1 OVERSEAS STUDENT HEALTH COVER WHAT YOU NEED WHILE YOU STUDY A
2 WELCOME TO AUSTRALIA While you re in Australia for study the last thing you want to worry about is what happens if you get sick or have an accident. The healthcare system in Australia is regarded as one of the best, but the cost of treatment can be expensive. As an international visitor, you will not be eligible for cover with Medicare, Australia s public healthcare system. That s why we offer cover made especially to suit the needs of international students. B
3 WELCOME TO BUPA We all want to live longer, healthier, happier lives. This brochure has been designed to provide information about how to make the most of your cover. It s about more than just what you can claim. Throughout these pages, you ll discover we re committed to supporting you for the long term, no matter where life takes you. It s all about creating a healthier you whilst you re in Australia, and it starts right here. The information in this brochure is important and should be read carefully and kept in a safe place. CONTENTS Why private health insurance? 2 Why Bupa? 4 We ve made choosing simple 9 Overseas Student Health Cover 11 Optional Extras Cover 17 Member exclusives 20 Join us today 22 Important information 26 1
4 WHY PRIVATE HEALTH INSURANCE? WE KNOW THE AUSTRALIAN HEALTHCARE SYSTEM We understand healthcare systems differ from country to country, so we ve provided some basic information to help you understand the Australian healthcare system and why you may need private health insurance during your stay. 2
5 MEDICARE Medicare is Australia s public healthcare system and is available to all Australian citizens and permanent residents. It provides free or subsidised cover for certain healthcare costs. When it comes to hospital treatment, Medicare generally won t cover your choice of doctor and for some procedures there may be a waiting list. In almost all cases, if you re on a student visa you will not be eligible for Medicare. That s where Overseas Student Health Cover helps. PRIVATE HEALTH INSURANCE It s a condition of your student visa that you must have Overseas Student Health Cover (OSHC) for the duration of your study period in Australia. OSHC will help cover the cost of your medical treatments in and out of hospital, should you get sick or have an accident. Plus, you can choose extras cover products which help pay for a wide range of services including dental, optical, physio, chiro, massage and much more. OVERSEAS STUDENT HEALTH COVER To be eligible for OSHC you must hold a student visa, be in the process of applying for a student visa or be on a bridging visa while applying to extend your student visa. Norwegian students do not need OSHC in Australia because health insurance is provided for them by their government. Swedish students who have not taken out CSN International (the Swedish National Board of Student Aid) will need to take out OSHC in Australia. Belgian students do not have to take out OSHC on the basis of the Reciprocal Health Care Agreement between Australia and Belgium. To find out the level of benefits provided, you can call Medicare on (within Australia) or (outside Australia). 3
6 WHY BUPA? WE WANT YOU TO LIVE A LONGER, HEALTHIER, HAPPIER LIFE Bupa is a healthcare leader proudly looking after the needs of more than three million Australians. We have been around for over 60 years and we re part of a global family whose care and expertise now stretches across 190 countries. It is our purpose that makes us different. We exist to help our members live longer, healthier, happier lives. Which is why our global family reinvests its profits to provide better services for members and to ensure quality healthcare remains affordable. We are dedicated to helping find a healthier you. To find out more: Call us on (within Australia) (from overseas) Visit bupa.com.au/students Drop by your local Bupa centre 4
7 WE PUT OUR MEMBERS AT THE HEART OF EVERYTHING WE DO For your convenience We give you choice so you can manage your cover. You can contact us by phone or talk to someone face to face at one of over 100 retail centres. Australia s largest combined provider network^ If you choose to also take out extras cover, we pay benefits at all recognised providers around the country, giving you great coverage and peace of mind. You can also enjoy the advantages of Australia s largest combined provider network choose from over 10,000 Members First providers of general dental, optical, physio and chiro services to receive higher benefits in most instances. We know the health system We know the health system can be confusing. That s why our friendly team are here to help you make sense of it. They can answer important questions like: what you re currently covered for, what to ask your doctor before treatment and how much you ll get back. By your side wherever you are If the unexpected happens during your stay or while you re travelling overseas, we re always here to provide phone-based support and guidance. Our 24-hour advice line is exclusive to Bupa and provides you with helpful information, including: basic advice on simple medical problems provided by doctors and nurses contact details and location of the nearest medical facilities medical translation services, including reviewing bills and help booking medical appointments passing telephone messages on to your family. And if you re planning a trip overseas, you can get pre-departure medical information on the countries you are visiting. We ll advise you on the health risks of that country and give you tips on how to stay healthy while you re travelling. Just look for the number on the back of your membership card. ^As at 1 February 2012 for dental, optical, physio and chiro providers. 5
8 WHY BUPA? FIND A HEALTHIER YOU At Bupa, we know that everyone wants to be healthy, but sometimes life gets in the way. That s why we support you with tools and apps and world-class health information to help you take your first step towards a healthier you. World-class health information Visit our website to stay in the know on health topics that are important to you. The information is designed by health professionals and ranges from conditions and treatments through to exercise and diet tips. We also recommend other reputable websites because our knowledge is your knowledge. See page 20 for other member exclusives. 6
9 GETTING TO A HEALTHIER YOU Online Health Assessment To really take charge of your health, you need to know just how healthy you are in the first place. Our new Online Health Assessment is very easy to use, and will help you take your first step towards a healthier you. What you ll find out Your real health age lifestyle risk scores recommended changes you can make to help improve your health age Bupa programs that may be helpful to you. Take your Online Health Assessment at bupa.com.au/oha Bupa mobile apps Download our Ready, Set, Run app to get a personalised training program. And our Bupa Provider Locator app lets you search our network to find a dentist, optical outlet, physio, chiro or hospital while you re out and about. We are regularly developing more new tools and apps so check bupa.com.au and our social media sites regularly for updates: Twitter.com/BupaAustralia Facebook.com/BupaAustralia Youtube.com/BupaAustralia 7
11 WE VE MADE CHOOSING SIMPLE Overseas Student Health Cover (OSHC) helps cover the cost of your medical treatments in and out of hospital, should you get sick or have an accident. You can take out OSHC on its own, but you also have the option to take out extras cover. The following pages will help you understand more about OSHC and your extras cover options, so you can choose what s right for you. 1. ABOUT OVERSEAS STUDENT HEALTH COVER Overseas Student Health Cover helps pay for hospital cover for inpatient hospital and medical services as well as medical cover outside of hospital, whilst in Australia See page OPTIONAL EXTRAS COVER Extras covers you for services that OSHC does not cover such as: dental, optical, physio, chiro, massage and much more. See page 17. 9
12 DIRECT BILLING DOCTORS If you seek treatment from one of our direct billing doctors, they ll charge us directly for the cost of your treatment* so you won t see a bill or have to file a claim! A list of our direct billing doctors is available on our website, bupa.com.au/students *You may be asked to pay a Medical Gap to the doctor that is not claimable under OSHC. 10
13 OVERSEAS STUDENT HEALTH COVER 1. ABOUT OVERSEAS STUDENT HEALTH COVER 11
14 OVERSEAS STUDENT HEALTH COVER ABOUT OVERSEAS STUDENT HEALTH COVER If you re on a student visa, our Overseas Student Health Cover (OSHC) ensures you have control of your health cover. You ll be covered for the cost of medical treatments both in and out of hospital. NIL EXCESS WHAT S COVERED? In-hospital Out of hospital Additional Benefits 100% cover for inpatient hospital costs for services included on your cover, including accommodation and theatre fees in all Members First and Network private hospitals and public hospitals Australia wide. (See page 15 for examples) up to 100% of the Medicare Benefits Schedule (MBS) fee for the cost of inpatient medical services such as fees charged by your doctor or specialist a single room or $50 back when you book your overnight admission at Members First hospitals (conditions apply contact us for details)* you will have no out-of-pocket hospital expenses and no gaps on your doctors fees at our Members First day facilities.*^ Up to 100% of the Medicare Benefits Schedule (MBS) fee for the cost of visits to a doctor or specialist in private practice, anywhere in Australia 100% of the balance up to $50 per script for selected Pharmaceutical Benefits Scheme (PBS) and non-pbs pharmacy items after you pay the PBS patient co-payment fee, up to a limit of $300 (for singles) or $600 (for couples or families) per calendar year. This is provided the items usage is approved by the Therapeutic Goods Administration (TGA). Emergency ambulance cover for unlimited emergency only ambulance transportation and on-the-spot treatment in most cases eliminate or reduce your out-of-pocket hospital expenses with our Members First and Network hospital agreements* direct billing doctors if you seek treatment from one of our direct billing doctors, they ll charge us directly for the cost of your treatment ~ access to our 24-hour Australian and overseas health advice line (see page 5). Waiting periods apply, see page 14. WHAT S NOT COVERED? For the duration of your cover you will not receive benefits for: assisted reproductive services (including IVF). Please note: there are also other services that are not fully covered or not covered at all by Bupa under any of our covers. See page 14 and the Important Information section at the back of this brochure for more details. *To see if your chosen facility has an arrangement with us, view our current Bupa Hospital Listing on our website or call us. ^Available in NSW, QLD, SA, VIC and WA. ~ You may be asked to pay a Medical Gap to the doctor that is not claimable under OSHC. See page 14 for details. Visit our website for a list of our direct billing doctors at bupa.com.au/students 12
15 THERE ARE DIFFERENT TYPES OF MEMBERSHIP AVAILABLE: single membership provides cover for you only couples membership provides cover for you and your partner family membership provides cover for you, your partner and your child dependants under 18 years of age if they live with you in Australia. Please note: OSHC does not provide cover for extended family members, such as your mother, father, brother or aunt. If these family members come to Australia to visit you, we can provide them with cover for overseas visitors. Contact us for more details. OVERSEAS STUDENT HEALTH COVER BUPA MEMBERS FIRST AND NETWORK HOSPITALS If you choose to go to a hospital in our network in most cases you will be fully covered for your accommodation, theatre, labour ward and intensive care fees.* *There are a small number of fixed fee hospitals that will charge you a fixed daily fee 13
16 OVERSEAS STUDENT HEALTH COVER UNDERSTANDING YOUR OSHC What s covered Your Overseas Student Health Cover helps pay for treatments that are recognised by Medicare when you are admitted to hospital. For treatments that are included in your OSHC we will help pay for things like: your room, theatre fees, surgically implanted prostheses up to the approved benefits in the Government s Prostheses List, pathology and radiology diagnostic tests performed in hospital by Bupa contracted providers and fees charged by your doctor/s when they treat you in hospital. You will also be covered for fees charged for treatment you receive from a doctor or specialist in private practice, or as a hospital outpatient. What s not covered There are situations where you are likely not to be covered under OSHC. The following are not covered by us at all (nil hospital, prosthesis or medical benefits): procedures not recognised by Medicare; procedures not approved by the Medical Services Advisory Committee; experimental treatment; respite care; assisted reproductive services (IVF) and cosmetic surgery that is not clinically required. Surgical podiatry receives minimum benefits (if a prosthesis is surgically implanted during a procedure, the cost of this will be covered). Waiting periods A waiting period is the time between when you joined us and when you are covered for a service or treatment. If you receive a service or treatment during this time, you are not eligible to receive a benefit payment from us, regardless of when you submit the claim. The following waiting periods apply to OSHC: pre-existing conditions, ailments or illnesses of a psychiatric nature two months all other pre-existing conditions, ailments or illnesses 12 months pregnancy related services (including childbirth) 12 months.* There is no waiting period for treatment you require as a result of an accident sustained after joining us, or for treatment that has a waiting period, if that treatment is classified as Emergency Treatment (see page 31 for details on Emergency Admissions and Emergency Treatment). There are also no waiting periods for newborn babies provided you are on a family policy and the baby is added to your membership no later than two months after their birth. Medical Gap This refers to the difference between what your doctor charges and the amount we will pay for inpatient and outpatient services. If your doctor charges up to the Medicare Benefits Schedule (MBS) fee or is participating in our Bupa Medical Gap Scheme (see page 25), in most cases you will have no medical gap costs to pay. For doctors who are not participating in our Medical Gap Scheme and are charging above the MBS fee, we will cover up to the MBS fee and any amount above that fee you will be required to pay. This is referred to as the Medical Gap. You should also see the Important Information section in the back of this brochure for more details. *Not applicable to OSHC members who joined before 1st July,
17 In and out of hospital costs MBS FEE GAP If your specialist charges above the MBS fee, there will be a gap. This gap is an extra amount which you will have to pay. If your specialist charges up to the MBS fee, in most cases you will have no medical gap costs to pay. For example, if your general practitioner (GP) charges $90 for out of hospital medical costs for MBS item 36 (Level C Consultation at consulting room) the MBS fee is $69^. Bupa will cover $69 and the balance of $21 would be your medical gap. OVERSEAS STUDENT HEALTH COVER Services See page 12 Benefits included on cover: Accommodation for Overnight and Same-day Stays Operating Theatre, Intensive Care, Ward Fees Bupa Medical Gap Scheme available Allied Services (e.g. physiotherapy in hospital) Private Hospital admissions Public Hospital admissions Inpatient Medical expenses Outpatient Medical expenses In-patient services included on cover: Accidents After Joining Knee Arthroscopy and Meniscectomy Procedures Appendicitis Removal of Tonsils and Adenoids Dental Surgery Minor Gynaecological Surgery Psychiatric Services Rehabilitation Services Palliative Care Pregnancy Related Services (including childbirth) Assisted Reproductive Services (including IVF) Cardiac and Cardiac Related Services (e.g. open heart and bypass surgery) Renal Dialysis for Chronic Renal Failure Cataract and Eye Lens Procedures Hip/Knee Replacement (including arthroplasty, revisions and resurfacing procedures) All Other Joint Replacements Sterilisation Reversal Cosmetic Surgery that is Clinically Necessary and Where Benefits are Payable by Medicare Cosmetic Surgery that is not Clinically Necessary All Other Inpatient Treatment Receiving a Medicare Benefit Additional Items: Outpatient Pharmacy Benefits^^ Full Ambulance Services Emergency Ambulance Services Repatriation Excesses Excess Nil OVERSEAS STUDENT HEALTH COVER ^Fees valid at 1 November Indicates the service is not included. ^^Limits apply, 15
20 OPTIONAL EXTRAS COVER HOW MUCH COVER DO YOU NEED? We want to help you choose the most relevant level of cover for you. These extras covers can be purchased in addition to your OSHC. For more information call us on BASIC BRONZE Enjoy a range of basic extras services like general dental, physio and chiro, with at least 60% back at our Members First providers. Plus receive good optical benefits. It's a great way to stay in good health on a budget. YOUR CHOICE Want the freedom to choose what you want? You ve got it. This option allows you to select the four services that suit you best so you're not paying for things you don't need. Plus you ll get at least 60% back at our Members First providers and annual rewards for loyalty. 18
21 + + EXTRAS COVER Get a quick quote on one of the covers listed below. Just scan the QR code above with your smart phone. ALL COVERS SUITABLE FOR SINGLES, COUPLES AND FAMILIES SILVER Silver Extras Cover gives you access to our complete range of extras services with at least 60% back at our Members First providers. You ll receive value for money with healthy annual maximums and additional benefits such as our unique Benefit Bonus. GOLD If you want generous benefits and a high level of cover, go for Gold. This cover has the same range of services as Silver Extras but you ll get at least 75% back at our Members First providers and higher annual maximums. COMPREHENSIVE PLATINUM Get peace of mind knowing that you re covered to our highest level. The list of services is the same as Silver and Gold but you ll enjoy at least 90% back with our Members First providers and even higher annual maximums. 19
22 MEMBER EXCLUSIVES MORE VALUE FOR MEMBERS Living Well Living Well provides practical support to help you reach your goals by covering some of the costs for health-related programs. These include: first aid courses, nicotine replacement therapy, weight management programs, children s swimming lessons (eligible products only), gym membership fees, Pilates and yoga courses. Eligibility criteria and conditions apply, so please contact us to find out more.* Greater Value with BLINK Optical Shop at BLINK Optical and receive a special discount just by having OSHC: get up to $100 off frames^ get 20% off a variety of sunglasses, non-standard prescriptive lenses and non-standard contact lenses.^ All you need to do is show your membership card at time of sale. Travel, home and car We re more than a health insurance provider. Through our partnership with CGU, we re able to offer you a full range of insurance products from travel insurance, home and contents insurance, to motor vehicle and caravan insurance. What s more, just for being a Bupa member, you ll also get a 10% discount on your home and contents insurance or motor vehicle insurance premiums, plus a 15% discount on travel insurance. *Only available if you purchase Extras cover. Insurance is issued by CGU Insurance Limited (CGU) ABN AFSL This is general advice only and does not take into account your individual circumstances. Travel insurance policies cannot be issued to cover trips back to your home country. Product Disclosure Statements are available at bupa.com.au and should be considered before making any decision on these products. Bupa Australia Pty Ltd ABN and Bupa Australia Health Pty Ltd ABN (together Bupa) are authorised representatives of CGU. ^Not available on any other offer. Membership card must be produced at time of sale. 20
23 MEMBER EXCLUSIVES 21
24 JOIN US TODAY JOINING OR RENEWING IS SIMPLE Only one form to fill in Simply fill in our application form and mail it back to us using our reply paid address or drop it into your local Bupa centre. Or just call us on (from within Australia) or (from outside Australia) to get a quote or visit bupa.com.au/students to join online. What it costs and how to pay Please contact us for a quote or we can send you our premiums list. We want you to pay in a way that suits you so we ve provided a number of options. You can choose to pay via credit card (Visa or Mastercard) online or over the phone, by Eftpos at most Bupa centres or by post with an Australia Post money order. Ordering your card You can order your membership card once you arrive in Australia. Contact your educational institution or order one online at bupa.com.au/students Changing or renewing your cover Contact us to update or change your membership details. Alternatively, download and complete the form provided on our website. If you ve decided to study for a longer period of time than you originally planned, you will need to renew your cover. You can use the application form attached in this brochure, renew online, download and complete a renewal form from our website or visit your local Bupa centre. Switching to Bupa is simple Enjoy a hassle-free experience when you transfer to us from your existing OSHC provider. Simply fill in our application form and make a payment for your new OSHC membership. If you have a clearance certificate or letter of cover from your current OSHC insurer please send it to us with your application form. If you don t have one, you will need to contact your insurer to obtain one. We will then provide you with a Verification Letter which confirms you have an OSHC membership with Bupa. You can use this letter to obtain a refund from your previous OSHC provider. 22
25 23 JOIN US TODAY
26 HOW DO I FIND A MEDICAL GAP SPECIALIST? Your general practitioner is in the best position to refer you to a specialist that will meet your clinical needs. You can ask your GP to refer you to a specialist who participates in our Medical Gap Scheme. 24
27 CLAIMING MADE EASY CLAIM ON YOUR OSHC Bupa Medical Gap Scheme and Direct Billing This is a direct billing arrangement between Bupa and your doctor/s that in most instances eliminates your out-of-pocket expenses for in-hospital doctors fees (the gap ). Under this scheme some doctors can charge you a known gap which means you have some out-of-pocket expenses to pay but they are limited to a defined amount. Doctors need to agree to participate in this scheme for it to apply so make sure you ask them about it before you are treated. Otherwise our medical benefits are limited to the Medicare Benefits Schedule (MBS) fee and if your doctor charges above the MBS you will have a gap to pay. If a doctor proposes to charge you a gap they need your informed financial consent. Please contact us for details. Also, if your doctor is registered for Direct Billing, they will bill us directly for any outpatient treatment, so you will not need to lodge a claim with us. You may need to pay a Medical Gap charge to the clinic at the time of your consultation. Members First and Network Private Hospitals Hospitals in our network will bill us directly for your accommodation, theatre, labour ward and intensive care fees. All you need to do is present your OSHC membership card. Public hospitals & non-agreement private hospitals If you choose to be treated in a public hospital or a non-agreement hospital, you may need to pay upfront. For more information call our friendly Bupa team on Medical Providers This includes services from General Practitioners (GPs), medical specialists, medical imaging providers (x-rays and ultrasounds), pathology providers, and more. You can pay these bills yourself and then claim them back. Or you can send us the unpaid bill and we will send you a cheque for the eligible medical expenses to send to the provider as part of your payment. CLAIMING ON BOTH OSHC AND EXTRAS By mail Simply print and fill in a claim form from our website and attach any original accounts or receipts from your health care provider/s. Then mail it to us at: Bupa, Reply Paid 990 ADELAIDE SA In person You can submit your claims at your local Bupa centre. Most centres are able to process claims on the spot and provide you with benefits, either by cash (limits apply), cheque or bank transfer. Claim queries Remember that claims can only be paid within two years of the date that the service was provided and are subject to standard conditions including waiting periods and annual maximums. Call our friendly Bupa team on , visit bupa.com.au/students or drop by your local Bupa centre if you have any questions about: the status of your claim how to fill in a claim form what documents you need to attach to your claim form. JOIN US TODAY 25
28 IMPORTANT INFORMATION Over the next few pages you will find information to help you understand how your health cover with us works. We recommend you keep this information in a safe place so that you can always refer to it. From time to time, things can change. Before you seek any treatment call us so we can give you the most complete and up-to-date information. Please be aware that these rules apply in addition to our Overseas Visitors Rules. UNDERSTANDING YOUR OVERSEAS STUDENT HEALTH COVER What is covered? Hospital costs With Overseas Student Health Cover (OSHC), you can choose to be treated in either a public or a private hospital. With us you are fully covered as a private patient in Members First and most Network hospitals, and all public hospitals across Australia. A small number of hospitals may charge a fixed daily fee, capped at a maximum number of days per stay. These hospitals should inform you of this fee when you make a booking. 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 pharmacy items approved by the Pharmaceutical Benefits Scheme (PBS) allied services including physiotherapy, occupational therapy and dietetics dressings and other consumables pathology and radiology diagnostic tests performed in hospital by Bupa contracted providers a surgically implanted prostheses up to the government approved benefit published in the Government s Prostheses List single room where available shared room only in public hospitals. We recommend you call us first before making a booking to confirm that your hospital of choice gives you certainty of full cover. You can find out if a hospital has an agreement with us by checking our website bupa.com.au Inpatient medical costs These are the fees charged by your doctor, surgeon, anaesthetist or other specialist for any treatment given to you when you are admitted to a hospital as an inpatient. Put simply, we pay 100% of the Medicare Benefits Schedule (MBS) fee. The MBS fee is set for each specific service by the Federal Government. Outpatient medical costs This is cover for any treatment you receive from a doctor or specialist in private practice, or as an outpatient (i.e. where you are not admitted into hospital) anywhere in Australia. This includes services from General Practitioners (GPs), medical specialists, medical imaging providers (x-rays and ultrasounds), pathology providers, and more. We cover you for 100% of the Medicare Benefits Schedule (MBS). The MBS fee is set for each specific service by the Federal Government. 26
29 What is not covered? Hospital costs Situations when you are likely not to be covered include: To ensure peace of mind, ask your doctor about their fees and whether they participate in our Medical Gap Scheme for your hospital treatment prior to admission. Remember to also ask your doctor about the fees for other practitioners that may be involved in your hospital treatment such as: the anaesthetist and assistant surgeons. during a waiting period when specific services or treatments are paid at minimum benefits or excluded from your level of cover when you are treated at a non-agreement hospital you will not be fully covered for the fixed fee charged by a fixed fee hospital or a hospital that has a fixed fee service when you have not been admitted into a hospital and are treated as an outpatient (e.g. emergency room treatment, outpatient antenatal consultations with an obstetrician prior to child birth) you will not be fully covered hospital treatment provided by a practitioner not authorised by a hospital to provide that treatment hospital treatment for which Medicare pays no benefit, including: medical costs in relation to surgical podiatry (including the fees charged by the podiatric surgeon); most cosmetic surgery; respite care; experimental treatment and/or any treatment/procedure not approved by the Medical Services Advisory Committee (MSAC) personal expenses such as: pay TV, non-local phone calls, newspapers, boarder fees, meals ordered for your visitors, hairdressing and any other personal expenses charged to you unless included in your cover if you are in hospital for more than 35 days and you have been classified as a nursing home type patient. In this situation you may receive limited benefits and be required to make a personal contribution towards the cost of your care for pharmacy items not opened at the point of leaving the hospital unless covered on your OSHC or extras cover if you choose to use your own allied health provider (e.g. chiropractors, dieticians or psychologists) rather than the hospital s practitioner for services that form part of your in-hospital treatment where compensation, damages or benefits may be claimed by another source (e.g. workers compensation) treatment for any children on a family membership if they are over 18 years of age additional charges applied for single room accommodation in a public hospital some non-pbs, and high cost drugs any treatment or service rendered outside Australia. This includes: treatment arranged before you arrived in Australia treatment while travelling to or from Australia expenses for treatment outside of Australia; or transportation into or out of Australia in any circumstance. Medical costs You will not be covered for: medical services for surgical procedures performed by a dentist, surgical podiatrist, or any other practitioner or service that is not eligible for a rebate through Medicare costs for medical examinations, x-rays, inoculation or vaccinations and other treatments required relating to acquiring a visa for entry into Australia or permanent residency visa. IMPORTANT INFORMATION 27
30 Waiting periods The following waiting periods apply to Overseas Student Health Cover: pre-existing conditions, ailments or illnesses of a psychiatric nature two months all other pre-existing conditions, ailments or illnesses 12 months pregnancy related services (including childbirth) 12 months.* *Not applicable to OSHC members who joined before 1st July, If you receive treatment that falls within a waiting period, you will have to pay for some or all of the hospital and medical charges unless the treatment is classed as Emergency Treatment. Situations when you will not be covered during a waiting period include: treatment provided in the first two months of membership for pre-existing ailments, illnesses or conditions of a psychiatric nature, unless classed as Emergency Treatment treatment provided in the first 12 months of membership for all other pre-existing ailments, illnesses or conditions, unless classed as Emergency Treatment treatment provided in the first 12 months of membership for pregnancy related services including childbirth, premature births, miscarriages or terminations, unless classed as Emergency Treatment^ treatment provided in the first 12 months of membership for secondary conditions or disabilities directly arising from a preexisting condition, ailment or illness unless classed as Emergency Treatment. ^ Not applicable to OSHC members who joined before 1st July, When to contact us If you have been a Bupa member for less than 12 months on your current OSHC, it is important to contact us before you are admitted to hospital and find out whether the pre-existing condition waiting period applies to you. We need about five working days to make the pre-existing condition assessment, subject to the timely receipt of information from your treating medical practitioner/s. Make sure you allow for this timeframe when you agree to a hospital admission date. If you proceed with the admission without confirming benefit entitlements and we (the health fund) subsequently determine your condition to be pre-existing, you will be required to pay all hospital charges and medical charges. Planning for a baby If you are thinking about starting a family we recommend that you contact us to check that you will be covered for pregnancy and other related services in advance. This is because there is a 12-month waiting period applied to all pregnancy related services (including childbirth). No waiting periods will apply to the newborn provided they have been added to the appropriate family cover within two months of their birth. UNDERSTANDING YOUR AMBULANCE COVER Emergency Ambulance Cover As part of your cover you receive unlimited emergency only ambulance cover for emergency ambulance air and road transportation and on-the-spot emergency treatment by a Recognised Ambulance Provider. You ll receive cover for ambulance transport provided by an approved ambulance service where medically necessary for admission to hospital or for Emergency Treatment. You re not covered for non-emergency transportation from a hospital to your home, a nursing home or another hospital. 28
31 Whether the transportation is deemed an emergency is determined by the paramedic and usually recorded on the account. If you need to make a claim for emergency ambulance benefits, we will give you a Patient Ambulance Transportation Form to complete. Recognised Ambulance Providers Bupa will only pay benefits towards ambulance services when they are provided by any of the following recognised providers: ACT Ambulance Service Ambulance Service of NSW Ambulance Victoria Queensland Ambulance Service South Australia Ambulance Service St John Ambulance Service NT St John Ambulance Service WA Tasmanian Ambulance Service. UNDERSTANDING YOUR EXTRAS COVER If you have chosen to take out extras cover together with your OSHC with us, please read this section to better understand how you ll be covered. What is covered? With extras cover, you can claim benefits for those services listed on your cover and that are not claimable elsewhere (e.g. from a third party like Medicare). For example, Medicare does not provide benefits for: most dental examinations and treatment most physiotherapy, occupational therapy, speech therapy, eye therapy, chiropractic services, podiatry or psychology services acupuncture (unless part of a doctor s consultation) or other natural therapies glasses and contact lenses most health aids and appliances home nursing. Extras cover allows you to claim benefits for extras services as long as: the treatment is given by a private practice provider who is recognised and registered with us for benefit purposes they meet the criteria set out in our policies and Fund Rules. We recommend you contact us before making a booking to confirm how much you can claim and to check that your chosen provider is registered with us. What is not covered? Extras benefits will not be payable: during a waiting period where a third party, including Medicare, a Government body, or an insurance company provided a benefit (except for hearing aids and breast prosthesis items) for different services within the same service type from the same provider on the same day. For example, if you went to see an acupuncturist and then received a massage from the same provider on the same day, you cannot claim for both services when a prescribed treatment is not fully custom made (e.g. orthotics, surgical shoes) when a provider is not recognised by us for benefit purposes for any treatment or service rendered outside Australia when you have reached the maximums on your product including annual, lifetime or service limits for the service you are claiming. Waiting periods for Extras The following waiting periods apply for extras cover: initial waiting period two months hire, repair and maintenance of health aids and appliances; and Living Well Programs six months major dental, orthodontics, selected health aids and appliances 12 months. IMPORTANT INFORMATION 29
32 CHANGING YOUR COVER Switching from another health fund If you re changing from another OSHC provider to Bupa, you ll continue to be covered for all benefit entitlements that you had on your old cover, as long as these services are offered on your new cover with us. This is referred to as continuity of cover. When changing health funds, extras benefits paid by your old fund will be counted towards your annual maximums in your first year of membership with us. Any benefits paid by your old fund also count towards lifetime maximums. Changing your visa If you change your overseas student visa to another visa which allows you to continue your stay in Australia, you will no longer be eligible for OSHC. You can however, change to one of our overseas visitor covers. You will continue to be covered for all benefit entitlements on your old cover, as long as you change over within 60 days of ceasing your Overseas Student Health Cover. Contact us for more details Becoming a permanent resident If you become a permanent Australian resident, you can change to one of our domestic health covers. You will continue to be covered for all benefit entitlements on your old cover, as long as you change over within 60 days of ceasing your Overseas Student Health Cover. Don t forget that you will need to transfer to a domestic health cover policy within 12 months of becoming eligible for full Medicare benefits. Otherwise you may be required to pay the Lifetime Health Cover (LHC) Loading. Ask us for more details. Changing your cover with us If you change your health cover, you may need to wait before you can receive your new benefits. Where your new level of cover is higher than what you previously held, the lower level of benefit applies. Please refer to the listed waiting periods included under the Understanding Your Extras Cover and Understanding Your Overseas Student Health Cover sections of this brochure. During this time you will be covered, however you will receive the lower benefits of the two covers. If you choose a lower level of cover than you previously held, then the lower benefits on your new cover will apply immediately. You may also need to serve waiting periods for services or treatments that weren t covered on your previous cover. In this case you won t be covered during the waiting period. If you have any questions about waiting periods, just contact us. Ending your membership It is a condition of your student visa that you maintain a current OSHC policy while you are studying in Australia. Bupa will only refund any premium paid for your OSHC policy under the following circumstances: you decide not to come to Australia to commence your studies your student visa extension is refused by the Department of Immigration and Citizenship (DIAC) you are transferring to another visa type (e.g. temporary or permanent residency) you are ceasing your studies and going back home overseas early you are transferring to another OSHC provider if your student visa is cancelled. You will need to provide proof of any of the above circumstances along with your refund request. For example, a copy of a letter from DIAC explaining that your student visa is cancelled, or proof of membership with another OSHC provider. To cancel your OSHC membership, and obtain a refund, simply complete a refund form and attach any relevant supporting documents. We are obligated to inform DIAC if your OSHC membership is cancelled and/or we refund your premium.* *Not applicable to OSHC members who joined before 1st July,
33 DEFINITIONS Accidents An accident is an unforeseen event, occurring by chance and caused by an unintentional and external force or object resulting in involuntary hurt or damage to the body, which requires immediate (within 72 hours) medical advice or treatment from a registered practitioner other than the policyholder. Bupa Medical Gap Scheme This is a direct billing arrangement between Bupa and your doctor/s that in most instances eliminates your out-of-pocket expenses for in-hospital doctors fees (the gap ). Under this scheme some doctors can charge you a known gap which means you have some out-of-pocket expenses to pay but they are limited to a defined amount. Doctors need to agree to participate in this scheme for it to apply so make sure you ask them about it before you are treated. Otherwise our medical benefits are limited to the Medicare Benefits Schedule (MBS) fee and if your doctor charges above the MBS fee you will have a gap to pay. If a doctor proposes to charge you a gap they need your informed financial consent. Please contact us for details. Emergency Treatment Emergency Treatment is any treatment required where a person: is in a life threatening situation and requires urgent assessment and resuscitation has suspected acute organ or system failure has an illness or injury where the function of a body part or organ is acutely threatened has a drug overdose, toxic substance or toxin effect has psychiatric disturbance whereby the health of the person or other people are at immediate risk has severe pain and the function of a body part or organ is suspected to be acutely threatened has acute haemorrhaging and requires urgent assessment and treatment has a condition that requires immediate admission to avoid imminent threat to their life and where a transfer to another facility is impractical. If you believe your admission may be deemed as Emergency Treatment, please ensure that you have your treating doctor provide us with all relevant information that we may require to assess and process your claims promptly. IMPORTANT INFORMATION Calendar year A calendar year is 1 January to 31 December. Emergency admissions In an emergency, we may not have time to determine if you are affected by the pre-existing condition rule before your admission. Consequently, if you have been a Bupa member for less than 12 months you might have to pay for some or all of the hospital and medical charges if: you are admitted to hospital and you choose to be treated as a private patient, and we later determine that your condition was pre-existing and not classed as Emergency Treatment. Exclusions If you require treatment for a specific procedure or service that is excluded under your level of cover you will not receive any benefits towards your hospital and medical costs and you may have significant out-of-pocket costs. If a service is not recognised by Medicare there will be no benefit payable from your OSHC so you should always check with us to see if you re covered before receiving treatment. 31
34 Minimum benefits For restricted services, there will be full cover in a shared room with your choice of doctor in a public hospital. Minimum benefits in a private hospital would not be adequate to cover all hospital costs and are likely to result in large out-of-pocket expenses. Out-of-pocket expenses You are likely to experience out-of-pocket expenses when you are not fully covered for services and benefits, or when a set benefit applies. You should refer to what is and isn t covered on your OSHC and any extras cover you hold to determine when an out-of-pocket expense may occur. You should also refer to our Overseas Visitors Rules for any additional information on benefits payable. A copy of our Overseas Visitors Rules can be found on our website or in our retail centres. It is important to ensure when being admitted to hospital that Informed Financial Consent is provided to you for a pre-booked admission to allow you to understand any out-of-pocket expenses upfront. If you have received any out-of-pocket expenses and require clarification, please contact us directly. Pharmacy On OSHC you will receive benefits for selected prescription items prescribed as an outpatient that are Pharmaceutical Benefits Scheme (PBS) and non-pbs and TGA (Therapeutic Goods Administration) approved. Refer to your cover details for more information. If you take out optional extras cover, your extras pharmacy entitlement pays benefits on prescription items that are only non-pbs listed and are TGA approved for that condition. When you make a claim, we will deduct a pharmacy PBS co-payment fee and pay the remaining balance up to the set amount under OSHC or your chosen level of extras cover. There are some items that are not covered by our OSHC or extras pharmacy benefits and these include: over the counter and non-prescription items compounded items weight loss medication (some weight loss medications are covered under the Living Well Programs) body enhancing medications (e.g. anabolic steroids). Pharmacy in-hospital When in hospital, if you are treated with drugs that are not approved by the Pharmaceuticals Benefits Scheme (PBS), you may not be fully covered and the hospital may charge you for all or part of the cost. You should be advised by the hospital of any charges before treatment. Pre-existing conditions A pre-existing condition is any condition, ailment or illness that you had signs or symptoms of during the six months before you joined or upgraded to a higher level of cover with us. It is not necessary that you or your doctor knew what your condition was or that the condition had been diagnosed. A condition can still be classed as pre-existing even if you hadn t seen your doctor about it before joining or upgrading to a higher level of cover. If you knew you weren t well, or had signs of a condition that a doctor would have detected (if you had seen one) during the six months prior to joining or upgrading, then the condition would be classed as pre-existing. A doctor appointed by us decides whether your condition is pre-existing, not you or your doctor. The appointed doctor must consider your treating doctors opinions on the signs and symptoms of your condition, but is not bound to agree with them. 32
35 Premium and benefits for OSHC To receive the benefits available on your cover, you need to: complete the application process and pay your premium in full before the start date of your cover advise us of any change of address ensure that newborns are enrolled onto a family membership within two months of their birth to avoid any waiting periods for your baby contact us to remove your adult children from your OSHC membership when they turn 18 years of age as they no longer qualify under your cover provide proof of purchase of what you have spent before we can reimburse you for any services received submit your claims within two years of when the service was given (we don t pay benefits for any claims that are older than this). Proof of identity and/or age Bupa may require you to provide proof of identity and/or age when joining, changing your level of cover or in relation to any other transaction with us. Surgically implanted prostheses You will be covered up to the benefit set out in the Government s Prostheses List for a listed prosthesis which is surgically implanted as part of your hospital treatment. The Prostheses List includes: pacemakers, defibrillators, cardiac stents, joint replacements, intraocular lenses and other devices. If a hospital proposes to charge you a gap for your prosthesis, they need your informed financial consent. Please contact us for further details. Suspension rules A membership may be suspended when travelling overseas. If you are travelling overseas, you can suspend your membership. Please note: for family memberships, if some family members on the policy remain in Australia while others leave the country, then the membership must be kept financial. You can suspend your cover under the following circumstances: for a minimum period of one month for a maximum period of nine months you can suspend your policy up to three times per calendar year. To be eligible to suspend your cover you must: apply for suspension prior to the departure date have a financial membership at the time of suspension provide overseas travel documentation showing your departure and return dates notify us of your return to Australia within 14 days of your arrival; and complete an overseas travel suspension form. Your membership will be cancelled if not resumed. Waiting periods A waiting period is the time between when you joined us and when you are covered for a service or treatment. If you receive a service or treatment during this time, you are not eligible to receive a benefit payment from us, regardless of when you submit the claim. Different waiting periods apply for different services. IMPORTANT INFORMATION 33
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