Bupa Health Insurer Profile

Bupa is part of a global family that re-invests its profits into areas that Bupa believes will benefit their members, including businesses, health services and the community – https://www.bupa.com.au/about-us

The team at Bupa wants lives to be happier and healthier, and there are many ways that Bupa can make a positive difference. That’s why Bupa is building a broad range of health and care services that do just that.

  • As one of Australia’s largest private health insurance providers, Bupa can provide its customers with a large variety of coverage options and extras. They offer options for people of diverse age, family planning, and financial stages in life.
  • Bupa strives to ensure all patients receive private rooms at private hospitals and offers a reimbursement for when private rooms are not available.
  • Bupa has built relationships with many hospitals and medical professionals. In doing so, it has negotiated lower prices for its clients – reducing any potential out of pocket expenses.

The above information was updated 14th November 2018 and is correct at time of writing.


Bupa prides itself on affording its customers with private, individual rooms at most private hospitals across Australia. This service is even included with Bupa’s most basic hospital cover. Therefore, Bupa customers do not have to worry about sharing a room during an emergency or elective hospital stay.

Bupa also provides additional customer benefits for those who chose to receive medical care at one of their Members First hospitals.

At these hospitals, patients will actually receive money back if a private room is not available. While it is rare, those who are inconvenienced with having to share a room at Members First hospitals will receive $50 back each night they do not have a private room.

In additional to a money back guarantee on private rooms, Bupa customers at Members First hospitals also receive certain luxuries to help make their hospital stays more enjoyable. These luxuries include complimentary local phone calls, free-to-air TV, and a daily newspaper.

Increased Savings

Like hospital cover, there are several different tiers from which to choose from provided by nib Health Fund.

Hospital Cover

Generally, the cost of a hospital stay includes two sets of fees: those charged by the hospital itself and those charged by the physician or specialist. As Bupa consistently works to increase quality and ease of care for its patients, it has made agreements with many private hospitals and medical professionals throughout Australia to help cut the overall costs. This also gives customers the benefit of knowing how much treatment will cost before they receive it.

Additionally, many of the agreements mean that Bupa will pay 100% of a patient’s covered hospitals costs. With this benefit, customers are only left to pay a small hospital excess or co-payment; depending on their selected cover and choice of doctor or surgeon.

Specialist Gap Cover

Bupa has negotiated lower wages with specialists to help cover Medicare gaps charges.

Normally, if a medical professional charges more than Medicare and private health cover offers for a specific service, the patient is left paying the difference.

Fortunately, Bupa has created the Bupa Medical Gap Scheme to help protect customers from such unforeseen costs.

Those who choose doctors that are part of the Bupa Medical Gap Scheme never pay more than $500 for the fee differential. Sometimes, patients have no fee at all.

Bupa representatives are available and eager to answer customer questions about which professionals are part of the Bupa Medical Gap Scheme and how much they should expect to pay for their surgeries or specialist care based on their level of coverage.

Extra Benefits for Expecting Mothers

Those expecting a child are privileged to receive extra benefits from Bupa that may not be available with other health care providers.

Bupa provides educational classes on childbirth, breastfeeding, and parenting at its Members First hospitals. It also allows members the opportunity to take advance of exclusive postnatal clinics. This benefits is offered at selected Members First hospitals and can be used up to eight weeks after the baby is born.

Self-Management Guides

Bupa also empowers its customers to take an active role in managing any chronic health conditions they might have. They do this by providing Self-Management Guides to all customers.

The guides provide up-to-date information on various chronic conditions and how to manage them. This resource allows customers the freedom to live more comfortably and keep their conditions under control without persistent medical intervention.

Bupa’s Self-Management Guides include topics like:

  • Back Pain Management
  • Osteoarthritis Positive Health
  • Asthma Positive Health
  • Chronic Obstructive Pulmonary Disease Positive Health
  • Health Failure Positive Health
  • Coronary Artery Disease and Angina Positive Health
  • Type 2 Diabetes Positive Health
  • Osteoporosis Positive Health

The above information was updated 14th November 2018 and is correct at time of writing.

Because of Bupa’s size, they are able to provide several different kinds of care at affordable prices. Their coverage options include people at various points in life and consist of plans for:

People in these groups can chose several ranges of cover including:

Hospital Cover

Bupa’s Hospital Cover helps pay for inpatient-related hospital treatments. This type of cover can be used at public or private hospitals throughout Australia and includes different levels of coverage, including:

  • Basic Hospital Cover: This option is best suited to people who are generally healthy and therefore only need a basic level of cover, or those looking to avoid the Lifetime Health Cover loading.
    The Lifetime Health Cover loading affects those who do not take out a private hospital policy by their 30th birthday. Under this initiative, patients who chose not to take out private health insurance by their 31st birthday, but decide to so later in life, may be subject to a 2% loading for on top of their premium for every year over 30 that they did not have private health insurance.
  • Budget Hospital: Budget Hospital cover is best for young, healthy people who are not planning to have children in the near future. It provides an affordable policy that includes many common hospital procedures and treatments.
  • Standard Hospital Cover: Bupa’s Standard Hospital cover is also designed for the young and healthy. It includes payment for most inpatient hospital treatments and also includes minimum benefits on some extended services.
  • Top Hospital No Pregnancy: This level of cover is for those who are not planning on having children soon, but still want the top level of healthcare coverage. Patients enrolled in this plan also have access to the exclusive Best Doctors program.
    The Best Doctors program provides patients with access to a network of over 50,000 leading specialist throughout the world. Customers can use this network to get a second opinion on a diagnosis. They can also use this service for help with a treatment plan.
  • Top Hospital: Top Hospital cover is Bupa’s most comprehensive coverage option. It allows customers the freedom to adjust their premiums with varying excess options – including zero. It also covers children up to age 25 with no hospital excess charges.

Extras Cover

Bupa offers Extras cover in several levels. They include:

  • Bronze
  • Your Choice
  • Silver
  • Gold
  • Platinum

These coverage plans help customers pay for many commonly used medical services such as:

  • Emergency Ambulance
  • General Dental
  • Optical
  • Physiotherapy
  • Chiropractic
  • Osteopathy
  • Pharmacy
  • Natural Therapies

Ambulance Cover

Customers can choose from a variety of Ambulance cover plans that range from Emergency Only Ambulance cover to Premium Ambulance cover. While Emergency Only Ambulance cover will cover patients in emergency situations, Premium Ambulance cover will also cover non-emergency transport. All of Bupa’s Ambulance cover plans also include air services and on-the-spot treatments.

The above information was updated 14th November 2018 and is correct at time of writing.

In the State of the Health Funds Report, Bupa demonstrates performance that is in line with its size and market share.

In many areas, such as management expenses and member retention, it even performs better than the Health Funds industry as a whole.

The amount of complaints that Bupa receives is also less than to be expected from a fund its size. It maintains about 27% market share, but only received 21.7 of all PHIO complaints. The below data is sourced from a 2016 report from www.ombudsman.gov.au.

BUPA compared to Industry

Share of Private Health Insurance Ombudsman complaints


The above information was updated 14th November 2018 and is correct at time of writing.

There are several ways to make claims through Bupa.

On-the-spot Claims

More than 20,000 health care providers are currently enrolled in Bupa’s On-the-spot claims service. It is the fastest way to make a claim and is initiated electronically as soon as the patient receives care.

After receiving treatment, the patient swipes his or her claims card and the claim is processed automatically. This process does not require any forms and patients will often know their balance immediately.


If a patient is unable to make an on-the-spot claim, he or she can easily make a claim online.

Patients can make online claims by logging onto myBupa and enter the details of their claim. After processing, Bupa will transfer the appropriate funds into the customer’s bank account.


Bupa customers also have the option to file claims via post.

Simply fill out the claim form and mail it to:

Bupa Reply Paid 990
Adelaide SA 5001

After processing, Bupa will send customers a cheque or deposit money via EFT – depending on their preference as indicated in the form.

The above information was updated 14th November 2018 and is correct at time of writing.

Bupa members are eligible for the Bupa Plus program. With this program, customers are eligible to receive discounts from a number of companies and programs. The discounts are intended to make the lives of Bupa customers healthier, more fun, and more rewarding.

The above information was updated 14th November 2018 and is correct at time of writing.

Bupa is a reputable healthcare company with many options and customisations to choose from. Any customer will be able to find suitable coverage to suit their medical and financial requirements.

For more information on pricing and cover specifics, contact Bupa at:

1800 812 535

GPO Box 9809
Brisbane, QLD 4001

Or, find your local Bupa Centre here:

The above information was updated 14th November 2018 and is correct at time of writing.

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