Bupa health insurance review

Hospital coverage

Bupa hospital cover policies now reflect the new government private health insurance tiers. It offers the following hospital cover options:

• Basic Accident Only Hospital. This covers you for things like operating theatre, intensive care and ward fees. It also comes with a feature called Accident Inclusion. For accidents sustained after joining, treatment which is restricted or is an exclusion on this cover may be payable in the same way as an included service.
• Basic Plus Starter Hospital. As well as Accident Inclusion, this one comes with services such as tonsils, adenoids and grommets, joint reconstructions and dental surgery.
• Bronze Plus Simple Hospital. This covers a handful of important treatments like cancer treatments, dental surgery, brain and nervous system, tonsils and hernia repair.
• Silver Plus Essential Hospital. This covers you for 28 of the 38 clinical categories, a few more than the minimum requirement for silver, which is 26.
• Silver Plus Advanced Hospital. This covers you for several gold tier services like, cataracts, joint replacements, and sleep studies.
• Gold Complete Hospital. This includes all 38 government-approved treatments you'd receive in a hospital including pregnancy, assisted reproductive services and weight loss surgery.

It's important to note that Bupa plans do not cover the following procedures:

• Surgical podiatry (a restricted benefit is paid)
• Cosmetic procedures that are not medically necessary
• Respite care
• Experimental treatments
• Certain high-cost non-PBS drugs
• Any treatment or procedure for which Medicare does not pay a benefit.

In addition, you will not have cover for the following:

• Outpatient treatments
• Hospital co-payments and excess
• Psychiatric and day programs at non-Bupa partner hospitals
• Treatments provided by unregistered providers
• Personal in-hospital expenses like pay TV, newspapers and similar
• Any services or treatments provided outside of Australia
• Any pharmacy items purchased and not opened before leaving hospital

Extras coverage

Here are each of the extras plans offered by Bupa, with a quick summary of what each includes.

• Freedom 50 Extras (formerly Orange 50). With Freedom 50 Extras, you'll get 50% back at any provider for services including general dental, physio, chiro and osteo, up to your yearly limits. You'll also get a flexi-limit, which allows you to spread your annual limit across a range of services or use the entire limit on one service.
• Budget Extras 60. This covers your basic treatments like general dental, optical and a range of therapies like physio and chiro but it also includes treatments you usually find in higher level policies like antenatal and postnatal treatments, exercise physiology and pharmacy. It also includes emergency ambulance cover. Bupa reimburses you 60% toward most covered treatments.
• Freedom 60 Extras (formerly Orange 60). This extras policy gives you 60% back at any provider for services like general dental, physio, chiro and osteo, up to your yearly limits. It also comes with a flexi-limit, so you can spread your annual limit across a range of services or use the entire limit on one service.
• Your Choice Extras 60. Your Choice Extras 60 gives you 60% back for most items at Bupa's network of extras providers, plus the ability to choose four services to suit their needs. You can change your service options on your anniversary, every 12 months.
• Top Extras 60. With the same reimbursements rate and all the same treatments as the previous two policies, Top Extras 60 adds quite a few more treatments to the mix, including psychology, dietary, home nursing, health aids/appliances and travel/accommodation expenses if you have to travel far for hospital treatment (you'd have to have a Bupa hospital policy to take advantage of this benefit).
• Top Extras 75. This is the same cover as the Top Extras 60 policy, but with a 75% reimbursement rate instead of 60%. It also has higher benefit limits on many treatments.
• Top Extras 90. This is the same as the other two top extras policies, but with a 90% reimbursement rate and higher benefit limits on most treatments.

Combined coverage

You can combine any of the standalone hospital policies with any of the extras policies to create your own customised packaged cover. Or you can choose one of Bupa's unique packages that combine hospital and extras cover that you can't buy individually. These are:

• Basic Plus Active Saver. This package is for someone who wants an entry level of both hospital and extras cover. The hospital portion covers a handful of basic treatments like tonsils, adenoids and grommets, joint reconstructions, dental surgery plus restricted cover for hospital psychiatric services, rehab and palliative care. Extras include a variety of basic inclusions such as general dental, physio, chiro and more – all of which have a combined limit of $1,000.
• Basic Plus Young Singles/Couples Saver. With this package, the hospital portion covers basic treatments like gynaecology, miscarriage and termination of pregnancy, and tonsils, adenoids and grommets. Your extras cover will give you 60% back on most treatments from Bupa's provider network, with cover for general and major dental, optical, podiatry and travel vaccines. Orthodontics is also covered if treatment is required as a result of an accident.
• Bronze Plus Young Singles/Couples Choice. The hospital portion of this cover includes everything necessary for it to be classed as bronze, plus 9 other benefits like sleep studies, dental surgery, blood and lung and chest cover. Extras offer services suitable for most young singles and couples, with higher benefit limits that those of Young Singles/Couples Saver. Like Young Singles/Couples Saver, orthodontics is covered if treatment is required as a result of an accident.
• Silver Plus Prime. This gives you top cover that's tailored to life's later years, minus the services you don't need like pregnancy and birth. As well as everything you get with a silver policy, you'll also get insulin pumps, pain management with device, sleep studies, joint replacements and a generous range of extras services.
• Gold Ultimate Health Cover. The hospital portion of this includes all 38 clinical categories, meaning you're covered for everything medically necessary in a private hospital. It also includes up to 100% back at Members First providers for selected services, and the highest benefit limits on all extras services that Bupa offers.

Ambulance coverage

• Emergency Only Ambulance Cover. Covers you for unlimited emergency ambulance trips including air services and on-the-spot treatment Australia wide, when provided by recognised providers.
• Premium Ambulance Cover. Covers you for unlimited emergency ambulance trips including air services and on-the-spot treatment Australia wide, when provided by recognised providers. You're also covered for non-emergency ambulance trips including air services when provided by recognised providers and are capped at $5,000 per person per calendar year.