Medicare Frequently Asked Questions.

I’m applying for a 457 working visa, which overseas visitors health cover meets the visa requirements?
If you are applying for a 457 Long Stay Working Visa, the following overseas visitor health covers meet the minimum level of insurance required as set out by the Department of Immigration and Citizenship (DIAC):

How do I receive my verification of cover letter to meet Department of Immigration and Citizenship (DIAC) requirements?
As long as you provide a valid email address on your application for cover, your verification letter will be emailed to you within four business days.

I have a reciprocal Medicare card, what type of cover is best for me? Do I need to take out overseas visitor health cover?
If you are from a Reciprocal Health Care Agreement (RHCA) country* and have a reciprocal Medicare card, your access to Medicare may be limited to immediately necessary medical treatment. To ensure you are covered for both in-patient and out-patient hospital services and treatment by a doctor or specialist in private practice, you will need to take out one of our overseas visitor health covers. If you were to take out one of our health insurance covers for Australian residents, you would not be covered for out-patient hospital services and treatment by a doctor or specialist in private practice, which would result in large out-of-pocket expenses.
* United Kingdom, New Zealand, Sweden, Malta, Norway, Finland, Italy, Ireland, Belgium, the Netherlands and Slovenia.

Why does my accountant ask me to get a Tax Statement?
There may be a number of reasons why your accountant has asked you for a Tax Statement, for example:

If you are liable for the Medicare Levy Surcharge you can take out Reciprocal Health Cover, which will exempt you from it. If you have Reciprocal Health Cover we will send you a Tax Statement at the end of the financial year, which you can present to your accountant at tax time.

Can I suspend my membership for overseas travel?
Yes, you can suspend your membership if you are travelling overseas for a period of between one and three months. To be eligible, you will need to have been a continuous member with us for at least six months, and your membership will need to be fully paid as of the suspension date. Memberships can be suspended once per calendar year during the first five years of membership. For full details, please contact us.

Why can't my doctor bulk-bill me like Australian residents?
Bulk-billing is administered by Medicare, Australia's public health system. As an overseas visitor, you do not have full access to Medicare and are not eligible to use the bulk-billing system. If your level of health cover with us includes benefits for out-patient medical services like visits to a GP or specialist, please lodge your claims for these types of services directly with us by fax or post as you will not be able to claim on-the-spot.

If I have Reciprocal Health Cover as well as overseas visitor health cover, which cover should I claim my doctor's bills under?
All your bills should be claimed under your overseas visitors health cover. Reciprocal Health Cover only exempts you from paying the Medicare Levy Surcharge.

I now have permanent residency and am eligible for full Medicare benefits, from what date should I start on Australian residents' cover?
You can start on a cover for Australian residents from the date you are eligible for full Medicare benefits. In order to change to a cover for Australian residents you will need to provide us with a copy of your Medicare eligibility letter as soon as possible after you receive it. To avoid any Lifetime Health Cover loading you will need to take out Australian residents' cover within 12 months of becoming eligible.

Covers for Australian residents can provide you with a wide range of alternative options to suit your needs and if you join on an equivalent level of cover to your overseas visitor health cover, you will continue to be covered for benefits on all services you were entitled to under your overseas visitors cover. This applies as long as you transfer to a cover for Australian residents within 60 days of ceasing your overseas visitor cover.

Can I take out private health insurance before arriving in Australia?
Yes, you can join on overseas visitor health cover before arriving in Australia and your cover will start from the date you arrive. If you wish to do this, it is easiest to join online.

If I change my level of health insurance is there anything I need to be aware of?
If you're changing from a recognised overseas health fund, general insurer or Australian health insurer to us you'll continue to be covered for all benefit entitlements that you had on your old cover, as long as these services are offered on your new cover with us and you have served any applicable waiting periods. This is referred to as 'continuity of cover'. To receive continuity of cover, you need to transfer to us within 60 days of leaving your old insurer.
If your level of cover with us is higher than the cover you had with your previous insurer, the lower level of benefits will apply until any waiting periods on the upgrade have been served. You may also need to serve waiting periods for any new benefits, services or treatments offered under your new cover with us.
If you chose a lower level of cover than you previously held, then the lower benefits of your new cover will apply immediately.
Please note that when changing health insurers, Extras benefits paid by your previous insurer will be counted towards your yearly maximums in the first year of membership with us.

Does my private health insurance cover me if I am sick when travelling interstate or overseas?
Your health insurance with us covers you in all states and territories of Australia. However, it does not cover you for any healthcare services overseas. If you are planning to move overseas to live and work, we suggest you consider purchasing International Private Medical Insurance, which provides you with access to planned or emergency medical care anywhere in the world. Contact us for more details.

How can I pay my premiums?
We offer a variety of payment options so you can choose the most convenient method of payment for you – you can pay online, by direct debit, BPay, over the telephone, by mail or at a local Bupa centre.

Can I claim the Federal Government Rebate on private health insurance on any part of my cover?
If you have a reciprocal Medicare card and take out Extras cover or combined Hospital and Extras cover, you will be able to claim the Federal Government Rebate on your Extras cover.
If you do not have a reciprocal Medicare card you are not eligible to claim the rebate.

Why do I have to pay GST on Hospital cover?
Under the new Private Health Insurance Act 2007, GST is included in all overseas visitor hospital insurance premiums from 1 July 2008.

What is the Medicare Benefits Schedule (MBS) fee?
The Medicare Benefits Schedule (MBS) fee is the maximum fee set by the Government for every medical procedure in Australia. Medicare benefits are calculated based on the Medicare Benefits Schedule (MBS) fee. Doctors may choose to charge more than the Medicare Benefits Schedule (MBS) fee.

What is the AMA fee?
The AMA (Australian Medical Association) fee is a fee recommended by the AMA for all medical and surgical procedures carried out in Australia. AMA fees are usually higher than the Medicare Benefits Schedule (MBS) fee.

What are waiting periods?
A waiting period starts from the date you join. During a waiting period you are not covered and will not receive any benefits for the types of treatment affected by the waiting period. Once you have served the relevant waiting period, you will receive the full benefits listed under your level of cover for that treatment type.
All health covers have a 12 month waiting period for pre-existing ailments and pregnancy (childbirth), where applicable. If you transfer from another health insurer to us, we will honour all the waiting periods you have already served for benefits that you had on your old insurance cover (as long as they are on your new level of cover with our health fund). To confirm this, we need a Clearance Certificate detailing your membership and level of cover from the previous health fund. To receive this continuity of cover, you will need to join our health fund within one month of leaving your previous insurer.
If your level of cover with us is higher than the cover you had with your previous insurer, the lower level of benefits will apply until any waiting periods on the upgrade have been served. You may also need to serve waiting periods for any new benefits, services or treatments offered under your new cover with us.
If you chose a lower level of cover than you previously held, then the lower benefits of your new insurance cover will apply immediately.
Please note that when changing health insurers, Extras benefits paid by your previous insurer will be counted towards your yearly maximums in the first year of membership with Bupa.

Do I have to provide a medical certificate for all claims in the first 12 months?
If your claim is in the first 12 months and relates to a pre-existing condition, you will need to provide a medical certificate.
However, if your claim is in the first 12 months, not related to a pre-existing condition and you ensure the section on medical symptoms on your claim form is completed, we will usually not require a medical certificate.

What are the applicable waiting periods for 'No gap dental for kids'?
If you join an eligible Hospital and Extras cover the standard waiting periods apply for 'No gap dental for kids':

I need to have my wisdom teeth removed. Am I covered?
There is a 12 month waiting period for the extraction of wisdom teeth in hospital. If you are planning on having your wisdom teeth removed by a dentist in private practice, there is a two month waiting period.
The dentist's account for the extractions would attract a benefit as long as you hold an Extras cover that offers general dental benefits. If you are likely to be admitted to hospital for the removal of your wisdom teeth, you will also need to have Hospital cover to cover hospital charges such as theatre fees and accommodation.

What is meant by calendar year benefits in my Extras cover?
Extras benefits are paid by us on a per calendar year basis. We define a calendar year as 1 January to 31 December no matter what date you join.

What is electronic claiming?
With electronic claiming you can claim your Extras services treatment on the spot. Simply swipe your membership card at the provider's room. The fund sends the applicable benefit directly to the provider and all you need to pay is the balance.

What is the Medical Gap Scheme?
If your doctor or specialist charges more than the Medicare Benefits Schedule (MBS) Fee for your hospital treatment, it's up to you to pay the 'gap'. With our Medical Gap Scheme, your doctor agrees to the fee charged for services and bills us directly. So in most cases, there's no gap and no bill, and if there is a gap, you will know the maximum amount you will need to pay prior to your treatment as the doctor needs to provide you with Informed Financial Consent.

What is a Restricted Benefits period?
A Restricted Benefit period is a period of time where specific services will not be covered in a private hospital. Once you have served the Restricted Benefit period, you will be entitled to full cover in a private hospital for those services.
If a service is covered with Restricted Benefits, this means you will be covered with your choice of doctor for shared room accommodation in a public hospital only. If you go to a private hospital for a specific service that has Restricted Benefits, it is likely to result in large out-of-pocket expenses.

What is an exclusion?
If a service is excluded no benefits are payable for that service on your level of cover.

What are 'minimum' benefits?
Minimum benefits are the minimum level of benefits that private health insurers must pay for a members' claims for treatment provided in public hospitals, non-contracted private hospitals and day surgeries. These are set by the Government and usually updated around July each year.

What is meant by medically necessary?
Medically necessary treatment is defined as treatment that requires urgent medical attention and is deemed necessary by a medical practitioner. Note that we do not pay benefits for services which are not recognised by Medicare (such as surgical podiatry procedures or cosmetic surgery that is not clinically necessary) or where a valid Medicare Benefits Schedule (MBS) item number is not provided.

Am I covered for prostheses?
In Australia, surgically implanted prostheses are classified by the government as 'no gap' or 'known gap' prostheses. If your doctor chooses a 'no gap' prosthesis you will not have any out-of-pocket expenses to pay where the prosthesis is implanted as part of your hospital treatment. However, if the prosthesis item used is classified as 'known gap' prosthesis, you will have to pay any gap charged by the hospital. If you would like to choose a 'no-gap' prosthesis simply ask your specialist – there is one available for all surgical requirements.

Who are recognised providers?
You can claim benefits for services provided to you by providers who are 'recognised' by us and in private practice. If we do not recognise a particular provider, we will not be able to pay benefits for services they provide to you.

What are considered compensation and damages from other sources?
Benefits are not payable when compensation and/or damages can be claimed from another source.
For example:

We reserve the right to recover any benefits paid in this regard.

 

Source : BUPA Australia