BUPA HOSPITAL COVERS WHAT YOU NEED TO KNOW AT A GLANCE

Transcription

1 BUPA S WHAT YOU NEED TO KNOW AT A GLANCE

2 CONTENTS Retail hospital covers at a glance 3 Corporate hospital covers at a glance 18 Visitors hospital covers at a glance 22 New Bupa membership cards 28 Bupa Global membership cards 29 Pre-authorisation hospital checks 31 for Bupa Global members This guide is for the use of hospital staff and providers only and does not contain all product information. Detailed product information can be found at: for retail hospital covers for corporate hospital covers for visitors hospital covers for student hospital covers Please also note this guide is subject to change without notice. 2

3 RETAIL S AT A GLANCE This guide is for the use of hospital staff and providers only and does not contain all product information. Please also note this guide is subject to change without notice. ACTIVE SAVER (PACKAGED) ADVANTAGE $1,000 EXCESS & VALUE $1,000 EXCESS* accommodation (including private room) and theatre fees only for accidents requiring urgent medical attention and the services included below. All other services that are not excluded receive Minimum Benefits for shared room accommodation. Public Hospitals: For Accidents requiring urgent medical attention and the services listed below shared room benefit plus a fixed benefit for a private overnight room. All other services that are not excluded receive shared room minimum benefits. Nil benefit for Inclusions: Knee arthroscopy and meniscectomy procedures Appendicitis Removal of tonsils and adenoids Dental surgery Minor gynaecological surgery (not including laparoscopy) accommodation (including private room) and theatre fees except for Minimum Benefit and Excluded services. Public Hospitals: Shared room minimum benefits plus a fixed benefit for a private overnight room. Private room benefit not applicable for minimum benefit services. Nil benefit for EXCESS N/A $1000 per hospital admission (including same day and public hospital admissions). Capped each calendar year at once per adult when amount has been met in full. The excess does not apply to any child dependant covered on The excess does not apply on admissions for services with a minimum benefit or for approved hospital ambulatory programs or psychiatric and rehabilitation day programs in private CO-PAYMENT $100 a day (including same day and public hospital admissions), up to a maximum of $500 per hospital stay. The co-payment does not apply on admissions for services with a minimum benefit, approved hospital ambulatory programs or psychiatric and rehabilitation day programs in private The co-payment will apply for all overnight and day services in a All services other than the services listed above and exclusions pay minimum benefits N/A Excess and Co-payments applies to in-patients only. *Hospital Value $1000 Excess was renamed Advantage Hospital $1000 Excess effective 1 April

4 RETAIL S AT A GLANCE BUDGET FAMILY (PACKAGED) BUDGET * & SELECT VALUE* $250 & $500 EXCESS EXCESS Public Hospitals: Shared room minimum benefit plus a fixed benefit for a private overnight room. Private room benefit not applicable for minimum benefits services. Nil benefit for $250 or $500 per hospital admission (including same day and public admissions). Capped each calendar year at once per adult when amount has been met in full. The excess does not apply to any child dependant covered on The excess does not apply on admissions for services with a minimum benefit, approved hospital ambulatory programs Public Hospitals: Shared room minimum benefit plus a fixed benefit for a private overnight room. Private room benefit not applicable for minimum benefits services. Nil benefit for $250 or $500 per hospital admission (including same day and public admissions). Capped each calendar year at once per person, twice per couples or family membership when amount has been met in full. The excess does not apply on admissions for services with a minimum benefit, approved hospital ambulatory programs Pregnancy (including childbirth) Hip and knee replacements including arthroplasty, revisions and resurfacing procedures Dialysis for chronic renal failure Psychiatric services Pregnancy (including childbirth) Hip and knee replacements including arthroplasty, revisions and resurfacing procedures Dialysis for chronic renal failure # Psychiatric services Gastric banding and obesity related services (including any abdominoplasty) # Dialysis only attracts minimum benefits if the member joined on or after 1 April 2006 *Hospital Select Value $250 & $500 Excess was renamed Budget Hospital $250 & $500 Excess effective 1 April. *Hospital Saver was renamed Budget Hospital $500 Excess effective 1 April

5 RETAIL S AT A GLANCE BUDGET & SELECT VALUE $1,000 EXCESS* CHOICES (PACKAGED) EXCESS Public Hospitals: Shared room minimum benefits plus a fixed $1000 per hospital admission (including same day and public admissions). Capped each calendar year at once per person, twice per couples or family membership when amount has been met in full. The excess does not apply on admissions for services with a minimum benefit, approved hospital ambulatory programs accommodation (including private room) and theatre fees only for accidents requiring urgent medical attention and the services included below. All other services that are not excluded receive Minimum Benefits for shared room accommodation. Public Hospitals: For Accidents requiring urgent medical attention and the services listed below shared room benefit plus a fixed benefit for a private overnight room. All other services that are not excluded receive shared room minimum benefits. Nil benefit for Inclusions: Knee arthroscopy and meniscectomy procedures Appendicitis Removal of tonsils and adenoids Dental surgery Ankle arthroscopy and ankle ligament repair Shoulder arthroscopy and selected minor shoulder procedures $250 per hospital admission (including same day and public admissions). Capped each calendar year at once per person, twice per couples membership when amount has been met in full. The excess does not apply on admissions for services with a minimum benefit, approved hospital ambulatory programs (Share room Psychiatric services All services other than the services listed above and exclusions pay minimum benefits Cardiac and cardiac-related services Pregnancy (including childbirth) All joint replacements including arthroplasty revisions and resurfacing procedures Dialysis for chronic renal failure # Gastric banding and all obesity related services (including any abdominoplasty) # Dialysis is an exclusion if the member joined on or after 1 April 2006 Cardiac and cardiac-related services Pregnancy (including childbirth) All joint replacements including arthroplasty, revisions and resurfacing procedures Dialysis for chronic renal failure *Hospital Select Value $1000 Excess was renamed Budget Hospital $1000 Excess effective 1 April

6 RETAIL S AT A GLANCE ESTABLISHED FAMILY FAMILY ESSENTIALS EXCESS Public Hospitals: Shared room minimum benefit plus a fixed $250 or $500 per hospital admission (including same day and public admissions). Capped each calendar year at once per adult when amount has been met in full. The excess does not apply to any child dependant covered on Members First & Network Hospitals Children: Cover for hospital accommodation, theatre fees at shared room (ie: no private add on payable) and ICU, except for minimum benefit or Nil benefit for excluded services. Adults: For accidents requiring urgent medical attention full cover for hospital accommodation at shared room (ie no private room add on payable) and theatre fees except for minimum benefit or All other services that are not excluded receive share room minimum benefits only. Nil benefit for Public Hospitals All services that are not excluded receive shared room minimum benefits. Nil benefit for N/A Pregnancy (including childbirth) All services for adults are paid at shared room minimum benefits other than accidents 6

7 RETAIL S AT A GLANCE FAMILY FIRST (PACKAGED) GROWING FAMILY (PACKAGED) EXCESS CO-PAYMENT accommodation (including private room) and theatre fees except for Minimum Benefit and Excluded services. Public Hospitals: Shared room Minimum Benefit plus a fixed $250, $500, or $1000 per hospital admission (including same day and public admissions). Capped each calendar year at once per person, twice per couples or family membership when amount has been met in full. The excess does not apply to any child dependant covered on $50 a day (including same day and public admissions), up to a maximum of $250 per hospital stay. A co-payment does not apply to any child dependant covered on The co-payment does not apply on admissions for services with a minimum benefit or for approved hospital ambulatory programs or psychiatric and rehabilitation day programs in private The co-payment will apply for all overnight and day services in a by the Medical Services Advisory Committee and experimental treatment rehabilitation services Public Hospitals: Shared room Minimum Benefit plus a fixed $250 or $500 per hospital admission (including same day and public admissions). Capped each calendar year at once per adult when amount has been met in full. The excess does not apply to any child dependant covered on N/A Hip and knee replacements including arthroplasty, revisions and resurfacing procedures Dialysis for chronic renal failure by the Medical Services Advisory Committee and experimental treatment rehabilitation services Excess and Co-payments applies to in-patients only. 7

8 RETAIL S AT A GLANCE HEALTHSMART DIAMOND (PACKAGED) HEALTHSMART GOLD (PACKAGED) EXCESS CO-PAYMENT (Share room accommodation (including private room) and theatre fees except for Minimum Benefit and Excluded services. Public Hospitals: Shared room Minimum Benefit plus a fixed $250, $500, or $1000 per hospital admission (including same day and public admissions). Capped each calendar year at once per person, twice per couple or family membership when amount has been met in full. $50 a day (including same day and public admissions), up to a maximum of $250 per hospital stay. The co-payment does not apply on admissions for services with a minimum benefit or for approved hospital ambulatory programs or psychiatric and rehabilitation day programs in private The co-payment will apply for all overnight and day services in a accommodation (including private room) and theatre fees except for Minimum Benefit and Excluded services. Public Hospitals: Shared room Minimum Benefit plus a fixed $250, $500, or $1000 per hospital admission (including same day and public admissions). Capped each calendar year at once per person, twice per couple or family membership when amount has been met in full. N/A Excess and Co-payments applies to in-patients only. 8

9 RETAIL S AT A GLANCE HEALTHSMART (PACKAGED) WITH EXCESS BONUS* EXCESS Public Hospitals: Shared room Minimum Benefit plus a fixed $250, $500, or $1000 per hospital admission (including same day and public admissions). Capped each calendar year at once per person, twice per couples membership when amount is met in full. accommodation (including private room) and theatre fees except for Minimum Benefit and Excluded services. Public Hospitals: Shared room Minimum Benefit plus a fixed $250 per hospital admission from 1 April 2013 (including same day and public admissions). From 1 April 2013 capped each calendar year at once per adult when amount is met in full. The excess will not apply to any child dependant covered on the membership. Excess Bonus: One excess-free overnight or same-day admission for single or single parent membership and two for a couple or family membership per calendar year (ceasing 1 June 2013). However, existing dollar amounts under the previous Excess Bonus dollar scheme may be used towards any additional excess. (Share room Gastric banding and all obesity related services Pregnancy (including childbirth) * Hospital Cover with Excess Bonus was renamed Top Hospital Cover $250 Excess from 1 June

10 RETAIL S AT A GLANCE WITH EXCESS BONUS PLUS WITH EXCESS* (LEVEL 4) EXCESS accommodation (including private room) and theatre fees except for Minimum Benefit and Excluded services. Public Hospitals: Shared room Minimum Benefit plus a fixed $200 per hospital admission (including same day and public admissions). From 1 April 2013 capped each calendar year at once per adult when amount is met in full. The excess will not apply to any child dependant covered on Excess Bonus: One excess-free overnight or same-day admission for single or single parent membership and two for a family membership per calendar year (ceasing 1 June 2013). However, existing dollar amounts under the previous Excess Bonus dollar scheme may be used towards any additional excess. accommodation (including private room) and theatre fees except for Minimum Benefit and Excluded services. Public Hospitals: Shared room Minimum Benefit plus a fixed $400 per hospital admission (including same day and public admissions). From 1 April 2013 capped each calendar year at once per adult when amount is met in full. The excess will not apply to any child dependant covered on (Share room *Hospital Cover with Excess Level 5 was renamed Top Hospital $500 Excess effective 1 April Refer to Top Hospital Cover for details. 10

11 RETAIL S AT A GLANCE ECONOMY ECONOMY WITH EXCESS BONUS EXCESS CO-PAYMENT accommodation (including private room) and theatre fees except for Minimum Benefit and Excluded services. Public Hospitals: Shared room Minimum Benefit plus a fixed $400 per hospital admission (including same day and public admissions). From 1 April 2013 capped each calendar year at once per adult when amount is met in full. The excess will not apply to any child dependant covered on Excess Bonus Dollars: Existing dollar amounts under the previous Excess Bonus dollar scheme may be used towards any excess. $40 a day (including same day and public admissions), up to a maximum of $200 per hospital stay. From 1 April 2013 the co-payment will not apply to any child dependant covered on The co-payment does not apply on admissions for services with a minimum benefit or for approved hospital ambulatory programs or psychiatric and rehabilitation day programs in private The co-payment will apply for all overnight and day services in a public hospital accommodation (including private room) and theatre fees except for Minimum Benefit and Excluded services. Public Hospitals: Shared room Minimum Benefit plus a fixed $400 per hospital admission (including same day and public admissions). From 1 April 2013 capped each calendar year at once per adult when amount is met in full. The excess will not apply to any child dependant covered on Excess Bonus Dollars: Existing dollar amounts under the previous Excess Bonus dollar scheme may be used towards any excess. N/A Excess and Co-payments applies to in-patients only. 11

12 RETAIL S AT A GLANCE SAVER* LIVE WELL (FROM 1 APRIL 2013) EXCESS Public Hospitals: Shared room Minimum Benefit plus a fixed $500 per hospital admission (including same day and public admissions). Capped each calendar year at once per person, twice per couple or family membership when met in full. The excess does not apply on admissions for services with a minimum benefit, approved hospital ambulatory programs Public Hospitals: Shared room Minimum Benefit plus a fixed Nil, $250 and $500 options. Applies per hospital admission including same day and public admissions. Capped each calendar year at once per person, twice per couples membership when amount has been paid in full. Hip and knee replacements including arthroplasty, revisions and resurfacing procedures Pregnancy (including childbirth) Psychiatric services Gastric banding and all obesity related services (including any abdominoplasty) Dialysis for chronic renal failure Pregnancy (including childbirth) Dialysis for chronic renal failure Gastric banding and all obesity related services (including any abdominoplasty) 12

13 RETAIL S AT A GLANCE PUBLIC SIMPLE START $500 EXCESS All hospitals: Minimum Benefits for shared room accommodation only. Excluded Services receive no benefits. accommodation (including private room) and theatre fees only for accidents requiring urgent medical attention and the services included below. All other services that are not excluded receive Minimum Benefits for shared room accommodation. Public Hospitals: For Accidents requiring urgent medical attention and the services listed below shared room benefit plus a fixed benefit for a private overnight room. All other services that are not excluded receive shared room minimum benefits. Nil benefit for Inclusions: Knee arthroscopy and meniscectomy procedures Appendicitis Removal of tonsils and adenoids Minor gynaecological surgery (not including laparoscopy) EXCESS N/A $500 per hospital admission (including same day and public hospital admissions). Capped each calendar year at once per adult when amount has been met in full. The excess does not apply to any child dependant covered on All services when in private hospitals All services other than the services listed above and exclusions pay minimum benefits Excess and Co-payments applies to in-patients only. 13

14 RETAIL S AT A GLANCE SINGLES CHOICE SAVER (PACKAGED) STANDARD & SELECT PLUS $250 & $500 EXCESS* accommodation (including private room) and theatre fees only for accidents requiring urgent medical attention and the services included below. All other services that are not excluded receive Minimum Benefits for share room accommodation. Public Hospitals: For Accidents requiring urgent medical attention and the services listed below shared room benefit plus a fixed benefit for a private overnight room. All other services that are not excluded receive shared room minimum benefits. Nil benefit for Inclusions: Knee arthroscopy and meniscectomy procedures Appendicitis Removal of tonsils and adenoids Dental surgery Minor gynaecological surgery (not including laparoscopy) Public Hospitals: Shared room Minimum Benefit plus a fixed EXCESS N/A $250 or $500 per hospital admission (including same day and public admissions). Capped each calendar year at once per adult when amount is met in full. The excess does not apply to any child dependant covered on All services other than the services listed above and exclusions pay minimum benefits Hip and knee replacements including arthroplasty, revisions and resurfacing procedures Dialysis for chronic renal failure # # Dialysis only attracts minimum benefits if the member joined on or after 1 April 2006 * Hospital Select Plus $250 & $500 Excess was renamed Standard Hospital $250 & $500 Excess effective 1 April Hospital Saver Plus Level 2 was renamed Standard Hospital $250 Excess effective 1 June Hospital Saver Plus Level 5 was renamed Standard Hospital $500 Excess effective 1 April Hospital Saver Plus Level 3 was renamed Standard Hospital $250 Excess effective 1 April Hospital Saver Plus Level 4 will be renamed Standard Hospital $250 Excess effective 1 April

15 RETAIL S AT A GLANCE STANDARD $1,000 EXCESS & SELECT PLUS $1000 EXCESS* START N SAVE EXCESS Public Hospitals: Shared room Minimum Benefit plus a fixed $1000 per hospital admission (including same day and public admissions). Capped each calendar year at once per person, twice per couples or family membership when amount has been met in full. accommodation (including private room) and theatre fees except for Minimum Benefit and Excluded services. Public Hospitals: Shared room Minimum Benefit plus a fixed $500 per hospital admission (including same day and public admissions). Capped each calendar year at once per adult when amount has been met in full. The excess does not apply to any child dependant on Excess Bonus Dollars: Existing dollar amounts under the previous Excess Bonus dollar scheme may be used towards any additional excess. CO-PAYMENT N/A $50 a day (including same day and public admissions), up to a maximum of $250 per hospital stay. The co-payment does not apply to any child dependant on The co-payment does not apply on admissions for services with a minimum benefit or for approved hospital ambulatory programs or psychiatric and rehabilitation day programs in private The co-payment will apply for all overnight and day services in a public hospital All joint replacements including arthroplasty, revisions and resurfacing procedures Dialysis for chronic renal failure # # Dialysis only attracts minimum benefits if the member joined on or after 1 April 2006 Excess and Co-payments applies to in-patients only. *Hospital Select Plus $1000 Excess was renamed Standard Hospital $1000 Excess effective 1 April

16 RETAIL S AT A GLANCE TOP (NOW INCORPORATING ADVANTAGE, PLUS, VALUE, SUPER PLUS, SAVER PLUS NIL EXCESS, EXCESS LEVEL 5 & PREMIUM )* ULTIMATE HEALTH (PACKAGED) EXCESS CO-PAYMENT accommodation (including private room) and theatre fees except for Minimum Benefit and Excluded services. Public Hospitals: Shared room minimum benefit plus a fixed benefit per day for a private overnight room. All other services that are not excluded receive shared room minimum benefits. Nil benefit for For the excess options: $250 or $500 per hospital admission (including same day and public admissions). Capped each calendar year at once per adult when amount has been met in full. The excess does not apply to any child dependant covered on or psychiatric and rehabilitation day programs in private For the co-payment option: $50 a day (including same day and public admissions), up to a maximum of $250 per hospital stay. The co-payment does not apply to child dependants on The co-payment does not apply on admissions for services with a or psychiatric and rehabilitation day programs in private The co-payment will apply for all overnight and day services in a public hospital accommodation (including private room) and theatre fees except for Minimum Benefit and Excluded services. Public Hospitals: Shared room minimum benefit plus a fixed benefit per day for a private overnight room. All other services that are not excluded receive shared room minimum benefits. Nil benefit for In addition this product covers laser eye procedures used to adjust the eyeball to correct sight (excludes laser procedures involving lens implants). Only at Bupa approved centres. Ultimate Health Cover members charged a fixed daily fee by any of our contracted fixed fee hospitals will be reimbursed or have the fee paid directly to the hospital. N/A N/A 12 months laser eye correction (excludes lens implant for eye correction) Excess and Co-payments applies to in-patients only. * Top Hospital Cover has 4 levels: Top Hospital Cover no excess or co-payment (includes previously named Premium Hospital, Hospital Super Plus & Hospital Saver Plus Nil Excess) Top Hospital Cover with Co-payment (includes previously named Advantage Hospital with Co-payment & Hospital Plus) Top Hospital Cover with $250 Excess (includes previously named Advantage Hospital $250 Excess, Hospital Value $250 Excess and Hospital Cover with Excess Bonus) Top Hospital Cover with $500 Excess (includes previously named Advantage Hospital $500 Excess, Hospital Value $500 Excess and Hospital Cover with Excess Level 5) 16

17 RETAIL S AT A GLANCE YOUNG SINGLES/COUPLES CHOICE (PACKAGED) YOUNG SINGLES/COUPLES SAVER (PACKAGED) Public Hospitals: Shared room minimum benefit plus a fixed benefit per day for a private overnight room. All other services that are not excluded receive shared room minimum benefits. Nil benefit for accommodation (including private room) and theatre fees only for accidents requiring urgent medical attention and the services included below. All other services that are not excluded receive Minimum Benefits for shared room accommodation. Public Hospitals: For Accidents requiring urgent medical attention and the services listed below shared room benefit plus a fixed benefit for a private overnight room. All other services that are not excluded receive shared room minimum benefits. Nil benefit for Inclusions: Knee arthroscopy and meniscectomy procedures Appendicitis Removal of tonsils and adenoids Dental surgery Minor gynaecological surgery (not including laparoscopy) EXCESS N/A N/A CO-PAYMENT $50 a day (including same day and public admissions), up to a maximum of $250 per hospital stay. The co-payment does not apply on admissions for services with a minimum benefit, approved hospital ambulatory programs The co-payment will apply for all overnight and day services in a Cardiac and cardiac-related services Pregnancy (including childbirth) Hip and knee replacements including arthroplasty, revisions and resurfacing procedures Psychiatric services Gastric banding and all obesity related services (including any abdominoplasty) Dialysis for chronic renal failure Rehabilitation services $50 a day (including same day and public admissions), up to a maximum of $250 per hospital stay. The co-payment does not apply on admissions for services with a minimum benefit, approved hospital ambulatory programs The co-payment will apply for all overnight and day services in a All services other than the services listed above and exclusions pay minimum benefits Excess and Co-payments applies to in-patients only. 17

18 CORPORATE S AT A GLANCE This guide is for the use of hospital staff and providers only and does not contain all product information. Please also note this guide is subject to change without notice. Please note some companies cover the cost of the excess on behalf of their employees on selected corporate covers. In this situation, we will confirm to you if the excess should be charged when you conduct an eligibility check. CORPORATE CORPORATE INTERMEDIATE EXCESS accommodation (including private room) and theatre fees except for Minimum Benefit and Excluded services. Public Hospitals: Shared room minimum benefit plus a fixed benefit per day for a private overnight room. All other services that are not excluded receive shared room minimum benefits. Nil benefit for Level 1 Nil Excess Level 2 $250 per hospital admission for adults Level 3 $500 per hospital admission for adults Excess payable on same day and public admissions. Capped each calendar year at once per adult when amount has been met in full. The excess does not apply to any child dependant covered on Public Hospitals: Shared room minimum benefit plus a fixed benefit per day for a private overnight room. All other services that are not excluded receive shared room minimum benefits. Nil benefit for Level 1 Nil Excess Level 2 $250 per hospital admission for adults Level 3 $500 per hospital admission for adults Excess payable on same day and public admissions. Capped each calendar year at once per adult when amount has been met in full. The excess does not apply to any child dependant covered on Hip and knee replacement including revisions and resurfacing procedures IVF & assisted reproductive services 18

19 CORPORATE S AT A GLANCE CORPORATE SAVER CORPORATE TOP EXCESS Public Hospitals: Shared room minimum benefit plus a fixed benefit per day for a private overnight room. All other services that are not excluded receive shared room minimum benefits. Nil benefit for Level 1 Nil Excess Level 2 $250 per hospital admission Level 3 $500 per hospital admission Excess payable on same day and public admissions. Capped each calendar year at once per person, twice per couples or family membership when amount has been met in full. The excess does not apply on admissions for services with a minimum benefit, approved hospital ambulatory programs accommodation (including private room) and theatre fees except for Minimum Benefit and Excluded services. Public Hospitals: Shared room minimum benefit plus a fixed benefit per day for a private overnight room. All other services that are not excluded receive shared room minimum benefits. Nil benefit for Level 1 Nil Excess Level 2 $250 per hospital admission for adults Level 3 $500 per hospital admission for adults Excess payable on same day and public admissions. Capped each calendar year at once per adult when amount has been met in full. The excess does not apply to any child dependant covered on Psychiatric services Pregnancy (including childbirth) Hip and knee replacements including revisions and resurfacing procedures Gastric banding & all obesity related services (including any abdominoplasty) 19

20 CORPORATE S AT A GLANCE HEALTHLINK ADVANTAGE/ CLASSIC/ESSENTIALS PLUS HEALTHLINK EXCESS EXCESS BONUS (Excess Waiver) Public Hospitals: Shared room minimum benefit plus a fixed benefit per day for a private overnight room. All other services that are not excluded receive shared room minimum benefits. Nil benefit for $0, $250, $500, or $1000 capped at once per person, twice per membership per calendar year when amount has been met in full. Excess payable on same day and public admissions. No excess for any child dependant on HealthLink Advantage only. N/A Public Hospitals: Shared room minimum benefit plus a fixed benefit per day for a private overnight room. All other services that are not excluded receive shared room minimum benefits. Nil benefit for $0, $250, $500, or $1000 capped at once per person, twice per membership per calendar year when amount has been met in full. Excess payable on same day and public admissions. N/A For the first 24 months: Hip and knee replacement including revisions and resurfacing procedures (except where they are required as a result of an accident which occurs after the cover commenced) Dialysis for chronic renal failure Bone marrow transplants All psychiatric conditions (except eating disorders and post natal depression) For the first 24 months: Hip and knee replacement including revisions and resurfacing procedures (except where they are required as a result of an accident which occurs after the cover commenced) Dialysis for chronic renal failure Bone marrow transplants All psychiatric conditions (except eating disorders and post natal depression) 20

21 CORPORATE S AT A GLANCE MINING AND RESOURCES HEALTH ULTIMATE CORPORATE HEALTH (PACKAGE) EXCESS EXCESS BONUS (Excess Waiver) accommodation (including private room) and theatre fees except for Minimum Benefit and Excluded services. Public Hospitals: Shared room minimum benefit plus a fixed benefit per day for a private overnight room. All other services that are not excluded receive shared room minimum benefits. Nil benefit for Level 1 Nil Excess Level 2 $250 per hospital admission for adults Excess payable on same day and public admissions. Capped each calendar year at once per adult when amount has been met in full. The excess does not apply to any child dependant covered on N/A accommodation (including private room) and theatre fees except for Minimum Benefit and Excluded services. Public Hospitals: Shared room minimum benefit plus a fixed benefit per day for a private overnight room. All other services that are not excluded receive shared room minimum benefits. Nil benefit for In addition this product covers laser eye procedures to correct sight (excludes laser procedures involving lens implants). Only at Bupa approved centres. Ultimate Corporate Health Cover members charged a fixed daily fee by any of our contracted fixed fee hospitals will be reimbursed or have the fee paid directly to the hospital. N/A N/A 12 months laser eye correction (excludes lens implant for eye correction) 21

22 VISITORS S AT A GLANCE NON-WORKING VISA This guide is for the use of hospital staff and providers only and does not contain all product information. Please also note this guide is subject to change without notice. ADVANTAGE VISITORS GUARDIAN PLUS VISITORS (FROM 1 MAY 2015) (FROM 1 MAY 2015) Public Hospitals: Cover for hospital accommodation. Shared room accommodation only for Minimum Benefit services. Nil benefit for Excluded services. Public Hospitals: Cover for hospital accommodation (including private room) for services that are not Minimum Benefit or Excluded services. Minimum benefit services generally paid at benefit equivalent to the shared room minimum benefit for an Australian resident. EXCESS N/A $300 per hospital admission (including same day and public admissions). Capped each calendar year at once per adult, when amount has been met in full. The excess does not apply to any child dependant on benefits) MEDICAL For the period specified: 2 years Cataract and eye lens procedures 2 years Hip and knee replacements including arthroplasty, revisions and resurfacing procedures (if medical advice sought within 72 hours) Up to 100% of MBS fee (or the Gap Scheme benefit if you re a Gap Scheme provider) for inpatient services. Up to 100% of MBS fee as a hospital out-patient or by a doctor or specialist in private practice anywhere in Australia. For the first 6 months: Cardiac and cardiac related services Hip and knee replacements including arthroplasty, revisions and resurfacing procedures Cataract surgery Renal dialysis Bone marrow transplants Organ transplants 2 months psychiatric services 2 months 2 months palliative care services (if medical advice sought within 72 hours) Up to 100% of MBS fee (or the Gap Scheme benefit if you re a Gap Scheme provider) for inpatient services. Up to 100% of MBS fee as a hospital outpatient or by a doctor or specialist in private practice anywhere in Australia. 22

23 VISITORS S AT A GLANCE MID VISITORS OVERSEAS STUDENT HEALTH / ADVANTAGE OVERSEAS STUDENT HEALTH OVERSEAS VISITORS Shared room benefits for hospital accommodation in all public hospitals only, except for Members First & Network Hospitals: Cover for hospital accommodation (including private room) and theatre fees for services that are not Minimum Benefit or Excluded services. Public Hospitals: Cover for hospital accommodation. Shared room accommodation only for Minimum Benefit services. Nil benefit for Excluded services. Members First & Network Hospitals: Cover for hospital accommodation (including private room) and theatre fees for services that are not Minimum Benefit or Excluded services. Public Hospitals: Cover for hospital accommodation. Shared room accommodation only for Minimum Benefit services. Nil benefit for Excluded services. EXCESS N/A N/A N/A N/A benefits) For the period specified: 12 months Cardiac and cardiac-related services 12 months Pregnancy (including childbirth) 2 years Cataract and eye lens procedures 2 years Hip and knee replacements including arthroplasty, revisions and resurfacing procedures 2 years Psychiatric services 2 years Rehabilitation services Cosmetic surgery that is clinically required and is recognised by Medicare Hip and knee replacements including arthroplasty, revisions and resurfacing procedures Procedures not recognised by Medicare or not approved by the Medical Services Advisory Committee and All cosmetic surgery (including clinically required) Sterilisation reversal For the duration of this cover Procedures not recognised by Medicare or not approved by the Medical Services Advisory Committee and Cosmetic surgery that is not clinically required Procedures not recognised by Medicare or not approved by the Medical Services Advisory Committee and # Cosmetic surgery that is not clinically required 12 months psychiatric and rehabilitation No waiting period for accidents sustained after joining (if medical advice sought within 72 hours) 2 month pre-existing condition of a psychiatric nature (not applicable to Advantage Overseas Student Health Cover) 12 months for all other pre-existing conditions No waiting period for accidents sustained after joining (if medical advice sought within 72 hours) No waiting period for accidents sustained after joining (if medical advice sought within 72 hours) MEDICAL Up to 100% of AMA Schedule fee (or the Gap Scheme benefit if you re a Gap Scheme provider) for inpatient services. Up to 100% of MBS fee as a hospital out-patient or by a doctor or specialist in private practice anywhere in Australia. Up to 100% MBS fee (or the Gap Scheme benefit if you're a Gap Scheme provider) for inpatient services. Up to 100% MBS fee as a hospital out-patient or by a doctor or specialist in private practice anywhere in Australia. Up to 100% of MBS fee (or the Gap Scheme benefit if you re a Gap Scheme provider) for inpatient services. Up to 100% of MBS fee as a hospital out-patient or by a doctor or specialist in private practice anywhere in Australia. 23

24 VISITORS S AT A GLANCE PREMIUM VISITORS SHORT STAY VISITORS Public Hospitals: Cover for hospital accommodation. Shared room accommodation only for Minimum Benefit services. Nil benefit for Excluded services. Public Hospitals: Cover for hospital accommodation. Shared room accommodation only for Minimum Benefit services. Nil benefit for Excluded services. EXCESS N/A $250 per hospital admission (including same day and public admissions). Capped each calendar year at once per adult, when amount has been met in full. benefits) MEDICAL For the period specified: 12 months Cardiac and cardiac-related services 12 months Pregnancy (including childbirth) 2 years Cataract and eye lens procedures 2 years Hip and knee replacements including arthroplasty, revisions and resurfacing procedures 2 years Psychiatric services 2 years Rehabilitation services Cosmetic surgery that is clinically required and is recognised by Medicare Up to 100% of MBS fee (or the Gap Scheme benefit if you re a Gap Scheme provider) for inpatient services. Up to 100% of MBS fee as a hospital out-patient or by a doctor or specialist in private practice anywhere in Australia. For the duration of this cover For the duration of this cover All pre-existing ailments, illnesses or conditions Pregnancy (including childbirth) Hip and knee replacements including arthroplasty, revisions and resurfacing procedures by the Medical Services Advisory Committee and experimental treatment All cosmetic surgery (including clinically required) 12 months psychiatric services 12 months 12 months palliative care Up to 100% MBS fee (or the Gap Scheme benefit if you re a Gap Scheme provider) for inpatient services. Up to 100% MBS fee as a hospital out-patient or by a doctor or specialist in private practice anywhere in Australia. 24

25 VISITORS S AT A GLANCE STANDARD VISITORS TOP VISITORS (FROM 1 MAY 2015) Public Hospitals: Cover for hospital accommodation. Shared room accommodation only for Minimum Benefit services. Nil benefit for Excluded services. Public Hospitals: Cover for hospital accommodation. Shared room accommodation only for Minimum Benefit services. Nil benefit for Excluded services. EXCESS N/A Nil excess option or $500 per hospital admission (including same day and public admissions). Capped each calendar year at once per adult, when amount has been met in full. The excess does not apply to any child dependant on benefits) MEDICAL Cardiac and cardiac related services Pregnancy (including childbirth) Hip and knee replacements including arthroplasty, revisions and resurfacing procedures Dialysis for chronic renal failure All cosmetic surgery (including clinically required) Sterilisation reversal 12 months psychiatric and rehabilitation Up to 100% of MBS fee (or the Gap Scheme benefit if you re a Gap Scheme provider) for inpatient services. Up to 100% of MBS fee as a hospital out-patient or by a doctor or specialist in private practice anywhere in Australia. Up to 100% of MBS fee (or the Gap Scheme benefit if you re a Gap Scheme provider) for inpatient services. Up to 100% of MBS fee as a hospital out-patient or by a doctor or specialist in private practice anywhere in Australia. 25

26 VISITORS S AT A GLANCE WORKING VISA This guide is for the use of hospital staff and providers only and does not contain all product information. Please also note this guide is subject to change without notice. CLASSIC VISITORS CORPORATE OVERSEAS VISITORS ESSENTIAL VISITORS /ESSENTIAL PLUS VISITORS Shared room benefits for hospital accommodation in all public hospitals only except for Members First & Network Hospitals: Cover for hospital accommodation (including private room) and theatre fees for services that are not Minimum Benefit or Excluded services. Public Hospitals: Cover for hospital accommodation. Shared room accommodation only for Minimum Benefit services. Nil benefit for Excluded services. Members First & Network Hospitals: Cover for hospital accommodation (including private room) and theatre fees for services that are not Minimum Benefit or Excluded services. Public Hospitals: Cover for hospital accommodation. Shared room accommodation only for Minimum Benefit services. Nil benefit for Excluded services. EXCESS N/A N/A N/A N/A benefits) Pregnancy (including childbirth) Procedures not recognised by Medicare or not approved by the Medical Services Advisory Committee and Cosmetic surgery that is not clinically required All pre-existing ailments, illnesses and conditions Procedures not recognised by Medicare or not approved by the Medical Services Advisory Committee and Cosmetic surgery that is not clinically required Outpatient psychiatric and psychology benefits Bone marrow transplants Organ transplants Cosmetic surgery that is not clinically required 12 months pregnancy (including childbirth) No waiting period for accidents sustained after joining (if medical advice sought within 72 hours) 12 months pregnancy (including childbirth) No waiting period for accidents sustained after joining (if medical advice sought within 72 hours) 12 months pregnancy (including childbirth) No waiting period for accidents sustained after joining (if medical advice sought within 72 hours) MEDICAL Up to 100% of AMA Schedule fee (or the Gap Scheme benefit if you re a Gap Scheme provider) for inpatient services. Up to 100% of MBS fee as a hospital out-patient or by a doctor or specialist in private practice anywhere in Australia. Up to 100% of MBS fee (or the Gap Scheme benefit if you re a Gap Scheme provider) for inpatient services. Up to 100% of MBS fee as a hospital out-patient or by a doctor or specialist in private practice anywhere in Australia. Up to 100% of MBS fee (or the Gap Scheme benefit if you re a Gap Scheme provider) for inpatient services. Up to 100% of MBS fee as a hospital out-patient or by a doctor or specialist in private practice anywhere in Australia. 26

27 VISITORS S AT A GLANCE EXECUTIVE CORPORATE VISITORS GOLD VISITORS /PLATINUM VISITORS Public Hospitals: Cover for hospital accommodation. Shared room accommodation only for Minimum Benefit services. Nil benefit for Excluded services. Public Hospitals: Cover for hospital accommodation. Shared room accommodation only for Minimum Benefit services. Nil benefit for Excluded services. EXCESS N/A Nil excess option or $500 per hospital admission (including same day and public admissions). Capped each calendar year at once per adult, when amount has been met in full. The excess does not apply to any child dependant covered on benefits) MEDICAL Up to 100% of AMA Schedule fee (or the Gap Scheme benefit if you re a Gap Scheme provider) for inpatient services. Up to 150% of MBS fee as a hospital out-patient or by a doctor or specialist in private practice anywhere in Australia. Up to 100% of AMA Schedule fee (or the Gap Scheme benefit if you re a Gap Scheme provider) for inpatient services. Up to 150% of MBS fee as a hospital out-patient or by a doctor or specialist in private practice anywhere in Australia. 27

28 VISITORS S AT A GLANCE SELECT VISITORS ULTIMATE CORPORATE VISITORS Shared room benefits for hospital accommodation in all public hospitals only, except for Public Hospitals: Cover for hospital accommodation. Shared room accommodation only for Minimum Benefit services. Nil benefit for Excluded services. Ultimate Health Cover members will be reimbursed if charged a fixed daily fee by any of our contracted fixed fee hospitals/ services or have the fee paid directly to the hospital. EXCESS N/A N/A benefits) MEDICAL Outpatient medical fees Up to 100% of AMA Schedule fee (or the Gap Scheme benefit if you re a Gap Scheme provider) for inpatient services. 100% of cost for inpatient services. 100% of cost as a hospital out-patient or by a doctor or specialist in private practice anywhere in Australia. 28

29 NEW BUPA MEMBERSHIP CARDS The following membership cards should be recognised at your hospital or practice. When HBA, MBF and Mutual Community were re-branded as Bupa, members would have received one of these cards. However, some members may still present an HBA, MBF or Mutual Community card and some of these cards may contain obsolete product names. To provide our members with affordable health insurance, after becoming Bupa we generally did not send out additional new cards to reflect changes to product names. Refer within the guide for renamed products. As long as the membership number is current and the member is financial, the old cards will work. If members would like to order a new card they should contact us or log in to mybupa. 01 Jane Sample 02 Greg Sample 03 Audrey Sample 04 Brian Sample 01 Jane Sample 02 Greg Sample 03 Audrey Sample 04 Brian Sample Membership number: Member since: 2009 Top Hospital Cover Platinum Extras Membership number: Member since: 2009 Ultimate Health Cover Pharmacy Saver NEW OSHC BUPA MEMBERSHIP CARDS The following membership cards should be recognised at your hospital or practice. 01 Mario Garabaldi 02 Betty Garabaldi 01 Mario Garabaldi 02 Betty Garabaldi Student Number: Education Faculty: University of Ballarat Membership number: Overseas Student Health Cover Cover valid until 01/01/2013 Membership number: Overseas Student Health Cover Cover valid until 01/01/2013 Please note: During 2014, Bupa will no longer be printing level of covers on membership cards. Bupa will not be reissuing any member cards, so from this date there will be a combination of Bupa cards with or without level of cover featured. 29

30 BUPA GLOBAL MEMBERSHIP CARDS Bupa Global members are covered by Bupa Australia hospital contracts. BUPA GLOBAL HEALTH INSURANCE Bupa Australia is part of the worldwide health and care specialists, BUPA. Bupa Global provides health insurance to expatriates living and working in other countries, including Australia. Members with the following cards are covered by Bupa Global: Bupa Arabia Bupa Hong Kong Bupa Insurance Limited Bupa Insurance Services Limited Bupa Latin America Bupa Thailand IHI Bupa Max Bupa Sanitas (Bupa) Spain USA Medical Services Corporation Bupa Global offers the following products: Bupa Global Health Plans Bupa Global Gold with dental Bupa Worldwide Health options Corporate bespoke plans Company Gold Superior IHHP (International Health Hospital Plan) ISM (International Swiss Medical) Lifeline Classic Lifeline Essential Lifeline Gold BUPA GLOBAL MEMBERSHIP CARDS The following global membership cards should be recognised at your hospital or practice. 30

31 PRE-AUTHORISATION CHECKS FOR BUPA GLOBAL MEMBERS A pre-authorisation hospital check for Bupa Global members is required via fax or with the form downloaded from the following website: Alternatively you can call the Bupa Global Helpline. Please see below for details. Contact information for Pre-Authorisation: Bupa Global Tel: Fax: [email protected] ihi Bupa Tel: Fax: [email protected] Note: Helpline operates: 24 / 7 / 365 days a year For general enquiries to the Provider Services Department, they may be contacted via: [email protected] If you need to pre-authorise treatment for a member of Bupa Latin America, please contact USA Medical Services on: Tel: , for USA Tel: , free of charge from USA Whenever a patient requires day-case or inpatient treatment, please contact us as per the above with the following information: Medical records Symptoms Diagnosis Procedure Admission and discharge date On receipt of the above information, the request will be reviewed and response given: If requested by telephone: immediate response If requested by or fax: response within 72 hours Please note that in case of an emergency admission always contact the 24 hour helplines. Hospital Services for Bupa Global Members Where a Bupa Global member attends a Members First or Network Hospital/Day Facility for a service Covered under the Bupa Australia Agreement, the Bupa Global member should be billed under the terms and conditions of the Bupa Australia Agreement. Hospital Claims for Bupa Global Members should be sent to Hospital Claims, GPO Box 990, Adelaide, SA,

32 FOR MORE INFORMATION: USE To ensure a timely response to your enquiry, please contact the correct department for assistance. Bupa Australia Pty Ltd ABN Effective April P Pre-Admission patient eligibility checks To verify a membership, hospitals can check Bupa Australia entitlement via the online eligibility system through Eclipse. This system is available 24/7. Membership Checking If this system is unavailable due to system issues at Bupa Australia or Medicare then EMERGENCY checks can be done via telephone to Contact Centre on (Current hours 8.00am to 8.00pm Mon to Fri, Sat 9.00am to 1.00pm EST). Post-Admission hospital claims enquiries Department: Hospital Claims Department For: Queries regarding a benefit received following hospitalisation [email protected] Tel: Fax: Hours availability: 9.15am 5.15pm, EST Monday to Friday DRS ROOMS USE For queries regarding payment of a medical claim please ring: (choose the provider option 3, followed by option 3 and another option 3) [email protected]