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Important Information Guide - Bupa

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Important Information Guide - Bupa 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?                                  ° any treatment or service rendered
information to help you understand how                   a booking to confirm that your hospital of        Hospital costs                                          outside australia
your health cover with us works. we                      choice gives you certainty of full cover. we
                                                                                                           Situations when you are likely not to be              ° some non-PBS, high cost drugs.
recommend you keep this information in a                 can also discuss any excess or co-payment
                                                                                                           covered include:                                      Medical costs
safe place so that you can always refer to it.           that may be applicable to your level of cover.
                                                         you can find out if a hospital has an agreement   ° during a waiting period                             you will not be covered for:
From time to time, things can change.
                                                         with us by checking our website bupa.com.au       ° when specific services or treatments are
Before you seek any treatment call us so we                                                                                                                      ° medical services for surgical procedures
                                                                                                             paid at minimum benefits or excluded from
can give you the most complete and                       Medical costs                                                                                             performed by a dentist, surgical podiatrist,
                                                                                                             your level of cover
up-to-date information.                                  these are the fees charged by a doctor,                                                                   or any other practitioner or service that is
                                                         surgeon, anaesthetist or other specialist         ° when you are treated at a non-agreement               not eligible for a rebate through Medicare.
Please be aware that these rules apply in                                                                    hospital you will not be fully covered
addition to our Fund and Policy Rules.                   for any treatment given to you in hospital.
                                                                                                                                                                 Inpatient vs outpatient
                                                         Private health insurance provides you with        ° for the fixed fee charged by a fixed
                                                         the choice of your own doctor, and you              fee hospital or a hospital that has a               if you are admitted as a private inpatient, you
undeRStanding                                            decide whether you will go to a public or a         fixed fee service                                   will be covered for the services listed in your
youR hoSPital CoveR                                      private hospital that your doctor attends. you                                                          chosen level of hospital cover. if you receive
                                                                                                           ° when you have not been admitted into a              treatment as an outpatient (i.e. you are not
What is covered?                                         may also have more choice as to when you            hospital and are treated as an outpatient
                                                         are admitted to hospital.                                                                               admitted), in most instances you will not be
                                                                                                             (e.g. emergency room treatment,
Hospital costs                                                                                                                                                   covered by private health insurance. if eligible
                                                                                                             outpatient ante-natal consultations with
with private hospital cover, you can choose to           you are covered for:                                                                                    these services may be claimed from Medicare.
                                                                                                             an obstetrician)
be treated as a private patient in either a public       ° the cost of these medical treatments up to                                                            Waiting periods
or a private hospital. with us you are fully                                                               ° hospital treatment provided by a
                                                           the Medicare Benefit Schedule (MBS) fee.          practitioner not authorised by a hospital to
covered as a private patient in most Members                                                                                                                     the following waiting periods apply for
                                                         the MBS fee is the amount set by the Federal        provide that treatment                              hospital cover:
First and network hospitals, and all public
                                                         government for each medical service covered
hospitals across australia. a small number of                                                              ° hospital treatment for which Medicare
                                                         by Medicare. you must be eligible for Medicare      pays no benefit, including: medical costs in        ° palliative care, psychiatric and rehabilitation
hospitals may charge a fixed daily fee, capped                                                                                                                     services – two months
                                                         in order to be covered up to the MBS fee. if        relation to surgical podiatry (including the
at a maximum number of days per stay. these
hospitals should inform you of this fee when
                                                         you choose to be treated as a private patient       fees charged by the podiatric surgeon); most        ° pre-existing conditions, ailments or illnesses
                                                         in a hospital (public or private), Medicare         cosmetic surgery; respite care; experimental          and pregnancy related services (including
you make a booking. this fee is in addition to
                                                         will cover you for 75% of the MBS fee for           treatment and/or any treatment/procedure              childbirth) – 12 months
any excess or co-payment you may have as
                                                         associated medical costs and we will cover
part of your hospital cover.                                                                                 not approved by the Medical Services                ° all other treatments included in your cover –
                                                         the remaining 25%. if your specialist charges       advisory Committee (MSaC)                             two months.
when admitted to hospital, in most cases                 more than the MBS fee there will be a ‘gap’ for
you will be covered for all in-hospital                  you to pay. however, the Bupa Medical Gap         ° personal expenses such as: pay tv, non-local        When to contact us
                                                                                                             phone calls, newspapers, boarder fees,
charges when provided as part of your                    Scheme can help eliminate or reduce the gap                                                             if you have been a Bupa member for less than
                                                                                                             meals ordered for your visitors, hairdressing
in-hospital treatment including:                         for you if your doctor/s choose to use it.                                                              12 months on your current hospital cover,
                                                                                                             and any other personal expenses charged
                                                                                                                                                                 it is important to contact us before you are
° accommodation for overnight or                         at Members First day facilities, not only           to you unless included in your cover
                                                                                                                                                                 admitted to hospital and find out whether the
  same-day stays                                         will you be fully covered for the facility
                                                                                                           ° if you are in hospital for more than 35 days        pre-existing condition waiting period applies
                                                         accommodation and theatre fees but there            and you have been classified as a ‘nursing
° operating theatre, intensive care and labour                                                                                                                   to you. we need about five working days to
  ward fees                                              are no out-of-pocket expenses for medical           home type’ patient. in this situation you may       make the pre-existing condition assessment,
                                                         treatments (e.g. your specialist’s fees).           receive limited benefits and be required to
° supplied pharmaceuticals approved by the                                                                                                                       subject to the timely receipt of information
  Pharmaceutical Benefits Scheme                                                                             make a personal contribution towards the            from your treating medical practitioner/s.
                                                           to ensure peace of mind, ask your                 cost of your care                                   Make sure you allow for this timeframe when
° allied services including physiotherapy,
  occupational therapy and dietetics                       doctor about their fees and whether             ° for pharmacy items not opened at the point          you agree to a hospital admission date. if
                                                           they participate in our Medical Gap               of leaving the hospital                             you proceed with the admission without
° dressings and other consumables                                                                                                                                confirming benefit entitlements and we
                                                           Scheme for your hospital treatment              ° if you choose to use your own allied
° pathology and radiology diagnostic                                                                         health provider rather than the hospital’s          (the health fund) subsequently determine
  tests performed in hospital by Bupa                      prior to admission. Remember to
                                                                                                             practitioner for services that form                 your condition to be pre-existing, you will
  contracted providers                                     also ask your doctor about the fees                                                                   be required to pay all hospital charges and
                                                           for other practitioners that may be               part of your in-hospital treatment (e.g.
° surgically implanted prostheses up to the                                                                  chiropractors, dieticians or psychologists)         medical charges not covered by Medicare.
  approved benefits in the government’s                    involved in your hospital treatment,
  Prostheses list                                          such as the anaesthetist and                    ° where compensation, damages or benefits
                                                           assistant surgeons.                               may be claimed by another source (e.g.
° single room where available.                                                                               workers compensation)

                                                     2                                                                                                       3
Planning for a baby                                    What is not covered?                               danger or the patient should be attended to             QLD and TAS members: if you reside in
if you are thinking about starting a family we         extras benefits will not be payable:               without undue delay.                                    Queensland or tasmania, you are covered
recommend that you contact us to check                                                                                                                            under your state service scheme.
                                                                                                          transportation will mean a journey from the
whether your current level of cover includes           ° during a waiting period
                                                                                                          place where immediate medical treatment                 VIC, SA, WA and NT members: if you
pregnancy and other related services in                ° where a third party, including Medicare, a       is sought to the casualty department of a               reside in victoria, South australia, western
advance. this is because there is a 12-month             government body, or an insurance company
                                                                                                          receiving hospital.                                     australia or the northern territory you will
waiting period applied to all pregnancy related          provided a benefit (except for hearing aids
                                                                                                                                                                  receive cover for recognised emergency
services (including childbirth) and assisted             and breast prosthesis items)                     emergency ambulance transportation is
                                                                                                                                                                  ambulance transport and on-the-spot
reproductive services.                                                                                    defined as air or road transportation by
                                                       ° for different services within the same service                                                           treatment from us. this is as long as you
                                                         type from the same provider on the same          a Recognised ambulance Provider of an
no waiting periods will apply to the newborn                                                                                                                      don’t have an ambulance subscription with
                                                         day. For example, if you went to see an          unplanned and of a non-routine nature for
provided they have been added to the                                                                                                                              your state ambulance service or cover
                                                         acupuncturist and then received a massage        the purpose of providing immediate medical
appropriate family hospital cover within two                                                                                                                      through a state-based arrangement.
                                                         from the same provider on the same day,          attention to a person.
months of their birth.                                                                                                                                            Most state schemes cover their respective
                                                         you cannot claim for both services               whether the transportation is deemed an
                                                                                                                                                                  residents within their state of residence
                                                       ° when a prescribed treatment is not fully         emergency is determined by the paramedic
                                                                                                                                                                  only. however, some states have entered
undeRStanding                                            custom made (e.g. orthotics, surgical shoes)     and usually recorded on the account.
                                                                                                                                                                  into reciprocal agreements that allow you
youR extRaS CoveR
                                                       ° when a provider is not recognised by us for      Benefits are not payable for:                           to be covered for ambulance services
What is covered?                                         benefit purposes                                                                                         when you travel outside your state of
                                                                                                          ° transportation from a hospital to                     residence. you should check with your
with extras cover, you can claim benefits for          ° for any treatment or service rendered              your home
those services listed on your cover and that             outside australia                                                                                        state ambulance provider for when these
                                                                                                          ° transportation from a hospital to a                   reciprocal arrangements apply and the level
are not claimable elsewhere (e.g. from a third         ° when you have reached the maximums on              nursing home
party like Medicare).                                                                                                                                             of cover offered.
                                                         your product including annual, lifetime or
                                                         service limits for the service you               ° transportation from a hospital to another             if you fall outside your state-based
For example, Medicare does not provide                                                                      hospital where the customer has been
                                                         are claiming.                                                                                            arrangement (including any reciprocal
benefits for:                                                                                               admitted to the transferring (first) hospital
                                                                                                                                                                  agreement) and are not covered for
                                                       Waiting periods
° most dental examinations and treatment                                                                  ° transportation from the person’s                      emergency ambulance services, you will
                                                       the following waiting periods apply for              home, a nursing home or hospital for                  be covered by Bupa up to the annual cap,
° most physiotherapy, occupational therapy,            extras cover:                                        ongoing medical treatment,
  speech therapy, eye therapy, chiropractic                                                                                                                       as long as your level of cover contains
                                                                                                            (e.g. chemotherapy, dialysis).                        ambulance cover and the services are
  services, podiatry or psychology services            ° initial waiting period – two months
                                                                                                          Ambulance Cover                                         provided by a recognised provider.
° acupuncture (unless part of a doctor’s               ° hire, repair and maintenance of health aids
  consultation) or other natural therapies               and appliances; and living well Programs –       we recommend that you take out an                       Recognised Ambulance Providers
                                                         six months                                       ambulance subscription with your
° glasses and contact lenses                                                                                                                                      Bupa will only pay benefits towards
                                                                                                          recognised State ambulance Provider if it’s
° most health aids and appliances                      ° major dental, orthodontics, selected health                                                              ambulance services when they are provided
                                                         aids and appliances – 12 months                  available in your state (viC, Sa, nt and rural          by any of the following recognised providers:
° home nursing.                                                                                           postcodes in wa).
extras cover allows you to claim benefits for          ° laser eye surgery, covered only under                                                                    ° aCt ambulance Service
                                                         ultimate health Cover – three years.             we will only provide ambulance benefits, in
extras services as long as:                                                                                                                                       ° ambulance Service of nSw
                                                                                                          accordance with your level of cover, when
° the treatment is given by a private practice         undeRStanding                                      you do not hold a subscription with an                  ° ambulance victoria
  provider who is recognised and registered                                                               ambulance provider and a state ambulance                ° Queensland ambulance Service
                                                       youR aMBulanCe CoveR                               scheme does not provide cover.
  with us for benefit purposes
                                                                                                                                                                  ° South australia ambulance Service
                                                       Emergency Ambulance definition
° they meet the criteria set out in our policies                                                          NSW and ACT members: if you reside in                   ° St John ambulance Service nt
  and Fund Rules.                                      when you or your partner take out our              new South wales or the australian Capital
                                                       hospital cover, extras cover (emergency            territory and you have hospital cover, you pay          ° St John ambulance Service wa
we recommend you contact us before making
a booking to confirm how much you can claim            ambulance services must be selected on             an ambulance levy as part of your premium.              ° tasmanian ambulance Service.
and to check that your chosen provider is              your Choice extras) or packaged cover,             this entitles you to free emergency ambulance           Certain types of concession cards issued by
registered with us.                                    you will receive capped cover for                  transport under the State government                    Centrelink or the department of veterans
                                                       recognised emergency ambulance                     ambulance transport schemes. when you                   affairs (dva) entitle the cardholders to free
                                                       transport and on-the-spot treatment.               receive an account for ambulance transport,             ambulance services. these arrangements also
                                                       an emergency is when there is reason to            simply send it to us and we’ll endorse it for you       vary per state so should be checked directly
                                                       believe that the patient’s life may be in          to send back to the appropriate ambulance               with Centrelink or the dva.
                                                                                                          transport scheme.

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

                                                    6                                                                                                           7
Minimum Benefits                                         Pharmacy in-hospital                                ° provide proof of purchase of what you have           ° you can only suspend your policy twice per
For restricted services there will be full cover         when you make a claim, we will deduct a               spent before we can reimburse you for any              calendar year
in a shared room with your choice of doctor              pharmacy co-payment and pay the remaining             services received
                                                                                                                                                                    ° one month contributions are required
in a public hospital and minimum/default                 balance up to the set amount under your             ° submit your claims within two years of when            between each suspension period.
benefits in a private hospital which would not           chosen level of cover.                                the service was given (we don’t pay benefits         to be eligible to suspend your cover you must:
be adequate to cover all hospital costs and are                                                                for any claims that are older than this).
                                                         Pre-existing conditions                                                                                    ° have been a financial member for at least
likely to result in large out-of-pocket expenses.
                                                         a pre-existing condition is any condition,          Proof of identity and/or age                             12 months
Out-of-pocket expenses                                   ailment or illness that you had signs or            Bupa may require you to provide proof of               ° have a financial membership at the time
you are likely to experience out-of-pocket               symptoms of during the six months before you        identity and/or age when joining, changing               of suspension
expenses when you are not fully covered for              joined or upgraded to a higher level of cover       your level of cover or in relation to any other
                                                                                                                                                                    ° apply for suspension prior to the
services and benefits, or when a set benefit             with us. it is not necessary that you or your       transaction with us.                                     departure date
applies. you should refer to what is and isn’t           doctor knew what your condition was or that
                                                                                                             Special Benefits                                       ° provide overseas travel documentation
covered for your relevant level of cover to              the condition had been diagnosed.
                                                                                                             if you’re on a cover that provides Special               showing your departure and return dates
determine when an out-of-pocket expense
                                                         if you knew you weren’t well, or had signs of a
may occur. you should also refer to our                                                                      Benefits cover, you could receive benefits             ° notify us of your return to australia within
                                                         condition that a doctor would have detected         for accommodation and meal costs if your                 30 days of your arrival; and
Fund Rules for any additional information
                                                         (if you had seen one) during the six months         partner, immediate family member, carer
on benefits payable. it is important to ensure                                                                                                                      ° complete an overseas travel
                                                         prior to joining or upgrading, then the condition   or next of kin is required to stay at hospital
when being admitted to hospital that informed                                                                                                                         suspension form.
                                                         would be classed as pre-existing.                   with you or a person on your membership.
Financial Consent is provided to you for a pre-
                                                                                                                                                                    your membership will be cancelled if
booked admission to allow you to understand              a doctor appointed by us decides whether            they will be covered for $60 per night for
                                                                                                                                                                    not resumed.
any out-of-pocket expenses upfront. if you               your condition is pre-existing, not you or your     accommodation in hospital and up to $30
have received any out-of-pocket expenses and             doctor. the appointed doctor must consider          a day for hospital meals. hospital meals are           Travel and accommodation
require clarification, please contact us directly.       your treating doctors’ opinions on the signs        covered when provided at a hospital cafeteria,
                                                                                                                                                                    on select levels of extras cover, if you’re
                                                         and symptoms of your condition, but is not          kiosk or patient meal menu. a $1,000 per
Pharmacy                                                                                                                                                            travelling for essential medical or hospital
                                                         bound to agree with them.                           person, per calendar year annual maximum
                                                                                                                                                                    treatment because treatment you need
your extras pharmacy entitlement covers                                                                      applies to Special Benefits.
                                                                                                                                                                    cannot be provided by your own doctor, we
you for prescription only items that are not             Premium and benefits
                                                                                                             Surgically implanted prostheses                        will help cover the cost when the total return
supplied under the PBS (Pharmaceutical                   you must pay the premium and the lifetime                                                                  distance is 200 kilometres or more from
Benefits Scheme); are tga (therapeutic goods             health Cover loading that applies to you.           you will be covered up to the benefit set out in
                                                                                                                                                                    your normal place of residence.
administration) approved; are prescribed by a            Premiums differ from state to state due             the government’s Prostheses list for a listed
registered medical practitioner; supplied by a           to different state charges. if you move to          prosthesis which is surgically implanted as            we also give a benefit towards your
Bupa recognised, registered pharmacist; and              another state your premium will change too.         part of your hospital treatment.                       overnight accommodation outside of hospital
not otherwise excluded by Bupa.                          therefore you must let us know about any                                                                   for you and a caregiver. Check your extras
                                                                                                             the Prostheses list includes: pacemakers,
                                                         change of address.                                                                                         cover to determine if you are covered for
when in hospital, if you are treated with drugs                                                              defibrillators, cardiac stents, joint
                                                                                                                                                                    these benefits.
that are not PBS approved, you may not be fully          to receive the benefits available on your cover,    replacements, intraocular lenses and other
covered and the hospital may charge you for all          you need to:                                        devices. if a hospital proposes to charge you          Waiting periods
or part of the cost. you should be advised by the                                                            a ‘gap’ for your prosthesis, they need your
                                                                                                                                                                    a waiting period is the time between when
hospital of any charges before treatment.                ° fully complete the application process and        informed financial consent. Please contact us
                                                                                                                                                                    you joined us and when you are covered
                                                           pay your premiums one month in advance.           for further details.
there are some additional items that are                                                                                                                            for a service or treatment. if you receive a
                                                           or, if you’re on a corporate plan, it’s up
not covered by our pharmacy benefit and                                                                      Suspension rules                                       service or treatment during this time, you
                                                           to you to make sure payments are made
these include:                                                                                                                                                      are not eligible to receive a benefit payment
                                                           during times of unpaid leave or if your           a membership may be suspended when
                                                                                                                                                                    from us, regardless of when you submit the
                                                           employment ends                                   travelling overseas for work or leisure. if you
° over the counter or non-prescription items                                                                 are travelling overseas, you can suspend your
                                                                                                                                                                    claim. different waiting periods apply for
                                                         ° ensure that newborns are enrolled onto a                                                                 different services.
° compounded items                                         family membership within two months of            membership. you can suspend your cover
° weight loss medication                                   their birth to avoid any waiting periods for      under the following circumstances:
  (some weight loss medications are covered                your baby
  under the living well Programs)                                                                            ° for a minimum period of two months
                                                         ° enrol your adult children under their own         ° for a maximum period of two years
° body enhancing medications                               names within 60 days after they no longer
  (e.g. anabolic steroids).                                qualify under your cover (to avoid a break in
                                                           their cover)



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


                                              10                                                                                                     11
                                    mailing details:
for m or e In fo r mat I o n        Bupa
                                    Po Box 14639
   Call us on 134 135               MelBouRne viC 8001

                                    Bupa australia Pty ltd
   Visit bupa.com.au                aBn 81 000 057 590
   Drop by your local Bupa centre   effective 1 april 2012
                                    10350–04–12S




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