Health Insurance. 40+ Singles and Couples health cover

Transcription

1 Health Insurance 40+ Singles and Couples health cover

2 At Bupa, it s our purpose that makes us different helping our members to live longer, healthier, happier lives. This brochure is a summary of the cover we offer. For more information, including what's covered and what's not, you should read this together with our Important Information Guide at bupa.com.au/info Unsure of any words? Visit bupa.com.au/glossary For more information: bupa.com.au/info Visit a local Bupa store

3 Why have private health cover? Reduce waiting time Enjoy lower average waiting times for non-emergency treatments by going to a private hospital. Choose your doctor Your choice of specialist and even where you d like to be treated. Claim on most Extras Enjoy the benefits of being able to claim for most Extras including dental, physio, optical, podiatry and chiro. Find out more on pages Save tax Depending on your income you could save tax by taking out hospital cover. Talk to your tax advisor or visit ato.gov.au to find out what this means for you. The Australian Government Rebate on private health insurance This could make your cover even more affordable. Find out what the Rebate means for you at bupa.com.au/rebate Visit bupa.com.au 1

4 Simple affordable cover to suit you now Unique benefits A world of benefits Gap free same day treatment If you are treated in a Members First day facility, there are no out-of-pocket expenses for medical services; e.g. your specialist s fees. (Any excess related to your level of cover will still apply. Not available in NT). Private room or money back guarantee At our Members First hospitals, you ll receive a private room when you book and request a private room at least 24 hours before the admission. If a private room is not available, you ll receive $50 back per night from the hospital.* Bupa Plus Even when you re in great health, there are still plenty of ways to get everyday value thanks to Bupa Plus. You ll get access to an exclusive range of health discounts, tools and information to help you live a healthier, happier life. Visit bupaplus.com.au Members First Provider Network Our national network of hospital and extras # providers can help you to reduce or eliminate out-of-pocket expenses on most items. Genesis Heart Care With the Genesis Heart Care group, you ll pay no out-of-pocket expenses for in-hospital cardiologist treatments (not available in NSW, TAS & NT). *Applies to overnight admissions only. Excludes nursing home type patients, emergency care, same-day stays or where a private room is medically inappropriate. # For most items at Members First extras providers covering dental, physio, chiro, podiatry consultations and selected optical. Fund and policy rules, waiting periods and yearly limits apply. Excludes orthodontics, orthotics and hospital treatments. Set benefits apply at other recognised providers. 2

5 Easy and Convenient More than Health Insurance mybupa online portal Manage your cover at a time that suits you. Accessible health support You can access a range of online tools and apps to help manage your health. Easy to use Extensive range of extras providers offering on-the-spot claiming. Care that comes to you We ve teamed up with 13SICK, National Home Doctor Service. As a Bupa member, you have complimentary access to their After Hours Plus membership. When you need urgent medical care after-hours and book a bulk-billed home visit, should you require commonly prescribed medications, they will be provided on the spot at no cost. For more info visit bupa.com.au/afterhoursplus Travel, Home, Car & Pet Insurance As a Bupa health member, you will also gain access to discounted Travel insurance, Home and Contents insurance, Car insurance and Pet insurance.^ Visit bupa.com.au/other-insurance for information ^Bupa Travel, Home & Contents, Pet and Car Insurance are issued by Insurance Australia Limited ABN AFSL Visit bupa.com.au 3

6 Find the right cover for you Choose one of our packaged covers Your choice starts here or Create your own 4

7 Choose a package (hospital and extras cover) Page 6 & 7 Choose your hospital cover Page 8 & 9 and or Choose your extras cover Page 14 & 15 VISIT BUPA.COM.AU/MATURE Visit bupa.com.au 5

8 Packaged cover at a glance To see a list of what's covered and what's not covered, see page 10, 11 and 14. Comprehensive cover Mid cover Ultimate Health Cover Our premium option for ultimate peace of mind, with top hospital and extras cover and an annual $200 medical gap bonus. Refer to page 7 for more details. Top level of hospital cover Top level of extras cover 100% Amount you get back # (limits apply) Extras General dental Yearly limits Unlimited Major dental $1,600 Optical $420^ Physio $1,500 $1,000 t Chiro $1,600 Natural therapies $1,000 Laser eye correction surgery t Per person 100% back at recognised Bupa providers** Per membership Prime Plus Enjoy a wide range of hospital and extras cover without paying for things you think you no longer need. Medium level of hospital cover Medium level of extras cover 70% Minimum amount you get back # Extras General dental Yearly limits Unlimited Major dental $1,000 Optical $260^ Physio Occupational therapy Chiro combined $350 t Natural therapies $300 1 Consultations via phone with Bupa x 2 dietitians Top-up Bonus on extras Enjoy a $50 $100 yearly Top-up Bonus for singles, or $100 $200 per couple towards out-of-pocket extras expenses.* # For most items at our Members First extras providers covering dental, physio, chiro, podiatry consultations and selected optical. Fund and policy rules, waiting periods and yearly limits apply. Excludes orthodontics, orthotics and hospital treatments. Set benefits apply at other providers. ^At Members First Optical providers only. Lower limits apply at other providers. *Applies each calendar year and increases after the first 12 months until maximum top-up bonus reached. Doesn t roll over and only applies where benefits are payable for the service. **A 3 year waiting period applies to Laser eye correction surgery for anyone joining Ultimate Health Cover from 1 July Limit combined with Dietary. 6

9 All packaged covers include: Private hospital cover for included services Medical cover Capped emergency ambulance + Plus more, see page 10 for more details and the full list Ultimate Health Cover Bonus features Medical gap bonus receive $200 when you join and every calendar year thereafter. This can be used towards a doctor or specialist's out-of-pocket costs (whilst in hospital) and any unused bonus amounts will accumulate each year. Ultimate Advice Line gives you access to information on a range of topics, including guidance navigating the healthcare system, and 24 hour medical and accident advice and Counsellings & Grief Support. 3 x dietitian health-coaching sessions. 100% rebate on Ambulance subscription (where applicable, in VIC, SA and NT only). Travel insurance bonus See page Fund rules apply. Visit bupa.com.au 7

10 Hospital cover at a glance Hospital cover helps cover your costs as a private patient in hospital, including treatment and accommodation. Choose from our three excellent options depending on your needs and budget. Comprehensive cover Basic cover Top Hospital Comprehensive cover, with additional benefits including family in-hospital benefit, selected annual health subscription refunds and Unemployment Cover (subject to eligibility). # Top level of hospital cover. No excess for kids. Top Hospital No pregnancy Nil $ 250 Comprehensive cover that excludes Pregnancy, IVF, and Obesity related procedures and surgeries. Also includes includes Best Doctors second opinion service and Ultimate Advice Line. Top level of hospital cover. No excess for kids. Standard Nil $ 250 Our medium level of hospital cover includes cover for pregnancy and cardiac services. Medium level of hospital cover. No excess for kids. Budget $ 250 Budget Hospital covers you for many hospital treatments including cardiac and cancer 1. Basic Budget level of hospital cover. No excess for kids. $ 250 $ 500 $ 500 $ 500 $ 500 Affordable cover that includes a basic range of hospital treatments like accidents, cancer 1 and more. Basic level of hospital cover. Accidents inclusion^^ $ 250 $ 500 Private room or money back guarantee At our Members First hospitals, you ll receive a private room when you book and request a private room at least 24 hours before the admission. If a private room is not available, you ll receive $50 back per night that you're not in a private room from the hospital.^ ^Applies to overnight admissions only. Excludes 'nursing home type patients', emergency care, same-day stays or where a private room is medically inappropriate. ^^For accidents sustained after joining, treatment that would normally be restricted or excluded on your cover will be included. # Cover for your premiums for up to 12 months in the event you lose your permanent full time employment due to involuntary retrenchment or redundancy. Must have held selected covers for 12 months. Unemployment must have occurred within 12 months of claim. Other eligibility criteria apply. 1 Some PBS drugs may not be covered. 8

11 All covers below include these hospital features: Private hospital cover for included services Medical cover Capped emergency ambulance Plus more, see page 10 for more details and the full list Our hospital covers include: Hospital services Benefits towards accommodation in a private hospital or as a private patient in a public hospital* Operating theatre, intensive care, and labour ward fees ~ Physio, occupational therapy, speech therapy and other allied health services provided whilst admitted to hospital. Medical services Doctor's fees charged by your surgeon, anaesthetist or other specialist whilst admitted to hospital. Medical costs are covered up to the Medicare Benefits Schedule Fee. If your doctor is one of the many who uses Bupa's Medical Gap Scheme ## there is additional cover for medical costs over the MBS Fee. Features to minimise your out-of-pocket costs Members First Day Facilities If you are treated in a Members First day facility, there are no out-of-pocket expenses for medical services (e.g. your specialist s fees). Not available in NT. ** Bupa Medical Gap Scheme The Bupa Medical Gap Scheme is an arrangement Bupa has with many medical specialists/doctors such as a surgeon, anaesthetist or other specialist to help minimise the amount you ll need to pay for your medical costs in hospital. ## For full details, see bupa.com.au/medicalgapscheme Medical Diagnostics (Radiology and Pathology) You'll pay no gap for in-hospital pathology and radiology diagnostic tests where recognised by Medicare and performed by Bupa contracted providers. Prostheses Surgically implanted prostheses up to the approved minimum benefits on the Government Prostheses List. Pharmacy PBS drugs supplied whilst admitted to hospital Emergency Ambulance cover Capped emergency ambulance transport and on-the-spot treatment^^ ## From 1 August 2018, where and when your doctor can use the Bupa Medical Gap Scheme will change. Contact us for more details. *If you elect to be treated as a private patient in a public hospital, Bupa will pay minimum benefits for shared room accommodation as set by the Government. Depending on your level of cover, if you choose to stay in a private room, Bupa may pay an additional fixed benefit towards the cost of your stay. If this benefit is less than the hospital charge, the hospital should let you know what out of pocket expenses you will have to pay. At Members First and Network Hospitals. **Any excess related to your level of cover will still apply. Not available in all areas. ~ Minimum benefits are payable for restricted cover services; no benefits are payable for exclusions. ^^Capped at 1 service for singles and 2 for couples/families from Bupa recognised providers in the state which the service occurs in. Visit bupa.com.au 9

12 Compare and choose your hospital cover Packages (hospital and extras cover) Ultimate Health Cover Prime Plus Accidents after joining ~ P P Cardiac services P P Hip/knee replacement P P All other joint replacements P P Knee arthroscopy and meniscectomy procedures P P All other joint arthroscopy and meniscectomy procedures P P Cataract and eye lens procedures P P Renal dialysis P P Pregnancy and Birth related services P O IVF and assisted reproductive services P O Minor gynaecological surgery P P Obesity related procedures and surgeries ++ P O Abdominoplasty and lipectomy P O Appendicitis P P Removal of tonsils and adenoids P P Cancer* P P Psychiatric services P P Rehabilitation services P P Palliative care P P Back surgery (includes spinal surgery) P P Spinal fusion P P Reconstructive surgery ++ P P Breast reconstruction post cancer P P All cosmetic surgery ++ O O All other in-patient treatment receiving Medicare benefits P P Emergency ambulance services (one per single/ two per family, per calendar year)^ P P Health subscription refunds P P Family in-hospital benefit P P Involuntary unemployment cover # P O Travel insurance bonus P P option Nil Nil $250 Want to see the extras cover that comes with your package? Go to page 14 Restricted cover applies, see the Important Information Guide at bupa.com.au/info to find out more. O Indicates the service is excluded, whereby no benefits are payable. ~Benefits for accidents will be paid based on what your hospital cover includes. For Accident definition, please refer to the fund rules at bupa.com.au/fundrules. *Some non PBS drugs may not be covered. ^Fund rules apply. ++ Refer to Bupa s glossary for definitions at # Cover for your premiums for up to 12 months in the event you lose your permanent full time employment due to involuntary retrenchment or redundancy. Must have held selected covers for 12 months. Unemployment must have occurred within 12 months of claim. Other eligibility criteria apply. Contact us for details. The Group Policy is a contract of insurance between Bupa HI Pty Ltd and Insurance Australia Limited ABN AFSL

13 For full details of what's covered and what's not, see the Important Information Guide at bupa.com.au/info Hospital only Top Top No Pregnancy Standard Budget Basic P P P P P P P P P O P P O O O P P P P O P P P P P P P P P P P P O O O P P O O O P O P O O P O O O O P P P P P P O P O O P O P O O P P P P P P P P P P P P P P P P P P P P P P P P P P P P P P O P P P O O P P P P + P + P P P P P O O O O O P P P P P P P P P P P P O O O P P O O O P P O O O O O O O P Nil $250 Nil $250 $250 $250 $250 Travel insurance bonus You can receive up to 8 days (7 nights) of economy travel insurance annually on select packaged and hospital only covers. Alternatively, you can use the equivalent value as a discount on your premium for any Bupa Travel Insurance policy. 2 Waiting periods The following waiting periods apply: Accidents after joining no waiting periods. Palliative care, psychiatric and rehabilitation services 2 months Pre-existing conditions, ailments or illnesses 12 months Pregnancy and birth related services 12 months All other treatments included in your cover 2 months 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. 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. The excess is capped once per person, twice per membership, per calendar year. Restricted Cover If a treatment is listed on this page as having O, this means you will have restricted cover. Restricted cover means we will only pay a certain amount set by the Government, called the minimum benefit. If you go to a public hospital for these treatments, in most instances, you d be covered in a shared room, but you may have an amount to pay yourself. A private hospital may charge even more, so you d probably have a significant amount to pay yourself. For the details, please check the Important Information Guide. + Excludes any breast procedures except where they are post breast cancer. Note breast reduction and mastectomy where recognised by Medicare are covered. 2 Based on cost of Economy travel insurance for under 65 s at standard rates. Available on Ultimate Health Cover, Prime Plus and Basic hospital covers. Travel, Home & Car. Insurance products are issued by Insurance Australia Limited (IAL) ABN AFSL Any advice is general advice only and does not take into account your individual circumstances. The relevant Product Disclosure Statements are available at bupa.com.au and should be considered before making any decision on these products. Bupa HI Pty Ltd ABN is an authorised representative (number ) of IAL. 11

14 Extras cover at a glance Extras cover is an easy way to help maintain your health. That s why we have extras including dental, physio and natural therapies that can make all the difference to help keep your health on track. Comprehensive cover Platinum Get at least 90% back on most items at Members First providers # up to yearly limits. Gold Get at least 75% back on most items at our Members First providers # up to yearly limits. Silver Get at least 60% back on most items at our Members First providers # up to yearly limits. Top extras cover 90% Minimum amount you get back # Extras Yearly limits t General dental Unlimited Major dental $1,200 Orthodontics $900 + Optical $380^ Physio $900 Chiro $700 Top extras cover 75% Minimum amount you get back # Extras Yearly limits t General dental Unlimited Major dental $1,100 Orthodontics $800 + Optical $340^ Physio $800 Chiro $600 60% Medium extras cover Minimum amount you get back # Extras Yearly limits t General dental Unlimited Major dental $1,000 Orthodontics $700 + Optical $290^ Physio $700 Chiro Natural therapies Natural therapies Natural therapies $400 Benefit Bonus For Platinum, Gold and Silver Extras, your percentage back increases by 2% each year at Members First Providers, up to a maximum of 10%. At Non-Members First providers, you get 2% more back each year up to a maximum of 10% (this applies each calendar year and increases after the first 12 months). t Per person Per membership # For most items at our Members First extras providers covering dental, physio, chiro, podiatry consultations and selected optical. Podiatry not included on Bronze extras. Excludes orthodontics, orthotics and hospital treatments. Fund and policy rules, waiting periods and yearly limits apply. Set benefits apply at other recognised providers. ^At Members First optical providers only. Lower limits apply at other providers. ~Extras can be re-selected every 12 months, waiting periods will reapply for major dental and orthodontics. *This amount increases year on year up to a maximum of six years. For Major Dental and Orthodontics, benefits start after 12 month waiting period served. + Lifetime Limits apply. 12

15 Dental Optical Physio Chiro Natural therapies Your Choice Extras Select four services that suit you best. ~ Capped emergency ambulance is automatically included in this cover. Medium extras cover 60% Minimum amount you get back # Loyalty Maximums We increase how much you can claim each year by 20% of the initial amount for most extras services until it has doubled after five years. (applies after the first 12 months up to a maximum increase of up to 100%). Loyalty Extras Maximums t General $700* dental Major * dental Bronze Basic cover A range of basic extras, each with at least 60% back on most items at our Members First providers # up to yearly limits. 60% Basic extras cover Minimum amount you get back # Extras Yearly limits t General dental $350 Optical $210^ Physio $350 Combined Chiro limit. $100 sub limit Natural for Natural therapies therapies More value with Members First With our Extras covers, you can enjoy the advantages of our extensive network of dental, optical, physiotherapy, podiatry and chiropractic providers. When you choose to visit a Members First provider, in most instances you will receive higher benefits and have the certainty of knowing how much you ll get back. # Set benefits A pre-defined amount you ll get back for a service when you get treatment from someone outside the Bupa Members First provider network. Yearly limits The most you can claim per person in a calendar year, depending on your cover. See more details on page 14 and 15 Orthodontics $450 + Optical $260^ Physio $450* Chiro Natural therapies $350 t* * * Want gap free optical? If your cover includes optical, ask us about our gap free optical packages available at Members First providers and optical partners. Visit bupa.com.au 13

16 Choose your extras cover This table shows yearly limits per person. Ultimate Health Cover Packages Prime Plus % back at Members First providers Up to 100% back + At least 70% back Services Waiting periods General dental 2 months Unlimited Unlimited Major dental Orthodontics 12 months $1,600 $1,000 $1,000 Lifetime Limit $3,200 Optical $420 Ë $300 º $260 Ë $180 º Physiotherapy $1,500 combined with Occupational therapy Chiropractic and osteopathy 2 months $1,000 t $1,600 $350 t Natural therapies $1,000 Massage sub-limit $250 $300 t combined with Dietary Massage sub-limit $100 Antenatal and Postnatal Health Management 6 months $300 $100 Pharmacy (includes travel vaccines)^^ $1,500 $350 Dietary $1,000 Combined with Natural therapies Mental Health (including Psychology & Counselling) $1,000 $200 Podiatry (excludes orthotics) 2 months $1,000 $400 Speech Therapy $1,000 Eye Therapy $1,000 Occupational Therapy $1,000 Combined with physiotherapy Home Nursing $400 $200 For most items at our Members First extras providers covering dental, physio, chiro, podiatry consultations and selected optical. Fund and policy rules, waiting periods and yearly limits apply. Excludes orthodontics, orthotics and hospital treatments. Set benefits apply at other recognised providers. ## A 3 year waiting period applied to laser eye correction surgery for anyone joining Ultimate Health Cover from 1 July Up to yearly limits and subject to set limits. 100% back in most instances up to the first then benefits of 90% apply for general dental. 100% for first 10 standard physio & chiro visits, and podiatry consultations per person per calendar year then benefits of at least 90% apply. Fund and policy rules and waiting periods apply. 3 A combined yearly limit applies to this service category. ^^Benefits for prescription items that are non-pbs, TGA approved, and not appearing on our exclusions list. # Hire and repair of health aids and appliances available, 6 month waiting period applies. 14 Health aids and appliances 3 Accident Benefit 2 Laser Eye Correction Surgery Travel and accommodation Emergency ambulance services 12 months No waiting period 36 months 2 months No waiting period 85% # of cost Sub-limits apply $2,000 t $4, % of cost back at recognised Bupa providers ## $200 travel/ $300 accommodation $800 Sub-limits apply $100 travel $150 accommodation 1 service per year (singles) 2 services per membership (couples) t Per person Per membership Ë Members First º Non-Members First Combined Maximum

17 Choose your own extras Platinum Extras Gold Extras Silver Extras Your Choice Extras Bronze Extras At least 90% Back At least 75% Back At least 60% Back At least 60% Back At least 60% Back Unlimited Unlimited Unlimited $1,200 $1,100 $1,000 $900 Lifetime Limit $2,800 $380 Ë $280 º $800 Lifetime Limit $2,600 $340 Ë $240 º $700 Lifetime Limit $2,000 $290 Ë $200 º $900 $800 $700 $700* Year 1 to $1,400 Year 6+ * Year 2 to $1,000 Year 7+ $450* Year 2 to $900 Year 7+ Lifetime Limit $1,300 $260 Ë $180 º $450* Year 1 to $900 Year 6+ $350 $210 Ë $150 º $700 t $1,400 Massage sub-limit $200 $600 t $1,200 Massage sub-limit $200 t $1,000 $400 Massage sub-limit $150 $450 $400 $350 $350* Year 1 to $700 Year 6+** * Year 1 to $1,000 Year 6+ Massage sub-limit $100 $350 Sub-limit Combined with physiotherapy $350 Natural therapies sub-limit $100 $200 $150 $100 $100 $50 $750 $600 $750 $400 $750 $400 $300* Year 1 to $600 Year 6+ $100 $750 $400 $750 $400 $750 $400 $750 $400 $400 $350 $350 $1,200 Sub-limits apply $1,000 Sub-limits apply $800 Sub-limits apply $350* Year 1 to $700 Year 6+ $400* Year 1 to $800 Year 6+ $100 travel $150 accommodation 1 service per year (singles) 2 services per membership (couples) *This amount increases year on year up to a maximum of six years. For Major Dental and Orthodontics, benefits start after 12 month waiting period served. **Membership limits apply: Year 1 to $1,000 Year Accident benefit can only be used towards hospital excess or co-payment. Extras limits can be boosted if service annual limit has been reached. 15

18 Enjoy great value when travelling overseas. Depending on your level of cover, receive benefits towards travel vaccines and access to our 24hr overseas health advice line, providing you with medical information whilst travelling. Also, Bupa members receive a 15% discount on Bupa travel insurance. 16

19 Bupa health cover made easy Unsure of any words? Visit: bupa.com.au/glossary Other important information you should know can be found at: bupa.com.au/info Go to bupa.com.au/fundrules to see our fund rules. To find out more about what the Australian Government Rebate on private health insurance means for you, visit: bupa.com.au/rebate To get a quote: bupa.com.au Visit a local Bupa store 17

20 For more information bupa.com.au Visit your local Bupa store Bupa PO Box Melbourne VIC 8001 Bupa HI Pty Ltd ABN Effective 1 July The World of Bupa The Health World Cover of Bupa Health Coaching & Programs Health International CoverHealth Cover Health Corporate Coaching Health & Solutions Programs International Optical Products Health & Services Cover Corporate Dental Services Health Solutions Optical Aged Care Products & Services Aged Medical Care services Travel, Home & Car Insurance Life Pet Insurance