Understanding your cover

Bupa’s OSHC membership provides cover for hospital and medical treatment

What's covered

Hospital expenses covered

In most cases, we will pay for these services when you’re in hospital including:

accommodation for overnight or same-day hospital stays
operating theatre, intensive care and labour ward fees
medication provided to you as part of your in-hospital treatment under the Pharmaceutical Benefits Scheme (PBS)
physiotherapy, occupational therapy and dietetics and other allied health services provided in hospital
surgically implanted prostheses up to the approved minimum benefits in the Government Prostheses List that used as part of your surgery
private room where available

Medical expenses covered

Each doctor or specialist that treats you will charge a fee for the service they provide. This also includes most tests you may be sent to have by your doctor including pathology and radiology services.

There is a set fee for each service, which is called the Medicare Benefits Schedule (MBS) fee. If your doctor charges you 100% of the MBS fee then you will be fully covered for treatment in hospital and out of hospital. If your doctor chooses to charge above 100% of the MBS fee then for the part above the MBS fee, you will have to pay it yourself.

Outpatient pharmacy

If you are prescribed pharmacy items by a doctor, specialist or when you have visited hospital and not been admitted, you can claim back $50 per approved prescription item, up to $300 (single) or $600 (couple/family) per year.

You will have to pay the first $38.80 each time (which is the Pharmaceutical Benefits Schedule co-payment fee, which is what Australian residents have to pay too).

Emergency Ambulance Services

You can claim for emergency ambulance transportation and on-the-spot treatment by our recognised providers anywhere in Australia.

What's not covered
procedures not approved by the Medical Services Advisory Committee
procedures not recognised by Medicare
cosmetic surgery (that is not clinically necessary and where benefits are not payable by Medicare)
non-emergency ambulance
IVF and assisted reproductive services
experimental treatment
respite care

We may not pay some or all of the costs for other services. For further information, please refer to the Important Information Guide below.

Things you should know

Waiting periods apply

You will need to be a member for a certain amount of time before claiming money back on services. This is called a waiting period.

If you have your condition before joining Bupa we call this a pre-existing condition and we also may not be able to cover you, or you may need to wait until you have completed your waiting period.

2 months^ = Pre-existing conditions, ailments or illnesses of a psychiatric nature
12 months = Pregnancy related services (including childbirth)
12 months = All other pre-existing conditions, ailments or illnesses for hospital and outpatient medical services

Waiting periods don’t apply when:

treatment is required as a result of an accident after joining Bupa
you have a condition which is defined under the Emergency Treatment section of the Important Information Guide (located in the box below)

Please remember that this is just a snapshot of your cover. For full details on what we will and won’t help you pay for under your Bupa OSHC membership, please read your full cover description located in the box below.

^ No waiting periods apply for conditions, ailments or illnesses of a psychiatric nature for Advantage OSHC customers.