMS or post) about products and services
due. If you pay premiums at three, six, and                                                          that may be of interest to you. If you do not
12 month intervals, then should your financial     Your privacy and maintaining the
                                                                                                     wish to receive this information, you may opt
institution dishonour a drawing, we will draw      confidentiality of your personal information
                                                                                                     out by contacting us.
the payment on the nominated day of the            is important to Bupa Australia Pty Ltd
following month. If two or more drawings are       (“we”, “us”, “our”). This statement provides      Can we help?
returned unpaid by your financial institution,     a summary of how we handle your personal
                                                                                                     If you have any questions we’re always
we will also stop deducting your premiums          and health information. For further
                                                                                                     happy to help. Simply refer to the back cover
from your nominated account and will start         information about how we handle your
                                                                                                     for our contact details and call us, visit our
sending you renewal notices, pending further       personal information, you should refer to
                                                                                                     website or pop by your local centre. If you
instructions from you. We will maintain the        our Information Handling Policy, available
                                                                                                     would like more information about our Fund
privacy and confidentiality of your billing        on our website or by calling us. We will only
                                                                                                     Rules or the Federal Government’s Private
information (unless you have requested             collect personal information (including
                                                                                                     Health Insurance Industry Code of Conduct,
or consented that we can disclose it to a          health information) about you and those
                                                                                                     you can find this information on our website.
third party or the law requires or allows us       people insured under your policy to provide,
                                                                                                     The Federal Government’s Private Patient’s
to do so). We may provide information to           manage and administer our products and
                                                                                                     Hospital Charter is available at
our or your financial institution to resolve a     services to you and to operate an efficient
                                                                                                     privatehealth.gov.au
dispute on your behalf. You must ensure your       and sustainable business. We are required
nominated account permits direct debiting          to collect and maintain certain information
and that sufficient cleared funds are available    about you and those on your policy to
in that account on the due date to cover           comply with the Private Health Insurance
the premiums due. Your financial institution       Act 2007 (Cth) and related legislation.
may charge a fee if the payment cannot             We may also collect personal and health
be met. You must ensure the authorisation          information about you from health service
given to draw on the nominated account is          providers for the purposes of administering
                                                   or verifying any claim. We may disclose your


                                                  10                                                                                                  11
                                     Mailing details:
FO R M OR E IN FO R M AT I O N       Bupa
                                     600 Glenferrie Road
    Call us on 134 135               HAWTHORN VIC 3122

    Visit bupa.com.au                Bupa Australia Pty Ltd
                                     ABN 81 000 057 590
    Drop by your local Bupa centre   Effective 1 November 2011
                                     10350-10-11S




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