Overseas

Student
Your Important
Information Guide
This guide is here to help you navigate
our healthcare system and health cover.
For further information on your overseas
student health cover (OSHC) policy with us,
please read your policy information.
Welcome to Bupa
It’s our purpose that makes us different – helping
our members to live longer, healthier, happier lives.
We focus on your health, so you can get back to
your everyday life.

Things to know
Take time to read this guide to further understand
and learn about your overseas student cover with us.
As a Bupa member, knowing how your cover works
will help you to get the most value from your
health insurance.

Contents
How Australia’s healthcare system works 3
What to do when you feel sick 4
Understanding your student health cover 5
What is covered - Hospital cover 8
Ambulance cover 10
What is not covered 10
Extras cover 14
Changing your cover 16
Definitions 17

This guide is in addition to our Fund Rules

available online or by contacting us.
Visit bupa.com.au/fundrules/oshc

2
How Australia’s
healthcare system works
We understand that healthcare can be confusing to overseas students.
That’s why we aim to provide the best advice and support to help you
find what’s right for your needs.
The Australian healthcare system is made up of two components, the public
healthcare system administered by the Australian Government, known as
Medicare and, the private healthcare system.

Private healthcare system What does Medicare cover?

The private system includes health (some out-of-pocket cost may still occur)
insurers like Bupa, who come together • Treatment in a public hospital that is
with Medicare to provide Australians with medically necessary
access to medical services and health
• Visiting a General Practitioner (GP)
providers.
• Referral to a specialist doctor
Public healthcare system • Medical tests and examinations
Medicare is Australia’s public healthcare
system for all citizens and most • Prescription medication subsidised by
permanent residents. It provides free or the Pharmaceutical Benefits Scheme
subsidised cover for certain healthcare (PBS)
services. Some international students
may receive Medicare benefits if a
What does Medicare not cover?
treatment is considered medically • Ambulance services
necessary. • Repatriation benefits to get you home
However, Medicare does not cover to your country of origin if you become
treatment in a private hospital. You may seriously ill
also not be able to choose your own • Extras services including optical
doctor in hospital. This means you will and dental
experience out-of-pocket costs that you
• Access to private doctors
will have to pay yourself.
and specialists
• Services and treatment in
public hospital that are not
clinically necessary
• Services and treatment in
private hospital

3
What to do when you feel sick

Emergency Non-Emergency
health issues health issues

Visit your local

Visit your local GP
hospital emergency
or medical centre
department

Call 000
Receive treatment
(triple zero)
from your GP
for an ambulance

GP refers you to a
specialist or other
health service

Need to visit a GP or doctor?

Find a Bupa friendly doctor to help reduce or eliminate out-of-pocket expenses.
Visit bupa.com.au/find-a-doctor for more details.

If you’re not sure if it’s an emergency health Do some countries have access
issue, it’s better to treat it as an emergency. to Medicare?
If you need more advice about your health Yes, the Australian Government has
issue, you could also: Reciprocal Health Care Agreements
• See a GP (RHCA) with a selected number of countries.
These agreements enable residents of these
• Visit healthdirect.gov.au countries to receive Medicare benefits when
• Call the Australian Government’s health studying in Australia.
advice line on 1800 022 222 The level of Medicare cover and the period
If it’s a mental health issue, you can also call for which you receive it varies depending on
LifeLine on 13 11 14. which country you are from.
For more information and for a list of
countries visit humanservices.gov.au
or contact us.

4
Understanding your
student health cover
What is covered? At a small number of Network Hospitals,
an additional set amount or ‘fixed fee’ may
Hospital costs
be charged by the hospital, capped at a
With Overseas Student Health Cover maximum number of days per stay. The
(OSHC) and Advantage Overseas Student hospital should inform you of this fee when
Health Cover, you can choose to be treated you make a booking. This fee is in addition to
as a private patient in either a private or a any excess or co-payment you may have as
public hospital. part of your hospital cover.
What if I am treated in a When admitted to hospital, in most cases you
Members First or Network Hospital? will be covered for in-hospital charges when
With OSHC you are covered as a private provided as part of your inpatient hospital
patient in most hospitals that Bupa has an treatment including:
agreement with, known as Members First and • Accommodation for overnight
Network Hospitals, across Australia for any or same-day stays.
treatment which is recognised by Medicare
and is not excluded under your cover. • Operating theatre, intensive care
and labour ward fees.
At our Members First Hospitals, you’ll receive
a private room if a private room is available. • Supplied pharmaceuticals approved for the
If a private room is not available, you’ll receive condition to be treated by the Australian
$50 back per night from the hospital. Please Government’s Pharmaceutical Benefits
note that the following conditions apply: Scheme (PBS) Schedule, and provided as
You must book and request a private room part of your inpatient hospital treatment.
in a Members First Hospital at least 24 hours • Physiotherapy, occupational therapy,
before admission. It applies to overnight speech therapy and other allied health
admissions only. It excludes ‘nursing home services provided as part of an inpatient
type patients’, admissions via an Emergency hospital admission.
Department, same day admissions or where a
• Surgically implanted prosthesis up to
private room is medically inappropriate
the approved benefit published on the
(e.g. medical practitioner requires the patient
Australian Government’s Prostheses List.
to an Intensive Care Unit or other particular
ward rather than a private room). You’ll also • Private room where available where
get complimentary local calls, TV usage and available and clinically appropriate.1
a daily newspaper. If you are treated in a Members First Day
If you are treated in a Members First Day Hospital, there are no out-of-pocket expenses
Hospital, there are no out-of-pocket expenses for medical fees charged by a surgeon,
for medical fees charged by a surgeon, anaesthetist or other specialists when
anaesthetist or other specialists when admitted to hospital for included services
admitted to hospital for included services. (not available in NT). Any co-payment or
(Not available in NT). Any co-payment or excess related to your level of cover will
excess related to your level of cover will still apply.
still apply. We recommend you call us first before
making a booking to confirm that your
hospital of choice gives you certainty of full
cover. You can find out if a hospital has an
agreement with us by checking our website
bupa.com.au/find-a-provider
1
Conditions apply. Contact us for more information. 5
What happens if I choose a private If this benefit is less than the hospital charge,
hospital that Bupa doesn’t have an the hospital should let you know what out-
agreement with? of-pocket expenses you will have to pay.
If you are admitted to a private hospital Bupa also pays benefits for prosthesis up
that Bupa does not have an agreement to the approved benefit in the Australian
with, you will have restricted cover for your Government Prostheses List. The above
hospital costs, and cover for prosthesis up applies for any treatment recognised by
to the approved benefit in the Australian Medicare unless it is excluded or restricted
Government Prostheses List. This will apply under your level of cover. It is important to
for any treatment recognised by Medicare, note that in public hospitals, private rooms are
unless it is excluded or restricted under your generally allocated to people who medically
level of cover. The amount we pay will only need them.
partially cover the full cost and you will have As a private patient in a public hospital you
significant out-of-pocket expenses. will also be responsible for personal expenses
It is important to note that you will be such as TV hire and telephone calls together
responsible for the cost of your stay and with any fee doctor/surgeon charges above
may be charged directly for your hospital the benefit Bupa pays and Prostheses charges
accommodation, doctor’s services (including above the approved benefit in the Australian
any diagnostic tests), surgically implanted Government Prostheses List.
prosthesis (such as artificial hips) and personal Please also refer to the Inpatient and
expenses such as TV hire and telephone calls. Outpatient Medical Costs section of this guide.
Some of these hospitals bill Bupa directly for
the limited benefits we pay. Please also refer Inpatient medical costs
to the Inpatient and Outpatient Medical Costs These are the fees charged by your doctor,
section of this guide. surgeon, anaesthetist or other specialist
for any treatment given to you when you
What happens if I choose to be a are admitted to a hospital as an inpatient.
private patient in a public hospital? This includes most inpatient diagnostic
Whether a public hospital will accept or tests recognised by Medicare as medically
admit a patient, or whether a doctor provides necessary (e.g. pathology, radiology).
treatment at a public hospital, or performs a We cover you for 100% of the Medicare
particular procedure in a public hospital, Benefits Schedule (MBS). This is the amount
is outside of Bupa’s control. determined by the Australian Government for
As a private patient in a public hospital you a specific service for Australian residents.
are entitled to choose your doctor, if they If your doctor or specialist charges more
are available. However, it is important to than the MBS Fee there will be a ‘gap’ for
understand that you may still be subject to you to pay.
public hospital waiting lists. Depending on
your illness or condition, this may be the same
doctor who would have been allocated to you
by the hospital as a public patient.
If you are admitted as a private patient in
a public hospital, you will have restricted
cover for your hospital costs, and cover for
prosthesis up to the approved benefit in the
Australian Government Prostheses List.

6
Cover outside of hospital (outpatient)
Also known as outpatient medical services, this
is cover for any treatment you receive where
you are not admitted into hospital in Australia
from a doctor or specialist in private practice
(including diagnostic services such as radiology
and pathology). We will cover you for up to
100% of the Medicare Benefits Schedule Fee
(MBS Fee) for outpatient services. The MBS
Fee is the amount determined by the Australian Help reduce
your medical
Government for a specific service for Australian
residents. If your doctor or specialist charges
more than the MBS Fee there will be a gap for
you to pay.
To find out the Medicare Benefit Schedule
costs with the
(MBS) fee visit mbsonline.gov.au
Bupa Medical
Gap Scheme
Medicines
You can also receive benefits on selected
pharmacy items including discharge medication
prescribed as an outpatient by a doctor or
specialist. This is provided the item’s usage Bupa’s Medical Gap Scheme helps to
is approved by the Therapeutic Goods remove or reduce the costs you pay for
Administration. your treatment in hospital.
See Page 18 for more details. Where a doctor chooses to use the
scheme for your treatment, they agree
Repatriation benefit to only charge up to a certain fee. We’ll
If you are on Advantage OSHC, you will receive then pay a much higher amount than
cover for repatriation to your country of origin we normally would to help cover the
if you become terminally ill or if you suffer extra cost. If a doctor uses the no-gap
a substantial life altering illness/injury up to option, we cover all of the extra charges,
$100,000. Or for the return of mortal remains so you pay nothing for that doctor’s
up to $10,000. Benefits are only payable once medical fees. Otherwise, for each doctor
approved by Bupa. choosing to use the Gap Scheme, the
most you’ll pay is up to $500 out-of-
No Repatriation Benefit will be paid if you were:
pocket on medical costs. Each doctor
• First diagnosed as terminally ill. involved in your treatment can choose
• A reasonable person would have first become to use the Bupa Medical Gap Scheme for
aware of the terminal illness. your admission in a Public Hospital, or a
Private Hospital with which Bupa has an
• If you suffered a substantial life altering illness
agreement.
or injury within the six months prior to the
date your level of cover commenced. For more info visit
bupa.com.au/medicalgapscheme
Mental health benefits
If you are on Advantage OSHC, you can access
mental health benefits including psychology
and counselling1 services without having a GP
care plan in place.

1
Receive up to $75 per consultation for psychology and up to $40 for
counselling, up to a maximum of $150 per person per calendar year by
recognised providers. Waiting periods, policy and fund rules apply. 7
What is covered - Hospital Cover
The below is a guide on the in-hospital treatments your student cover provides.
For further information, refer to your policy information.

Student Cover

Hospital & Medical services OSHC Advantage OSHC

Rehabilitation P P
Hospital psychiatric services P P
Palliative care P P
Brain and nervous system P P
Blood P P
Bone marrow transfusion or transplant P P
Chemotherapy, radiotherapy and immunotherapy for cancer P P
Eye (not cataracts) P P
Cataracts P P
Ear, nose and throat P P
Implantation of hearing devices P P
Tonsils, adenoids and grommets P P
Bone, joint and muscle P P
Joint reconstructions P P
Joint replacements (other than Hip and Knee) P P
Joint replacements (Hip and Knee) P P
Back, neck and spine P P
Kidney and bladder P P
Organ transplant P P
Dialysis for chronic kidney failure P P
Digestive system P P
Hernia and appendix P P
Gastrointestinal endoscopy P P
Weight loss surgery P P
Heart and vascular system P P
Lung and chest P P
Gynaecology P P
Miscarriage and termination of pregnancy P P
Pregnancy and birth P P
Assisted reproductive services O O
Male reproductive system P P
Diabetes management (excluding insulin pumps) P P
Insulin pumps P P
Pain management P P
Pain management with device P P
Breast surgery (medically necessary) P P
Plastic and reconstructive surgery (medically necessary) P P
Skin P P
Dental surgery P P
Sleep studies P P
Podiatric surgery (provided by an accredited podiatric surgeon) P P
8
Choosing a hospital? Call us first
We recommend you call us first on
1800 888 942 (within Australia) or
+613 9937 4223 (outside Australia) to
discuss your hospital options and to get
the most out of your students cover.
You can also find out if a hospital has
an agreement with us by visiting
bupa.com.au/find-a-provider

9
Ambulance What is not
Cover covered
Emergency Ambulance Cover Hospital costs
As part of your cover you receive Situations when you are likely not to be
unlimited emergency only ambulance covered or to have significant additional
cover for emergency ambulance air and expenses include:
road transportation and on-the-spot
• During a waiting period.
emergency treatment by a Recognised
Ambulance Provider. • When you are treated at a non-agreement
private hospital.
You’ll receive cover for ambulance
transport provided by an approved • For the fixed fee charged by a fixed
ambulance service where medically fee hospital or a hospital that has a fixed
necessary for admission to hospital fee service.
or for Emergency Treatment. You’re • When you have not been admitted into a
not covered for non-emergency hospital and are treated as an outpatient
transportation from a hospital to your (e.g. emergency room treatment, outpatient
home, a nursing home or another antenatal consultations with an obstetrician
hospital. Whether the transportation is prior to child birth) you may not be covered.
deemed an emergency is determined by
the paramedic and usually recorded on • For psychiatric and rehabilitation day
the account. programs, at a hospital that Bupa does not
have an agreement with.
If you need to make a claim for
emergency ambulance benefits, • Hospital treatment provided by a practitioner
we will give you an Ambulance Claim not authorised by a hospital to provide that
Form to complete. treatment.

Transportation means a journey from • Hospital treatment for which Medicare pays
the place where immediate medical no benefit, including: medical costs in relation
treatment is sought to the casualty to surgical podiatry (including the fees
department of a receiving hospital. charged by the podiatrist); cosmetic surgery;
respite care; experimental treatment and/
Recognised Ambulance Providers or any treatment/procedure not approved
We will generally only pay benefits by the Medical Services Advisory Committee
towards ambulance services when they (MSAC).
are provided by any of the following • Personal expenses such as: pay TV,
recognised providers: non-local phone calls, newspapers, boarder
• ACT Ambulance Service. fees, meals ordered for your visitors,
hairdressing and any other personal expenses
• Ambulance Service of NSW/PTS.
charged to you unless included
• Ambulance Victoria. in your cover.
• Queensland Ambulance Service.
• If you are in hospital for more than 35 days
• South Australia Ambulance Service. and you have been classified as a ‘nursing
• St John Ambulance NT. home type’ patient. In this situation you may
receive limited benefits and be required to
• St John Ambulance WA.
make a personal contribution towards the
• Ambulance Tasmania. cost of your care.

10
• Some hospital-substitute treatment and Medical cost
operative services that are a continuation You will not be covered for:
of care associated with an early discharge • Medical services for surgical procedures
from hospital. performed by a dentist, podiatrist, or any
• For pharmaceuticals items supplied upon other practitioner or service that is not
discharge from the hospital unless covered eligible for a rebate through Medicare.
on your OSHC or Extras cover. • Costs for medical examinations, x-rays,
• If you choose to use your own allied health inoculation or vaccinations and other
provider (e.g. chiropractors, dieticians or treatments required relating to acquiring a
psychologists) rather than the hospital’s visa for entry into Australia or permanent
practitioner for services that form part of residency visa.
your inpatient hospital treatment.
Waiting periods
• Where compensation, damages or benefits The following waiting periods apply to
may be claimed by another source Overseas Student Health Cover:
(e.g. workers compensation).
• For any amount charged by a public or Hospital cover Waiting period
non-agreement private hospital which is not
covered by us or which is above the benefit Pre-existing conditions,
that we pay. aliments or illnesses of a 2 months2
psychiatric nature
• Treatment for any children on a family
membership if they are over 18 years of age.
Pre-existing conditions,
• Additional charges applied for private room 12 months
aliments or Illnesses
accommodation in a public hospital.
• Non-PBS, high cost drugs.
• For any treatments or services rendered Pregnancy and birth 12 months
outside Australia. This includes:
- Treatment arranged before you No waiting period applies to a pre-existing
arrived in Australia condition, ailment or illness of a psychiatric
- Treatment while travelling to nature for Advantage OSHC customers.
or from Australia
If you receive treatment that falls within
- Expenses for treatment a waiting period, you will have to pay for
outside of Australia some or all of the hospital and medical
- Transportation into or out of charges unless the treatment is classed
Australia in any circumstance as Emergency Treatment.
• Cosmetic surgery.
See definitions on Page 16 for more
information.

2
The standard 2 months waiting period for pre-existing conditions of a
psychiatric nature is not enforced by Bupa until further notice. 11
When to contact us
If you have been a Bupa member for less Eligibility and Types of membership
than 12 months on your current OSHC, it To be eligible for OSHC, you must hold a
is important to contact us before you are student visa, be in a process of applying for
admitted to hospital and find out whether the a student visa or be on a bridging visa whilst
pre-existing condition waiting period applies applying to extend your student visa. There
to you. We need about five working days to are 3 different types of OSHC membership
make the pre-existing condition assessment, available:
subject to the timely receipt of information
from your treating medical practitioner/s. • Single – Cover for student only. Student is
defined as the primary student visa holder.
Make sure you allow for this timeframe
when you agree to a hospital admission date. • Couples – Cover for student and
If you proceed with the admission without their partner as listed on the student’s
confirming benefit entitlements and we dependant visa.
(the health fund) subsequently determine • Family – Cover for student, their partner
your condition to be pre-existing, you will and their dependent children under 18 years
be required to pay all hospital charges and of age if they live with the student
medical charges not covered by Medicare. in Australia.

Planning for a baby Note, student’s partner and/or dependent

children as listed on the student’s dependant
If you are thinking about starting a family
visa must be on the same membership as the
we recommend that you contact us to
student.
check whether your current cover includes
pregnancy and birth in advance. This is
because there is a 12-month waiting period
applied to pregnancy and birth conditions.
No waiting periods will apply to the newborn
provided they have been added to the
appropriate family cover within 90 days of
their birth.

12
Additional benefits

24 hour Student Bupa health and wellness

Advice Line • Find reliable health information.
Our 24 hour Student Advice Line • Track and manage health goals.
provides advice and assistance, in 180
• Get a snapshot of your health status
languages, for a range of emergency
and explore your ‘real’ health age.
situations including:
• Medical and accident assistance. Visit bupa.com.au/health
• Home and property inquiries.
• General tax and legal enquiries.
• Personal safety, drug or
alcohol issues.
• Trauma counselling.
Call 1300 884 235

myBupa
Once registered, you’ll have instant
access and can do the following 24/7:
• Submit a claim online.
Bupa Plus • Update your contact details.
rewards & discounts • Order a membership card.
Even when you’re in great health, there • Renew your cover.
are still plenty of ways to get everyday • View information about what you’re
value thanks to Bupa Plus. A range covered for.
of rewarding health discounts, tools • View claims history.
and more to help you live a healthier,
happier life.
Visit bupaplus.com.au for more info.

13
Extras Cover
What is covered?
With OSHC Extras or any Domestic Extras cover, you can claim benefits for some
services that may not be covered by Medicare. You can claim for the services listed that
are included on your cover, as long as benefits are not claimable from a third party.

For example, Medicare may not provide benefits for:

Dental Physiotherapy Chiropractic Occupational

examinations services therapist
and treatment

Speech therapy Podiatry Mental health Acupuncture1

Services or other natural
(includes psychology therapies
and counselling)

Eye therapy Glasses Health aids Home nursing

and contact lenses and appliances

Extras cover allows you to claim benefits for extra services as long as:
• The treatment is given by a provider in private practice provider who is
recognised by us for benefit purposes.
• They meet the criteria set out in our policies and Overseas Student Health
Cover rules and Fund Rules.
We recommend you contact us before making a booking to confirm how much
you can claim and to check that your chosen provider is recognised by us.

14 1
Unless part of a doctor’s consultation.
Members First Provider Network What is not covered?
Bupa Members First is an extensive network Extras benefits will not be payable:
of healthcare professionals including dental, • During a waiting period.
optical, physiotherapy, chiropractic and
• Where a service is not included on your
podiatry providers. OSHC Extras is available
product.
exclusively through this network with the
benefit of 100% cover on the set number • Where a third party, including Medicare,
of included services (subject to yearly visit a Australian Government body, or an
limits). This means you won’t have to pay insurance company provided a benefit
any out-of-pocket expenses when you (except for hearing aids and breast
visit a Members First Network provider for prosthesis items).
these services. OSHC Extras does not cover • For different services within the same
any services at non-Bupa Members First service type from the same provider on the
healthcare providers. same day. For example, if you went to see an
acupuncturist and then received a massage
from the same provider on the same day,
Members First Extras - Yearly you cannot claim for both services.
What’s Covered visits • When a provider is not recognised by us
for benefit purposes.
P Dental check up2 1 • For any treatment or service rendered
outside Australia.
Physio, chiro and / or • When you have reached the limits on your
P 3
podiatry consultations product including yearly, lifetime or service
limits for the service you are claiming.
Bonus Dollars - $50 for
P 1
singles, $100 for couples Waiting periods
An initial waiting period of 2 months applies
Bupa Optical for OSHC Extras cover. The following waiting
P 1
- $50 voucher3
periods apply for Domestic Extras cover:
Consultations via phone
P 2 Extras cover Waiting period
with Bupa Dietitians4

A 2 month initial waiting period All other Extras services 2 months

for Extras services applies
Hire and repair of health
6 months
aids and appliances
Bonus Dollars
Health management
We will contribute a total of $50 ($100 for 6 months4
programs
couple and family memberships), payable
once per year, that can be shared across
your extras services to put towards out-of- Major dental 12 months
pocket (extras) expenses at Members First
healthcare providers (e.g. for a filling or Orthodontics 12 months
additional physio treatment).
Purchase of health aids
12 months
2
Includes exam, scale and clean, fluoride and two bitewing x-rays and appliances
only. 3Provision of email address required for voucher delivery. 4Bupa
Dietitian consultations are available and conducted in English only. 15
Changing your cover
Switching from another OSHC provider During this time you will be covered, however
If you’re changing from another OSHC provider you will receive the lower benefits of the two
to Bupa, you’ll continue to be covered for all covers (this includes any applicable excess).
benefit entitlements that you had on your old If you choose a lower level of cover than
cover, as long as these services are offered on you previously held, then the lower benefits
your new cover with us, and there is no gap on your new level of cover will apply
between your previous OSHC and your Bupa immediately and may include different excess
cover. This is referred to as ‘continuity’. levels. You may also need to serve waiting
When changing health funds, extras benefits periods for services or treatments that weren’t
paid by your old fund will be counted covered on your previous cover. In this case
towards your yearly limits in your first year you won’t be covered during the waiting
of membership with us. Any benefits paid period. If you have any questions about
by your old fund also count towards lifetime waiting periods, just contact us.
maximums.
Ending your membership
Changing your visa It is a condition of your student visa that you
If you change your overseas student visa to maintain a current OSHC policy while you are
another visa which allows you to continue your studying in Australia. Bupa will only refund any
stay in Australia, you will no longer be eligible premium paid for your OSHC policy under the
for OSHC. You can however, change to one of following circumstances:
our overseas visitor covers. You will continue to • You decide not to come to Australia
be covered for all benefit entitlements on your to commence your studies.
old cover, as long as you change over within • Your student visa extension is refused by
60 days of your OSHC end date. Contact us the Department of Home Affairs (DHA).
for more details.
• You are transferring to another visa type
Becoming a permanent resident (e.g. temporary or permanent residency).
If you become a permanent Australian resident, • You are ceasing your studies and going
you can change to one of our domestic health back home overseas early.
covers. You will continue to be covered for • You are transferring to another
all benefit entitlements on your old cover, OSHC provider.
as long as you change over within 60 days of
• If your student visa is cancelled.
your OSHC end date. Don’t forget that, unless
you transfer to a domestic health cover policy You will need to provide proof of any of the
within 12 months of becoming eligible for full above circumstances along with your refund
Medicare benefits, you may be required to pay request. For example, a copy of a letter from
the Lifetime Health Cover (LHC) loading. Department of Home Affairs explaining that
Ask us for more details. your student visa is cancelled, or proof of
membership with another OSHC provider.
Changing your cover with us
To cancel your OSHC membership, and obtain
If you change your health cover, you may a refund, simply complete a refund form and
need to wait before you can access your attach any relevant supporting documents.
new benefits. Where your new level of cover
is higher than what you previously held, the We are obligated to inform Department of
lower level of benefit applies. Please refer to Home Affairs if your OSHC membership is
the listed waiting periods included earlier in cancelled and/or we refund your premium.
this guide.

16
Definitions
Agents Emergency Treatment
A third party such as a broker or agent ‘Emergency Treatment’ is any treatment
may establish and administer your policy required where a person:
or corporate health plan. In these cases, • Is in a life threatening situation and requires
some information about you such as your urgent assessment and resuscitation.
name, address and other policy information
• Has suspected acute organ or system failure.
will be given and received from the agent
to help Bupa HI administer your policy or • Has an illness or injury where the function of
corporate health plan. This will not include a body part or organ is acutely threatened.
personal claims information (also see Privacy • Has a drug overdose, toxic substance
Statement on Page 20). or toxin effect.
• Has psychiatric disturbance whereby the
Calendar year
health of the person or other people are at
A calendar year is 1 January to 31 December.
immediate risk.
Bupa-friendly doctors • Has severe pain and the function of a body
A Bupa-friendly doctor has a direct billing part or organ is suspected to be acutely
agreement with Bupa to help reduce or threatened.
eliminate your out-of-pocket expenses. • Has acute haemorrhaging and requires
urgent assessment and treatment.
Visit bupa.com.au/find-a-doctor to find your
nearest Bupa Friendly Doctor. • Has a condition that requires immediate
admission to avoid imminent threat to their
Cosmetic Surgery life and where a transfer to another hospital
A cosmetic treatment is one which is is impractical.
concerned with altering the appearance of
a body part or tissue which lies within the Exclusions
bounds of normal variation. If you require treatment for a specific
procedure or service that is excluded under
Examples of Cosmetic Surgery:
your level of cover you will not receive any
• Rhinoplasty (nose reconstruction) without benefits towards your hospital, medical and
previous trauma or congenital defect. prosthesis costs and you may have significant
• Breast enlargement. out-of-pocket expenses.
• Liposuction. If a service is not covered by Medicare there
will be no benefit payable from your student
Emergency admissions cover so you should always check with us
In an emergency, we may not have time to see if you’re covered before receiving
to determine if you are affected by the treatment.
pre-existing condition rule before your
admission. Consequently, if you have been
a Bupa member for less than 12 months
you might have to pay for some or all of
the hospital and medical charges if you are
admitted to hospital and you choose to be
treated as a private patient, and we later
determine that your condition was pre-existing.
We tell you more about pre-existing conditions
on Page 18.
17
Out-of-pocket expenses There are some items that are not covered by
You are likely to experience out-of-pocket our OSHC or extras pharmacy benefits and
expenses when you are not fully covered for these include:
services and benefits, or when a set benefit • Over-the-counter and non-prescription items.
applies. You should refer to what is and isn’t • Compounded items.
covered on your OSHC and any Extras cover
you hold to determine when an out-of-pocket • Weight loss medication.
expense may occur. You should also refer to • Body enhancing medications
our Overseas Student Health Cover Rules for (e.g. anabolic steroids).
any additional information on benefits payable.
A copy of our Overseas Student Health Pharmacy in-hospital
Cover Rules can be found on our website or When in hospital, if you are treated
in our local Bupa Health Insurance store. It is with drugs that are not approved by the
important to ensure when being admitted to Pharmaceutical Benefits Scheme (PBS)
hospital that Informed Financial Consent is Schedule, you may not be fully covered and
provided to you for a pre-booked admission the hospital may charge you for all or part of
to allow you to understand any out-of-pocket the cost. You should be advised by the hospital
expenses upfront. If you have received any of any charges before treatment.
out-of-pocket expenses and require
clarification, please contact us directly. Pre-existing conditions
A pre-existing condition is any condition,
Pharmacy ailment or illness that you had signs or
On OSHC you may receive benefits for symptoms of during the six months before you
selected prescription items prescribed as an joined or upgraded to a higher level of cover
outpatient that are Australian Government’s with us. It is not necessary that you or your
Pharmaceutical Benefit Scheme (PBS) doctor knew what your condition was or that
Schedule listed or non-PBS listed and TGA the condition had been diagnosed. If you knew
approved, prescribed by a doctor or a you weren’t well, or had signs of a condition
specialist and not appearing on our exclusions that a doctor would have detected (if you
list. Refer to your cover details for more had seen one) during the six months prior to
information. joining or upgrading, then the condition would
be classed as pre-existing.
If you take out optional Extras cover, your
extras pharmacy entitlement pays benefits on A doctor appointed by us decides whether
prescription items that are only non-PBS listed your condition is pre-existing, not you or your
and TGA approved and not appearing on our doctor. The appointed doctor must consider
exclusions list. your treating doctors’ opinions on the signs
and symptoms of your condition, but is not
When you make a claim, we will deduct a PBS
bound to agree with them.
co-payment fee and pay the remaining balance
up to the set amount under your OSHC or
chosen level of Extras cover.

18
Premium and benefits for OSHC for breast cancer, there may be a desire to
To access the benefits available on your level reconstruct the breast back to an acceptable
of cover, you need to: appearance for you, whereas changing the
appearance of the breast for most other
• Complete the application process and pay
reasons would be cosmetic in nature and
your premium in full before the start date of
intent.
your level of cover.
• Advise us of any change of address. Other examples of ‘Reconstructive Surgery’:

• Ensure that newborns are enrolled onto • Repairing a scar resulting from an accident
a family membership within 90 days of or previous surgery (unless it was cosmetic
their birth to avoid any waiting periods surgery).
for your baby. • Facial reconstructive surgery following
• Contact us to remove your adult children severe trauma, cancer surgery or a major
from your OSHC membership when they congenital problem (from birth).
turn 18 years of age as they no longer qualify • Repairing a body part after a trauma injury.
under your level of cover.
Surgically implanted prostheses
• Provide proof of purchase of what you have
spent before we can reimburse you for any You will be covered up to the approved
services received. benefit set out in the Australian Government’s
Prostheses List for a listed prosthesis which is
• Submit your claims within two years of when surgically implanted as part of your hospital
the service was given (we don’t pay benefits treatment.
for any claims that are older than this).
The Prostheses List includes: pacemakers,
Private room in a public hospital defibrillators, cardiac stents, joint
From 1 October 2017, for the purposes of a replacements, intraocular lenses and other
private room in a public hospital, this is a room devices. If a hospital proposes to charge you
in a hospital which is purpose built and suitable a ‘gap’ for your prosthesis, they need your
for no one other than a single admitted adult informed financial consent. Please contact us
patient; holds one single sized bed; and has a for further details.
dedicated ensuite.
Waiting periods
Proof of identity and/or age A waiting period is the time when you are not
Bupa may require you to provide proof of covered for a particular service. It starts on the
identity, visa details and/or age when joining, date that you enter Australia or the date that
changing your level of cover or in relation to you start your membership, whichever is the
any other transaction with us. later date. If you receive a service or treatment
during this time, you are not eligible to receive
Reconstructive Surgery a benefit payment from us, regardless of when
Surgery to restore function or typical you submit the claim. Different waiting periods
appearance by reconstructing defective organs apply for different services.
or parts. The reason for the surgery is what’s
important. It would usually follow a previous
medically necessary surgery, a traumatic event For more terms explained visit
that caused a change in the appearance and/or bupa.com.au/glossary
function of a part of the body or a significant
congenital problem (something you were born
with), that created problems with how your
body works. For example, after a mastectomy
19
Other important information
Privacy and your personal information
Your privacy is important to Bupa. personal information as set out here and in
This statement summarises how we handle our Information Handling Policy. Each person
your personal information. For further on a policy aged 18 or over may complete
information about our information handling a ‘Keeping your personal information
practices or our complaints handling process, confidential’ form to specify who should
please refer to our Information Handling receive information about their health claims.
Policy, available on our website at bupa.com. You are entitled to reasonable access to your
au or by calling us on 1800 888 942. When personal information within a reasonable
you join, you agree to the handling of your timeframe. We reserve the right to charge a
personal information as set out here and in fee for collating such information.
our Information Handling Policy. If you or any insured person does not consent
to the way we handle personal information,
We will only collect personal information
or does not provide us with the information
that we require to provide, manage and
we require, we may be unable to provide
administer our products and services and to
you with our products and services. We
operate an efficient and sustainable business.
may use your personal (including health)
We are required to collect certain information
information to contact you to advise you
from you to comply with the Private Health
of health management programs, products
Insurance Act 2007 (Cth). We may also collect
and services. When you take out cover with
information about you from health service
us, you consent to us using your personal
providers for the purposes of administering or
information to contact you (by phone, email,
verifying any claim, and from your employer,
SMS or post) about products and services
broker or agent if you are on a corporate
that may be of interest to you. If you do not
health plan or have joined through a broker
wish to receive this information, you may opt
or agent. We may disclose your personal
out by contacting us.
information to our related entities, and to
third parties including healthcare providers,
Here to help
Australian Government and regulatory bodies,
If you have any questions we’re always happy
other private health insurers, and any persons
to help. Simply refer to the back cover for our
or entities engaged by us or acting on our
contact details and call us, visit our website
behalf. If we send your information outside of
or pop by your local Health Insurance store.
Australia, we will require that the recipient of
If you would like more information about our
the information complies with privacy laws
Overseas Student Rules or the Australian
and contractual obligations to maintain the
Government’s Private Health Insurance
security of the data. If you are on a corporate
Industry Code of Conduct, you can find this
health plan, we may disclose your information
information on our website.
to your employer to verify your eligibility to
be on that corporate plan. The policy holder The Australian Government’s Private
is responsible for ensuring that each person Patient’s Hospital Charter is available at
on their policy is aware that we handle their privatehealth.gov.au

For more student resources visit

our overseas student hub at
bupa.com.au/students
20
Complaints or feedback
If you have any concerns or you don’t
understand a decision we have made,
we’d like to hear from you.

You can contact us by:

Phone: 1800 802 386
Fax: 1300 662 081
Email: [email protected]
Mail: Customer Relations Manager Bupa
GPO Box 9809
Brisbane QLD 4001

If you’re still not satisfied with your

outcomes from Bupa you may contact
the Private Health Insurance Ombudsman on
1300 362 072 or visit them at
ombudsman.gov.au
If your concerns aren’t resolved when you
first raise them, and you’d like to discuss
it further, you can find our full complaints
process online for how to go about it.

21
Bupa health
cover made easy
Unsure of any words? Visit: bupa.com.au/glossary

This guide is in addition to our Fund Rules available online or

by contacting us.

Go to bupa.com.au/fundrules/oshc
to see our Overseas Student rules.

For more information

Bupa
1800 888 942 from within Australia PO Box 14639
Melbourne VIC 3001
+61 3 9937 4223 from outside Australia
Bupa HI Pty Ltd
bupa.com.au/students ABN 81 000 057 590

Effective 1 July 2019

Visit a Bupa store
11542-07-19