Bupa Health Fund

  • Bupa offers hospital, extras, and combination plans to their customers.
  • Save on extras services by bundling your hospital and extras cover together.
  • There are several different ways you can make a claim through Bupa, including electronic claims, online, and through the post.

Bupa is an international insurance provider that has been operating in Australia for years. They’re one of the biggest health funds in the country, and has invested more than $30 million in national health initiatives through the Bupa Health Foundation.

Ahead, we’ll take a look at the policies, performance, and process for Bupa.

Bupa offers hospital only, extras only, and package options to their customers. Combining hospital and extras policies under Bupa can result in savings, though it depends on your medical needs.

Hospital Only

Bupa provides their members with five hospital only policies to choose from. These policies have varying degrees of coverage, but all come with accommodation for overnight and same day stays, operating theatre, intensive care, ward fees, and an available medical gap scheme.

Ahead is a breakdown of the hospital only coverage options, what they include, and what restricted coverage each has. These policies are listed from the least to most expensive.

Policy Included Restricted
Basic Hospital Accidents Inclusion
Emergency Ambulance Services
Excess Options
Travel Insurance Bonus
Cancer
Dental Surgery
Appendicitis
Minor Gynaecological Surgery
Brain Surgery
Knee Arthroscopy or Meniscectomy Procedures
Colonoscopies
Gastroscopies
Grommets
Hernia Repair
Reconstructive Surgery
Breast Reconstruction Post Cancer
All Other Inpatient Treatments
Receiving a Medicare Benefit Tonsil and Adenoid Removal
Psychiatric Services
Rehabilitation Services
Palliative Care
Budget Hospital All Benefits Covered Under Basic Hospital
No Excess for Kids
Cardiac and Cardiac Related Services
Other Joint Replacements
Rehabilitation Services
Palliative Care
Psychiatric Services
Standard Hospital All Benefits Covered Under Budget Hospital
Psychiatric Services
Pregnancy and Birth Related Services
Abdominoplasty and Lipectomy
Joint Replacement
Spinal Fusion
Obesity Related Procedures andSurgeries
Top Hospital (No Pregnancy Cover) Most Benefits Covered Under Standard Hospital (See Exclusions*)
Best Doctors Second
Opinion Service
Single Room Guarantee
Family In-Hospital Benefit (pay for partner/family accommodations)
Health Subscription Refunds
Access to the Ultimate Advice Line
Unemployment Cover
Hip and Knee Replacement
Cataract and Eye Lens Procedures
Renal dialysis for chronic renal failure
* Exclusions: Pregnancy Cover,Abdominoplasty and Lipectomy,Obesity Related Procedures orSurgeries
Top Hospital All Coverage From Above Policies
Pregnancy and Birth Related Services
Assisted Reproductive Services (IVF)
Abdominoplasty and Lipectomy
Obesity Related Procedures or Surgeries
Exclusion: All Cosmetic Surgeries
Extras Only

Like the hospital cover options from Bupa, there are five extras only policies you can purchase. You can combine these with select hospital cover policies, or as standalone policies.

Bupa uses a member network called “Members First” for some of their extras.You’ll have both a Members First annual limit and a regular annual limit through most extras policies, so you’ll be able to get more for your money if you visit one of their in-network locations.

Bronze Extras

Bronze Extras is the simplest and cheapest form of extras cover that Bupa provides. Members can claim up to 60% back on basic extras that are covered by the policy. You’ll be able to access the following services up to your annual limit:

  • General dental
  • Optical
  • Ambulance services
  • Natural Therapies
  • Chiro and Osteo
  • Physiotherapy
  • Antenatal and Postnatal
  • Health Management
  • Pharmacy

The annual limits for this policy are on a per person and per membership basis. If you buy a policy for you and your partner, for instance, you will each be able to reach half of the membership’s total annual limit.

You can also pay $0.70 more per week to access a 20% savings on your pharmacy prescriptions.

Your Choice Extras

Your Choice Extras is the step up from Bronze. Members can claim up to 60% back on basic extras that are covered by the policy. This policy offers higher annual limits than Bronze and provides you with loyalty benefits that raise the limit each year.

For example, you’ll have an annual limit of $700 per person for general dental the first year. If you stick with the policy for five years, you’ll be able to spend $1,260 per person per year.

As is the case with the Bronze Extras policy, you can pay a bit more to receive a 20% savings on pharmacy. With Your Choice Extras, this cost is an additional $0.65 per week.

In addition to the coverage you get from Bronze, Your Choice also covers:

  • Orthodontics
  • Major Dental
  • Podiatry
  • Speech therapy, eye therapy, occupational therapy
Your Choice Extras

Your Choice Extras is the step up from Bronze. Members can claim up to 60% back on basic extras that are covered by the policy. This policy offers higher annual limits than Bronze and provides you with loyalty benefits that raise the limit each year.

For example, you’ll have an annual limit of $700 per person for general dental the first year. If you stick with the policy for five years, you’ll be able to spend $1,260 per person per year.

As is the case with the Bronze Extras policy, you can pay a bit more to receive a 20% savings on pharmacy. With Your Choice Extras, this cost is an additional $0.65 per week.

In addition to the coverage you get from Bronze, Your Choice also covers:

  • Orthodontics
  • Major Dental
  • Podiatry
  • Speech therapy, eye therapy, occupational therapy
Silver Extras

Silver Extras gives you 60-66% back on Members First dental physio, chiro, and selected optical and podiatry consultations up to your annual limit. This policy also has other benefits, such as unlimited annual limits on general dental.

As you can expect, the annual limits on this policy are relatively high. Some procedures have lifetime maximums, such as orthodontics with a lifetime limit of $2,000. This and all subsequent policies also include the Pharmacy Saver option for the same price ($0.65/week).

You will receive all of the services and procedures from Your Choice Extras, with the addition of:

  • Travel and Accommodation
  • Health Aids and Appliances
  • Home Nursing
  • Mental Health
  • Dietary
Gold Extras

Gold Extras gives you 75-82.5% back on most services from a Members First provider. You will receive all of the same services and procedures as Silver Extras, but with higher annual limits.

Platinum Extras

Platinum Extras is the highest level of extras coverage that Bupa offers. This policy gives you 90-100% back on select Members First procedures, with the highest annual limit of any extras policy from Bupa.

Hospital and Extras Packages

There are dozens of Hospital and Extras packages from Bupa, most of which combine an existing hospital policy with an existing extras policy.

Combining extras cover with hospital cover gives you free dental check-ups at Members First Platinum Dentists (up to yearly limit) and most kids’ dental, chiro, podiatry, some optical, and physio from Members First providers until they turn 25.

Pre-packaged options include:

  • Active Saver: Basic hospital + basic extras
  • Simple Start: Basic hospital + basic extras
  • Young Singles Saver: Basic hospital + basic extras
  • Young Singles Choice: Basic hospital + basic extras
  • Young Couples Saver: Basic hospital + basic extras
  • Young Couples Choice: Basic hospital + basic extras
  • Budget Family: Basic hospital + basic extras
  • Growing Family: Medium hospital + medium extras
  • Established Family: Medium hospital + medium extras
  • Ultimate Health Cover: Top Hospital + top extras

These policies have different annual limits on extras but have similar coverage options as the standalone hospital and extras policies.

The Private Health Insurance Ombudsman provided the following information that compares Bupa to the rest of the health insurance industry.

Hospital Related Charges Covered

Bupa is slightly below industry average

Medicare Services with No Gaps

Bupa is below the industry average

Medicare Services No or Known Gap

Bupa is below the industry average

General Treatment Covered

Bupa is below the industry average

Bupa Industry Average
Benefits as % Contributions 85% 86%
Management Expenses (% Fund Cont.) 7.9% 8.8%
Management Expenses (Average Policy) $283 $310
Surplus (-Loss) from Health Insurance 7.2% 5.2%
Member Retention (hospital) 85% 83%
Bupa market share: 26.9%
Benefits as % Contributions 21%
Service Complaints 9.9%
All Complaints 17.6%
Investigations 27.4%
Source: http://www.ombudsman.gov.au/__data/assets/pdf_file/0015/27501/Bupa.pdf

Here are the different ways you can make a claim from Bupa:

Electronic Claiming

Electronic claiming is the simplest way to claim through Bupa, but it’s only available from select providers. All you have to do is swipe your card at the end of your visit to claim this way.

Claim Online

Log into your myBupa account, click ‘claim online,’ and input the details from your receipt into the required section

Claim via Post

Fill out a claims form and mail it to:
Bupa Reply Paid 990
Adelaide SA 5001

Bupa has partnered with dozens of fitness, parenting, nutrition, entertainment, travel, and other companies through their Bupa Plus program to help bring value to a health fund membership.

You’ll be able to receive discounts and exclusive services through these providers. Members can log in or register with myBupa to find out how to get the most out of your Bupa health fund membership.

Phone: 134 135

Outside Australia: +61 3 9487 6400Hours:Mon – Fri 8am – 8pm

Mail:Bupa

GPO Box 9809

Brisbane, QLD 4001

Australia

Website:bupa.com.au
Find a Retail Store::bupa.com.au/find-a-centre
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