Bupa Going to Hospital Guide

8/3/2019 Bupa Going to Hospital Guide

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GO ING TO HO S PITAL

WIT H YOU ONYOUR J OURN EY

B. fid hethie y


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AbOUT bUAbupa is a healthcare leader, proudly looking ater the needso more than three million Australians. We have een aroundor over 60 years and were part o a gloal group whose careand expertise now stretches across 190 countries.

It is our purpose that makes us diferent. We exist to help ourmemers live longer, healthier, happier lives. Which is why our

gloal amily reinvests its prots to provide etter services ormemers and to ensure quality healthcare remains afordale.

We are dedicated to helping nd a healthier you.

C A U I RTRememer, i youre going to hospital and youd like to discussthe inormation in this guide, give us a call were here to help.

Call us on 134 135

drop b our local Bupa cnr

Vs bupa.com.au


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I you havent een to hospital very oten,you may not e amiliar with how the hospitalsystem works. o weve created this guide,especially or you.

With this guide, our goal is to help makeyour hospital experience as simple aspossile. rom discussing your treatmentwith your specialist, to making a successulrecovery, there are many steps to consider

eore, during and ater your hospital stay.

This guide will hopeully make these stepseasier or you. It includes inormation aoutthe hospital process rom what to packto how to claim.

I you eel overwhelmed or need moreinormation, eel ree to call us. Were hereto help you understand and make the mosto your cover.

CONTNTS

Bef e h it 4

reparing or your stay 5

bupa Medical Gap cheme 7

Choosing a hospital 8

What to take with you 11

di g hi t 12

What to expect 13

What youre covered or 14

Whats not covered 15

fte hi t 18

Getting ack on track 19

How to claim 20gy 21

AbO UT TH I GUI E


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bEOREHOITA


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REARINGOR YOUR TAY

In most cases your admission to hospital arises rom a visit to yourGeneral ractitioner (G), who then reers you to a specialist either a surgeon or physician.

Heres what we recommend you do eore going to hospital:

1 . TALk TO S

To get the most rom your cover, like avoiding unexpected out-o-pocket expenses and conusion, call us eore planning your stay.

You may want to ask us the ollowing questions:

Am I covered or my treatment?

Are there any waiting periods, exclusions or restricted enets?(ee page 15)

o I need to pay any excess or co-payments? (ee page 16)

Which hospital should I go to, and whats the diference etweena Memers irst and a Network hospital? (ee page 9)

2. TALk TO yO GP

There are several options you can discuss with your G to ensure you

pay minimal out-o-pocket expenses or your treatment.Ask your G questions including:

Can you reer me to a specialist who uses the bupa Medical Gapcheme (see page 7)?

Can you give me an open reerral? This means you can choose roma list o relevant specialists. You can then call us to nd a specialistwho uses our Medical Gap cheme.

Can you reer me to specialists who can treat me in a Memersirst or Network hospital?

3 . TALk TO yO SPCIALIST

The next step will e a consultation with your specialist.

beore agreeing to your hospital treatment, e sure to ask the ollowing:

Can you tell me more aout my condition?

What are my treatment options including non-surgical options,diferent types o surgery and the consequences o not havingtreatment?

What are the enets and risks o each treatment option(eg potential complications)?


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Other questions to ask include:

What hospital/s do you recommend and why?

How long will I e in hospital or?

o you use the bupa Medical Gap cheme, and i not, what willmy out-o-pocket expenses e?

Can you conrm what other specialists will e involved in mytreatment (eg anaesthetist, pathologist, radiologist, assistantsurgeon) and whether they use the Medical Gap cheme?

oes my treatment involve a prosthesis (eg hip or knee replacement,cardiac stent) and, i so, will I incur an out-o-pocket expense?

hould I continue taking the medicines Im on?

Can you provide me with a medical certicate (or leave rom work)?

How long will it take me to recover and will I need assistance(eg help at home or in a rehailitation centre)?

INfOmd f INANCIAL CONSNT

I your hospital stay involves any out-o-pocket hospital charges,the hospital should disclose the cost and otain your agreementin writing eore your admission.

I your doctors ees include any out-o-pocket charges, yourspecialist should disclose the cost and otain your agreementeore your admission to hospital. They should provide adviceon ees charged not only y themselves ut also y otherspecialists or surgeons as well as y anaesthetists, assistantsurgeons, pathologists and radiologists.


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The Medicare benet chedule (Mb) ee is the amount set y the ederal Government or amedical service. When you receive treatment in hospital as a private patient, Medicare pays75 percent o the Mb ee and bupa pays the remaining 25 percent.

I your specialist charges more than the Mb ee, there will e an out-o-pocket expense(also known as a gap amount or medical gap), which youll have to pay.

You can reduce or eliminate this gap amount i you choose a specialist who uses our MedicalGap cheme an arrangement designed y us or your enet.

Whether or not your specialist uses our Medical Gap cheme, heres how it works:

bUA MEI CAGA C HEME

CENARIO

your specialist uses our meical Gap Schee with no out-o-pocet expense

Your specialist accepts bupas agreed payment and the Medicare enet as ullpayment o their services.

Your specialist will send your account directly to bupa and Medicare or payment.

You wont receive a ill and wont have to make a claim.

CENARIOyour specialist uses our meical Gap Schee but also charges an

out-o-pocet expense

Your specialist will tell you the gap amount you need to pay (also calledKnown Gap). I not, you should ask.

Youll need to sign a orm, acknowledging that youve een told o the gap amount.

Youll receive an invoice rom your specialist or the gap amount either eore orater your treatment. An account or the remainder will go to bupa and Medicare.

CENARIO

your specialist oesnt use our meical Gap Schee

You should e told o the expected cost and sign a orm consentingto the expense.

Youll receive an account rom your specialist ater treatment.

You can then claim up to the Mb ee rom bupa and Medicare, and paythe alance to the specialist.

rior to your treatment, ask your specialist i they will use our Medical Gap cheme. Alternatively,ask us or your G or the details o specialists who use our Medical Gap cheme.


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As a bupa memer with private hospital cover, you can choose to e treated in either a privateor pulic hospital. Your choice will depend on your level o cover and the type o treatmentyoure having.

Keep in mind that even as a private patient in a pulic hospital, its possile youll e placedon a waiting list.

C HO O I NGA HO ITA

PIvAT O PLIC PATINT

RIATE ATIENTIN A RIATEHOITA

RIATE ATIENTIN A UbICHOITA

UbIC ATIENTIN A UbICHOITA

Covered or hospital expenses(ie accommodation, theatreand intensive care ees)

Covered or specialists ees,up to the Mb ee or ourMedical Gap cheme enet

NOT APPLICAL

Your choice o specialist

Your choice o hospital

Aility to access treatmentat your convenience


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Get the most rom your cover y selecting one o our Memers irst or Network hospitals andday acilities weve entered into a special agreement with them to help reduce or eliminateyour out-o-pocket hospital expenses.

C HO O I NG AR IATE HO I TA

* You must book and request a single room in a Members First hospital at least 24 hours before admission. If you dont get a single room youll

receive $50 a day from the hospital for every day youre not in a single room. Applies to overnight admissions only. Excludes nursing home

type patients (see page 17), emergency care, same-day stays or where a single room is medically inappropriate.

fId fS

This is a daily charge illed y a small numer o Memers irst and Network hospitals that youreresponsile or paying. The hospital should inorm you o any ee when you make a ooking.

ixed ees allow us to ring you a greater range o hospitals that provide certainty aroundyour costs. And i you have Ultimate Health cover, youre reimursed or any xed ee.

NON-AGmNT HOSPITALS

These are private hospitals and day acilities that have not entered into an agreement withbupa. because o this, you may incur large out-o-pocket expenses when attending one othese hospitals.

mmS f I ST HOSPITALS

At Memers irst hospitals and day acilities, in most instances youll e ully covered oryour hospital expenses, such as accommodation, theatre and intensive care ees. At Memersirst day acilities there are also no out-o-pocket expenses or medical treatments (eg yourspecialists ees).

At these hospitals and day acilities, youll also have access to special enets such as oursingle room or money ack ofer*, a daily newspaper, local phone calls and ree-to-air T at noadditional cost.

Weve also negotiated maternity care at Memers irst hospitals that ofer ostetric services.At these hospitals you can enet rom:

childirth and parenting education classes prior to and ater delivery;

postnatal clinics that provide support, advice and education to mothersand amilies or up to eight weeks ater you leave hospital;

a 24-hour postnatal support phone line;

parenting support services; and

reasteeding classes or new and experienced mothers.

NTOk HOSPITALS

These are private hospitals and day acilities where, in most instances, youll e ully coveredor your hospital expenses such as accommodation, theatre and intensive care ees. At a Networkhospital, youll also have access to local phone calls and ree-to-air T at no additional cost.

To nd your nearest Memers irst or Network hospital, call us or search under ind ahealthcare provider at bupa.com.au


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bRI NGI NGYOU GREATERAU E AN CERTAINTY

Memers irst and Networkhospitals weve entered into aspecial agreement with them tohelp reduce or eliminate yourout-o-pocket hospital expenses.

ingle room or money ack ofer*at Memers irst hospitals.

Other special enets at Memersirst hospitals#.

The bupa Medical Gap cheme isdesigned to reduce or eliminate yourout-o-pocket medical expenses.

Memers irst day acilities extendthe no-gap arrangement to medicaltreatments (eg specialists ees).

*You must book and request a single room in a Members

First hospital at least 24 hours before admission. If you

dont get a single room youll receive $50 a day from the

hospital for every day youre not in a single room. Applies

to overnight admissions only. Excludes nursing home type

patients (see page 17), emergency care, same-day staysor where a single room is medically inappropriate.

#Includes a daily newspaper, local phone calls and free-to-air

TV at no additional cost. Weve also negotiated maternity

care at Members First hospitals that oer obstetric

services.


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WH AT TO TAKEWITH YOU

your bupa memership card

your Medicare card

medicines youre taking, including prescription andnon-prescription medicines such as complementarymedicines, vitamins and over-the-counter painkillers

X-rays or medical images

specialists letters or reerrals

inormation aout your lood type

your hospital ag or laour (i pregnant)

your hospitals pre-admission pack (i you received one).

WE U GGETYOU ACK:

COTHING

leepwear

Underwear

lippers (non-slip)

ay clothes

TOIETRIE

Hairrush

Toothrushand toothpaste

Antiseptic soap

hampooand conditioner

eodorant

OTHER

books

Magazines

ersonal musicplayer

I youre staying in hospital overnight, dont orget the ollowing items(and rememer to keep valuale personal items at home):

Call us rst to discuss your cover including any waiting periods,exclusions, restricted enets, excess or co-payments.

Talk to your G aout selecting an appropriate specialist.

Talk to your specialist aout your condition, treatment optionsand any out-o-pocket expenses.

earn aout our Medical Gap cheme, designed to reduce oreliminate your out-o-pocket medical expenses.

Choose your hospital select one o our Memers irst or

Network hospitals or day acilities to reduce your out-o-pockethospital expenses.

repare or your stay y deciding what to take.

bEOREHOITACH ECK IT


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URINGHOITA


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While every hospital works a little diferently, the ollowing may assistyou during your stay.

vISITOS

Ask your hospital aout their visiting hours and arrangements or youramily and riends. ind out who is considered amily, arrangementsor parents or guardians (i the patient is a child), and when yourriends can visit.

m ALS

Ask your nurse aout meal times and how to order, and let the nursesknow i you have any dietary restrictions. Inormation aout meals isoten included on the hospitals television inormation channel.

T L vIS ION

ome hospitals charge or television use and some have their owninormation channel explaining their services, such as a chaplain.Note that youre covered or ree-to-air T at our Memers irstand Network hospitals.

T L P HON

ome hospitals will charge you to make local, interstate and internationalcalls. Others restrict the use o moile phones within the hospital.Note that youll e ale to make local telephone calls or no additionalcost at our Memers irst and Network hospitals.

INT N T

Most hospitals now ofer wireless internet (Wi-i) though some maycharge you to use it.

WHAT TO EX ECT


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YOUR HOITA COT

I youre admitted to hospital as a private patient youre coveredor the hospitals service charges, which typically include:

accommodation or overnight or same-day stays

operating theatre, intensive care and laour ward ees

medicines approved y the harmaceutical benets cheme(b) and provided as part o your in-hospital treatment

allied services including physiotherapy, occupational therapyand dietetics

dressings and other consumales

surgically implanted prostheses up to the enet pulishedon the Governments rostheses ist.

YOUR MEICA COT

These are the ees charged y specialists involved in your hospitaltreatment.

As a private patient, youre covered or the cost o medical treatmentup to the Mb ee. Medicare pays 75 percent o the Mb ee and bupapays the remaining 25 percent. I your specialist charges more thanthe Mb ee, there will e a gap or you to pay.

However, i your specialist uses it, our Medical Gap cheme can helpeliminate or reduce the gap or you (see page 7).

ROTH EE

I your hospital treatment includes a surgically implanted prosthesis(eg a cardiac stent), youll e covered up to the enet noted in theGovernments rostheses ist.

To avoid any out-o-pocket expense, we suggest discussing prosthesischoices with your specialist eore going to hospital.

EMERGENCY AMbU ANCEIn most circumstances, well cover you or emergency amulancetransport and on-the-spot treatment. These services are capped percalendar year at one service a year or single memerships and twoservices a year or amily and single parent memerships.

There are diferent state amulance arrangements across Australia learn more aout these y contacting your states amulance service.

WHAT YOURECOERE OR


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While your hospital cover helps pay or a wide range o services youmay receive as a private patient, there are occasions when you wonte ully covered and may experience out-o-pocket expenses.

or example:

AT A NO N-AGREEMENT HOI TA

A small numer o hospitals in Australia are not part o bupasnetwork. I you choose to e treated at a non-agreement hospital(see page 9), you may ace large out-o-pocket expenses.

URING A WAITING ERIO

A waiting period starts rom the date you take out your healthinsurance or upgrade your cover. I a treatment has a waiting period,you wont e covered during that time.

2 MONTH Initial waiting period, palliative care, psychiatricand rehailitation services.

12 MONTH regnancy-related services (including childirth)and assisted reproductive services (ie I).

re-existing ailments, illnesses or conditions(anything you had signs or symptoms o in the six

months eore you joined or upgraded your coveris regarded as pre-existing). I you visit hospitalduring this time, you may need to providedocumentation that shows your treatment isntrelated to a pre-existing ailment, illness or condition.

3 YEAR aser eye correction surgery (only availale onUltimate Health Cover and Ultimate CorporateHealth Cover).

COERAGE OR YOUR bAbY

No waiting periods apply to your neworn i they have een added tothe appropriate amily hospital cover within two months o their irth.

EXCUION AN RETRICTE bENEIT

ometimes specic services or treatments are excluded or restrictedunder your level o cover.

I your treatment is an exclusion, youll e responsile or all expensesrelated to your hospital admission or that procedure or service.

I restricted enets apply to your cover, youre covered or shared-roomaccommodation in a pulic hospital only, with your choice o specialist.I you attend a private hospital or request a private room in a pulichospital its likely youll incur out-o-pocket expenses, and therestricted enet amount set y the Government wont e enough

to cover your costs.

WHAT NOTCOERE


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EXCE AN CO-AYMENT

epending on your level o cover,you may need to pay an excess orco-payment or your hospital admission.ome levels o cover, including UltimateHealth Cover, Top Hospital Cover andsome corporate covers are excess andco-payment ree. or dependent childrenon your memership, theres no excess

or co-payments with Advantage HospitalCover and no excess with tandardHospital Cover and some corporatecovers. Check with us to see what excessor co-payment (i any) will apply to yourhospital stay.

IXE EE

This is a daily charge illed y a smallnumer o Memers irst and Networkhospitals that youre responsile orpaying. The hospital should inorm youo any ee when you make a ooking.

NON-EMERGENCYAMbU ANCE

While in most cases youll e coveredor emergency amulance services,some amulance services wont ecovered. These include:

transport rom a hospital toyour home, a nursing home oranother hospital where youveeen admitted to the transerring

(rst) hospital; and

transport rom your home,a nursing home or a hospitalor ongoing medical treatment(eg chemotherapy, dialysis).

COMETIC U RGERY

Youre not covered or cosmetic surgerywhich isnt clinically required. hould youneed ollow-up surgery ater your initialprocedure and this is recognised yMedicare, bupa will cover minimum

enets and the cost o any prosthesis.I Medicare doesnt recognise your ollow-up treatment, you wont e eligile orany enets.


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WHEN EAING HOI TA

You may need to pay or certain services or products when you aredischarged rom hospital. epending on your level o cover and thehospital you attend, these may include:

pharmacy items not opened at the point o leaving hospital

aids supplied or use at home (eg a raised toilet seat or a splint)

pay T, movies and non-local phone calls

patient-requested non-emergency amulance transportation.

OUT-ATIENT ERICE

With the exception o a limited range o specic programs, yourhospital cover only applies when youre admitted to hospital as anin-patient. Your hospital can tell you i youre covered y a speciedout-patient program ut i youre unsure, contact us.

ometimes people visit an emergency department in a private hospitalut are not admitted ater eing assessed. I youre not admitted youreconsidered an out-patient and wont e covered y bupa. In this case,you may e out-o-pocket. I out-o-pocket, check whether youreeligile or a reate under the Medicare aety Net (see page 20).

WHERE YOU RECEIE bENEITROM ANOTHER OURCE

Your health insurance doesnt apply where compensation, damages orenets may e claimed rom another source in relation to a condition,injury or ailment (eg workers compensation, travel insurance).

A A NURING H OME TYE ATIENT

I youre assessed during your hospital stay as no longer needingacute care or are in hospital or more than 35 days, youll e classedas a nursing home type patient. In this case, bupa will pay enets thatare much lower than normal hospital enets and youll e required tomake a personal contriution towards the cost o your care.

WHERE MEI CARE AY NO bENEI T

There are certain hospital procedures perormed y a dentist, surgicalpodiatrist or other practitioner that are not eligile or a Medicarereate and which are not covered y your hospital cover. Contact usor urther inormation.

earn more aout your hospital includingvisiting hours and how to order meals.

Take note o what youre covered orin hospital.

be aware o which costs you may note covered or.

U RINGHOITACH ECK IT


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ATERHOITA


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You may not eel 100 percent well when you leave hospital and itspossile you might need urther treatment. Most o all, youll proalyneed to take time out to rest and recover. Were here to help you getack on your eet and stay well once youve recovered.

beore leaving hospital, ask your specialist the ollowing questions:

What medicines will I need during my recovery?

When can I resume day-to-day activities?

When is my next appointment?

What complications might arise and what should I do i this happens?

Will I need help at home, and how can I organise it?

I you have extras cover, dont orget to use it i you need ongoingtreatment (eg physiotherapy). by using our Memers irst networkproviders you can save money and claim most services on the spot yswiping your memership card.

Also take advantage o our range o health and wellnessprograms y visiting our wesite at bupa.com.au

GETTIN G bACKON TRACK


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The ollowing inormation will help you work through the claims process so you can return homewithout the worry o extra paperwork and unexpected ills.

YOUR HOITA COT

All Memers irst and Network hospitals will ask you to complete claim orms, which they willsumit directly to bupa on your ehal. The hospital would have asked you to pay any excess,co-payment or xed ee upon your admission.

I youre treated at a non-agreement hospital, youll have out-o-pocket expenses and may easked to pay the whole amount up ront. I thats the case, you can sumit a claim orm to

bupa to e reimursed or some o these ees.

YOUR MEICA COT

I your specialist doesnt use our Medical Gap cheme, youll need to complete a two-wayclaim orm or all your medical costs. The orm is availale at any Medicare or bupa centre.Medicare will process your claim and pay you the enet, and liaise with bupa to pay aportion o the ill.

I you cant visit a Medicare oce during your recovery, contact either bupa or Medicare andask or the relevant orms to e sent to you.

TATEMENT O bEN EIT

Ater your hospital and medical (rom doctors and specialists) claims have een processed,well send you statements showing what has een paid on your ehal. lease check thatthese details are correct and contact us straight away i you have any queries. Your medicalstatement may include costs charged y specialists you may not have seen directly suchas pathologists.

MEICARE AN b AETY NET

The Governments Medicare aety Net provides nancial assistance to people with highout-o-pocket expenses or out-patient services that pay a Medicare enet. Once you reacha threshold, you may e eligile or additional Medicare enets or the rest o the calendaryear. The b aety Net is also availale to those who need a lot o medicines each year.

or more inormation or to register or these schemes visit mcarausrala.ov.au

Talk to your specialist aout how to maximise your recovery.Also call us to nd out how you can enet rom your extrascover and our health and wellness programs.

I treated at a Memers irst or Network hospital, youll e askedto complete a claim orm which the hospital will send to us.

I your specialist hasnt used our Medical Gap cheme and youreceive a medical ill, complete Medicares two-way claim ormto e reimursed.

When you receive your tatement o benets rom us, check thatthe details are correct and contact us i you have any queries.

ATERHOITACH ECK IT

HOW TO CAI M


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GOARY


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GOARY

ALLId HALTH SvICS

Services provided by allied health professionals. Examples include but are

not limited to: chiropractic, dietetics, exercise physiology, occupational therapy,

osteopathy, physiotherapy, podiatry, psychology, social work and speech pathology.

PA mdICAL GAP SCHm

An arrangement managed by Bupa under which medical providers can claim

reimbursement for the provision of medical services. Private patients are covered

for the cost of medical treatment up to the MBS fee. Medicare pays 75 percent of

the MBS fee and Bupa pays the remaining 25 percent. If specialists charge morethan the MBS fee there will be a gap to pay. However, if a specialist uses Bupas

Medical Gap Scheme, the gap can be reduced or eliminated.

CO-PAymNT

An amount you agree to pay towards the cost of your daily hospital bill.

A co-payment is similar to an excess except that the co-payment is charged per

day and capped after ve days. In return for choosing a co-payment, you pay

reduced premiums compared to a similar cover without a co-payment.

m G NCy Am LANC S vIC S

Emergency ambulance services are used when theres reason to believe that your

life may be in danger or that you should be attended to without undue delay.

CSS

An excess is a set amount you pay upfront before your benet is paid. In return for

choosing an excess, you pay reduced premiums compared to a similar cover without

an excess. Before going to hospital, contact us to see what excess (if any) will apply

to your hospital stay.

CLSIONS

Exclusions are specic procedures or services that are not covered. If your

treatment is an exclusion under your chosen level of cover, you will be responsible

for all expenses related to your hospital admission for that procedure or service.

f I d f

A daily charge billed by a small number of Members First and Network hospitals

that youre responsible for paying. The fee is charged per day and capped at a

maximum number of days, and is in addition to any excess or co-payment you

may have as part of your hospital cover. In most instances a xed fee will only

apply to certain types of services at a hospital (eg psychiatric or rehabilitation

services). In very few instances, it applies to all services provided by the hospital.


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INf O m d f INANCIAL CONS NT

Knowing how much your treatment will cost you including any extra money you

may have to pay out of your own pocket.

The hospital must obtain your agreement in writing for any out-of-pocket costs

before admission. Likewise, your specialist should also inform you of any costs and

obtain your agreement before admission.

IN-PATINT

Youre an in-patient if youre admitted into hospital for either same-day or

overnight treatment. If youre admitted as a private in-patient, youll be covered

for the services listed in your chosen level of hospital cover.

LvL Of COv

Refers to the type of product(s) you have. For example, if you have chosen Top

Hospital Cover and Platinum Extras, these products make up your level of cover.

m dICAL GAP

Also referred to as an out-of-pocket expense or gap amount, the medical gap

is the dierence between the doctors fee for services provided in hospital and the

combined Medicare benet and health insurance benet.

m dICA N f ITS SCH dL (m S) f

The MBS fee is the amount set by the Government for each medical service

covered by Medicare.

m dICA SAf Ty N T

The Medicare Safety Net provides families and individuals with nancial assistance

for high out-of-pocket costs for out-of-hospital MBS services. Once you meet

a Medicare Safety Net threshold, you may be eligible for additional Medicare

benets for out-of-hospital MBS services for the rest of the calendar year.

mmS f I ST HOSP ITALS ANd dAy fACIL IT I S

Bupa has entered into a special agreement with these hospitals and day facilitiesto help reduce or eliminate your out-of-pocket expenses and provide you with

special benets not available at other hospitals and day facilities.

NTOk HO SPITALS ANd dAy fACIL IT I S

Bupa has entered into a special agreement with these hospitals and day facilities

to help reduce or eliminate your out-of-pocket expenses.


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NON- m G NCy Am LANC

Ambulance transportation thats provided when your life isnt in danger or when

you dont require treatment without undue delay. Examples include: transportation

from a hospital to your home; transportation from a hospital to a nursing home;

transportation from a hospital to another hospital where youve been admitted

to the transferring (rst) hospital; and transportation from your home, a nursing

home or a hospital for ongoing medical treatment.

NON-AGmNT H OSPITALS ANd dAy fACIL IT IS

These are private hospitals and day facilities that Bupa doesnt have anagreement with. If you visit a non-agreement hospital or day facility, we pay

benets for your stay but the hospital may still charge out-of-pocket fees over

and above these benets.

NSING H Om TyP PATINT

You may be classed as a nursing home type patient if youre assessed during your

hospital stay as no longer needing acute care.

OPN fAL

Where you can choose from a list (provided by your GP) of relevant specialists.

OT-Of-POCkT PNS

This is an expense youll need to pay to settle your bill. Examples of when youll

have an out-of-pocket expense are when the service or treatment is not covered

at all (eg exclusions) or when you receive benets from us that are not sucient

to cover the full cost (eg restricted benets or medical gaps).

OT-PATINT SvICS

Out-patient services are provided to a person who has not been admitted to hospital.

They can include medical, nursing or allied health care. No benets are payable

by health funds for out-patient services except for a small range of selected

services. Out-patient medical services may be eligible for Medicare benets.

P HA m AC TICAL N f ITS SCH m (P S)

The PBS gives Australians access to prescription medicines by subsidising their

cost as part of the Australian Governments broader National Medicines Policy.

P S SAf Ty N T

If you or your family need a lot of medicines in a year, the PBS Safety Net helps

you with the cost of your medicines. Once you or your family reach a Safety Net

threshold, you can apply for a PBS Safety Net card then your PBS medicine will

be less expensive or free* for the rest of the calendar year.

* If you choose a more expensive brand of medicine, or your doctor prescribes one, you may need to pay more.


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P-ISTING AILmNT, ILLNSS O CONdITION

Any ailment, illness or condition that you had signs or symptoms of during the six

months before you joined or upgraded to a higher level of cover with us. Its not

necessary that you or your doctor knew what your condition was or that it had

been diagnosed. A condition can still be classed as pre-existing even if you hadnt

seen your doctor about it before joining or upgrading to a higher level of cover. If

you knew you werent well, or had signs or symptoms that a doctor would have

detected (if you had seen one) during the six months prior to joining or upgrading,

then your condition is classed as pre-existing.

P OSTH S S

Prostheses are designed to replace a part of the body or to make a part of the

body work more eciently. Prostheses include pacemakers, debrillators, cardiac

stents, hip and knee replacements, intraocular lenses and other devices implanted

surgically to replace or augment a part of the body.

P OSTH S S L IST

A list of prostheses with applicable private health insurance benets, published

by the Department of Health and Ageing under the Private Health Insurance Act.

ST ICT d N f ITS

When you choose to pay a lower premium for your private health cover in return

for agreeing to lower benets on some services. Restricted benet services attract

minimum default benets which means you wont be fully covered in private

hospitals and will have out-of-pocket expenses.

STATmNT O f NfI TS

These are statements you receive after your treatment that detail the benet paid

and, for hospital expenses, any excess or co-payment deducted. Youll receive

separate statements for your hospital and medical treatments.

TO-Ay CLAIm fOm

Medicares two-way claim form aims to make lodging health claims easier,saving you from making separate trips to both Medicare and your health fund.

If your specialist doesnt use our Medical Gap Scheme (where your doctor bills us

directly) youll need to complete this form for your medical costs.

AITING PIOdS

A waiting period is a period of time during which you are not covered for a particular

service. It generally applies from the time you joined or upgraded your cover with

us. If you receive a service or treatment during a waiting period, youre not eligible

to receive a benet from us, regardless of when you submit your claim.


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WERE I TENI NGWe hope this guide has helped you to etter understand howyour private health cover works in the event that you have togo to hospital.

Other resources you may nd useul when visiting hospital include:

Australian Governments rivate atients Hospital Charter al.ov.au

rivate Health Insurance Omudsman wesite po.or.au

Medicare Australia wesite mcarausrala.ov.au

I you have any eedack aout your hospital experience (goodor ad), let us know. We welcome your thoughts so we can keepyou happy, healthy and enjoying lie. imply call us were hereto help.

Efective 6 Octoer 2011. The inormation in this ooklet is intended toe a guide only and is not intended to e, nor should e, relied on as a

sustitute or proessional medical advice. bupa makes no warranties orrepresentations regarding the quality, accuracy or completeness o theinormation. bupa is not liale to readers or any loss or damage suferedarising out o the use or reliance on the inormation, except that which cannote excluded y law.

Call us on 134 135


Vs bupa.com.au


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mailing etails:bupaO box 14639MEbOURNE IC 8001

bupa Australia ty tdAbN 81 000 057 590

Efective 6 Octoer 201110272-10-11

Health InsuranceCorporate Health ervicesHealth AssessmentsHealth CoachingHealth rogramsInternational rivate Medical InsuranceOverseas isitors Health InsuranceOptical ervicesTravel InsuranceAged CareCare and Home Insuranceie Insurance

fO mO INfOmATION:

Call us on 134 135

Vs bupa.com.au


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Documents

Bupa Going to Hospital Guide