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GOING TO HOSPITAL

W I T H YO U O N YO U R J O U R N E Y
Bupa. find a healthier you

A b O U T b U pA
bupa is a healthcare leader, proudly looking after the needs of more than three million Australians. We have been around for over 60 years and were part of a global group whose care and expertise now stretches across 190 countries. It is our purpose that makes us different. We exist to help our members live longer, healthier, happier lives. Which is why our global family reinvests its profits to provide better services for members and to ensure quality healthcare remains affordable. We are dedicated to helping find a healthier you.

CAll Us fIRsT
Remember, if youre going to hospital and youd like to discuss the information in this guide, give us a call were here to help.

Call us on 134 135 Visit bupa.com.au drop by your local Bupa centre

AbOUT THIs GUIdE


If you havent been to hospital very often, you may not be familiar with how the hospital system works. so weve created this guide, especially for you. With this guide, our goal is to help make your hospital experience as simple as possible. from discussing your treatment with your specialist, to making a successful recovery, there are many steps to consider before, during and after your hospital stay. This guide will hopefully make these steps easier for you. It includes information about the hospital process from what to pack to how to claim. If you feel overwhelmed or need more information, feel free to call us. Were here to help you understand and make the most of your cover.

CONTeNTS
B e f o r e h o s p i ta l preparing for your stay bupa Medical Gap scheme Choosing a hospital What to take with you d u r i n g h o s p i ta l What to expect What youre covered for Whats not covered a f t e r h o s p i ta l Getting back on track How to claim g lo ssa ry 4 5 7 8 11 12 13 14 15 18 19 20 21

bEfORE H O s p I TA l

p R E pA R I N G f O R YO U R s TAY
In most cases your admission to hospital arises from a visit to your General practitioner (Gp), who then refers you to a specialist either a surgeon or physician. Heres what we recommend you do before going to hospital:

1 . TA L k T O u S
To get the most from your cover, like avoiding unexpected out-ofpocket expenses and confusion, call us before planning your stay. You may want to ask us the following questions:

Am I covered for my treatment? Are there any waiting periods, exclusions or restricted benefits? (see page 15) do I need to pay any excess or co-payments? (see page 16) Which hospital should I go to, and whats the difference between a Members first and a Network hospital? (see page 9)

2 . TA L k T O yO u r G P
There are several options you can discuss with your Gp to ensure you pay minimal out-of-pocket expenses for your treatment. Ask your Gp questions including:

Can you refer me to a specialist who uses the bupa Medical Gap scheme (see page 7)? Can you give me an open referral? This means you can choose from a list of relevant specialists. You can then call us to find a specialist who uses our Medical Gap scheme. Can you refer me to specialists who can treat me in a Members first or Network hospital?

3 . TA L k T O yO u r S P e C I A L I S T
The next step will be a consultation with your specialist. before agreeing to your hospital treatment, be sure to ask the following:

Can you tell me more about my condition? What are my treatment options including non-surgical options, different types of surgery and the consequences of not having treatment? What are the benefits and risks of each treatment option (eg potential complications)?

Other questions to ask include:

What hospital/s do you recommend and why? How long will I be in hospital for? do you use the bupa Medical Gap scheme, and if not, what will my out-of-pocket expenses be? Can you confirm what other specialists will be involved in my treatment (eg anaesthetist, pathologist, radiologist, assistant surgeon) and whether they use the Medical Gap scheme? does my treatment involve a prosthesis (eg hip or knee replacement, cardiac stent) and, if so, will I incur an out-of-pocket expense? should I continue taking the medicines Im on? Can you provide me with a medical certificate (for leave from work)? How long will it take me to recover and will I need assistance (eg help at home or in a rehabilitation centre)?

INfOrmed fINANCIAL CONSeNT


If your hospital stay involves any out-of-pocket hospital charges, the hospital should disclose the cost and obtain your agreement in writing before your admission. If your doctors fees include any out-of-pocket charges, your specialist should disclose the cost and obtain your agreement before your admission to hospital. They should provide advice on fees charged not only by themselves but also by other specialists or surgeons as well as by anaesthetists, assistant surgeons, pathologists and radiologists.

b U pA M E d I C A l GAp sCHEME
The Medicare benefit schedule (Mbs) fee is the amount set by the federal Government for a medical service. When you receive treatment in hospital as a private patient, Medicare pays 75 percent of the Mbs fee and bupa pays the remaining 25 percent. If your specialist charges more than the Mbs fee, there will be an out-of-pocket expense (also known as a gap amount or medical gap), which youll have to pay. You can reduce or eliminate this gap amount if you choose a specialist who uses our Medical Gap scheme an arrangement designed by us for your benefit. Whether or not your specialist uses our Medical Gap scheme, heres how it works:

sCENARIO
your specialist uses our medical Gap Scheme with no out-of-pocket expense

Your specialist accepts bupas agreed payment and the Medicare benefit as full payment of their services. Your specialist will send your account directly to bupa and Medicare for payment. You wont receive a bill and wont have to make a claim.

sCENARIO
your specialist uses our medical Gap Scheme but also charges an out-of-pocket expense

Your specialist will tell you the gap amount you need to pay (also called Known Gap). If not, you should ask. Youll need to sign a form, acknowledging that youve been told of the gap amount. Youll receive an invoice from your specialist for the gap amount either before or after your treatment. An account for the remainder will go to bupa and Medicare.

sCENARIO
your specialist doesnt use our medical Gap Scheme

You should be told of the expected cost and sign a form consenting to the expense. Youll receive an account from your specialist after treatment. You can then claim up to the Mbs fee from bupa and Medicare, and pay the balance to the specialist.

prior to your treatment, ask your specialist if they will use our Medical Gap scheme. Alternatively, ask us or your Gp for the details of specialists who use our Medical Gap scheme.

CHOOsING A H O s p I TA l
As a bupa member with private hospital cover, you can choose to be treated in either a private or public hospital. Your choice will depend on your level of cover and the type of treatment youre having. Keep in mind that even as a private patient in a public hospital, its possible youll be placed on a waiting list.

P r I vAT e O r P u b L I C PAT I e N T
pRIvATE pATIENT IN A pRIvATE HOspITAl pRIvATE pATIENT IN A pUblIC HOspITAl pUblIC pATIENT IN A pUblIC HOspITAl

Covered for hospital expenses (ie accommodation, theatre and intensive care fees) Covered for specialists fees, up to the Mbs fee or our Medical Gap scheme benefit Your choice of specialist Your choice of hospital Ability to access treatment at your convenience
NOT APPLICAbLe

CHOOsING A p R I vAT E H O s p I TA l
Get the most from your cover by selecting one of our Members first or Network hospitals and day facilities weve entered into a special agreement with them to help reduce or eliminate your out-of-pocket hospital expenses.

m e m b e r S f I r S T H O S P I TA L S
At Members first hospitals and day facilities, in most instances youll be fully covered for your hospital expenses, such as accommodation, theatre and intensive care fees. At Members first day facilities there are also no out-of-pocket expenses for medical treatments (eg your specialists fees). At these hospitals and day facilities, youll also have access to special benefits such as our single room or money back offer*, 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 offer obstetric services. At these hospitals you can benefit from:

childbirth and parenting education classes prior to and after delivery; postnatal clinics that provide support, advice and education to mothers and families for up to eight weeks after you leave hospital; a 24-hour postnatal support phone line; parenting support services; and breastfeeding classes for new and experienced mothers.

N e T w O r k H O S P I TA L S
These are private hospitals and day facilities where, in most instances, youll be fully covered for your hospital expenses such as accommodation, theatre and intensive care fees. At a Network hospital, youll also have access to local phone calls and free-to-air Tv at no additional cost. To find your nearest Members first or Network hospital, call us or search under find a healthcare provider at bupa.com.au

fIxed feeS
This is a daily charge billed by a small number of Members first and Network hospitals that youre responsible for paying. The hospital should inform you of any fee when you make a booking. fixed fees allow us to bring you a greater range of hospitals that provide certainty around your costs. And if you have Ultimate Health cover, youre reimbursed for any fixed fee.

N O N - A G r e e m e N T H O S P I TA L S
These are private hospitals and day facilities that have not entered into an agreement with bupa. because of this, you may incur large out-of-pocket expenses when attending one of these hospitals.

* 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.

bRINGING YO U G R E AT E R vA l U E A N d C E R TA I N T Y

Members first and Network hospitals weve entered into a special agreement with them to help reduce or eliminate your out-of-pocket hospital expenses. single room or money back offer* at Members first hospitals. Other special benefits at Members first hospitals#. The bupa Medical Gap scheme is designed to reduce or eliminate your out-of-pocket medical expenses. Members first day facilities extend the no-gap arrangement to medical treatments (eg specialists fees).

*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. # 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 offer obstetric services.

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W H AT T O TA K E W I T H YO U
WE sUGGEsT YO U pA C K : your bupa membership card your Medicare card medicines youre taking, including prescription and non-prescription medicines such as complementary medicines, vitamins and over-the-counter painkillers X-rays or medical images specialists letters or referrals information about your blood type your hospital bag for labour (if pregnant) your hospitals pre-admission pack (if you received one). If youre staying in hospital overnight, dont forget the following items (and remember to keep valuable personal items at home): C lOT H I N G sleepwear Underwear slippers (non-slip) day clothes TO I l E T R I E s Hairbrush Toothbrush and toothpaste Antiseptic soap shampoo and conditioner deodorant OT H E R books Magazines personal music player

bEfORE H O s p I TA l CHECKlIsT

Call us first to discuss your cover including any waiting periods, exclusions, restricted benefits, excess or co-payments. Talk to your Gp about selecting an appropriate specialist. Talk to your specialist about your condition, treatment options and any out-of-pocket expenses. learn about our Medical Gap scheme, designed to reduce or eliminate your out-of-pocket medical expenses. Choose your hospital select one of our Members first or Network hospitals or day facilities to reduce your out-of-pocket hospital expenses. prepare for your stay by deciding what to take.

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dURING H O s p I TA l

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W H AT T O E X p E C T

While every hospital works a little differently, the following may assist you during your stay. v I S I TO r S Ask your hospital about their visiting hours and arrangements for your family and friends. find out who is considered family, arrangements for parents or guardians (if the patient is a child), and when your friends can visit. meALS Ask your nurse about meal times and how to order, and let the nurses know if you have any dietary restrictions. Information about meals is often included on the hospitals television information channel. TeLevISION some hospitals charge for television use and some have their own information channel explaining their services, such as a chaplain. Note that youre covered for free-to-air Tv at our Members first and Network hospitals. TeLePHONe some hospitals will charge you to make local, interstate and international calls. Others restrict the use of mobile phones within the hospital. Note that youll be able to make local telephone calls for no additional cost at our Members first and Network hospitals. INTerNeT Most hospitals now offer wireless internet (Wi-fi) though some may charge you to use it.

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W H AT YO U R E COv E R E d fO R
YO U R H O s p I TA l C O s T s If youre admitted to hospital as a private patient youre covered for the hospitals service charges, which typically include:

accommodation for overnight or same-day stays operating theatre, intensive care and labour ward fees medicines approved by the pharmaceutical benefits scheme (pbs) and provided as part of your in-hospital treatment allied services including physiotherapy, occupational therapy and dietetics dressings and other consumables surgically implanted prostheses up to the benefit published on the Governments prostheses list.

YO U R M E d I C A l C O s T s These are the fees charged by specialists involved in your hospital treatment. As a private patient, youre 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 your specialist charges more than the Mbs fee, there will be a gap for you to pay. However, if your specialist uses it, our Medical Gap scheme can help eliminate or reduce the gap for you (see page 7). pROsTHEsEs If your hospital treatment includes a surgically implanted prosthesis (eg a cardiac stent), youll be covered up to the benefit noted in the Governments prostheses list. To avoid any out-of-pocket expense, we suggest discussing prosthesis choices with your specialist before going to hospital. EMERGENCY AMbUlANCE In most circumstances, well cover you for emergency ambulance transport and on-the-spot treatment. These services are capped per calendar year at one service a year for single memberships and two services a year for family and single parent memberships. There are different state ambulance arrangements across Australia learn more about these by contacting your states ambulance service.

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W H AT s N O T COv E R E d
While your hospital cover helps pay for a wide range of services you may receive as a private patient, there are occasions when you wont be fully covered and may experience out-of-pocket expenses. for example: AT A N O N - A G R E E M E N T H O s p I TA l A small number of hospitals in Australia are not part of bupas network. If you choose to be treated at a non-agreement hospital (see page 9), you may face large out-of-pocket expenses. d U R I N G A WA I T I N G p E R I O d A waiting period starts from the date you take out your health insurance or upgrade your cover. If a treatment has a waiting period, you wont be covered during that time. 2 MONTHs Initial waiting period, palliative care, psychiatric and rehabilitation services. pregnancy-related services (including childbirth) and assisted reproductive services (ie Ivf). pre-existing ailments, illnesses or conditions (anything you had signs or symptoms of in the six months before you joined or upgraded your cover is regarded as pre-existing). If you visit hospital during this time, you may need to provide documentation that shows your treatment isnt related to a pre-existing ailment, illness or condition. laser eye correction surgery (only available on Ultimate Health Cover and Ultimate Corporate Health Cover).

12 MONTHs

3 YEARs

C O v E R A G E f O R YO U R b A b Y No waiting periods apply to your newborn if they have been added to the appropriate family hospital cover within two months of their birth. E XC l U s I O N s A N d R E s T R I C T E d b E N E f I T s sometimes specific services or treatments are excluded or restricted under your level of cover. If your treatment is an exclusion, youll be responsible for all expenses related to your hospital admission for that procedure or service. If restricted benefits apply to your cover, youre covered for shared-room accommodation in a public hospital only, with your choice of specialist. If you attend a private hospital or request a private room in a public hospital its likely youll incur out-of-pocket expenses, and the restricted benefit amount set by the Government wont be enough to cover your costs.

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E XC E s s A N d C O - pAY M E N T s depending on your level of cover, you may need to pay an excess or co-payment for your hospital admission. some levels of cover, including Ultimate Health Cover, Top Hospital Cover and some corporate covers are excess and co-payment free. for dependent children on your membership, theres no excess or co-payments with Advantage Hospital Cover and no excess with standard Hospital Cover and some corporate covers. Check with us to see what excess or co-payment (if any) will apply to your hospital stay. fIXEd fEEs This is a daily charge billed by a small number of Members first and Network hospitals that youre responsible for paying. The hospital should inform you of any fee when you make a booking. NON-EMERGENCY AMbUlANCE While in most cases youll be covered for emergency ambulance services, some ambulance services wont be covered. These include:

transport from a hospital to your home, a nursing home or another hospital where youve been admitted to the transferring (first) hospital; and transport from your home, a nursing home or a hospital for ongoing medical treatment (eg chemotherapy, dialysis).

COsMETIC sURGERY Youre not covered for cosmetic surgery which isnt clinically required. should you need follow-up surgery after your initial procedure and this is recognised by Medicare, bupa will cover minimum benefits and the cost of any prosthesis. If Medicare doesnt recognise your followup treatment, you wont be eligible for any benefits.

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W H E N l E Av I N G H O s p I TA l You may need to pay for certain services or products when you are discharged from hospital. depending on your level of cover and the hospital you attend, these may include:

pharmacy items not opened at the point of leaving hospital aids supplied for use at home (eg a raised toilet seat or a splint) pay Tv, movies and non-local phone calls patient-requested non-emergency ambulance transportation.

O U T- pAT I E N T s E R v I C E s With the exception of a limited range of specific programs, your hospital cover only applies when youre admitted to hospital as an in-patient. Your hospital can tell you if youre covered by a specified out-patient program but if youre unsure, contact us. sometimes people visit an emergency department in a private hospital but are not admitted after being assessed. If youre not admitted youre considered an out-patient and wont be covered by bupa. In this case, you may be out-of-pocket. If out-of-pocket, check whether youre eligible for a rebate under the Medicare safety Net (see page 20). W H E R E YO U R E C E I v E b E N E f I T s f R O M A N OT H E R s O U R C E Your health insurance doesnt apply where compensation, damages or benefits may be claimed from another source in relation to a condition, injury or ailment (eg workers compensation, travel insurance). A s A N U R s I N G H O M E T Y p E pAT I E N T If youre assessed during your hospital stay as no longer needing acute care or are in hospital for more than 35 days, youll be classed as a nursing home type patient. In this case, bupa will pay benefits that are much lower than normal hospital benefits and youll be required to make a personal contribution towards the cost of your care. W H E R E M E d I C A R E pAY s N O b E N E f I T There are certain hospital procedures performed by a dentist, surgical podiatrist or other practitioner that are not eligible for a Medicare rebate and which are not covered by your hospital cover. Contact us for further information.

dURING H O s p I TA l CHECKlIsT

learn more about your hospital including visiting hours and how to order meals. Take note of what youre covered for in hospital. be aware of which costs you may not be covered for.

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AfTER H O s p I TA l
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G E T T I N G b AC K O N T R AC K
You may not feel 100 percent well when you leave hospital and its possible you might need further treatment. Most of all, youll probably need to take time out to rest and recover. Were here to help you get back on your feet and stay well once youve recovered. before leaving hospital, ask your specialist the following 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 if this happens? Will I need help at home, and how can I organise it?

If you have extras cover, dont forget to use it if you need ongoing treatment (eg physiotherapy). by using our Members first network providers you can save money and claim most services on the spot by swiping your membership card. Also take advantage of our range of health and wellness programs by visiting our website at bupa.com.au

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H OW TO C l A I M

The following information will help you work through the claims process so you can return home without the worry of extra paperwork and unexpected bills. YO U R H O s p I TA l C O s T s All Members first and Network hospitals will ask you to complete claim forms, which they will submit directly to bupa on your behalf. The hospital would have asked you to pay any excess, co-payment or fixed fee upon your admission. If youre treated at a non-agreement hospital, youll have out-of-pocket expenses and may be asked to pay the whole amount up front. If thats the case, you can submit a claim form to bupa to be reimbursed for some of these fees. YO U R M E d I C A l C O s T s If your specialist doesnt use our Medical Gap scheme, youll need to complete a two-way claim form for all your medical costs. The form is available at any Medicare or bupa centre. Medicare will process your claim and pay you the benefit, and liaise with bupa to pay a portion of the bill. If you cant visit a Medicare office during your recovery, contact either bupa or Medicare and ask for the relevant forms to be sent to you. s TAT E M E N T O f b E N E f I T s After your hospital and medical (from doctors and specialists) claims have been processed, well send you statements showing what has been paid on your behalf. please check that these details are correct and contact us straight away if you have any queries. Your medical statement may include costs charged by specialists you may not have seen directly such as pathologists. MEdICARE ANd pbs sAfETY NETs The Governments Medicare safety Net provides financial assistance to people with high out-of-pocket expenses for out-patient services that pay a Medicare benefit. Once you reach a threshold, you may be eligible for additional Medicare benefits for the rest of the calendar year. The pbs safety Net is also available to those who need a lot of medicines each year. for more information or to register for these schemes visit medicareaustralia.gov.au

AfTER H O s p I TA l CHECKlIsT

Talk to your specialist about how to maximise your recovery. Also call us to find out how you can benefit from your extras cover and our health and wellness programs. If treated at a Members first or Network hospital, youll be asked to complete a claim form which the hospital will send to us. If your specialist hasnt used our Medical Gap scheme and you receive a medical bill, complete Medicares two-way claim form to be reimbursed. When you receive your statement of benefits from us, check that the details are correct and contact us if you have any queries.

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G lO ssA RY

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G lO ssA RY

A L L I e d H e A LT H S e r v I C e S 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. b u PA m e d I C A L G A P S C H e m e 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 more than 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. C O - PAy m e N T 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 five days. In return for choosing a co-payment, you pay reduced premiums compared to a similar cover without a co-payment. emerGeNCy AmbuLANCe ServICeS 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. e xC e S S An excess is a set amount you pay upfront before your benefit 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. e xC Lu S I O N S Exclusions are specific 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. fIxed fee 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 fixed 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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INfOrmed fINANCIAL CONSeNT 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. I N - PAT I e N T 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. L e v e L O f COv e r 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. medICAL GAP Also referred to as an out-of-pocket expense or gap amount, the medical gap is the difference between the doctors fee for services provided in hospital and the combined Medicare benefit and health insurance benefit. medICAre beNefITS SCHeduLe (mbS) fee The MBS fee is the amount set by the Government for each medical service covered by Medicare. medICAre SAfeTy NeT The Medicare Safety Net provides families and individuals with financial 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 benefits for out-of-hospital MBS services for the rest of the calendar year. m e m b e r S f I r S T H O S P I TA L S A N d d Ay fA C I L I T I e S Bupa has entered into a special agreement with these hospitals and day facilities to help reduce or eliminate your out-of-pocket expenses and provide you with special benefits not available at other hospitals and day facilities. N e T w O r k H O S P I TA L S A N d d Ay fA C I L I T I e 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-emerGeNCy AmbuLANCe 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 (first) hospital; and transportation from your home, a nursing home or a hospital for ongoing medical treatment. N O N - A G r e e m e N T H O S P I TA L S A N d d Ay fA C I L I T I e S These are private hospitals and day facilities that Bupa doesnt have an agreement with. If you visit a non-agreement hospital or day facility, we pay benefits for your stay but the hospital may still charge out-of-pocket fees over and above these benefits. N u r S I N G H O m e T y P e PAT I e N T You may be classed as a nursing home type patient if youre assessed during your hospital stay as no longer needing acute care. OPeN referrAL Where you can choose from a list (provided by your GP) of relevant specialists. O u T- O f - P O C k e T e x P e N S e 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 benefits from us that are not sufficient to cover the full cost (eg restricted benefits or medical gaps). O u T- PAT I e N T S e r v I C e S 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 benefits 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 benefits. P H A r m AC e u T I C A L b e N e f I TS S C H e m e ( P b S ) The PBS gives Australians access to prescription medicines by subsidising their cost as part of the Australian Governments broader National Medicines Policy. PbS SAfeTy NeT 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 r e - e x I S T I N G A I L m e N T, I L L N e S S O r C O N d I T I O N 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. PrOSTHeSeS Prostheses are designed to replace a part of the body or to make a part of the body work more efficiently. Prostheses include pacemakers, defibrillators, cardiac stents, hip and knee replacements, intraocular lenses and other devices implanted surgically to replace or augment a part of the body. PrOSTHeSeS LIST A list of prostheses with applicable private health insurance benefits, published by the Department of Health and Ageing under the Private Health Insurance Act. reSTrICTed beNefITS When you choose to pay a lower premium for your private health cover in return for agreeing to lower benefits on some services. Restricted benefit services attract minimum default benefits which means you wont be fully covered in private hospitals and will have out-of-pocket expenses. S TAT e m e N T O f b e N e f I T S These are statements you receive after your treatment that detail the benefit paid and, for hospital expenses, any excess or co-payment deducted. Youll receive separate statements for your hospital and medical treatments. T w O - wAy C L A I m f O r m 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. wA I T I N G P e r I O d S 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 benefit from us, regardless of when you submit your claim.

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WERE lIsTENING
We hope this guide has helped you to better understand how your private health cover works in the event that you have to go to hospital. Other resources you may find useful when visiting hospital include:

Australian Governments private patients Hospital Charter health.gov.au private Health Insurance Ombudsman website phio.org.au Medicare Australia website medicareaustralia.gov.au

If you have any feedback about your hospital experience (good or bad), let us know. We welcome your thoughts so we can keep you happy, healthy and enjoying life. simply call us were here to help.

Call us on 134 135 Visit bupa.com.au drop by your local Bupa centre

Effective 6 October 2011. The information in this booklet is intended to be a guide only and is not intended to be, nor should be, relied on as a substitute for professional medical advice. bupa makes no warranties or representations regarding the quality, accuracy or completeness of the information. bupa is not liable to readers for any loss or damage suffered arising out of the use or reliance on the information, except that which cannot be excluded by law.

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f O r m O r e I N f O r m AT I O N :

Call us on 134 135 Visit bupa.com.au drop by your local Bupa centre

mailing details: bupa pO box 14639 MElbOURNE vIC 8001 bupa Australia pty ltd AbN 81 000 057 590 Effective 6 October 2011 10272-10-11s

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