Private Health Information Statement - Combined policy

Basic Plus Active Saver

Monthly Premium

$114.85 #

(before any rebate, loading or discount)

Covers only one person

Available in Northern Territory

# You may be entitled to an Australian Government rebate on the above premium. Your premium may also include a Lifetime Health Cover loading, an age-based discount or an insurer discount. Check with your insurer for details.

Hospital cover

This policy exempts you from the Medicare Levy Surcharge.

This policy provides accident cover and benefits for travel or accommodation (outside of hospital) - check with your insurer for details.

This policy includes cover for

Hospital Cover Legend
Dental surgeryMiscarriage and termination of pregnancyPalliative care
GynaecologyPodiatric surgery (provided by a registered podiatric surgeon – limited benefits)Rehabilitation
Hernia and appendixTonsils, adenoids and grommets
Joint reconstructionsHospital psychiatric services

This policy does not include cover for

Hospital Cover Legend
Assisted reproductive servicesDigestive systemMale reproductive system
Back, neck and spineEar, nose and throatPain management
BloodEye (not cataracts)Pain management with device
Bone, joint and muscleGastrointestinal endoscopyPlastic and reconstructive surgery (medically necessary)
Brain and nervous systemHeart and vascular systemPregnancy and birth
Breast surgery (medically necessary)Implantation of hearing devicesSkin
CataractsInsulin pumpsSleep studies
Chemotherapy, radiotherapy and immunotherapy for cancerJoint replacementsWeight loss surgery
Diabetes management (excluding insulin pumps)Kidney and bladder
Dialysis for chronic kidney failureLung and chest

The benefits paid for hospital treatment will depend on the type of cover you purchase and whether your fund has an agreement in place with the hospital in which you are treated. See ‘Agreement Hospitals’ on privatehealth.gov.au for which hospitals have arrangements with your insurer – https://privatehealth.gov.au/dynamic/agreementhospitals.

Under this policy, you may have to pay out-of-pocket costs above what you get from Medicare or your private health insurer. Before you go to hospital, you should ask your doctors, hospital and health insurer about any out-of-pocket costs that may apply to you.

The following payments may also apply for hospital admissions

Excess: No excess

Co-payments: Every time you go to hospital you will have to pay:

  • $100 per day for a shared room for overnight admissions - up to $500 per hospital stay
  • $100 per day for a private room for overnight admissions - up to $500 per hospital stay
  • $100 for day surgery (no overnight stay)

The following waiting periods for hospital admissions apply to new or upgrading members

Waiting periods:

  • 2 months for palliative care, rehabilitation and hospital psychiatric treatments, even if pre-existing
  • 12 months for other pre-existing conditions
  • 2 months for all other treatments

Hospital Accommodation

For accommodation we pay up to $50 per night to a limit of $150 per person per trip. Benefits are payable per return trip. Eligibility criteria apply. Contact Bupa for more information.

Gap Cover

This provider offers 'known gap' or 'no gap' cover for medical bills for this product.

The Medical Costs Finder lets you find out more about the cost of specialist medical services.

Other features of this hospital cover

Cover for limited hospital services to help protect you from the unexpected. For more details on the product contact Bupa.

General Treatment Cover

We have agreements with a network of dental practitioners, chiros, physios & podiatrists across Australia called Members First providers. By using them, in most cases you’ll receive up to 60% back, up to your yearly limits. See http://www.bupa.com.au/find-a-provider.

This policy includes General treatment (Extras) cover for

General treatment legend
Note, for items marked with an asterisk *: There is an overall combined yearly limit of $1000 on extras on this cover (sub-limits apply). Step down benefits apply after first 10 total services across Chiropractic and Osteopathy. Podiatry does not include Orthotics. Where applicable, benefits may be payable under Health Aids & Appliances. Dentures payable once every 3 years. Periodic oral examination (012), Scale & Clean (114), Fluoride treatment (121) payable once every 6 months. Major Dental, Endodontic and Orthodontic treatment is only covered if resulting from an accident requiring immediate medical attention sustained after joining this cover.
TreatmentWaiting period (months)Benefit limits (per 12 months unless otherwise stated)Examples of maximum benefits
General dental*2$1,000 per policy
(combined limit for general dental, major dental, endodontic, orthodontic, physiotherapy, chiropractic, podiatry, psychology, acupuncture, remedial massage, chinese medicine, dietetics/dietary advice, exercise physiology, health management / healthy lifestyle & osteopathy - Sub-limits apply)
Periodic oral examination - $19.00
Scale & clean - $41.00
Fluoride treatment - $13.50
Surgical tooth extraction - $65.00
Major dental*12Full crown veneered - $300.00
Endodontic*12Filling of one root canal - $84.00
Orthodontic*12Braces for upper & lower teeth, including removal plus fitting of retainer - 100% of charge
Physiotherapy*2Initial visit - $27.00
Subsequent visit - $20.50
Chiropractic*2Initial visit - $26.25
Subsequent visit - $17.00
Podiatry*2Initial visit - $23.00
Subsequent visit - $17.00
Psychology2Initial visit - $86.00
Subsequent visit - $67.00
Acupuncture*2Initial visit - $22.00
Subsequent visit - $16.00
Remedial massage*2Initial visit - $18.50
Subsequent visit - $18.50
Chinese medicine*2Initial visit - $17.00
Subsequent visit - $17.00
Dietetics/dietary advice*2Initial visit - $37.00
Subsequent visit - $19.00
Exercise physiology*2Initial visit - $20.00
Subsequent visit - $16.50
Health management / Healthy lifestyle*6Health management - 50% of charge
Osteopathy*2Initial visit - $32.50
Subsequent visit - $21.00
Counselling and Psychology share a combined limit under Mental Health.

This policy does not include General treatment (Extras) cover for

General treatment legend
Blood glucose monitorsNon PBS pharmaceuticalsOther treatments - check with your insurer
Hearing aidsOptical

Ambulance cover

In Northern Territory this policy provides:

Emergency: Unlimited with a waiting period of 1 day.

Call-out fees:  will be paid for each attendance, including emergency treatment without transport to hospital.

Other features of this ambulance cover

You are covered for the costs associated with uncapped emergency ambulance transport services, including on-the-spot emergency attendances where the service is provided by a Bupa recognised ambulance service. The following ambulance services are recognised by Bupa: ACT Ambulance Service, Ambulance Service of NSW, Ambulance Victoria, Queensland Ambulance Service, South Australia Ambulance Service, St John Ambulance NT, St John Ambulance WA, and Ambulance Tasmania. If you are eligible to claim from another source, a benefit won’t be paid by Bupa.

For further information about this policy see

http://www.bupa.com.au/health-insurance/cover/ambulance

Disclaimer

The information contained in this Private Health Information Statement was provided by the insurer and is intended as general information. It may not take into account your particular circumstances. For information please contact the insurer.

Covered

For information on what is covered under each category, see https://www.privatehealth.gov.au/categories

Restricted

Restricted categories partially cover your hospital costs as a private patient in a public hospital. You may incur significant expenses in a private room or private hospital.

Not Covered

These categories are not covered by this policy.