1 April 2014
Your level of cover is a packaged hospital and extras cover.
Your hospital cover helps pay for hospital and in-patient hospital medical expenses in private and public hospitals. Minimum benefits apply to some services you don't think you'll need now.
What Is Covered
With private hospital cover, you can choose to be treated as a private patient in either a public or a private hospital.
With us, you are fully covered as a private patient in most hospitals that Bupa has an agreement, known as Members First and Network hospitals across Australia for any treatment which is recognised by Medicare and is not either restricted or excluded under your cover.
A small number of these hospitals may charge a fixed daily fee. This fee is capped at a maximum number of days for overnight stays. The hospital should inform you of this fee when you make a booking. This fee is in addition to any excess or co-payment you may have as part of your hospital cover.
When admitted to hospital, in most cases you will be covered for all in-hospital charges when provided as part of your in-hospital treatment including: accommodation for overnight or same-day stays
operating theatre, intensive care and labour ward fees
supplied pharmaceuticals approved by the Pharmaceutical Benefits Scheme
allied health services including physiotherapy, occupational therapy and dietetics
dressings and other consumables
pathology and radiology diagnostic tests recognised by Medicare and performed in hospital by Bupa contracted providers
surgically implanted prostheses up to the approved benefits in the Government’s Prostheses List
private room where available.
We recommend you call us first before making a booking to confirm that your chosen hospital gives certainty of full cover. We can also discuss any excess or co-payment that might apply to your level of cover. You can find out if a hospital has an agreement with us by checking our website bupa.com.au/find-a-provider.
If you elect to be treated as a private patient in a public hospital or are admitted to a private hospital that Bupa does not have an agreement with, you are covered as set out below for any treatment recognised by Medicare unless it is excluded or restricted under your cover. In these circumstances, you are likely to incur out-of-pocket expenses for your hospital costs.
As a private patient in a public hospital you are entitled to choose your doctor, if they are available. Depending on your illness or condition, this may be the same doctor who would have been allocated to you by the hospital as a public patient.
If you elect to be treated as a private patient in a public hospital, we will pay shared room minimum benefits and benefits for prostheses up to the benefit in the Government Prostheses List. This will apply for any treatment recognised by Medicare unless it is excluded or restricted under your cover. If you choose to stay in a private room for an overnight stay, Bupa will pay a fixed benefit towards the cost of your stay. If this benefit is less than the hospital charge, the hospital should let you know what out-of-pocket expenses you will have to pay. It is important to note that in public hospitals, private rooms are generally allocated to people who medically need them. You will also be responsible for personal expenses such as TV hire and telephone calls and any prostheses charges above the benefit in the Government Prostheses List.
If you are admitted to a private hospital that Bupa does not have an agreement with, we will pay shared room minimum benefits and benefits for prostheses up to the benefit in the Government Prostheses List. This will apply for any treatment recognised by Medicare, unless it is excluded or restricted under your cover. These benefits will only partially cover the full cost and you will have significant out-of-pocket expenses. It is important to note that you will be